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Biffi A, Palermi S, D'Ascenzi F, Bonifazi M, Zorzi A, Corrado D. Premature ventricular beats in athletes: to detrain or not to detrain? Br J Sports Med 2024; 58:407-408. [PMID: 38471745 DOI: 10.1136/bjsports-2023-107384] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Alessandro Biffi
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Stefano Palermi
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
- Public Health Department, University of Naples Federico II, Sulmona, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Marco Bonifazi
- Department of Medicine, Surgery, and NeuroScience, University of Siena, Siena, Italy
| | - Alessandro Zorzi
- Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Domenico Corrado
- Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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2
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Porcu G, Biffi A, Ronco R, Adami G, Alvaro R, Bogini R, Caputi AP, Frediani B, Gatti D, Gonnelli S, Iolascon G, Lenzi A, Leone S, Michieli R, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Rossini M, Tarantino U, Cianferotti L, Brandi ML, Corrao G. Refracture following vertebral fragility fracture when bone fragility is not recognized: summarizing findings from comparator arms of randomized clinical trials. J Endocrinol Invest 2024; 47:795-818. [PMID: 37921990 DOI: 10.1007/s40618-023-02222-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/19/2023] [Accepted: 10/10/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE Since vertebral fragility fractures (VFFs) might increase the risk of subsequent fractures, we evaluated the incidence rate and the refracture risk of subsequent vertebral and non-vertebral fragility fractures (nVFFs) in untreated patients with a previous VFF. METHODS We systematically searched PubMed, Embase, and Cochrane Library up to February 2022 for randomized clinical trials (RCTs) that analyzed the occurrence of subsequent fractures in untreated patients with prior VFFs. Two authors independently extracted data and appraised the risk of bias in the selected studies. Primary outcomes were subsequent VFFs, while secondary outcomes were further nVFFs. The outcome of refracture within ≥ 2 years after the index fracture was measured as (i) rate, expressed per 100 person-years (PYs), and (ii) risk, expressed in percentage. RESULTS Forty RCTs met our inclusion criteria, ranging from medium to high quality. Among untreated patients with prior VFFs, the rate of subsequent VFFs and nVFFs was 12 [95% confidence interval (CI) 9-16] and 6 (95% CI 5-8%) per 100 PYs, respectively. The higher the number of previous VFFs, the higher the incidence. Moreover, the risk of VFFs and nVFFs increased within 2 (16.6% and 8%) and 4 years (35.1% and 17.4%) based on the index VFF. CONCLUSION The highest risk of subsequent VFFs or nVFFs was already detected within 2 years following the initial VFF. Thus, prompt interventions should be designed to improve the detection and treatment of VFFs, aiming to reduce the risk of future FFs and properly implement secondary preventive measures.
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Affiliation(s)
- G Porcu
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - A Biffi
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - R Ronco
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - G Adami
- Rheumatology Unit, University of Verona, Verona, Italy
| | - R Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - R Bogini
- Local Health Unit (USL) Umbria, Perugia, Italy
| | - A P Caputi
- Department of Pharmacology, School of Medicine, University of Messina, Messina, Italy
| | - B Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - D Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - S Gonnelli
- Department of Medicine, Surgery, and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - G Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - S Leone
- AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - R Michieli
- Italian Society of General Medicine and Primary Care (SIMG), Florence, Italy
| | - S Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - T Nicoletti
- CnAMC, Coordinamento nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy
| | - M Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Pennini
- Rheumatology Unit, University of Verona, Verona, Italy
| | - E Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - M Rossini
- Rheumatology Unit, University of Verona, Verona, Italy
| | - U Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - L Cianferotti
- Italian Foundation for Research on Bone Diseases (FIRMO), Florence, Italy
| | - M L Brandi
- Italian Foundation for Research on Bone Diseases (FIRMO), Florence, Italy
| | - G Corrao
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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3
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Biffi A, Palermi S. The heart of the matter: understanding the implications of detraining on cardiac health. Eur J Prev Cardiol 2024; 31:412-414. [PMID: 38167951 DOI: 10.1093/eurjpc/zwae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024]
Affiliation(s)
- Alessandro Biffi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, via Vittorio Veneto 108, 00187 Rome, Italy
| | - Stefano Palermi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, via Vittorio Veneto 108, 00187 Rome, Italy
- Public Health Department, University of Naples Federico II, via Pansini 5, 80131 Naples, Italy
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Palermi S, Vecchiato M, Saglietto A, Niederseer D, Oxborough D, Ortega-Martorell S, Olier I, Castelletti S, Baggish A, Maffessanti F, Biffi A, D'Andrea A, Zorzi A, Cavarretta E, D'Ascenzi F. Unlocking the potential of artificial intelligence in sports cardiology: does it have a role in evaluating athlete's heart? Eur J Prev Cardiol 2024; 31:470-482. [PMID: 38198776 DOI: 10.1093/eurjpc/zwae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
The integration of artificial intelligence (AI) technologies is evolving in different fields of cardiology and in particular in sports cardiology. Artificial intelligence offers significant opportunities to enhance risk assessment, diagnosis, treatment planning, and monitoring of athletes. This article explores the application of AI in various aspects of sports cardiology, including imaging techniques, genetic testing, and wearable devices. The use of machine learning and deep neural networks enables improved analysis and interpretation of complex datasets. However, ethical and legal dilemmas must be addressed, including informed consent, algorithmic fairness, data privacy, and intellectual property issues. The integration of AI technologies should complement the expertise of physicians, allowing for a balanced approach that optimizes patient care and outcomes. Ongoing research and collaborations are vital to harness the full potential of AI in sports cardiology and advance our management of cardiovascular health in athletes.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, via Pansini 5, 80131 Naples, Italy
| | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, 10129 Turin, Italy
- Department of Medical Sciences, University of Turin, 10129 Turin, Italy
| | - David Niederseer
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Sandra Ortega-Martorell
- Data Science Research Centre, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Ivan Olier
- Data Science Research Centre, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Silvia Castelletti
- Cardiology Department, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Alessandro Biffi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
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Bonatesta L, Palermi S, Sirico F, Mancinelli M, Torelli P, Russo E, Annarumma G, Vecchiato M, Fernando F, Gregori G, Niebauer J, Biffi A. Short-term economic evaluation of physical activity-based corporate health programs: a systematic review. J Occup Health 2024; 66:uiae002. [PMID: 38183160 PMCID: PMC10939391 DOI: 10.1093/joccuh/uiae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/22/2023] [Revised: 12/05/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024] Open
Abstract
OBJECTIVES Corporate health programs (CHPs) aim to improve employees' health through health promotion strategies at the workplace. Physical activity (PA) plays a crucial role in primary prevention, leading many companies to implement PA-based CHPs. However, there is limited examination in the scientific literature on whether PA-based CHPs (PA-CHPs) lead to economic benefits. This systematic review aimed to summarize the available literature on the economic aspects of PA-CHPs. METHODS A systematic review was conducted to identify studies focused on PA-CHPs targeting healthy sedentary workers and reporting at least one economic outcome, such as return on investment (ROI), costs, or sick leave. RESULTS Of 1036 studies identified by our search strategy, 11 studies involving 60 020 participants met the inclusion criteria. The mean (±SD) cost per capita for PA-CHPs was estimated as 359€ (±238€) (95% CI, 357-361€). In 75% of the studies, the net savings generated by PA-CHPs in 12 months were reported, with an average of 1095€ (±865€) (95% CI, 496-1690€). ROI was assessed in 50% of the included studies, with an average of 3.6 (±1.41) (95% CI, 2.19-5.01). CONCLUSIONS In addition to promoting a healthy lifestyle, PA-CHPs have the potential to generate significant economic returns. However, the heterogeneity among the existing studies highlights the need for standardization and accurate reporting of costs in future research.
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Affiliation(s)
- Lorenzo Bonatesta
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
| | - Stefano Palermi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Felice Sirico
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Mario Mancinelli
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
| | - Pierpaolo Torelli
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
| | - Ettore Russo
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
| | - Giada Annarumma
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
| | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Frederik Fernando
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
| | - Giampietro Gregori
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Alessandro Biffi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
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Fernandes M, Sun H, Chemali Z, Mukerji SS, M V R Moura L, Zafar SF, Sonni A, Biffi A, Rosand J, Brandon Westover M. Brain health scores to predict neurological outcomes from electronic health records. Int J Med Inform 2023; 180:105270. [PMID: 37890202 PMCID: PMC10842359 DOI: 10.1016/j.ijmedinf.2023.105270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/07/2022] [Revised: 03/30/2023] [Accepted: 10/21/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Preserving brain health is a critical priority in primary care, yet screening for these risk factors in face-to-face primary care visits is challenging to scale to large populations. We aimed to develop automated brain health risk scores calculated from data in the electronic health record (EHR) enabling population-wide brain health screening in advance of patient care visits. METHODS This retrospective cohort study included patients with visits to an outpatient neurology clinic at Massachusetts General Hospital, between January 2010 and March 2021. Survival analysis with an 11-year follow-up period was performed to predict the risk of intracranial hemorrhage, ischemic stroke, depression, death and composite outcome of dementia, Alzheimer's disease, and mild cognitive impairment. Variables included age, sex, vital signs, laboratory values, employment status and social covariates pertaining to marital, tobacco and alcohol status. Random sampling was performed to create a training (70%) set for hyperparameter tuning in internal 5-fold cross validation and an external hold-out testing (30%) set of patients, both stratified by age. Risk ratios for high and low risk groups were evaluated in the hold-out test set, using 1000 bootstrapping iterations to calculate 95% confidence intervals (CI). RESULTS The cohort comprised 17,040 patients with an average age of 49 ± 15.6 years; majority were males (57 %), White (78 %) and non-Hispanic (80 %). The low and high groups average risk ratios [95 % CI] were: intracranial hemorrhage 0.46 [0.45-0.48] and 2.07 [1.95-2.20], ischemic stroke 0.57 [0.57-0.59] and 1.64 [1.52-1.69], depression 0.68 [0.39-0.74] and 1.29 [0.78-1.38], composite of dementia 0.27 [0.26-0.28] and 3.52 [3.18-3.81] and death 0.24 [0.24-0.24] and 3.96 [3.91-4.00]. CONCLUSIONS Simple risk scores derived from routinely collected EHR accurately quantify the risk of developing common neurologic and psychiatric diseases. These scores can be computed automatically, prior to medical care visits, and may thus be useful for large-scale brain health screening.
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Affiliation(s)
- Marta Fernandes
- Department of Neurology, Massachusetts General Hospital (MGH), Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Clinical Data Animation Center (CDAC), MGH, Boston, MA, United States.
| | - Haoqi Sun
- Department of Neurology, Massachusetts General Hospital (MGH), Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Clinical Data Animation Center (CDAC), MGH, Boston, MA, United States.
| | - Zeina Chemali
- Department of Neurology, Massachusetts General Hospital (MGH), Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, United States.
| | - Shibani S Mukerji
- Department of Neurology, Massachusetts General Hospital (MGH), Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Lidia M V R Moura
- Department of Neurology, Massachusetts General Hospital (MGH), Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Sahar F Zafar
- Department of Neurology, Massachusetts General Hospital (MGH), Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Akshata Sonni
- Department of Neurology, Massachusetts General Hospital (MGH), Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, United States.
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital (MGH), Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, United States; Broad Institute of MIT and Harvard, Cambridge, MA, United States.
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital (MGH), Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, United States; Broad Institute of MIT and Harvard, Cambridge, MA, United States.
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital (MGH), Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Clinical Data Animation Center (CDAC), MGH, Boston, MA, United States; Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, United States.
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7
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Adami G, Biffi A, Porcu G, Ronco R, Alvaro R, Bogini R, Caputi AP, Cianferotti L, Frediani B, Gatti D, Gonnelli S, Iolascon G, Lenzi A, Leone S, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Tarantino U, Brandi ML, Corrao G, Rossini M, Michieli R. A systematic review on the performance of fracture risk assessment tools: FRAX, DeFRA, FRA-HS. J Endocrinol Invest 2023; 46:2287-2297. [PMID: 37031450 PMCID: PMC10558377 DOI: 10.1007/s40618-023-02082-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 12/15/2022] [Accepted: 03/27/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE Preventing fragility fractures by treating osteoporosis may reduce disability and mortality worldwide. Algorithms combining clinical risk factors with bone mineral density have been developed to better estimate fracture risk and possible treatment thresholds. This systematic review supported panel members of the Italian Fragility Fracture Guidelines in recommending the use of best-performant tool. The clinical performance of the three most used fracture risk assessment tools (DeFRA, FRAX, and FRA-HS) was assessed in at-risk patients. METHODS PubMed, Embase, and Cochrane Library were searched till December 2020 for studies investigating risk assessment tools for predicting major osteoporotic or hip fractures in patients with osteoporosis or fragility fractures. Sensitivity (Sn), specificity (Sp), and areas under the curve (AUCs) were evaluated for all tools at different thresholds. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies-2; certainty of evidence (CoE) was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Forty-three articles were considered (40, 1, and 2 for FRAX, FRA-HS, and DeFRA, respectively), with the CoE ranging from very low to high quality. A reduction of Sn and increase of Sp for major osteoporotic fractures were observed among women and the entire population with cut-off augmentation. No significant differences were found on comparing FRAX to DeFRA in women (AUC 59-88% vs. 74%) and diabetics (AUC 73% vs. 89%). FRAX demonstrated non-significantly better discriminatory power than FRA-HS among men. CONCLUSION The task force formulated appropriate recommendations on the use of any fracture risk assessment tools in patients with or at risk of fragility fractures, since no statistically significant differences emerged across different prediction tools.
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Affiliation(s)
- G Adami
- Rheumatology Unit, University of Verona, Verona, Italy
| | - A Biffi
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - G Porcu
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - R Ronco
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - R Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - R Bogini
- Local Health Unit (USL) Umbria, Perugia, Italy
| | - A P Caputi
- Department of Pharmacology, School of Medicine, University of Messina, Messina, Italy
| | - L Cianferotti
- Italian Bone Disease Research Foundation (FIRMO), Florence, Italy
| | - B Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - D Gatti
- Rheumatology Unit, University of Verona, Verona, Italy.
| | - S Gonnelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - G Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - S Leone
- AMICI Onlus, Associazione Nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - S Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - T Nicoletti
- Coordinamento Nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, CnAMC, Rome, Italy
| | - M Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Pennini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - E Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - U Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - M L Brandi
- Italian Bone Disease Research Foundation (FIRMO), Florence, Italy
| | - G Corrao
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - M Rossini
- Rheumatology Unit, University of Verona, Verona, Italy
| | - R Michieli
- Italian Society of General Medicine and Primary Care (SIMG), Florence, Italy
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Hanssen H, Moholdt T, Bahls M, Biffi A, Siegrist M, Lewandowski AJ, Biondi-Zoccai G, Cavarretta E, Kokkvoll A, Løchen ML, Maestrini V, Pinto RS, Palermi S, Thivel D, Wojcik M, Hansen D, Van Craenenbroeck EM, Weghuber D, Kraenkel N, Tiberi M. Lifestyle interventions to change trajectories of obesity-related cardiovascular risk from childhood onset to manifestation in adulthood: a joint scientific statement of the task force for childhood health of the European Association of Preventive Cardiology and the European Childhood Obesity Group. Eur J Prev Cardiol 2023; 30:1462-1472. [PMID: 37491406 DOI: 10.1093/eurjpc/zwad152] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 02/13/2023] [Revised: 04/20/2023] [Accepted: 05/06/2023] [Indexed: 07/27/2023]
Abstract
There is an immediate need to optimize cardiovascular (CV) risk management and primary prevention of childhood obesity to timely and more effectively combat the health hazard and socioeconomic burden of CV disease from childhood development to adulthood manifestation. Optimizing screening programs and risk management strategies for obesity-related CV risk in childhood has high potential to change disease trajectories into adulthood. Building on a holistic view on the aetiology of childhood obesity, this document reviews current concepts in primary prevention and risk management strategies by lifestyle interventions. As an additional objective, this scientific statement addresses the high potential for reversibility of CV risk in childhood and comments on the use of modern surrogate markers beyond monitoring weight and body composition. This scientific statement also highlights the clinical importance of quantifying CV risk trajectories and discusses the remaining research gaps and challenges to better promote childhood health in a population-based approach. Finally, this document provides an overview on the lessons to be learned from the presented evidence and identifies key barriers to be targeted by researchers, clinicians, and policymakers to put into practice more effective primary prevention strategies for childhood obesity early in life to combat the burden of CV disease later in life.
