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Ruzzarin A, Muraglia S, Fabris E, Caretta G, Zilio F, Pezzato A, Campo G, Unterhuber M, Donazzan L. Impact of Contrast-Associated Acute Kidney Injury on One-Year Outcomes in Very Elderly STEMI Patients: Insights From a Multicenter Registry in Northern Italy. Angiology 2024:33197241233771. [PMID: 38379162 DOI: 10.1177/00033197241233771] [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: 02/22/2024]
Abstract
Data about contrast-associated acute kidney injury (CA-AKI) in oldest old (age ≥85 years) ST-elevation myocardial infarction (STEMI) patients are scarce. We evaluated the incidence and the 1-year prognostic impact of CA-AKI in this population. Patients were included in a multicenter real-world registry, and CA-AKI was defined according to KDIGO (Kidney Disease Improving Global Outcomes) criteria. Major adverse cardiac and cerebrovascular events (MACCEs) were defined as the composite of all-cause death, stroke, unplanned coronary revascularization, and heart failure hospitalization. The primary outcome was the incidence and impact of CA-AKI on MACCEs at 1 year follow-up. Out of 461 STEMI patients (mean age 88.6 ± 2.9 years), 102 (22.1%) patients developed CA-AKI. Chronic kidney disease was the strongest predictor of CA-AKI (odds ratio [OR]: 4.52, 95% CI: 2.81-7.30, P < .01). The CA-AKI cohort showed a higher risk of MACCEs (adjusted HR: 1.75, 95% CI: 1.13-2.71, P = .01), driven mainly by all-cause death (adjusted hazard ratio [HR]: 2.39, 95% CI: 1.41-4.07, P = .01) and followed by heart failure hospitalization (adjusted HR: 2.01, 95% CI: 1.08-3.76, P = .01). Among oldest old STEMI, CA-AKI was frequent and associated with a higher incidence of MACCEs at 1-year follow-up.
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Affiliation(s)
| | - Simone Muraglia
- Department of Cardiology, Santa Chiara Hospital, Trento, Italy
| | - Enrico Fabris
- Cardiothoracovascular Department, University of Trieste, Trieste, Italy
| | - Giorgio Caretta
- Sant'Andrea Hospital, ASL 5 Regione Liguria, La Spezia, Italy
| | - Filippo Zilio
- Department of Cardiology, Santa Chiara Hospital, Trento, Italy
| | - Andrea Pezzato
- Cardiothoracovascular Department, University of Trieste, Trieste, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | - Luca Donazzan
- Department of Cardiology, San Maurizio Hospital, Bolzano, Italy
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2
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Maione D, De Luca A, Pezzato A, Vitrella G, Perkan A, Rauber E, Butera G, Sinagra G. Bioprosthetic pulmonary valve dysfunction in a primary cardiac sarcoma survivor: Clinical considerations and treatment options. Clin Case Rep 2024; 12:e8401. [PMID: 38356779 PMCID: PMC10865915 DOI: 10.1002/ccr3.8401] [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] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/25/2023] [Accepted: 12/14/2023] [Indexed: 02/16/2024] Open
Abstract
The case highlights the good survival after radical surgery and chemotherapy of a cardiac sarcoma, and the need for close follow-up due to possible early postsurgical complications.
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Affiliation(s)
- Davide Maione
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
- Postgraduate School of Cardiovascular Medicine University of TriesteTriesteItaly
| | - Antonio De Luca
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Andrea Pezzato
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
- Postgraduate School of Cardiovascular Medicine University of TriesteTriesteItaly
| | - Giancarlo Vitrella
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Andrea Perkan
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Elisabetta Rauber
- Cardiothoracovascular Department, Division of Cardiac SurgeryAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
| | - Gianfranco Butera
- Division of Interventional CardiologyChildren's Hospital Bambino GesùRomeItaly
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
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Aimo A, Milandri A, Barison A, Pezzato A, Morfino P, Vergaro G, Merlo M, Argirò A, Olivotto I, Emdin M, Finocchiaro G, Sinagra G, Elliott P, Rapezzi C. Electrocardiographic abnormalities in patients with cardiomyopathies. Heart Fail Rev 2024; 29:151-164. [PMID: 37848591 PMCID: PMC10904564 DOI: 10.1007/s10741-023-10358-7] [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] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
Abnormalities in impulse generation and transmission are among the first signs of cardiac remodeling in cardiomyopathies. Accordingly, 12-lead electrocardiogram (ECG) of patients with cardiomyopathies may show multiple abnormalities. Some findings are suggestive of specific disorders, such as the discrepancy between QRS voltages and left ventricular (LV) mass for cardiac amyloidosis or the inverted T waves in the right precordial leads for arrhythmogenic cardiomyopathy. Other findings are less sensitive and/or specific, but may orient toward a specific diagnosis in a patient with a specific phenotype, such as an increased LV wall thickness or a dilated LV. A "cardiomyopathy-oriented" mindset to ECG reading is important to detect the possible signs of an underlying cardiomyopathy and to interpret correctly the meaning of these alterations, which differs in patients with cardiomyopathies or other conditions.