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Affiliation(s)
- Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Grosse Allee 6, 4052 Basel, Switzerland
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Women's Clinic, St. Olavs Hospital, Trondheim, Norway
| | - Martin Bahls
- Department of Internal Medicine B University Medicine Greifswald, University of Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Alessandro Biffi
- Med-Ex Medicine & Exercise, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Monika Siegrist
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital 'rechts der Isar', Technical University of Munich, Munich, Germany
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Ane Kokkvoll
- Department of Paediatrics, Finnmark Hospital Trust, Hammerfest, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, 'Sapienza' University of Rome, Policlinico Umberto I, Rome, Italy
| | | | - Stefano Palermi
- Med-Ex Medicine & Exercise, Medical Partner Scuderia Ferrari, Rome, Italy
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Malgorzata Wojcik
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Dominique Hansen
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
| | - Emeline M Van Craenenbroeck
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Campus Drie Eiken, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Daniel Weghuber
- Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Nicolle Kraenkel
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiology, Angiology and Intensive Care, Campus Benjamin-Franklin (CBF), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany
- Friede Springer- Cardiovascular Prevention Center @ Charité, Charite- Universitätsmedizin Berlin, Berlin, Germany
| | - Monica Tiberi
- Department of Public Health, Azienda Sanitaria Unica Regionale Marche AV 1, Pesaro, Italy
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Cianferotti L, Porcu G, Ronco R, Adami G, Alvaro R, Bogini R, Caputi AP, Frediani B, Gatti D, Gonnelli S, Iolascon G, Lenzi A, Leone S, Michieli R, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Rossini M, Tarantino U, Brandi ML, Corrao G, Biffi A. The integrated structure of care: evidence for the efficacy of models of clinical governance in the prevention of fragility fractures after recent sentinel fracture after the age of 50 years. Arch Osteoporos 2023; 18:109. [PMID: 37603196 PMCID: PMC10442313 DOI: 10.1007/s11657-023-01316-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 01/26/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023]
Abstract
Randomized clinical trials and observational studies on the implementation of clinical governance models, in patients who had experienced a fragility fracture, were examined. Literature was systematically reviewed and summarized by a panel of experts who formulated recommendations for the Italian guideline. PURPOSE After experiencing a fracture, several strategies may be adopted to reduce the risk of recurrent fragility fractures and associated morbidity and mortality. Clinical governance models, such as the fracture liaison service (FLS), have been introduced for the identification, treatment, and monitoring of patients with secondary fragility fractures. A systematic review was conducted to evaluate the association between multidisciplinary care systems and several outcomes in patients with a fragility fracture in the context of the development of the Italian Guidelines. METHODS PubMed, Embase, and the Cochrane Library were investigated up to December 2020 to update the search of the Scottish Intercollegiate Guidelines Network. Randomized clinical trials (RCTs) and observational studies that analyzed clinical governance models in patients who had experienced a fragility fracture were eligible. Three authors independently extracted data and appraised the risk of bias in the included studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Effect sizes were pooled in a meta-analysis using random-effects models. Primary outcomes were bone mineral density values, antiosteoporotic therapy initiation, adherence to antiosteoporotic medications, subsequent fracture, and mortality risk, while secondary outcomes were quality of life and physical performance. RESULTS Fifteen RCTs and 62 observational studies, ranging from very low to low quality for bone mineral density values, antiosteoporotic initiation, adherence to antiosteoporotic medications, subsequent fracture, mortality, met our inclusion criteria. The implementation of clinical governance models compared to their pre-implementation or standard care/non-attenders significantly improved BMD testing rate, and increased the number of patients who initiated antiosteoporotic therapy and enhanced their adherence to the medications. Moreover, the treatment by clinical governance model respect to standard care/non-attenders significantly reduced the risk of subsequent fracture and mortality. The integrated structure of care enhanced the quality of life and physical function among patients with fragility fractures. CONCLUSIONS Based on our findings, clinicians should promote the management of patients experiencing a fragility fracture through structured and integrated models of care. The task force has formulated appropriate recommendations on the implementation of multidisciplinary care systems in patients with, or at risk of, fragility fractures.
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Affiliation(s)
- L Cianferotti
- Italian Bone Disease Research Foundation (FIRMO), Florence, Italy
| | - G Porcu
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
| | - R Ronco
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
| | - G Adami
- Rheumatology Unit, University of Verona, Verona, Italy
| | - R Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - R Bogini
- Local Health Unit (USL) Umbria, Perugia, Italy
| | - A P Caputi
- Department of Pharmacology, School of Medicine, University of Messina, Sicily, Italy
| | - B Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - D Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - S Gonnelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - G Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - S Leone
- AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - R Michieli
- Italian Society of General Medicine and Primary Care (SIMG), Florence, Italy
| | - S Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - T Nicoletti
- CnAMC, Coordinamento nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy
| | - M Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Pennini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - E Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - M Rossini
- Rheumatology Unit, University of Verona, Verona, Italy
| | - U Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - M L Brandi
- Italian Bone Disease Research Foundation (FIRMO), Florence, Italy
| | - G Corrao
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - A Biffi
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
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Das AS, Gokcal E, Biffi A, Regenhardt RW, Pasi M, Abramovitz Fouks A, Viswanathan A, Goldstein J, Schwamm LH, Rosand J, Greenberg SM, Gurol ME. Mechanistic Implications of Cortical Superficial Siderosis in Patients With Mixed Location Intracerebral Hemorrhage and Cerebral Microbleeds. Neurology 2023; 101:e636-e644. [PMID: 37290968 PMCID: PMC10424843 DOI: 10.1212/wnl.0000000000207476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/17/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hypertensive cerebral small vessel disease (HTN-cSVD) is the predominant microangiopathy in patients with a combination of lobar and deep cerebral microbleeds (CMBs) and intracerebral hemorrhage (mixed ICH). We tested the hypothesis that cerebral amyloid angiopathy (CAA) is also a contributing microangiopathy in patients with mixed ICH with cortical superficial siderosis (cSS), a marker strongly associated with CAA. METHODS Brain MRIs from a prospective database of consecutive patients with nontraumatic ICH admitted to a referral center were reviewed for the presence of CMBs, cSS, and nonhemorrhagic CAA markers (lobar lacunes, centrum semiovale enlarged perivascular spaces [CSO-EPVS], and multispot white matter hyperintensity [WMH] pattern). The frequencies of CAA markers and left ventricular hypertrophy (LVH), a marker for hypertensive end-organ damage, were compared between patients with mixed ICH with cSS (mixed ICH/cSS[+]) and without cSS (mixed ICH/cSS[-]) in univariate and multivariable models. RESULTS Of 1,791 patients with ICH, 40 had mixed ICH/cSS(+) and 256 had mixed ICH/cSS(-). LVH was less common in patients with mixed ICH/cSS(+) compared with those with mixed ICH/cSS(-) (34% vs 59%, p = 0.01). The frequencies of CAA imaging markers, namely multispot pattern (18% vs 4%, p < 0.01) and severe CSO-EPVS (33% vs 11%, p < 0.01), were higher in patients with mixed ICH/cSS(+) compared with those with mixed ICH/cSS(-). In a logistic regression model, older age (adjusted odds ratio [aOR] 1.04 per year, 95% CI 1.00-1.07, p = 0.04), lack of LVH (aOR 0.41, 95% CI 0.19-0.89, p = 0.02), multispot WMH pattern (aOR 5.25, 95% CI 1.63-16.94, p = 0.01), and severe CSO-EPVS (aOR 4.24, 95% CI 1.78-10.13, p < 0.01) were independently associated with mixed ICH/cSS(+) after further adjustment for hypertension and coronary artery disease. Among ICH survivors, the adjusted hazard ratio of ICH recurrence in patients with mixed ICH/cSS(+) was 4.65 (95% CI 1.38-11.38, p < 0.01) compared with that in patients with mixed ICH/cSS(-). DISCUSSION The underlying microangiopathy of mixed ICH/cSS(+) likely includes both HTN-cSVD and CAA, whereas mixed ICH/cSS(-) is likely driven by HTN-cSVD. These imaging-based classifications can be important to stratify ICH risk but warrant confirmation in studies incorporating advanced imaging/pathology.
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Affiliation(s)
- Alvin S Das
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston.
| | - Elif Gokcal
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Alessandro Biffi
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Robert W Regenhardt
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Marco Pasi
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Avia Abramovitz Fouks
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anand Viswanathan
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Joshua Goldstein
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Lee H Schwamm
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan Rosand
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Steven M Greenberg
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - M Edip Gurol
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
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Mayerhofer E, Zaba NO, Parodi L, Ganbold AS, Biffi A, Rosand J, Yechoor N, Anderson CD. Disparities in brain health comorbidity management in intracerebral hemorrhage. Front Neurol 2023; 14:1194810. [PMID: 37360335 PMCID: PMC10285101 DOI: 10.3389/fneur.2023.1194810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Background Intracerebral hemorrhage (ICH) disproportionally affects underserved populations, and coincides with risk factors for cardiovascular events and cognitive decline after ICH. We investigated associations between social determinants of health and management of blood pressure (BP), hyperlipidemia, diabetes, obstructive sleep apnea (OSA), and hearing impairment before and after ICH hospitalization. Methods Survivors of the Massachusetts General Hospital longitudinal ICH study between 2016 and 2019 who received healthcare at least 6 months after ICH were analyzed. Measurements of BP, LDL and HbA1c and their management in the year surrounding ICH and referrals for sleep studies and audiology up to 6 months after ICH were gathered from electronic health records. The US-wide area deprivation index (ADI) was used as proxy for social determinants of health. Results The study included 234 patients (mean 71 years, 42% female). BP measurements were performed in 109 (47%) before ICH, LDL measurements were performed in 165 (71%), and HbA1c measurements in 154 (66%) patients before or after ICH. 27/59 (46%) with off-target LDL and 3/12 (25%) with off-target HbA1c were managed appropriately. Of those without history of OSA or hearing impairment before ICH, 47/207 (23%) were referred for sleep studies and 16/212 (8%) to audiology. Higher ADI was associated with lower odds of BP, LDL, and HbA1c measurement prior to ICH [OR 0.94 (0.90-0.99), 0.96 (0.93-0.99), and 0.96 (0.93-0.99), respectively, per decile] but not with management during or after hospitalization. Conclusion Social determinants of health are associated with pre-ICH management of cerebrovascular risk factors. More than 25% of patients were not assessed for hyperlipidemia and diabetes in the year surrounding ICH hospitalization, and less than half of those with off-target values received treatment intensification. Few patients were evaluated for OSA and hearing impairment, both common among ICH survivors. Future trials should evaluate whether using the ICH hospitalization to systematically address co-morbidities can improve long-term outcomes.
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Affiliation(s)
- Ernst Mayerhofer
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Natalie O. Zaba
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Livia Parodi
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Alena S. Ganbold
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Alessandro Biffi
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Jonathan Rosand
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Nirupama Yechoor
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Christopher D. Anderson
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, United States
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Donati F, Guicciardi C, Lodi E, Fernando F, Palermi S, Modena MG, Biffi A. Echocardiography in the preparticipation screening: an old topic revisited. J Cardiovasc Med (Hagerstown) 2023; 24:297-301. [PMID: 36938818 PMCID: PMC10219667 DOI: 10.2459/jcm.0000000000001460] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/21/2022] [Revised: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Preparticipation screenings have been conceived for the potential to prevent sudden cardiac death in young athletes by early identification of hidden cardiac diseases. Commonly used protocols include family history collection, physical examination, and resting electrocardiogram. Transthoracic echocardiography has been hypothesized to have a primary role in the preparticipation screening. AIMS The present study aimed to evaluate the additional role of echocardiogram in identifying cardiovascular abnormalities that might be undetected by commonly used preparticipation screening. METHODS We retrospectively reviewed Ferrari Formula Benessere, a corporate wellness program database, and analyzed data recorded from 2017 to 2022 to compare two medical models: a 'standard' preparticipation screening including medical history, physical examination, electrocardiogram and exercise stress testing versus an 'advanced' preparticipation screening comprising history, physical examination, electrocardiogram, exercise stress testing and echocardiography. RESULTS From an initial sample size of 7500 patients, we included 500 patients (420 male, 33.69 ± 7.9 mean age) enrolled for the first time in the corporate wellness program between 2017 and 2022. Three hundred and thirty-nine (67.8%) patients had no abnormal findings at 'standard' preparticipation screening and, even if they would have not required further evaluation, we performed echocardiography anyway ('advanced' preparticipation screening): 31 (9.1%) showed some abnormal cardiovascular findings at echocardiography, such as patent foramen ovalis, bicuspid aortic valve, aortic root ectasia or mitral valve prolapse. CONCLUSIONS Screening echocardiogram showed an additional value (about 10% more) in detecting patients with cardiovascular abnormalities, otherwise undiagnosed with the 'standard' preparticipation screening protocol.
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Affiliation(s)
- Federica Donati
- Public Health Department, PASCIA Center
- Public Health Department, University of Modena and Reggio Emilia, Modena
| | - Claudio Guicciardi
- Public Health Department, PASCIA Center
- Public Health Department, University of Modena and Reggio Emilia, Modena
| | - Elisa Lodi
- Public Health Department, PASCIA Center
- Public Health Department, University of Modena and Reggio Emilia, Modena
| | - Fredrick Fernando
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome – Maranello (Mo)
| | - Stefano Palermi
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome – Maranello (Mo)
- Public Health Department, University of Naples Federico II, Naples, Italy
| | - Maria Grazia Modena
- Public Health Department, PASCIA Center
- Public Health Department, University of Modena and Reggio Emilia, Modena
| | - Alessandro Biffi
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome – Maranello (Mo)
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13
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Wong KH, Muddasani V, Peterson C, Sheibani N, Arkin C, Cheong I, Majersik JJ, Biffi A, Petersen N, Falcone GJ, Sansing LH, de Havenon AH. Baseline Serum Biomarkers of Inflammation and Subsequent Visit-to-Visit Blood Pressure Variability: A Post Hoc Analysis of MESA. Am J Hypertens 2023; 36:144-147. [PMID: 36315490 DOI: 10.1093/ajh/hpac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Higher blood pressure variability (BPV) is associated with the development of major vascular diseases, independent of mean blood pressure. However, despite data indicating that serum inflammatory markers are linked to hypertension, the association between serum inflammatory markers and BPV has not been studied in humans. METHODS This is a post hoc analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) study. The study exposure was tertiles of serum level of interleukin-6 (IL-6), C-reactive protein (CRP), d-dimer, plasmin-antiplasmin complex (PAP), fibrinogen antigen, and calibrated Factor VIII (%) at the baseline study visit. The primary outcome was visit-to-visit BPV measured as the residual standard deviation (rSD) of at least 4 study visits (2000-2018). Two logistic regression models were fit to the top tertile of rSD during follow-up: in Model 1, we adjusted for age, sex, and hypertension, and in Model 2, for patient age categories, sex, race/ethnicity, education, hypertension, diabetes, smoking, drinking, body mass index, lipid-lowering medication, and mean systolic blood pressure. RESULTS Our analysis included 5,483 patients, with a mean (SD) age of 61.4 (10.0) years, 52.9% female, and 40.7% White. In unadjusted analyses, all markers of inflammation were associated with higher BPV, but after adjustment, only IL-6 retained significance (P < 0.001). The odds ratio for the highest tertile of BPV and IL-6 was 1.49 (95% confidence interval [CI] 1.28-1.74, P < 0.001). CONCLUSIONS Baseline serum IL-6 was associated with increased subsequent BPV in a large multiracial cohort. Further investigation is needed to better understand the relationship between chronic inflammation and BPV.
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Affiliation(s)
- Ka-Ho Wong
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Varsha Muddasani
- Department of Neurology, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Cecilia Peterson
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Nazanin Sheibani
- Department of Neurology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Cameron Arkin
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Irene Cheong
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nils Petersen
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Guido J Falcone
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Lauren H Sansing
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Adam H de Havenon
- Department of Neurology, Yale University, New Haven, Connecticut, USA
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14
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Mallick A, Biffi A. Diagnostic and Management Strategies for Common Neurobehavioral and Psychiatric Disturbances Among Patients with Cognitive Impairment and the Dementias. Clin Geriatr Med 2023; 39:161-175. [PMID: 36404029 DOI: 10.1016/j.cger.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/03/2022]
Abstract
Neurobehavioral and neuropsychiatric symptoms are highly prevalent among individuals diagnosed with cognitive impairment or dementia and impact the quality of life for patients and caregivers alike. Diagnosis and management of these conditions (including primarily depression, anxiety, apathy, psychosis, agitation, and aggression) is crucial to optimal patient care outcomes in clinical practice. The present article provides a practical review of diagnostic approaches and management strategies for behavioral and neuropsychiatric disorders arising in patients with cognitive impairment, up to and including dementia.
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Affiliation(s)
- Akashleena Mallick
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Henry and Allison McCance Center for Brain Health, 100 Cambridge Street, Room 2054, Boston, MA 02144, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Henry and Allison McCance Center for Brain Health, 100 Cambridge Street, Room 2054, Boston, MA 02144, USA.
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15
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Gokcal E, Becker JA, Horn MJ, Das AS, Abramovitz Fouks A, Schwab K, Biffi A, Rosand J, Viswanathan A, Polimeni J, Johnson KA, Greenberg SM, Gurol EM. Abstract 162: Molecular And Microstructural Alterations In Cerebral Amyloid Angiopathy-related Hemorrhagic Manifestations. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.162] [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: 02/05/2023]
Abstract
Background and Purpose:
We aimed to compare the amyloid load and degree of microstructural injury among Cerebral Amyloid Angiopathy (CAA) patients with either higher lobar cerebral microbleed (CMB) counts or higher cortical superficial siderosis (cSS) extent against CAA patients with lower hemorrhagic load.
Methods:
The study included 38 cognitively healthy probable CAA patients with lobar intracerebral hemorrhage (ICH) and 38 age, sex-matched healthy controls (HC) who underwent advanced MRI, and Pittsburgh Compound B (PiB) PET scans. Patients were categorized into CMB-Dominant (CMB-D) and cSS-Dominant (cSS-D) based on the number and extent of CMB and cSS using previously identified cutoffs (Figure). The mean global cortical amyloid load was calculated from PiB-PET scans and represented by PiB-DVR. Within the CAA cohort, the Peak Width of Skeletonized Mean Diffusivity (PSMD) was calculated from diffusion MRIs and used as a marker of microstructural integrity.
Results:
Patients with CAA had significantly higher PiB-DVR than HCs (1.40±0.24 vs. 1.19±0.22, p<0.001). Both CMB-D and cSS-D CAA patients had significantly higher amyloid and increased (worse) PSMD compared to CAA patients with a non-dominant low hemorrhagic load (Figure). These results did not change in separate regression models corrected for age and sex. PiB-DVR significantly correlated with increased PSMD (r=0.346, p=0.033).
Conclusions:
Our findings support the view that vascular amyloid load drives higher CMB counts, more extensive cSS, and microstructural injury in patients with CAA. Furthermore, the correlations among these markers suggest that these MRI-based categorizations (CMB-D and cSS-D patients) can be used for disease staging and further research.
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Affiliation(s)
| | | | | | - Alvin S Das
- Beth Israel Deaconess Med Cente, Cambridge, MA
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16
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Das AS, Gokcal E, Biffi A, Regenhardt R, Abramovitz Fouks A, Viswanathan A, Kimberly WT, Goldstein JN, Schwamm LH, Rosand J, Greenberg S, Gurol EM. Abstract WP118: Mechanistic Implications Of Cortical Superficial Siderosis In Patients With Mixed Location Intracerebral Hemorrhage And Cerebral Microbleeds. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp118] [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: 02/05/2023]
Abstract
Introduction:
Hypertensive cerebral small vessel disease (HTN-cSVD) is the predominant microangiopathy in patients with a combination of lobar and deep cerebral microbleeds (CMBs) and intracerebral hemorrhage (mixed ICH/CMB). We tested the hypothesis that cerebral amyloid angiopathy (CAA) is also a contributing microangiopathy in mixed ICH/CMB patients with cortical superficial siderosis (cSS), a marker that is strongly associated with CAA.
Methods:
Brain MRIs from a prospective database of consecutive non-traumatic ICH patients admitted to a single referral center (2003 to 2019) were reviewed for the presence of CMBs, cSS, and non-hemorrhagic CAA markers (lobar lacunes, centrum semiovale enlarged perivascular spaces (CSO-EPVS), and multispot pattern of leukoaraiosis). The frequency of CAA markers and left ventricular hypertrophy (LVH), a marker for hypertensive end-organ damage, were compared between mixed ICH/CMB patients with cSS (mixed
+cSS
) and without cSS (mixed
-cSS
) in univariate and multivariate models.
Results:
Of the 1824 ICH patients, 40 had mixed
+cSS
and 256 had mixed
-cSS
. LVH was less common in patients with mixed
+cSS
compared to those with mixed
-cSS
(34% vs. 59%,
p =
0.01). The frequency of multispot pattern (18% vs. 4%,
p
< 0.01) and severe CSO-EPVS (33% vs. 11%,
p
< 0.01) were higher in patients with mixed
+cSS
compared to mixed
-cSS
, whereas lobar lacune frequency was similar (23% vs. 20%,
p
= 0.67). In a logistic regression model, older age (aOR 1.04 per year, 95% CI [1.01-1.08],
p
= 0.01), presence of multispot pattern (aOR 5.82, 95% CI [1.82-18.60],
p
< 0.03), severe CSO-EPVS (aOR 4.08, 95% CI [1.73-9.61],
p
< 0.01), and LVH (aOR 0.43, 95% CI [0.20-0.94],
p
= 0.03) were independently associated with mixed
+cSS
after further adjustment for sex and hypertension (Table).
Conclusions:
CAA and HTN-cSVD appear to confer injury in patients with mixed ICH/CMB and cSS, a finding that warrants confirmation in studies incorporating advanced imaging/pathology.
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Affiliation(s)
- Alvin S Das
- Beth Israel Deaconess Med Cente, Cambridge, MA
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17
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Koemans EA, Castello JP, Rasing I, Abramson JR, Voigt S, Perosa V, van Harten TW, van Zwet EW, Terwindt GM, Gurol ME, Rosand J, Greenberg SM, van Walderveen MA, Biffi A, Viswanathan A, Wermer MJ. Sex Differences in Onset and Progression of Cerebral Amyloid Angiopathy. Stroke 2023; 54:306-314. [PMID: 36689586 PMCID: PMC9855754 DOI: 10.1161/strokeaha.122.040823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/02/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cerebral Amyloid Angiopathy (CAA) disease course is highly variable even in hereditary forms. Sex may be a possible modifying factor. We investigated biological sex differences in clinical disease course and magnetic resonance imaging-markers in sporadic (sCAA) and Dutch-type hereditary CAA (D-CAA). METHODS Patients with D-CAA and sCAA were included from hospital and research databases of the Leiden University Medical Center (2012-2020) and Massachusetts General Hospital (1994-2012). Key outcomes were: sex differences in symptomatic intracerebral hemorrhage (sICH) onset, recurrence and survival (analyzed using Kaplan Meier survival and regression analyses), and sex differences in magnetic resonance imaging-markers in D-CAA (explored using scatterplots), and in sCAA (investigated using regression analysis). RESULTS We included 136 patients with D-CAA (mean age 57 years, 56% women, 64% with previous sICH) and 370 patients with sCAA (mean age 76 years, 51% women, all with previous sICH). Men and women with D-CAA did not differ for sICH onset (median age 54 in men and 56 in women [P=0.13]). Men with D-CAA had a slightly higher number of sICH compared with women (median 2 versus 1; adjusted RR, 1.5 [95% CI, 1.1-1.9]) and a shorter interval between the first and second sICH (median 1.8 years for men and 3.1 years for women, P=0.02). Men with sCAA had their first sICH at an earlier age (median 75 versus 78 years, respectively, P=0.003) and more lobar microbleeds (median 1 versus 0, P=0.022) compared with women with sCAA. No substantial differences were found in the other magnetic resonance imaging markers. Survival after first sICH was comparable between sexes for D-CAA (P=0.12) and sCAA (P=0.23). CONCLUSIONS Men with CAA seem to have an earlier onset (sCAA) and more hemorrhagic disease course (sCAA and D-CAA) compared with women. Future studies are necessary to confirm these findings and determine the underlying role of sex-related factors.
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Affiliation(s)
- Emma A. Koemans
- Department of Neurology, Leiden University Medical Center, the Netherlands (E.A.K., I.R., S.V., G.M.T., M.J.H.W.)
| | - Juan Pablo Castello
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston (J.P.C., J.R.A., J.R., A.B.)
- Department of Neurology, J Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.P.C., J.R.A., V.P., M.E.G., J.R., S.M.G., A.B., A.V.)
- Department of Neurology, University of Miami Miller School of Medicine, FL (J.P.C.)
| | - Ingeborg Rasing
- Department of Neurology, Leiden University Medical Center, the Netherlands (E.A.K., I.R., S.V., G.M.T., M.J.H.W.)
| | - Jessica R. Abramson
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston (J.P.C., J.R.A., J.R., A.B.)
- Department of Neurology, J Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.P.C., J.R.A., V.P., M.E.G., J.R., S.M.G., A.B., A.V.)
| | - Sabine Voigt
- Department of Neurology, Leiden University Medical Center, the Netherlands (E.A.K., I.R., S.V., G.M.T., M.J.H.W.)
- Department of Radiology, Leiden University Medical Center, the Netherlands (S.V., T.W.v.H., M.A.A.v.W.)
| | - Valentina Perosa
- Department of Neurology, J Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.P.C., J.R.A., V.P., M.E.G., J.R., S.M.G., A.B., A.V.)
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany (V.P.)
| | - Thijs W. van Harten
- Department of Radiology, Leiden University Medical Center, the Netherlands (S.V., T.W.v.H., M.A.A.v.W.)
| | - Erik W. van Zwet
- Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands (E.W.v.Z.)
| | - Gisela M. Terwindt
- Department of Neurology, Leiden University Medical Center, the Netherlands (E.A.K., I.R., S.V., G.M.T., M.J.H.W.)
| | - M. Edip Gurol
- Department of Neurology, J Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.P.C., J.R.A., V.P., M.E.G., J.R., S.M.G., A.B., A.V.)
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston (J.P.C., J.R.A., J.R., A.B.)
- Department of Neurology, J Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.P.C., J.R.A., V.P., M.E.G., J.R., S.M.G., A.B., A.V.)
| | - Steven M. Greenberg
- Department of Neurology, J Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.P.C., J.R.A., V.P., M.E.G., J.R., S.M.G., A.B., A.V.)
| | | | - Alessandro Biffi
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston (J.P.C., J.R.A., J.R., A.B.)
- Department of Neurology, J Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.P.C., J.R.A., V.P., M.E.G., J.R., S.M.G., A.B., A.V.)
| | - Anand Viswanathan
- Department of Neurology, J Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.P.C., J.R.A., V.P., M.E.G., J.R., S.M.G., A.B., A.V.)
| | - Marieke J.H. Wermer
- Department of Neurology, Leiden University Medical Center, the Netherlands (E.A.K., I.R., S.V., G.M.T., M.J.H.W.)
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18
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Das AS, Gokcal E, Regenhardt RW, Horn MJ, Schwab K, Daoud N, Viswanathan A, Kimberly WT, Goldstein JN, Biffi A, Rost N, Rosand J, Schwamm LH, Greenberg SM, Gurol ME. Improving detection of cerebral small vessel disease aetiology in patients with isolated lobar intracerebral haemorrhage. Stroke Vasc Neurol 2023; 8:26-33. [PMID: 35981809 PMCID: PMC9985798 DOI: 10.1136/svn-2022-001653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/19/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND PURPOSE We evaluate whether non-haemorrhagic imaging markers (NHIM) (white matter hyperintensity patterns, lacunes and enlarged perivascular spaces (EPVS)) can discriminate cerebral amyloid angiopathy (CAA) from hypertensive cerebral small vessel disease (HTN-cSVD) among patients with isolated lobar intracerebral haemorrhage (isolated-LICH). METHODS In patients with isolated-LICH, four cSVD aetiologic groups were created by incorporating the presence/distribution of NHIM: HTN-cSVD pattern, CAA pattern, mixed NHIM and no NHIM. CAA pattern consisted of patients with any combination of severe centrum semiovale EPVS, lobar lacunes or multiple subcortical spots pattern. HTN-cSVD pattern consisted of any HTN-cSVD markers: severe basal ganglia PVS, deep lacunes or peribasal ganglia white matter hyperintensity pattern. Mixed NHIM consisted of at least one imaging marker from either pattern. Our hypothesis was that patients with HTN-cSVD pattern/mixed NHIM would have a higher frequency of left ventricular hypertrophy (LVH), which is associated with HTN-cSVD. RESULTS In 261 patients with isolated-LICH, CAA pattern was diagnosed in 93 patients, HTN-cSVD pattern in 53 patients, mixed NHIM in 19 patients and no NHIM in 96 patients. The frequency of LVH was similar among those with HTN-cSVD pattern and mixed NHIM (50% vs 39%, p=0.418) but was more frequent in HTN-cSVD pattern compared with CAA pattern (50% vs 20%, p<0.001). In a regression model, HTN-cSVD pattern (OR: 7.38; 95% CI 2.84 to 19.20) and mixed NHIM (OR: 4.45; 95% CI 1.25 to 15.90) were found to be independently associated with LVH. CONCLUSION Among patients with isolated-LICH, NHIM may help differentiate HTN-cSVD from CAA, using LVH as a marker for HTN-cSVD.