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Affiliation(s)
- Alberto Aimo
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | | | - Andrea Barison
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Andrea Pezzato
- Center for Diagnosis and Management of Cardiomyopathies, Cardiothoracovascular Department Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Paolo Morfino
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Giuseppe Vergaro
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Marco Merlo
- Center for Diagnosis and Management of Cardiomyopathies, Cardiothoracovascular Department Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | | | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Meyer Children Hospital Florence, Florence, Italy
| | - Michele Emdin
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Gherardo Finocchiaro
- Royal Brompton and Harefield Hospital, London, UK
- St George's University of London, London, UK
| | - Gianfranco Sinagra
- Center for Diagnosis and Management of Cardiomyopathies, Cardiothoracovascular Department Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Perry Elliott
- UCL Centre for Heart Muscle Disease and Lead of the Inherited Cardiovascular Disease Unit, Bart's Heart Centre, London, UK
- Cardiology Centre, University of Ferrara, Ferrara, Italy
| | - Claudio Rapezzi
- UCL Centre for Heart Muscle Disease and Lead of the Inherited Cardiovascular Disease Unit, Bart's Heart Centre, London, UK
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Fabris E, Boldrin C, Gregorio C, Pezzato A, Gagno G, Giannini F, Perkan A, Sinagra G. The Prognostic impact of treatments evolution in STEMI. Int J Cardiol 2024; 394:131352. [PMID: 37696362 DOI: 10.1016/j.ijcard.2023.131352] [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: 05/11/2023] [Revised: 09/02/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To evaluate in a real-world primary percutaneous coronary intervention (pPCI) registry the impact of the evolution of evidence-based treatments on prognosis. METHODS STEMI patients undergoing pPCI at the University Hospital of Trieste, Italy, were enrolled. The first cohort (old treatments cohort) included STEMI patients treated between January-2007 and December-2012, and the second cohort (new treatments cohort), between January-2013 and December-2020. Inverse Probability of Treatment Weighting (IPTW) Cox regression models as well as multivariable Cox regression models were performed to assess the risk of a composite primary endpoint (PE) of all cause death, reinfarction and re-PCI at 5 years. RESULTS A total of 2425 STEMI patients were enrolled. At multivariable Cox regression, the new-treatments cohort had lower risk of PE and mortality. Weighted (IPTW) Cox proportional hazard models confirmed the lower risk of the new treatments cohort for PE (HR 0.72; 95% CI 0.56-0.91, p = 0.007) and 5-year mortality (HR 0.70, 95%CI 0.54-0.91, p = 0.009). When considering both clinical and procedural variables, complete revascularization (HR 0.46, 95%CI 0.27-0.80, p = 0.006) and the administration of prasugrel or ticagrelor (HR 0.72, 95%CI 0.52-0.99, p = 0.013) were independent predictors of PE as well as of 5-year mortality. Patients receiving prasugrel or ticagrelor or drug eluting stent were at lower risk of 1-year stent thrombosis (HR 0.50, 95%CI 0.28-0.90, p = 0.021). CONCLUSIONS In a real-word STEMI population the prognosis of patients has improved in the last decades, and this was associated to the use of new antithrombotic treatments and to the implementation of complete revascularization.
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Affiliation(s)
- Enrico Fabris
- Cardiothoracovascular Department, University of Trieste, Trieste, Italy
| | - Claudia Boldrin
- Cardiothoracovascular Department, University of Trieste, Trieste, Italy
| | - Caterina Gregorio
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy; MOX - Modeling and Scientific Computing Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Andrea Pezzato
- Cardiothoracovascular Department, University of Trieste, Trieste, Italy
| | - Giulia Gagno
- Cardiothoracovascular Department, University of Trieste, Trieste, Italy
| | - Francesco Giannini
- Clinical and Interventional Cardiology Unit, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Andrea Perkan
- Cardiothoracovascular Department, University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, University of Trieste, Trieste, Italy.