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Affiliation(s)
- Alvin S Das
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Elif Gokcal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchell J Horn
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nader Daoud
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - W Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalia Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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19
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Keins S, Abramson JR, Mallick A, Castello JP, Rodriguez-Torres A, Popescu D, Hoffman D, Kourkoulis C, Gurol ME, Greenberg SM, Anderson CD, Viswanathan A, Rosand J, Biffi A. Association of Depression Onset and Treatment With Blood Pressure Control After Intracerebral Hemorrhage. Stroke 2023; 54:105-112. [PMID: 36444719 DOI: 10.1161/strokeaha.122.040331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Blood pressure (BP) control represents a crucial intervention to improve long-term outcomes following spontaneous intracerebral hemorrhage (ICH). However, fewer than half of ICH survivors achieve target treatment goals. ICH survivors are also at very high risk for poststroke depression, which may contribute to inadequate BP control. We, therefore, sought to determine whether depressive symptoms after ICH are associated with inadequate BP control. We also investigated whether associations between depression after ICH and BP measurements were mediated by treatment with selective serotonin reuptake inhibitors or norepinephrine-serotonin reuptake inhibitors antidepressants. METHODS We leveraged data from a single-center longitudinal study of ICH conducted at Massachusetts General Hospital (Boston, MA) between 2006 and 2018. We collected data from semiautomated review of electronic health records, baseline and follow-up interviews, and computed tomography imaging. Information on BP measurements, depression diagnoses, antidepressants medication use, and medical visits were collected longitudinally and analyzed using mixed effects models. Primary outcomes included systolic and diastolic BP measurements during long-term follow-up after ICH. RESULTS We included 1243 consecutive ICH patients without pre-stroke depression history. Of these, 721 (58%) were diagnosed with incident depression over a median follow-up time of 52.8 months (interquartile range, 42.1-60.5). Depression onset was associated with subsequent increase in systolic (+8.3 mm Hg, SE, 2.4 mm Hg, P=0.012) and diastolic (+4.4 mm Hg, SE, 1.2 mm Hg) BP measurements. Resolution of depressive symptoms was associated with subsequent decrease in systolic (-5.9 mm Hg, SE, 1.4 mm Hg, P=0.031) and diastolic (-3.4 mm Hg, SE, 1.1 mm Hg, P=0.041) BP measurements. We also found associations between higher systolic BP measurements and use of selective serotonin reuptake inhibitor and noradrenaline-serotonin reuptake inhibitor antidepressants, independent of whether depression symptoms were active or not (all P<0.05). CONCLUSIONS ICH survivors displayed increasing BP values after receiving a diagnosis of depression, followed by decreasing values among those experiencing resolution of depressive symptoms. Use of selective serotonin reuptake inhibitor and noradrenaline-serotonin reuptake inhibitor antidepressants was independently associated with higher systolic BP measurements. Clinicians ought to closely monitor BP for ICH survivors being treated for depression, especially using selective serotonin reuptake inhibitor and noradrenaline-serotonin reuptake inhibitor. Future studies will also be required to investigate the mechanisms underlying these associations.
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Affiliation(s)
- Sophia Keins
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., A.M., D.P., D.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Jessica R Abramson
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., A.M., D.P., D.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Akashleena Mallick
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., A.M., D.P., D.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Juan Pablo Castello
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Axana Rodriguez-Torres
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Dominique Popescu
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., A.M., D.P., D.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Danielle Hoffman
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., A.M., D.P., D.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Christina Kourkoulis
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston
| | - M Edip Gurol
- Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Steven M Greenberg
- Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Christopher D Anderson
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., A.M., D.P., D.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology, Brigham and Women's Hospital, Boston, MA (C.D.A.)
| | - Anand Viswanathan
- Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., A.M., D.P., D.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Alessandro Biffi
- Henry and Allison McCance Center for Brain Health (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology (S.K., J.R.A., A.M., J.P.C., A.R.-T., D.P., D.H., C.K., M.E.G., S.M.G., C.D.A., A.V., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., A.M., D.P., D.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
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Castelletti S, Zorzi A, Ballardini E, Basso C, Biffi A, Brancati F, Cavarretta E, Crotti L, Contursi M, D'Aleo A, D'Ascenzi F, Delise P, Dello Russo A, Gazale G, Mos L, Novelli V, Palamà Z, Palermi S, Palmieri V, Patrizi G, Pelliccia A, Pilichou K, Romano S, Sarto P, Schwartz PJ, Tiberi M, Zeppilli P, Corrado D, Sciarra L. Corrigendum to "Molecular genetic testing in athletes: Why and when a position statement from the Italian Society of Sports Cardiology" [International Journal of Cardiology Volume 364, 1 October 2022, Pages 169-177]. Int J Cardiol 2023; 370:476. [PMID: 36344375 DOI: 10.1016/j.ijcard.2022.10.162] [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: 11/06/2022]
Affiliation(s)
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Enrico Ballardini
- Sports Medicine Centre, Gruppo Mantova Salus, Ospedale San Pellegrino, Mantova, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandro Biffi
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Francesco Brancati
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Aquila, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Naples, Italy
| | - Lia Crotti
- Cardiology Department, IRCCS Istituto Auxologico Italiano, Milan, Italy; Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Maurizio Contursi
- Sports Cardiology Unit, Centro Polidiagnostico Check-up, Salerno, Italy
| | | | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Pietro Delise
- Division of Cardiology, Hospital of Peschiera del Garda, Veneto, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Lancisi-Umberto I- Salesi", Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Giovanni Gazale
- Center of Sport Medicine and Sports Cardiology, ASL 1, Sassari, Italy
| | - Lucio Mos
- San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | | | - Zefferino Palamà
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Aquila, Italy; Casa di Cura Villa Verde, Taranto, Italy
| | - Stefano Palermi
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Vincenzo Palmieri
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Kalliopi Pilichou
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Aquila, Italy
| | | | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Monica Tiberi
- Department of Public Health, Azienda Sanitaria Unica Regionale Marche AV 1, Pesaro, Italy
| | - Paolo Zeppilli
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy.
| | - Luigi Sciarra
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Aquila, Italy
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21
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Teo KC, Keins S, Abramson JR, Leung WCY, Leung IYH, Wong YK, Yeung C, Kourkoulis C, Warren AD, Chan KH, Cheung RTF, Ho SL, Gurol ME, Viswanathan A, Greenberg SM, Anderson CD, Lau KK, Rosand J, Biffi A. Blood Pressure Control Targets and Risk of Cardiovascular and Cerebrovascular Events After Intracerebral Hemorrhage. Stroke 2023; 54:78-86. [PMID: 36321455 DOI: 10.1161/strokeaha.122.039709] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) survivors are at high risk for recurrent stroke and cardiovascular events. Blood pressure (BP) control represents the most potent intervention to lower these risks, but optimal treatment targets in this patient population remain unknown. We sought to determine whether survivors of ICH achieving more intensive BP control than current guideline recommendations (systolic BP <130 mmHg and diastolic BP <80 mmHg) were at lower risk of major adverse cardiovascular and cerebrovascular events and mortality. METHODS We analyzed data for 1828 survivors of spontaneous ICH from 2 cohort studies. Follow-up BP measurements were recorded 3 and 6 months after ICH, and every 6 months thereafter. Outcomes of interest were major adverse cardiovascular and cerebrovascular events (recurrent ICH, incident ischemic stroke, myocardial infarction), vascular mortality (defined as mortality attributed to recurrent ICH, ischemic stroke, or myocardial infarction), and all-cause mortality. RESULTS During a median follow-up of 46.2 months, we observed 166 recurrent ICH, 68 ischemic strokes, 69 myocardial infarction, and 429 deaths. Compared with survivors of ICH with systolic BP 120 to 129 mmHg, participants who achieved systolic BP <120 mmHg displayed reduced risk of recurrent ICH (adjusted hazard ratio [AHR], 0.74 [95% CI, 0.59-0.94]) and major adverse cardiovascular and cerebrovascular events (AHR, 0.69 [95% CI, 0.53-0.92]). All-cause mortality (AHR, 0.76 [95% CI, 0.57-1.03]) and vascular mortality (AHR, 0.68 [95% CI, 0.45-1.01]) did not differ significantly. Among participants aged >75 years or with modified Rankin Scale score 4 to 5, systolic BP <120 mmHg was associated with increased all-cause mortality (AHR, 1.38 [95% CI, 1.02-1.85] and AHR, 1.36 [95% CI, 1.03-1.78], respectively), but not vascular mortality. We found no differences in outcome rates between survivors of ICH with diastolic BP <70 versus 70 to 79 mmHg. CONCLUSIONS Targeting systolic BP <120 mmHg in select groups of survivors of ICH could result in decreased major adverse cardiovascular and cerebrovascular events risk without increasing mortality. Our findings warrant investigation in dedicated randomized controlled trials.
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Affiliation(s)
- Kay-Cheong Teo
- Department of Medicine, Queen Mary Hospital (K.-C.T., W.C.Y.L., I.Y.H.L., Y.-K.W., C.Y., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong
| | - Sophia Keins
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Henry and Allison McCance Center for Brain Health (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Jessica R Abramson
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Henry and Allison McCance Center for Brain Health (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - William C Y Leung
- Department of Medicine, Queen Mary Hospital (K.-C.T., W.C.Y.L., I.Y.H.L., Y.-K.W., C.Y., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong
| | - Ian Y H Leung
- Department of Medicine, Queen Mary Hospital (K.-C.T., W.C.Y.L., I.Y.H.L., Y.-K.W., C.Y., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong
| | - Yuen-Kwun Wong
- Department of Medicine, Queen Mary Hospital (K.-C.T., W.C.Y.L., I.Y.H.L., Y.-K.W., C.Y., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong
| | - Charming Yeung
- Department of Medicine, Queen Mary Hospital (K.-C.T., W.C.Y.L., I.Y.H.L., Y.-K.W., C.Y., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong
| | - Christina Kourkoulis
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Henry and Allison McCance Center for Brain Health (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Andrew D Warren
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Koon-Ho Chan
- Research Center of Heart, Brain, Hormone and Healthy Aging (K.-H.C., R.T.F.C., S.-L.H., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong (K.-H.C., R.T.F.C., K.-K.L.)
| | - Raymond T F Cheung
- Research Center of Heart, Brain, Hormone and Healthy Aging (K.-H.C., R.T.F.C., S.-L.H., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong (K.-H.C., R.T.F.C., K.-K.L.)
| | - Shu-Leong Ho
- Research Center of Heart, Brain, Hormone and Healthy Aging (K.-H.C., R.T.F.C., S.-L.H., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong
| | - M Edip Gurol
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Anand Viswanathan
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Steven M Greenberg
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Christopher D Anderson
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Henry and Allison McCance Center for Brain Health (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Department of Neurology, Brigham and Women's Hospital, Boston, MA (C.D.A.)
| | - Kui-Kai Lau
- Department of Medicine, Queen Mary Hospital (K.-C.T., W.C.Y.L., I.Y.H.L., Y.-K.W., C.Y., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong.,Research Center of Heart, Brain, Hormone and Healthy Aging (K.-H.C., R.T.F.C., S.-L.H., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong (K.-H.C., R.T.F.C., K.-K.L.)
| | - Jonathan Rosand
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Henry and Allison McCance Center for Brain Health (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
| | - Alessandro Biffi
- Department of Neurology (S.K., J.R.A., C.K., A.D.W., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Center for Genomic Medicine (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston.,Henry and Allison McCance Center for Brain Health (S.K., J.R.A., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston
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22
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Donati F, Guicciardi C, Lodi E, Modena MG, Palermi S, Biffi A, Fernando F. 320 THE POTENTIAL ROLE OF ECHOCARDIOGRAPHY IN THE PRE-PARTICIPATION SCREENING: RESULTS OF AN OBSERVATIONAL RETROSPECTIVE STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.701] [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: 12/23/2022]
Abstract
Abstract
Introduction
Preparticipation screenings (PPs) have been conceived for the potential to prevent SCD in young athletes by early identification of hidden cardiac diseases. Commonly used protocols include history collection, physical examination and baseline electrocardiogram. Nevertheless, transthoracic echocardiography has been hypothesized to have a primary role in the PPs.
Aim of the Study
The aim of the present paper was to evaluate the potential role of echocardiogram in identifying life-threatening cardiovascular abnormalities that might be undetected by commonly used PPS.
Methods
We retrospectively reviewed a corporate wellness program - database and analyzed data recorded from 2017 to 2022 to compare two medical models: a “standard” PPS including medical history, physical examination, electrocardiogram (ECG) and exercise stress test (EST); an “advanced” PPS comprising history, physical examination, ECG, EST and echocardiography. The primary outcome of the study was to assess the efficacy of the advanced PPS in detecting CV abnormalities compared to the “standard” PPS.
Results
We analyzed data from 500 subjects (420 male, 33.69 ± 7.9 mean aged) enrolled for the first time in the corporate wellness program between 2017 and 2022. 339 (67.8%) subjects had no pathological findings at “standard” PPS and, even if would have not required further evaluation including echocardiogram, performed the ultrasound exam anyway (“advanced” PPS): 31 (9.1%) showed some abnormal findings at echocardiography.
Conclusions
Even if with some limitations, performing a screening echocardiogram could help to detect subjects with some form of cardiovascular morpho-functional abnormalities, otherwise difficult to diagnose with “standard” PPS protocol.
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Affiliation(s)
- Federica Donati
- Centro Pascia (Programma Assistenziale Scompenso Cardiaco, Cardiopatie Dell’infanzia E A Rischio), Aou Policlinico Di Modena
- University Of Modena E Reggio Emilia
| | - Claudio Guicciardi
- Centro Pascia (Programma Assistenziale Scompenso Cardiaco, Cardiopatie Dell’infanzia E A Rischio), Aou Policlinico Di Modena
- University Of Modena E Reggio Emilia
| | - Elisa Lodi
- Centro Pascia (Programma Assistenziale Scompenso Cardiaco, Cardiopatie Dell’infanzia E A Rischio), Aou Policlinico Di Modena
- University Of Modena E Reggio Emilia
| | - Maria Grazia Modena
- Centro Pascia (Programma Assistenziale Scompenso Cardiaco, Cardiopatie Dell’infanzia E A Rischio), Aou Policlinico Di Modena
- University Of Modena E Reggio Emilia
| | | | - Alessandro Biffi
- Med-Ex, Medicine And Exercise, Medical Partner Scuderia Ferrari , Rome , Italy
| | - Frederick Fernando
- Med-Ex, Medicine And Exercise, Medical Partner Scuderia Ferrari , Rome , Italy
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23
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Das AS, Gökçal E, Regenhardt RW, Warren AD, Biffi A, Goldstein JN, Kimberly WT, Viswanathan A, Schwamm LH, Rosand J, Greenberg SM, Gurol ME. Clinical and neuroimaging risk factors associated with the development of intracerebral hemorrhage while taking direct oral anticoagulants. J Neurol 2022; 269:6589-6596. [PMID: 35997817 PMCID: PMC10947801 DOI: 10.1007/s00415-022-11333-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/07/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Intracerebral hemorrhage (ICH) associated with direct oral anticoagulant (DOAC) usage confers significant mortality/disability. We aimed to understand the clinical and neuroimaging features associated with developing ICH among DOAC users. METHODS Clinical and radiological data were collected from consecutive DOAC users with ICH (DOAC-ICH) and age-matched controls without ICH from a single referral center. The frequency/distribution of MRI markers of hemorrhage risk were assessed. Baseline demographics and neuroimaging markers were compared in univariate tests. Significant associations (p < 0.1) were entered into a multivariable regression model to determine predictors of ICH. RESULTS 86 DOAC-ICH and 94 ICH-free patients were included. Diabetes, coronary artery disease, prior ischemic stroke, smoking history, and antiplatelet usage were more common in ICH patients than ICH-free DOAC users. In the neuroimaging analyses, severe white matter hyperintensities (WMHs), lacunes, cortical superficial siderosis (cSS), and cerebral microbleeds (CMBs) were more common in the ICH cohort than the ICH-free cohort. In the multivariable regression, diabetes [OR 3.53 95% CI (1.05-11.87)], prior ischemic stroke [OR 14.80 95% CI (3.33-65.77)], smoking history [OR 3.08 95% CI (1.05-9.01)], CMBs [OR 4.07 95% CI (1.45-11.39)], and cSS [OR 39.73 95% CI (3.43-460.24)] were independently associated with ICH. CONCLUSIONS Risk factors including diabetes, prior stroke, and smoking history as well as MRI biomarkers including CMBs and cSS are associated with ICH in DOAC users. Although screening MRIs are not typically performed prior to initiating DOAC therapy, these data suggest that patients of high-hemorrhagic risk may be identified.
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Affiliation(s)
- Alvin S Das
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Elif Gökçal
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Robert W Regenhardt
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Andrew D Warren
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Alessandro Biffi
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - W Taylor Kimberly
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Lee H Schwamm
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Jonathan Rosand
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - M Edip Gurol
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
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24
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de Havenon A, Petersen N, Stulberg E, Anadani M, Biffi A, Sheth KN. Interaction of Mean Arterial Pressure and Blood Pressure Variability in Critically Ill Brain Injured Patients. Stroke 2022; 53:e512-e514. [PMID: 36367101 PMCID: PMC9712254 DOI: 10.1161/strokeaha.122.041274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022]
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25
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Damanti C, Cani A, Lovisa F, Gaffo E, Borile G, Garbin A, Gallingani I, Ferrone L, Tosato A, Contarini G, Carraro E, Pillon M, Bortoluzzi S, Biffi A, Bresolin S, Mussolin L. PLASMA S-Evs miRNAs IN PEDIATRIC B-mALL: TUMOR BIOMARKERS AND TRANSFORMING FACTORS OF BONE MARROW NICHE. Leuk Res 2022. [DOI: 10.1016/s0145-2126(22)00264-8] [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: 11/05/2022]
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26
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Palermi S, Vecchiato M, Pennella S, Marasca A, Spinelli A, De Luca M, De Martino L, Fernando F, Sirico F, Biffi A. The Impact of the COVID-19 Pandemic on Childhood Obesity and Lifestyle-A Report from Italy. Pediatr Rep 2022; 14:410-418. [PMID: 36278553 PMCID: PMC9589932 DOI: 10.3390/pediatric14040049] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 08/24/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
During the COVID-19 lockdown, especially in the first wave of pandemic (March 2020), sedentary lifestyle and calorie intake increase in children became considerably more prevalent. The aim of the present paper was to evaluate changes in children's weights and nutritional habits during the COVID-19 pandemic in Italy. In this cross-sectional observational study, for 3 years, as part of the corporate wellness program (2019-2021) in Emilia Romagna region of Italy, anthropometric data of Ferrari car company employers' children were collected, analyzed, and compared. Moreover, at the visit of November 2020, performed after the first wave of the pandemic with the most rigorous lockdown rules in Italy, a questionnaire on nutritional and lifestyle habits was administered. We evaluated 307 children (163 M, 10.1 ± 2.3 mean aged in 2019). A significant increase in BMI percentile in 2020 (65.2) compared to 2019 (49.2) was observed; it was confirmed, albeit slightly decreased, in 2021 (64.5). About one-third of participants reported an increase in consumption of fatty condiments and more than half report an increase in consumption of junk food. Levels of physical activity were still high during the COVID-19 lockdown, while sleeping time was significantly reduced. Our findings alert us to the importance of carefully monitoring eating behaviors in young to avoid the adoption of unhealthy food habits and prevent childhood obesity, especially during the period of COVID-19 lockdown.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
- Med-Ex Medicine & Exercise, Via Vittorio Veneto 108, 00187 Rome, Italy
| | - Marco Vecchiato
- Sport and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, 35128 Padova, Italy
| | - Sonia Pennella
- Med-Ex Medicine & Exercise, Via Vittorio Veneto 108, 00187 Rome, Italy
| | - Anna Marasca
- Med-Ex Medicine & Exercise, Via Vittorio Veneto 108, 00187 Rome, Italy
| | - Alessandro Spinelli
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Mariarosaria De Luca
- Department of Translational Medical Sciences, University Federico II, 80131 Naples, Italy
| | - Lorena De Martino
- Med-Ex Medicine & Exercise, Via Vittorio Veneto 108, 00187 Rome, Italy
| | - Fredrick Fernando
- Med-Ex Medicine & Exercise, Via Vittorio Veneto 108, 00187 Rome, Italy
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
- Med-Ex Medicine & Exercise, Via Vittorio Veneto 108, 00187 Rome, Italy
| | - Alessandro Biffi
- Med-Ex Medicine & Exercise, Via Vittorio Veneto 108, 00187 Rome, Italy
- Correspondence:
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27
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D’Ascenzi F, Castelletti S, Adami PE, Cavarretta E, Sanz-de la Garza M, Maestrini V, Biffi A, Kantor P, Pieles G, Verhagen E, Tiberi M, Hanssen H, Papadakis M, Niebauer J, Halle M. Cardiac screening prior to return to play after SARS-CoV-2 infection: focus on the child and adolescent athlete: A Clinical Consensus Statement of the Task Force for Childhood Health of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022; 29:2120-2124. [PMID: 36059208 PMCID: PMC9494331 DOI: 10.1093/eurjpc/zwac180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 04/06/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 01/11/2023]
Abstract
Cardiac sequelae after COVID-19 have been described in athletes, prompting the need to establish a return-to-play (RTP) protocol to guarantee a safe return to sports practice. Sports participation is strongly associated with multiple short- and long-term health benefits in children and adolescents and plays a crucial role in counteracting the psychological and physical effects of the current pandemic. Therefore, RTP protocols should be balanced to promote safe sports practice, particularly after an asymptomatic SARS-CoV-2 infection that represents the common manifestation in children. The present consensus document aims to summarize the current evidence on the cardiac sequelae of COVID-19 in children and young athletes, providing key messages for conducting the RTP protocol in paediatric athletes to promote a safe sports practice during the COVID-19 era.
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Affiliation(s)
| | - Silvia Castelletti
- IRCCS Istituto Auxologico Italiano, Cardiomyopathy Unit and Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
| | - Paolo Emilio Adami
- Health and Science Department, World Athletics, Monaco, Principality of Monaco
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy,Mediterranea Cardiocentro, Naples, Italy
| | - María Sanz-de la Garza
- Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Biffi
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Paul Kantor
- Division of Cardiology, Department of Pediatrics, Children’s Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Guido Pieles
- Sports Medicine Department, Aspetar, Orthopaedic and Sports Medicine Hospital, Doh, Qatar,Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Monica Tiberi
- Sport Medicine, Department of Prevention, ASUR Marche Area Vasta 1, Pesaro, Italy
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George’s, University of London, London, UK
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University of Salzburg, Salzburg, Austria
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28
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Gifford A, Biffi A, Gelaye B, Chemali Z. Shedding Light on the Causes and Characteristics of Stroke in Lebanon: A Systematic Review of Literature. J Geriatr Psychiatry Neurol 2022; 35:655-662. [PMID: 34555937 DOI: 10.1177/08919887211044753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND The prevalence and severity of stroke in Lebanon has increased over the past decade and stroke is currently the second leading cause of death in the country. METHODS We systematically reviewed existing research on stroke prevalence, risk factors, mortality and morbidity of stroke, stroke treatment, and stroke education to assess the epidemiology of stroke in Lebanon. A literature search was conducted on the PubMed database for articles presenting data in any of these 5 categories in Lebanon, as well as articles discussing the Middle East and North Africa region generally. RESULTS A high prevalence of modifiable risk factors (cigarette and waterpipe smoking) and risk factors that could be mitigated by lifestyle changes (obesity and hypertension) were found in Lebanon. Stroke mortality rates and risk factors of mortality were consistent with global trends, though the cost of treatment in Lebanon was significantly higher than in other developing nations. CONCLUSION Urgent public health initiatives are needed to educate the public about the dangers of modifiable stroke risk factors and to reduce the burden of stroke in Lebanon.
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Affiliation(s)
- Abbott Gifford
- Department of Psychology, Colorado College, Colorado Springs, CO, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Alessandro Biffi
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Departments of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Bizu Gelaye
- Harvard T. H. Chan School of Public Health, MA, USA.,The Chester M. Pierce, M.D. Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Zeina Chemali
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Departments of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,The Chester M. Pierce, M.D. Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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29
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Myserlis EP, Mayerhofer E, Abramson JR, Teo KC, Montgomery BE, Sugita L, Warren AD, Goldstein JN, Gurol ME, Viswanathan A, Greenberg SM, Biffi A, Anderson CD, Rosand J. Lobar intracerebral hemorrhage and risk of subsequent uncontrolled blood pressure. Eur Stroke J 2022; 7:280-288. [PMID: 36082262 PMCID: PMC9446337 DOI: 10.1177/23969873221094412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/28/2022] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Uncontrolled blood pressure (BP) in intracerebral hemorrhage (ICH) survivors is common and associated with adverse clinical outcomes. We investigated whether characteristics of the ICH itself were associated with uncontrolled BP at follow-up. METHODS Subjects were consecutive patients aged ⩾18 years with primary ICH enrolled in the prospective longitudinal ICH study at Massachusetts General Hospital between 1994 and 2015. We assessed the prevalence of uncontrolled BP (mean BP ⩾140/90 mmHg) 6 months after index event. We used multivariable logistic regression models to assess the effect of hematoma location, volume, and event year on uncontrolled BP. RESULTS Among 1492 survivors, ICH was lobar in 624 (42%), deep in 749 (50%), cerebellar in 119 (8%). Lobar ICH location was associated with increased risk for uncontrolled BP after 6 months (OR 1.35; 95% CI [1.08-1.69]). On average, lobar ICH survivors were treated with fewer antihypertensive drugs compared to the rest of the cohort: 2.1 ± 1.1 vs 2.5 ± 1.2 (p < 0.001) at baseline and 1.8 ± 1.2 vs. 2.4 ± 1.2 (p < 0.001) after 6 months follow-up. After adjustment for the number of antihypertensive drugs prescribed, the association of lobar ICH location with risk of uncontrolled BP was eliminated. CONCLUSIONS ICH survivors with lobar hemorrhage were more likely to have uncontrolled BP after 6 months follow-up. This appears to be a result of being prescribed fewer antihypertensive medications. Future treatment strategies should focus on aggressive BP control after ICH independent of hemorrhage location.
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Affiliation(s)
- Evangelos Pavlos Myserlis
- Center for Genomic Medicine,
Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population
Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Henry and Allison McCance Center for
Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Ernst Mayerhofer
- Center for Genomic Medicine,
Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population
Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Henry and Allison McCance Center for
Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Jessica R Abramson
- Center for Genomic Medicine,
Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population
Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Henry and Allison McCance Center for
Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Kay-Cheong Teo
- Department of Medicine, Queen Mary
Hospital, LKS Faculty of Medicine, The University of Hong Kong, HK, China SAR
| | - Bailey E. Montgomery
- Center for Genomic Medicine,
Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population
Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Henry and Allison McCance Center for
Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Lansing Sugita
- Center for Genomic Medicine,
Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
- Henry and Allison McCance Center for
Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew D Warren
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine,
Massachusetts General Hospital, Boston, MA, USA
| | - Mahmut Edip Gurol
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
- Henry and Allison McCance Center for
Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher D Anderson
- Center for Genomic Medicine,
Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population
Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Henry and Allison McCance Center for
Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Jonathan Rosand
- Center for Genomic Medicine,
Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population
Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Henry and Allison McCance Center for
Brain Health, Massachusetts General Hospital, Boston, MA, USA
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30
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Compagno S, Palermi S, Pescatore V, Brugin E, Sarto M, Marin R, Calzavara V, Nizzetto M, Scevola M, Aloi A, Biffi A, Zanella C, Carretta G, Gallo S, Giada F. Physical and psychological reconditioning in long COVID syndrome: Results of an out-of-hospital exercise and psychological - based rehabilitation program. Int J Cardiol Heart Vasc 2022; 41:101080. [PMID: 35854691 PMCID: PMC9286763 DOI: 10.1016/j.ijcha.2022.101080] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022]
Abstract
Background Long Covid Syndrome (LCS) is used to describe signs and symptoms that continue or develop after acute COVID-19 infection. Natural history and treatment of this syndrome are still poorly understood, even if evidences suggest the potential role of physical rehabilitation in improving symptoms in these patients. Aim of the study The aim of the present study was to evaluate effectiveness, safety and feasibility of an out-of-hospital multidisciplinary rehabilitation (MDR) program, based both on physical and psychological reconditioning, in reducing symptoms and improving physical fitness and psychological parameters in patients with LCS. Methods Thirty consecutive patients with LCS (18 males, mean age 58 years) underwent an accurate medical screening process including anthropometric and muscular strength evaluation, cardiopulmonary exercise test, quality of life (QoL) and psychological appraisal before and after a MDR program. Results At baseline, all LCS patients were strongly symptomatic and showed severe impairments in physical performance, QoL and psychological parameters. No adverse effects and dropouts were observed during the exercise training sessions. After the MDR program, COVID-19 residual symptoms significantly decreased, and significant improvements in upper and lower limb muscular strength, cardiopulmonary parameters, perceived physical and mental health, depression and anxiety were observed. Conclusions The present study confirms the severe physical and psychological impairment of patients with LCS and suggests that a MDR program is effective, safe and feasible in these patients and could promote their physical and psychological recovery.