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Pezzato A, Fabris E, Gregorio C, Cittar M, Contessi S, Carriere C, Lardieri G, Zecchin M, Perkan A, Sinagra G. Implantable-cardioverter-defibrillator after ST-elevation myocardial infarction: when and how frequently is it implanted and what is the rate of appropriate interventions? Insight from Trieste registry. J Cardiovasc Med (Hagerstown) 2023; 24:871-879. [PMID: 37851355 DOI: 10.2459/jcm.0000000000001565] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND There are limited data on implantable-cardioverter-defibrillator (ICD) implantation after ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Therefore, we evaluated when and how frequently an ICD is implanted after pPCI, the rate of appropriate ICD interventions, and predictors of ICD implantation. METHODS We analyzed STEMI patients treated with pPCI at the University Hospital of Trieste, Italy, between January 2010 and December 2019. We cross-matched patients' data with those present in the Trieste ICD registry. RESULTS Among 1805 consecutive patients treated with pPCI, 3.6% underwent ICD implantation during a median follow-up of 6.7 [interquartile range (IQR) 4.3-9.2] years. At 12 months, the mean number of ICD implantations was 2.3/100 patients [95% confidence interval (95% CI) 1.7-3.1] and remained stable over time (at 24 months: 2.5/100 patients, 95% CI 2.0-3.5 and at 36 months: 2.6/100 patients, 95% CI 2.3-3.8); 83.1% of ICDs were implanted for primary prevention, and more than half (55%) were implanted in patients with ejection fraction more than 35% at the moment of STEMI discharge. The rate of appropriate ICD interventions was 16.9% at a median follow-up of 5.7 years (IQR 3.3-8.3 years) after ICD implantation. At 12 months, the mean number of appropriate ICD interventions was 5/100 patients and 7/100 patients after 24 months. In patients with ejection fraction more than 35% at STEMI discharge (median ejection fraction 43%; IQR 40-48), independent predictors of ICD implantation were male sex, anterior STEMI and troponin peak more than 100 000 ng/dl. CONCLUSION The rate of ICD implantations after pPCI is low; however, the rate of appropriate ICD interventions is high. A relevant subgroup of patients received ICD implantations at follow-up despite a nonsevere ejection fraction at discharge after STEMI. Among these patients, those with high troponin release deserve strict follow-up and full optimal medical treatment.
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Affiliation(s)
| | | | - Caterina Gregorio
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste
- MOX - Modeling and Scientific Computing Laboratory, Department of Mathematics, Politecnico di Milano, Milan
| | | | | | | | - Gerardina Lardieri
- Emergency Department, Division of Cardiology, Gorizia & Monfalcone Hospital, ASUGI, Trieste, Italy
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Pezzato A, Milandri A, Tortorici G, Sinagra G, Merlo M. Pragmatic electrocardiogram tracings in non-ischaemic dilated cardiomyopathy: diagnostic and prognostic role. Eur Heart J Suppl 2023; 25:C162-C168. [PMID: 37125300 PMCID: PMC10132561 DOI: 10.1093/eurheartjsupp/suad018] [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] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Dilated cardiomyopathy (DCM) is a primitive heart muscle disease characterized by a great heterogeneous aetiology and prognostic outcome. Dilated cardiomyopathy is an umbrella term encompassing different aetiologies that might require specific treatments. It principally affects young and male adults, with high-risk arrhythmic competitive risk. Unfortunately, the prevention of major ventricular arrhythmic events remains a clinical challenge. In the era of advanced multimodality imaging and widely available genetic testing, electrocardiogram (ECG) continues to represent a reliable diagnostic tool, for specific work up of every single patient. However, approaching DCM patients, only a cardiomyopathy-oriented reading makes the role of ECG central in the management of DCM, both for diagnosis, prognosis, and therapeutic management. In this paper, we present four ECGs of four different DCM patients, in order to guide a cardiomyopathy-oriented ECG reading, emphasizing its impact in an early, cost-effective, and personalized diagnostic and prognostic work up in this specific setting.