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Affiliation(s)
- Silvia Compagno
- Cardiovascular Rehabilitation and Sports Medicine Service, Noale - Venice, Italy
| | - Stefano Palermi
- Cardiovascular Rehabilitation and Sports Medicine Service, Noale - Venice, Italy.,Federico II University Hospital, Naples, Italy
| | - Valentina Pescatore
- Cardiovascular Rehabilitation and Sports Medicine Service, Noale - Venice, Italy
| | - Erica Brugin
- Cardiovascular Rehabilitation and Sports Medicine Service, Noale - Venice, Italy
| | | | - Ruggero Marin
- Cardiovascular Rehabilitation and Sports Medicine Service, Noale - Venice, Italy
| | - Valli Calzavara
- Cardiovascular Rehabilitation and Sports Medicine Service, Noale - Venice, Italy
| | - Manuele Nizzetto
- Sub-Intensive Care COVID Unit, Pneumology Service, Dolo - Venice, Italy
| | - Moreno Scevola
- Non-critical COVID Area, Internal Medicine Service, Dolo - Venice, Italy
| | - Accurso Aloi
- Sub-Intensive Care COVID Unit, Pneumology Service, Dolo - Venice, Italy
| | - Alessandro Biffi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Carlo Zanella
- Cardiovascular Rehabilitation and Sports Medicine Service, Noale - Venice, Italy
| | | | - Silvia Gallo
- Medical Direction, Azienda ULLS 3 Serenissima, Venice, Italy
| | - Franco Giada
- Cardiovascular Rehabilitation and Sports Medicine Service, Noale - Venice, Italy
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31
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Das AS, Regenhardt RW, Gokcal E, Horn MJ, Daoud N, Schwab KM, Rost NS, Viswanathan A, Kimberly WT, Goldstein JN, Biffi A, Schwamm LH, Rosand J, Greenberg SM, Gurol ME. Idiopathic primary intraventricular hemorrhage and cerebral small vessel disease. Int J Stroke 2022; 17:645-653. [PMID: 34427471 PMCID: PMC10947797 DOI: 10.1177/17474930211043957] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although primary intraventricular hemorrhage is frequently due to trauma or vascular lesions, the etiology of idiopathic primary intraventricular hemorrhage (IP-IVH) is not defined. AIMS Herein, we test the hypothesis that cerebral small vessel diseases (cSVD) including hypertensive cSVD (HTN-cSVD) and cerebral amyloid angiopathy are associated with IP-IVH. METHODS Brain magnetic resonance imaging from consecutive patients (January 2011 to September 2019) with non-traumatic intracerebral hemorrhage from a single referral center were reviewed for the presence of HTN-cSVD (defined by strictly deep or mixed-location intracerebral hemorrhage/cerebral microbleeds) and cerebral amyloid angiopathy (applying modified Boston criteria). RESULTS Forty-six (4%) out of 1276 patients were identified as having IP-IVH. Among these, the mean age was 74.4 ± 12.2 years and 18 (39%) were females. Forty (87%) had hypertension, and the mean initial blood pressure was 169.2 ± 40.4/88.8 ± 22.2 mmHg. Of the 35 (76%) patients who received a brain magnetic resonance imaging, two (6%) fulfilled the modified Boston criteria for possible cerebral amyloid angiopathy and 10 (29%) for probable cerebral amyloid angiopathy. Probable cerebral amyloid angiopathy was found at a similar frequency when comparing IP-IVH patients to the remaining patients with primary intraparenchymal hemorrhage (P-IPH) (27%, p = 0.85). Furthermore, imaging evidence for HTN-cSVD was found in 8 (24%) patients with IP-IVH compared to 209 (28%, p = 0.52) patients with P-IPH. CONCLUSIONS Among IP-IVH patients, cerebral amyloid angiopathy was found in approximately one-third of patients, whereas HTN-cSVD was detected in 23%-both similar rates to P-IPH patients. Our results suggest that both cSVD subtypes may be associated with IP-IVH.
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Affiliation(s)
- Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elif Gokcal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mitchell J Horn
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nader Daoud
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin M Schwab
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Natalia S Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - W Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Gokcal E, Horn MJ, Becker JA, Das AS, Schwab K, Biffi A, Rost N, Rosand J, Viswanathan A, Polimeni JR, Johnson KA, Greenberg SM, Gurol ME. Effect of vascular amyloid on white matter disease is mediated by vascular dysfunction in cerebral amyloid angiopathy. J Cereb Blood Flow Metab 2022; 42:1272-1281. [PMID: 35086372 PMCID: PMC9207495 DOI: 10.1177/0271678x221076571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 01/30/2023]
Abstract
We postulated that vascular dysfunction mediates the relationship between amyloid load and white matter hyperintensities (WMH) in cerebral amyloid angiopathy (CAA). Thirty-eight cognitively healthy patients with CAA (mean age 70 ± 7.1) were evaluated. WMH was quantified and expressed as percent of total intracranial volume (pWMH) using structural MRI. Mean global cortical Distribution Volume Ratio representing Pittsburgh Compound B (PiB) uptake (PiB-DVR) was calculated from PET scans. Time-to-peak [TTP] of blood oxygen level-dependent response to visual stimulation was used as an fMRI measure of vascular dysfunction. Higher PiB-DVR correlated with prolonged TTP (r = 0.373, p = 0.021) and higher pWMH (r = 0.337, p = 0.039). Prolonged TTP also correlated with higher pWMH (r = 0.485, p = 0.002). In a multivariate linear regression model, TTP remained independently associated with pWMH (p = 0.006) while PiB-DVR did not (p = 0.225). In a bootstrapping model, TTP had a significant indirect effect (ab = 0.97, 95% CI: 0.137-2.461), supporting that the association between PiB-DVR and pWMH is mediated by TTP response. There was no longer a direct effect independent of the hypothesized pathway. Our study suggests that the effect of vascular amyloid load on white matter disease is mediated by vascular dysfunction in CAA. Amyloid lowering strategies might prevent pathophysiological processes leading to vascular dysfunction, therefore limiting ischemic brain injury.
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Affiliation(s)
- Elif Gokcal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mitchell J Horn
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Alex Becker
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Natalia Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Keith A Johnson
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Squeo MR, Di Giacinto B, Perrone MA, Santini M, Sette ML, Fabrizi E, Vaquer A, Parisi A, Spataro A, Biffi A. Efficacy and Safety of a Combined Aerobic, Strength and Flexibility Exercise Training Program in Patients with Implantable Cardiac Devices. J Cardiovasc Dev Dis 2022; 9:jcdd9060182. [PMID: 35735811 PMCID: PMC9224932 DOI: 10.3390/jcdd9060182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/23/2022] [Accepted: 06/03/2022] [Indexed: 02/07/2023] Open
Abstract
Purpose: The “FIDE Project” (Fitness Implantable DEvice) was organized by the Institute of Sports Medicine and Science and the World Society of Arrhythmias with the aim of demonstrating the usefulness of exercise training in improving functional capacity in patients with implantable cardiac devices. Materials and Methods: Thirty sedentary patients were selected for the project (25 males and 5 females), with a mean age of 73 ± 5 years (range 44–94 years). Twenty-five were implanted with a Pacemaker (PM) and five with an Implantable Cardioverter Defibrillator (ICD). Atrial fibrillation/atrial flutter was present in ten (34%) patients, post-ischemic dilated cardiomyopathy in five (17.2%), sick sinus syndrome in six (20,7%), complete atrium-ventricular block in six (20.7%), hypertrophic cardiomyopathy in one (3.4%) and recurrent syncope in one (3.4%). The baseline assessment comprised cardiovascular examination, resting and stress ECG, cardiopulmonary exercise testing (V ̇O2peak), strength assessment of different muscle groups, and a flexibility test. The same measurements were repeated after 15–20 consecutive training sessions, over a 2-month period. The exercise prescription was set to 70–80% of HRR (Heart rate reserve) and to 50–70% of 1RM (1-repetition maximum, muscular force). The training protocol consisted of two training sessions per week performed in our institute, 90 min for each (warm-up, aerobic phase, strength phase and stretching) and one or more at home autonomously. Results: The cardiopulmonary testing after the training period documents a significant improvement in V ̇O2peak (15 ± 4 mL/kg/min vs. 17 ± 4; p = 0.001) and in work load (87 ± 30 watts vs. 108 ± 37; p = 0.001). Additionally, strength capacity significantly increased after the cardiac rehabilitation program, (quadriceps: 21 ± 18 kg vs. 29 ± 16 kg, p = 0.00003). Flexibility tests show a positive trend, but without statistical significance (sit-and-reach test: −19 ± 11 cm vs. −15 ± 11.7 cm; back-scratch test: −19 ± 11.6 cm vs. −15 ± 10 cm; lateral flexibility right −44 ± 1.4 cm vs. −43 ± 9.5 cm; left −43 ± 5 vs. −45 ± 8.7 cm). Conclusion: A brief period of combined aerobic, strength and flexibility exercise training (FIDE project) proved to be effective and safe in improving functional capacity in patients with cardiac implantable devices.
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Affiliation(s)
- Maria Rosaria Squeo
- Institute of Sports Medicine, Sport e Salute, 00197 Rome, Italy; (M.R.S.); (B.D.G.); (M.S.); (M.L.S.); (E.F.); (A.S.); (A.B.)
| | - Barbara Di Giacinto
- Institute of Sports Medicine, Sport e Salute, 00197 Rome, Italy; (M.R.S.); (B.D.G.); (M.S.); (M.L.S.); (E.F.); (A.S.); (A.B.)
| | - Marco Alfonso Perrone
- Institute of Sports Medicine, Sport e Salute, 00197 Rome, Italy; (M.R.S.); (B.D.G.); (M.S.); (M.L.S.); (E.F.); (A.S.); (A.B.)
- Department of Cardiology and University Sports Centre, University of Rome Tor Vergata, 00133 Rome, Italy
- Correspondence:
| | - Massimo Santini
- Institute of Sports Medicine, Sport e Salute, 00197 Rome, Italy; (M.R.S.); (B.D.G.); (M.S.); (M.L.S.); (E.F.); (A.S.); (A.B.)
| | - Maria Luisa Sette
- Institute of Sports Medicine, Sport e Salute, 00197 Rome, Italy; (M.R.S.); (B.D.G.); (M.S.); (M.L.S.); (E.F.); (A.S.); (A.B.)
| | - Emanuele Fabrizi
- Institute of Sports Medicine, Sport e Salute, 00197 Rome, Italy; (M.R.S.); (B.D.G.); (M.S.); (M.L.S.); (E.F.); (A.S.); (A.B.)
| | - Antonia Vaquer
- Department of Cardiology, Fundacio Clinic, 08036 Barcelona, Spain;
| | - Attilio Parisi
- Department of Movement, Human and Health Science, University of Rome Foro Italico, 00135 Rome, Italy;
| | - Antonio Spataro
- Institute of Sports Medicine, Sport e Salute, 00197 Rome, Italy; (M.R.S.); (B.D.G.); (M.S.); (M.L.S.); (E.F.); (A.S.); (A.B.)
| | - Alessandro Biffi
- Institute of Sports Medicine, Sport e Salute, 00197 Rome, Italy; (M.R.S.); (B.D.G.); (M.S.); (M.L.S.); (E.F.); (A.S.); (A.B.)
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. [2021 ESC Guidelines on cardiovascular disease prevention in clinical practice]. G Ital Cardiol (Rome) 2022; 23:e3-e115. [PMID: 35708476 DOI: 10.1714/3808.37926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Palermi S, Sirico F, Fernando F, Gregori G, Belviso I, Ricci F, D'Ascenzi F, Cavarretta E, De Luca M, Negro F, Montagnani S, Niebauer J, Biffi A. Limited diagnostic value of questionnaire-based pre-participation screening algorithms: a "risk-exposed" approach to sports activity. J Basic Clin Physiol Pharmacol 2022; 33:655-663. [PMID: 35647906 DOI: 10.1515/jbcpp-2022-0109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several pre-participation screening algorithms (PPSAs) have been proposed to assess sports eligibility in different populations. They are usually based on self-administered questionnaires, without further medical assessment if no risk factors are documented. The Med-Ex "Formula Benessere" worksite program includes a complete cardiovascular (CV) screening for all participants. The purpose of this study was to assess PPSAs accuracy in detecting medical and/or CV abnormalities in the general population, comparing the results with the date derived from Med-Ex program. METHODS The Med-Ex medical evaluation, consisting of medical history, physical examination (including body composition), resting electrocardiogram (ECG) and exercise stress test in 464 male subjects (38.4 aged) was analyzed and matched to several PPSAs - Physical Activity Readiness Questionnaire (PAR-Q) (2002-2020), American Heart Association (AHA)/American College of Sport Medicine (ACSM) (1998-2009-2014-2015), European Association of Cardiovascular Prevention and Rehabilitation (EACPR) (2011) - retrospectively simulated. RESULTS Five-hundred and 67 abnormalities were detected though Med-Ex medical evaluation, and one-fourth (24%) would have been undetected applying PPSA alone. In particular 28% of high blood pressure, 21% of impaired fasting glycaemia, 21% of high Body Mass Index (BMI) values and 19% of ECG abnormalities would have been missed, on average, by all PPSAs. CONCLUSIONS The simulation analysis model performed in this study allowed to highlight the limits of PPSAs in granting sport eligibility, compared to a medical-guided CV screening. These findings emphasize the importance of a more balanced approach to pre-participation screening that includes a thorough evaluation of the cost/benefit ratio.
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Affiliation(s)
- Stefano Palermi
- Med-Ex, Medicine & Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy.,Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Felice Sirico
- Med-Ex, Medicine & Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy.,Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Fredrick Fernando
- Med-Ex, Medicine & Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Giampietro Gregori
- Med-Ex, Medicine & Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Immacolata Belviso
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Cardiology, "G. d'Annunzio" University, Chieti, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Mariarosaria De Luca
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Francesco Negro
- Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Stefania Montagnani
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Alessandro Biffi
- Med-Ex, Medicine & Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
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36
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Castelletti S, Zorzi A, Ballardini E, Basso C, Biffi A, Bracati F, Cavarretta E, Crotti L, Contursi M, D'Aleo A, D'Ascenzi F, Delise P, Dello Russo A, Gazale G, Mos L, Novelli V, Palamà Z, Palermi S, Palmieri V, Patrizi G, Pelliccia A, Pilichou K, Romano S, Sarto P, Schwartz PJ, Tiberi M, Zeppilli P, Corrado D, Sciarra L. Molecular genetic testing in athletes: Why and when a position statement from the Italian society of sports cardiology. Int J Cardiol 2022; 364:169-177. [PMID: 35662561 DOI: 10.1016/j.ijcard.2022.05.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/08/2022] [Accepted: 05/30/2022] [Indexed: 12/31/2022]
Abstract
Molecular genetic testing is an increasingly available test to support the clinical diagnosis of inherited cardiovascular diseases through identification of pathogenic gene variants and to make a preclinical genetic diagnosis among proband's family members (so-called "cascade family screening"). In athletes, the added value of molecular genetic testing is to assist in discriminating between physiological adaptive changes of the athlete's heart and inherited cardiovascular diseases, in the presence of overlapping phenotypic features such as ECG changes, imaging abnormalities or arrhythmias ("grey zone"). Additional benefits of molecular genetic testing in the athlete include the potential impact on the disease risk stratification and the implications for eligibility to competitive sports. This position statement of the Italian Society of Sports Cardiology aims to guide general sports medical physicians and sports cardiologists on clinical decision as why and when to perform a molecular genetic testing in the athlete, highlighting strengths and weaknesses for each inherited cardiovascular disease at-risk of sudden cardiac death during sport. The importance of early (preclinical) diagnosis to prevent the negative effects of exercise on phenotypic expression, disease progression and worsening of the arrhythmogenic substrate is also addressed.
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Affiliation(s)
- Silvia Castelletti
- Cardiomyopathy Center and Rehabilitation Unit, Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Enrico Ballardini
- Sports Medicine Centre, Gruppo Mantova Salus, Ospedale San Pellegrino, Mantova, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandro Biffi
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Francesco Bracati
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Aquila, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Naples, Italy
| | - Lia Crotti
- Cardiomyopathy Center and Rehabilitation Unit, Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Maurizio Contursi
- Sports Cardiology Unit, Centro Polidiagnostico Check-up, Salerno, Italy
| | | | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Pietro Delise
- Division of Cardiology, Hospital of Peschiera del Garda, Veneto, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Lancisi-Umberto I- Salesi", Ancona, Italy, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Giovanni Gazale
- Center of Sport Medicine and Sports Cardiology, ASL 1, Sassari, Italy
| | - Lucio Mos
- San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | | | - Zefferino Palamà
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Aquila, Italy; Casa di Cura Villa Verde, Taranto, Italy
| | - Stefano Palermi
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Vincenzo Palmieri
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Kalliopi Pilichou
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Aquila, Italy
| | | | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Monica Tiberi
- Department of Public Health, Azienda Sanitaria Unica Regionale Marche AV 1, Pesaro, Italy
| | - Paolo Zeppilli
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy.
| | - Luigi Sciarra
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Aquila, Italy
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Abramson JR, Castello JP, Keins S, Kourkoulis C, Gurol ME, Greenberg SM, Viswanathan A, Anderson CD, Rosand J, Biffi A. Association of Symptomatic Hearing Loss with Functional and Cognitive Recovery 1 Year after Intracerebral Hemorrhage. J Stroke 2022; 24:303-306. [PMID: 35677987 PMCID: PMC9194545 DOI: 10.5853/jos.2022.00836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jessica R. Abramson
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Juan Pablo Castello
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Sophia Keins
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christina Kourkoulis
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - M. Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher D. Anderson
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Alessandro Biffi
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Correspondence: Alessandro Biffi Divisions of Stroke, Behavioral Neurology and Memory Disorders, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Room 2064, 100 Cambridge Street, Boston, MA 02144, USA Tel: +1-617-726-5358 Fax: +1-617-643-3293 E-mail:
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Palermi S, Brugin E, Compagno S, Pescatore V, Tegon G, Gerbino L, Sarto M, Marin R, Volpato R, Masato M, Panico A, Biffi A, Giada F. P372 PATIENTS WITH MINOR NON–DISABLING STROKE (MINDS): RESULTS OF A STRUCTURED CARDIOVASCULAR REHABILITATION PROGRAM. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.358] [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: 11/14/2022]
Abstract
Abstract
Background
Ischemic cerebral and cardiac events are the leading causes of mortality and morbidity in Minor non–Disabling Stroke (MiNDS) patients. Control of cardiovascular risk factors, including physical activity levels, is a key strategy in secondary prevention of MiNDS. However, there is a gap between recommendations and real achieved physical activity levels in these patients. Clinical benefits obtained with cardiovascular rehabilitation in cardiac ischemic patients could be obtained with similar programs also in patients with MiNDS, given the common pathophysiological substrate of these two diseases Purpose To evaluate safety, effectiveness and feasibility of a cardiovascular rehabilitation program based on structured physical exercise (SPE) in patients with MiNDS
Methods
39 MiNDS patients (26 males, mean age 66 years) underwent an accurate medical screening process, body composition evaluation, cardiopulmonary exercise test (CPET) and muscular strength assessment, before and after a 12–sessions in–hospital SPE program, and after 6– and 12–months follow–up during which they could continue their training schedule on their own Results After in–hospital rehabilitation program, a significant improvement in CPET parameters, body composition and muscular strength was observed. These modifications persisted in the 32 patients who continued 6– and 12– months follow–up training, while regressed in the 7 patients who stopped training
Conclusions - Results
of the present study show that a SPE–based cardiovascular rehabilitation program provides clinical benefit in patients with MiNDS
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Affiliation(s)
- S Palermi
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - E Brugin
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - S Compagno
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - V Pescatore
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - G Tegon
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - L Gerbino
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - M Sarto
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - R Marin
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - R Volpato
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - M Masato
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - A Panico
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - A Biffi
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - F Giada
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
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Compagno S, Palermi S, Pescatore V, Brugin E, Tegon G, Sarto M, Marin R, Calzavara V, Nizzetto M, Scevola M, Albertin C, Biffi A, Giada F. P368 PHYSICAL AND PSYCHOLOGICAL RECONDITIONING IN LONG COVID SYNDROME: RESULTS OF AN OUT–OF–HOSPITAL EXERCISED–BASED CARDIOVASCULAR REHABILITATION PROGRAM. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.354] [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: 11/14/2022]
Abstract
Abstract
Background
Long Covid Syndrome (LCS) is used to describe signs and symptoms that continue or develop after acute COVID–19 infection. Natural history and treatments of this syndrome are still poorly understood, even if evidence suggests the potential role of physical rehabilitation in improving symptoms in these subjects.
Aim
The aim of the present study was to evaluate safety, effectiveness and feasibility of a multidisciplinary, out–of–hospital, exercise–based cardiac rehabilitation (EBCR) program, of two months duration, in improving symptoms and physical and psychological parameters in patients with LCS Methods Thirty consecutive patients with LCS (18 males, mean age 58 years) underwent an accurate medical screening process including anthropometric and muscular strength evaluation, cardiopulmonary exercise test (CPET), quality of life (QoL) and psychological appraisal before and after an EBCR program.
Results
At baseline, all LCS patients were strongly symptomatic and showed severe impairments in physical performance, QoL and psychological parameters. No adverse effects and dropouts were observed during the exercise training sessions. After the EBCR program, COVID–19 residual symptoms significantly decreased and significant improvements in upper and lower limb muscular strength, CPET parameters, perceived physical and mental health, depression and anxiety were observed.
Conclusions
The present study confirms the severe physical and psychological impairment of patients with LCS and suggests that a multidisciplinary EBCR program could promote their physical and psychological recovery
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Affiliation(s)
- S Compagno
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - S Palermi
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - V Pescatore
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - E Brugin
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - G Tegon
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - M Sarto
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - R Marin
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - V Calzavara
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - M Nizzetto
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - M Scevola
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - C Albertin
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - A Biffi
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - F Giada
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
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Palermi S, Brugin E, Compagno S, Pescatore V, Tegon G, Sarto M, Marin R, Masato M, Panico A, Biffi A, Giada F. Patients with Minor Non-Disabling Stroke (MiNDS): results of a structured cardiovascular rehabilitation program. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.244] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Ischemic cerebral and cardiac events are the leading causes of mortality and morbidity in Minor non-Disabling Stroke (MiNDS) patients. Control of cardiovascular risk factors, including physical activity levels, is a key strategy in secondary prevention of MiNDS. However, there is a gap between recommendations and real achieved physical activity levels in these patients. Clinical benefits obtained with cardiovascular rehabilitation in cardiac ischemic patients could be obtained with similar programs also in patients with MiNDS, given the common pathophysiological substrate of these two diseases.
Purpose
To evaluate safety, effectiveness and feasibility of a cardiovascular rehabilitation program based on structured physical exercise (SPE) in patients with MiNDS.
Methods
39 MiNDS patients (26 males, mean age 66 years) underwent an accurate medical screening process, body composition evaluation, cardiopulmonary exercise test (CPET) and muscular strength assessment, before and after a 12-sessions in-hospital SPE program, and after 6- and 12-months follow-up during which they could continue their training schedule on their own.
Results
After in-hospital rehabilitation program, a significant improvement in CPET parameters, body composition and muscular strength was observed. These modifications persisted in the 32 patients who continued 6- and 12- months follow-up training, while regressed in the 7 patients who stopped training.
Conclusions
Results of the present study show that a SPE-based cardiovascular rehabilitation program provides clinical benefit in patients with MiNDS.
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Affiliation(s)
- S Palermi
- Federico II University Hospital, Naples, Italy
| | - E Brugin
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - S Compagno
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - V Pescatore
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - G Tegon
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - M Sarto
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - R Marin
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | | | | | - A Biffi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, Rome, Italy
| | - F Giada
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
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Palermi S, Compagno S, Pescatore V, Brugin E, Tegon G, Sarto M, Marin R, Calzavara V, Nizzetto M, Scevola M, Albertin C, Biffi A, Giada F. Physical and psychological reconditioning in long covid syndrome patients: results of a structured physical exercise program. Eur J Prev Cardiol 2022. [PMCID: PMC9383996 DOI: 10.1093/eurjpc/zwac056.218] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Background Long Covid Syndrome (LCS) is used to describe signs and symptoms that continue or develop after acute COVID-19 infection. Natural history and treatments of this syndrome is still poorly understood. In literature there is currently a lack of data on the real effectiveness of a multidisciplinary rehabilitation program based on structured physical exercise (SPE) in these patients. Purpose To evaluate safety, effectiveness and feasibility of a structured individualized rehabilitation program in improving physical and psychological parameters in patients with LCS. Methods Twenty-eight patients with LCS (19 males, mean age 57 years) underwent an accurate medical screening process, body composition evaluation, cardiopulmonary exercise test (CPET), muscular strength assessment, quality of life (QoL), psychological assessment and counselling, before and after a 12-sessions SPE program. Results At baseline, all LCS patients showed severe impairments in physical performance, QoL and psychological parameters. No adverse effects and dropouts were observed during training session. After the rehabilitation program, significant improvement in CPET parameters, upper and lower limb muscular strength, perceived physical and mental health, body composition, depression and anxiety and Covid residual symptoms was observed. Conclusions The present study confirms severe impairment of patients with LCS and suggest that a multidisciplinary rehabilitation program based on SPE could promote their physical and psychological recovery.
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Affiliation(s)
- S Palermi
- Federico II University Hospital, Naples, Italy
| | - S Compagno
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - V Pescatore
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - E Brugin
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - G Tegon
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - M Sarto
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - R Marin
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - V Calzavara
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - M Nizzetto
- Sub-Intensive Care COVID Unit in Pneumology, Dolo, Italy
| | - M Scevola
- Non-critical COVID Area in Internal Medicine, Dolo, Italy
| | - C Albertin
- Physical Medicine & Rehabilitation service, Dolo, Italy
| | - A Biffi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, Rome, Italy
| | - F Giada
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
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Horn MJ, Gokcal E, Becker AJ, Das AS, Warren AD, Schwab K, Goldstein JN, Biffi A, Rosand J, Polimeni JR, Viswanathan A, Greenberg SM, Gurol ME. Cerebellar atrophy and its implications on gait in cerebral amyloid angiopathy. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-328553. [PMID: 35534189 PMCID: PMC10936558 DOI: 10.1136/jnnp-2021-328553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/06/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Recent data suggest that cerebral amyloid angiopathy (CAA) causes haemorrhagic lesions in cerebellar cortex as well as subcortical cerebral atrophy. However, the potential effect of CAA on cerebellar tissue loss and its clinical implications have not been investigated. METHODS Our study included 70 non-demented patients with probable CAA, 70 age-matched healthy controls (HCs) and 70 age-matched patients with Alzheimer's disease (AD). The cerebellum was segmented into percent of cerebellar subcortical volume (pCbll-ScV) and percent of cerebellar cortical volume (pCbll-CV) represented as percent (p) of estimated total intracranial volume. We compared pCbll-ScV and pCbll-CV between patients with CAA, HCs and those with AD. Gait velocity (metres/second) was used to investigate gait function in patients with CAA. RESULTS Patients with CAA had significantly lower pCbll-ScV compared with both HC (1.49±0.1 vs 1.73±0.2, p<0.001) and AD (1.49±0.1 vs 1.66±0.24, p<0.001) and lower pCbll-CV compared with HCs (6.03±0.5 vs 6.23±0.6, p=0.028). Diagnosis of CAA was independently associated with lower pCbll-ScV compared with HCs (p<0.001) and patients with AD (p<0.001) in separate linear regression models adjusted for age, sex and presence of hypertension. Lower pCbll-ScV was independently associated with worse gait velocity (β=0.736, 95% CI 0.28 to 1.19, p=0.002) in a stepwise linear regression analysis including pCbll-CV along with other relevant variables. INTERPRETATION Patients with CAA show more subcortical cerebellar atrophy than HC or patients with AD and more cortical cerebellar atrophy than HCs. Reduced pCbll-ScV correlated with lower gait velocity in regression models including other relevant variables. Overall, this study suggests that CAA causes cerebellar injury, which might contribute to gait disturbance.
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Affiliation(s)
- Mitchell J Horn
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Elif Gokcal
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Alex J Becker
- Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alvin S Das
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew D Warren
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kristin Schwab
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua N Goldstein
- Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alessandro Biffi
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Rosand
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan R Polimeni
- Athinoula A Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - Anand Viswanathan
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Steven M Greenberg
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - M Edip Gurol
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Palermi S, Annarumma G, Spinelli A, Massa B, Serio A, Vecchiato M, Demeco A, Brugin E, Sirico F, Giada F, Biffi A. Acceptability and Practicality of a Quick Musculoskeletal Examination into Sports Medicine Pre-Participation Evaluation. Pediatr Rep 2022; 14:207-216. [PMID: 35645365 PMCID: PMC9149839 DOI: 10.3390/pediatric14020028] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/26/2022] [Accepted: 04/30/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Child musculoskeletal (MSK) diseases are common and, even if often benign, sometimes can lead to significant impairment in the future health of children. Italian pre-participation evaluation (PPE), performed by a sports medicine physician, allows for the screening of a wide range of children every year. Therefore, this study aims to evaluate the feasibility and the acceptability of pGALS (pediatric Gait, Arms, Legs and Spine) screening, a simple pediatric MSK screening examination, when performed as part of a routine PPE. METHODS Consecutive school-aged children attending a sports medicine screening program were assessed with the addition of pGALS to the routine clinical examination. Practicability (time taken) and patient acceptability (discomfort caused) were recorded. RESULTS 654 children (326 male, mean age 8.9 years) were evaluated through pGALS. The average time taken was 4.26 min (range 1.9-7.3 min). Acceptability of pGALS was deemed high: time taken was "adequate" (97% of parents) and caused little or no discomfort (94% of children). Abnormal MSK findings were common. CONCLUSIONS pGALS is a practical and acceptable tool to perform in sports medicine PPE, even if performed by a non-expert in MSK medicine. Although common, abnormal MSK findings need to be interpreted in the global clinical context and assessment.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Giada Annarumma
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Alessandro Spinelli
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Bruno Massa
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Alessandro Serio
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35100 Padova, Italy;
| | - Andrea Demeco
- Unit of Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy;
| | - Erica Brugin
- Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale Hospital, 30033 Noale, Italy; (E.B.); (F.G.)
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Franco Giada
- Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale Hospital, 30033 Noale, Italy; (E.B.); (F.G.)
| | - Alessandro Biffi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00118 Rome, Italy
- Correspondence:
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Angelantonio ED, Franco OH, Halvorsen S, Richard Hobbs FD, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). Rev Esp Cardiol (Engl Ed) 2022; 75:429. [PMID: 35525570 DOI: 10.1016/j.rec.2022.04.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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Campello E, Francavilla A, Pelizza M, Sebellin S, Nosadini M, Pin J, Lorenzoni G, Biffi A, Gregori D, Forestan C, Martinato M, Sartori S, Simioni P. PO-59: Dealing with pediatric cancer associated thrombosis: a case report and a monocentric cohort study. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00249-3] [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: 11/25/2022]
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Abstract
Poststroke cognitive impairment and dementia (PSCID) is a major source of morbidity and mortality after stroke worldwide. PSCID occurs as a consequence of ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. Cognitive impairment and dementia manifesting after a clinical stroke is categorized as vascular even in people with comorbid neurodegenerative pathology, which is common in elderly individuals and can contribute to the clinical expression of PSCID. Manifestations of cerebral small vessel disease, such as covert brain infarcts, white matter lesions, microbleeds, and cortical microinfarcts, are also common in patients with stroke and likewise contribute to cognitive outcomes. Although studies of PSCID historically varied in the approach to timing and methods of diagnosis, most of them demonstrate that older age, lower educational status, socioeconomic disparities, premorbid cognitive or functional decline, life-course exposure to vascular risk factors, and a history of prior stroke increase risk of PSCID. Stroke characteristics, in particular stroke severity, lesion volume, lesion location, multiplicity and recurrence, also influence PSCID risk. Understanding the complex interaction between an acute stroke event and preexisting brain pathology remains a priority and will be critical for developing strategies for personalized prediction, prevention, targeted interventions, and rehabilitation. Current challenges in the field relate to a lack of harmonization of definition and classification of PSCID, timing of diagnosis, approaches to neurocognitive assessment, and duration of follow-up after stroke. However, evolving knowledge on pathophysiology, neuroimaging, and biomarkers offers potential for clinical applications and may inform clinical trials. Preventing stroke and PSCID remains a cornerstone of any strategy to achieve optimal brain health. We summarize recent developments in the field and discuss future directions closing with a call for action to systematically include cognitive outcome assessment into any clinical studies of poststroke outcome.
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Affiliation(s)
- Natalia S Rost
- J. Philip Kistler Stroke Research Center (N.S.R., S.J.v.V., A. Biffi), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia (A. Brodtmann).,Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (A. Brodtmann. M.P.P.)
| | - Matthew P Pase
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (A. Brodtmann. M.P.P.).,Harvard T.H. Chan School of Public Health, Boston (M.P.P.)
| | - Susanne J van Veluw
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Charlestown (S.J.v.V.)
| | - Alessandro Biffi
- J. Philip Kistler Stroke Research Center (N.S.R., S.J.v.V., A. Biffi), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston.,Divisions of Memory Disorders and Behavioral Neurology (A. Biffi), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Marco Duering
- J. Philip Kistler Stroke Research Center (N.S.R., S.J.v.V., A. Biffi), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston.,Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany (M. Duering, M. Dichgans).,Medical Image Analysis Center and Department of Biomedical Engineering, University of Basel, Switzerland (M. Duering)
| | - Jason D Hinman
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles (J.D.H.).,Department of Neurology, West Los Angeles VA Medical Center, CA (J.D.H.)
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany (M. Duering, M. Dichgans).,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M. Dichgans).,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M. Dichgans)
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Abstract
INTRODUCTION Cerebral Small Vessel Disease (CSVD), a progressive degenerative disorder of small caliber cerebral vessels, represents a major contributor to stroke and vascular dementia incidence worldwide. We sought to conduct a systematic review of the role of retinal biomarkers in diagnosis and characterization of CSVD. METHODS We conducted a systematic review of MEDLINE, PubMed, Scopus, the Cochrane Library Database, and Web of Science. We identified studies of sporadic CSVD (including CSVD not otherwise specified, Cerebral Amyloid Angiopathy, and Hypertensive Arteriopathy) and the most common familial CSVD disorders (including CADASIL, Fabry disease, and MELAS). Included studies used one or more of the following tools: visual fields assessment, fundus photography, Optical Coherence Tomography and OCT Angiography, Fluorescein Angiography, Electroretinography, and Visual Evoked Potentials. RESULTS We identified 48 studies of retinal biomarkers in CSVD, including 9147 cases and 12276 controls. Abnormalities in retinal vessel diameter (11 reports, n = 11391 participants), increased retinal vessel tortuosity (11 reports, n = 617 participants), decreased vessel fractal dimension (5 reports, n = 1597 participants) and decreased retinal nerve fiber layer thickness (5 reports, n = 4509 participants) were the biomarkers most frequently associated with CSVD. We identified no reports conducting longitudinal retinal evaluations of CSVD, or systematically evaluating diagnostic performance. CONCLUSION Multiple retinal biomarkers were associated with CSVD or its validated neuroimaging biomarkers. However, existing evidence is limited by several shortcomings, chiefly small sample size and unstandardized approaches to both biomarkers' capture and CSVD characterization. Additional larger studies will be required to definitively determine whether retinal biomarkers could be successfully incorporated in future research efforts and clinical practice.
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Affiliation(s)
- Elena Biffi
- New England College of Optometry, Boston, MA, United States of America
- * E-mail:
| | - Zachary Turple
- New England College of Optometry, Boston, MA, United States of America
| | - Jessica Chung
- New England College of Optometry, Boston, MA, United States of America
| | - Alessandro Biffi
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
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48
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Castello JP, Teo K, Abramson JR, Keins S, Takahashi CE, Leung IYH, Leung WCY, Wang Y, Kourkoulis C, Pavlos Myserlis E, Warren AD, Henry J, Chan K, Cheung RTF, Ho S, Gurol ME, Viswanathan A, Greenberg SM, Anderson CD, Lau K, Rosand J, Biffi A. Long‐Term Blood Pressure Variability and Major Adverse Cardiovascular and Cerebrovascular Events After Intracerebral Hemorrhage. J Am Heart Assoc 2022; 11:e024158. [PMID: 35253479 PMCID: PMC9075304 DOI: 10.1161/jaha.121.024158] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Survivors of intracranial hemorrhage (ICH) are at increased risk for major adverse cardiovascular and cerebrovascular events (MACCE), in the form of recurrent stroke and myocardial Infarction. We investigated whether long‐term blood pressure (BP) variability represents a risk factor for MACCE after ICH, independent of average BP. Methods and Results We analyzed data from prospective ICH cohort studies at Massachusetts General Hospital and the University of Hong Kong. We captured long‐term (ie, visit‐to‐visit) BP variability, quantified as individual participants’ variation coefficient. We explored determinants of systolic and diastolic BP variability and generated survival analyses models to explore their association with MACCE. Among 1828 survivors of ICH followed for a median of 46.2 months we identified 166 with recurrent ICH, 68 with ischemic strokes, and 69 with myocardial infarction. Black (coefficient +3.8, SE 1.3) and Asian (coefficient +2.2, SE 0.4) participants displayed higher BP variability. Long‐term systolic BP variability was independently associated with recurrent ICH (subhazard ratio [SHR], 1.82; 95% CI, 1.19–2.79), ischemic stroke (SHR, 1.62; 95% CI, 1.06–2.47), and myocardial infarction (SHR, 1.54; 95% CI, 1.05–2.24). Average BP during follow‐up did not modify the association between long‐term systolic BP variability and MACCE. Conclusions Long‐term BP variability is a potent risk factor for recurrent hemorrhage, ischemic stroke, and myocardial infarction after ICH, even among survivors with well‐controlled hypertension. Our findings support the hypothesis that combined control of average BP and its variability after ICH is required to minimize incidence of MACCE.
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Affiliation(s)
- Juan Pablo Castello
- Department of Neurology Massachusetts General Hospital Boston MA
- Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA
| | - Kay‐Cheong Teo
- Department of Medicine Queen Mary HospitalLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR
| | - Jessica R. Abramson
- Department of Neurology Massachusetts General Hospital Boston MA
- Center for Genomic Medicine Massachusetts General Hospital Boston MA
- Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA
| | - Sophia Keins
- Department of Neurology Massachusetts General Hospital Boston MA
- Center for Genomic Medicine Massachusetts General Hospital Boston MA
- Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA
| | | | - Ian Y. H. Leung
- Department of Medicine Queen Mary HospitalLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR
| | - William C. Y. Leung
- Department of Medicine Queen Mary HospitalLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR
| | - Yujie Wang
- Department of Medicine Queen Mary HospitalLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR
| | - Christina Kourkoulis
- Department of Neurology Massachusetts General Hospital Boston MA
- Center for Genomic Medicine Massachusetts General Hospital Boston MA
- Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA
| | - Evangelos Pavlos Myserlis
- Department of Neurology Massachusetts General Hospital Boston MA
- Center for Genomic Medicine Massachusetts General Hospital Boston MA
- Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA
| | - Andrew D. Warren
- Department of Neurology Massachusetts General Hospital Boston MA
| | - Jonathan Henry
- Department of Neurology Massachusetts General Hospital Boston MA
- Center for Genomic Medicine Massachusetts General Hospital Boston MA
- Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA
| | - Koon‐Ho Chan
- Department of Medicine Queen Mary HospitalLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR
- Research Center of HeartBrain, Hormone and Healthy AgingLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR
| | - Raymond T. F. Cheung
- Department of Medicine Queen Mary HospitalLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR
- Research Center of HeartBrain, Hormone and Healthy AgingLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR
| | - Shu‐Leong Ho
- Department of Medicine Queen Mary HospitalLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR
| | - M. Edip Gurol
- Department of Neurology Massachusetts General Hospital Boston MA
| | | | | | - Christopher D. Anderson
- Department of Neurology Massachusetts General Hospital Boston MA
- Center for Genomic Medicine Massachusetts General Hospital Boston MA
- Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA
| | - Kui‐Kai Lau
- Department of Medicine Queen Mary HospitalLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR
- Research Center of HeartBrain, Hormone and Healthy AgingLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR
- The State Key Laboratory of Brain and Cognitive Sciences The University of Hong Kong Hong Kong SAR
| | - Jonathan Rosand
- Department of Neurology Massachusetts General Hospital Boston MA
- Center for Genomic Medicine Massachusetts General Hospital Boston MA
- Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA
| | - Alessandro Biffi
- Department of Neurology Massachusetts General Hospital Boston MA
- Center for Genomic Medicine Massachusetts General Hospital Boston MA
- Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA
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49
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Sheth KN, Anderson CD, Biffi A, Dlamini N, Falcone GJ, Fox CK, Fullerton HJ, Greenberg SM, Hemphill JC, Kim A, Kim H, Ko NU, Roland JL, Sansing LH, van Veluw SJ, Rosand J. Maximizing Brain Health After Hemorrhagic Stroke: Bugher Foundation Centers of Excellence. Stroke 2022; 53:1020-1029. [PMID: 35109678 PMCID: PMC8885885 DOI: 10.1161/strokeaha.121.036197] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Kevin N. Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Christopher D. Anderson
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA,Broad Institute, Cambridge, MA,Division of Stroke and Cerebrovascular Diseases, Brigham and Women’s Hospital, Boston, MA
| | - Alessandro Biffi
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA,Division of Neuropsychiatry, Massachusetts General Hospital, Boston, MA,Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Nomazulu Dlamini
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | | | - Christine K. Fox
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | - Heather J. Fullerton
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | | | - J. Claude Hemphill
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | - Anthony Kim
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | - Helen Kim
- Department of Anesthesia, University of California at San Francisco, San Francisco, CA
| | - Nerissa U. Ko
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | - Jarod L Roland
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA
| | | | | | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA,Broad Institute, Cambridge, MA,Department of Neurology, Massachusetts General Hospital, Boston, MA
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50
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Wilhelm M, Abreu A, Adami PE, Ambrosetti M, Antonopoulou M, Biffi A, Cavarretta E, D'Ascenzi F, Gibson I, Grobbee DE, Iliou MC, Koskinas K, Marques-Vidal P, Nixdorff U, Papadakis M, Piepoli MF, Vassiliou V, Wood D, Dendale P, Halle M. EAPC Core Curriculum for Preventive Cardiology. Eur J Prev Cardiol 2022; 29:251-274. [PMID: 33791783 DOI: 10.1093/eurjpc/zwab017] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023]
Abstract
Preventive cardiology encompasses the whole spectrum of cardiovascular disease (CVD) prevention, at individual and population level, through all stages of life. This includes promotion of cardiovascular (CV) health, management of individuals at risk of developing CVD, and management of patients with established CVD, through interdisciplinary care in different settings. Preventive cardiology addresses all aspects of CV health in the context of the social determinants of health, including physical activity, exercise, sports, nutrition, weight management, smoking cessation, psychosocial factors and behavioural change, environmental, genetic and biological risk factors, and CV protective medications. This is the first European Core Curriculum for Preventive Cardiology, which will help to standardize, structure, deliver, and evaluate training in preventive cardiology across Europe. It will be the basis for dedicated fellowship programmes and a European Society of Preventive Cardiology (EAPC) subspecialty certification for cardiologists, with the intention to improve quality and outcome in CVD prevention.
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Affiliation(s)
- Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Ana Abreu
- Servico de Cardioologia, Hospital Universitario de Santa Maria/Centro Hospitalar Universitario Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal
| | - Paolo Emilio Adami
- Health and Science Department, World Athletics, Monaco Principality, 6-8 Quai Antoine 1er, 98007 Monaco, Monaco
| | - Marco Ambrosetti
- Cardiac Rehabilitation Unit, ASST, Via Medaglie D'Oro, 9, 26013 Crema, Italy
| | - Maria Antonopoulou
- Spili Primary Care Centre, Regional Health System of Crete, 740 53 Spili, Greece
| | - Alessandro Biffi
- Med-Ex Medicine & Exercise, Medical Partner Scuderia Ferrari, Via Vittorio Veneto 108, 00187 Rome, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 97, 04100 Latina, Italy
- Mediterranea Cardiocentro, Via Orazio, 2, 80122 Naples, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Irene Gibson
- National Institute for Prevention and Cardiovascular Health, Moyola Lane, Newcastle, Galway H91 FF68, Ireland
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, and University Medical Center Utrecht, 3584 CX Utrech, The Netherlands
| | - Marie-Christine Iliou
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, Assistance Publique Hopitaux de Paris Centre Université de Paris, Parvis Corentin Celton 4, 92130 Issy-les-Moulineaux, Paris, France
| | - Konstantinos Koskinas
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Uwe Nixdorff
- European Prevention Center c/o Medical Center Düsseldorf, Luise-Rainer-Straße 6-10, 40235 Düsseldorf, Germany
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's, University of London, London SW17 0RE, UK
| | - Massimo F Piepoli
- Cardiac Unit, Guglielmo da Saliceto Hospital, University of Parma, 29121 Piacenza, Italy
| | - Vass Vassiliou
- Department of Cardiovascular Medicine, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, University Road, Galway H91 TK33, Ireland
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Paul Dendale
- Heart Centre Hasselt and Hasselt University, 3500 Hasselt, Belgium
| | - Martin Halle
- Department of Prevention and Sports Medicine, University Hospital rechts der Isar, Technical University Munich, German Centre for Cardiovascular Research, Georg-Brauchle-Ring 56, 80992 Munich, Germany
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