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Affiliation(s)
- Andrea Pezzato
- Cardiothoracovascular Department, University of Trieste, Via Valdoni 7, 34129 Trieste, Italy
| | - Agnese Milandri
- Cardiovascular Department, Bentivoglio Hospital, Via Marconi 35, 40010 Bologna, Italy
| | - Gianfranco Tortorici
- Cardiovascular Department, Bentivoglio Hospital, Via Marconi 35, 40010 Bologna, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, University of Trieste, Via Valdoni 7, 34129 Trieste, Italy
| | - Marco Merlo
- Corresponding author. Tel: +39 0403994477, Fax: +39 0403994878,
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Marcori S, Pezzato A, Hinojosa AK, Gant A, Uliana A, Koni M, Rakar S, Aleksova A, Sinagra G, Merlo M. [Out-of-hospital cardiac arrest: University of Trieste students' skills on resuscitative maneuvers and automated external defibrillator]. G Ital Cardiol (Rome) 2023; 24:310-317. [PMID: 36971175 DOI: 10.1714/4004.39822] [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] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest is the third leading cause of death in industrialized countries. Although most cardiac arrests are witnessed, survival is only 2-10%, since bystanders are often unable to correctly perform cardiopulmonary resuscitation (CPR). This study aims to assess the theoretical and practical knowledge of CPR and the use of the automatic external defibrillator in university students. METHODS The study involved a total of 1686 students from 21 different faculties of the University of Trieste, 662 students from healthcare faculties and 1024 from non-healthcare faculties. Basic life support and early defibrillation (BLS-D) courses and retrainings after 2 years are mandatory for students in their final 2-year healthcare faculties at the University of Trieste. Through the platform "EUSurvey" from March to June 2021, they were given an online questionnaire of 25 multiple choice questions to investigate the performance of BLS-D. RESULTS In the overall population, 68.7% knew how to diagnose a cardiac arrest and 47.5% knew the time frame after which irreversible brain damage occurs. Practical knowledge was analyzed by evaluating the correct answers to all four questions on performing CPR (i.e. hand position during compressions, frequency of compressions, depth of compressions, and ventilation-compression ratio). Health faculties students have better theoretical and practical knowledge of CPR than their colleagues of non-healthcare faculties, with better overall knowledge on the all four practical questions (11.2% vs 4.3%; p<0.001). Final-year medical students of the University of Trieste, who attended the BLS-D course and underwent retraining after 2 years, have achieved better results than first year medical students (without BLS-D training) (38.1% vs 2.7%; p<0.001). CONCLUSION Mandatory BLS-D training and retraining leads to a better knowledge of cardiac arrest management and consequently a better patient outcome. In order to improve patient survival, heartsaver (BLS-D for laics) training should be extended as obligatory in all university courses.
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Affiliation(s)
| | | | - Ana Karina Hinojosa
- Corso di Laurea in Infermieristica, Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Alessia Gant
- S.C. Medicina d'Urgenza, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Andrea Uliana
- Sistema 118, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Miranda Koni
- S.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Trieste
| | - Serena Rakar
- S.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Trieste
| | - Aneta Aleksova
- S.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Trieste
| | - Gianfranco Sinagra
- S.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Trieste
| | - Marco Merlo
- S.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Trieste
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Pezzato A, Fabris E, Korcova R, Belgrano M, Sinagra G. Long-Term Follow-Up of a Nonprogressive Left Main Coronary Artery Fistula to Right Atrium. JACC Case Rep 2023; 9:101735. [PMID: 36909265 PMCID: PMC9998730 DOI: 10.1016/j.jaccas.2023.101735] [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: 10/19/2022] [Revised: 12/15/2022] [Accepted: 12/27/2022] [Indexed: 01/28/2023]
Abstract
Coronary artery fistula is a rare cardiac abnormality, occurring more frequently in young patients and treated with cardiac surgery or percutaneous interventions in most cases. We present the case of a 63-year-old man with an incidental diagnosis of coronary artery fistula, treated with conservative strategy. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Andrea Pezzato
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Trieste, Italy
| | - Enrico Fabris
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Trieste, Italy
| | - Renata Korcova
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Trieste, Italy
| | - Manuel Belgrano
- Department of Radiology, Azienda Sanitaria Universitaria Integrata of Trieste, University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Trieste, Italy
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Pezzato A, Zecchin M, Sinagra G. [The ECG as a "red flag" and potential prognostic predictor (2)]. G Ital Cardiol (Rome) 2023; 24:92. [PMID: 36735306 DOI: 10.1714/3963.39415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Andrea Pezzato
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) e Università degli Studi di Trieste, Trieste
| | - Massimo Zecchin
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) e Università degli Studi di Trieste, Trieste
| | - Gianfranco Sinagra
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) e Università degli Studi di Trieste, Trieste
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Pezzato A, Merlo M, Sinagra G. [The ECG as a "red flag" and potential prognostic predictor (1)]. G Ital Cardiol (Rome) 2023; 24:4. [PMID: 36573503 DOI: 10.1714/3934.39173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Andrea Pezzato
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) e Università degli Studi di Trieste, Trieste
| | - Marco Merlo
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) e Università degli Studi di Trieste, Trieste
| | - Gianfranco Sinagra
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) e Università degli Studi di Trieste, Trieste
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Pistacchi M, Pezzato A, Rudà R, Gioulis M, Contin F, Fragiacomo F, Marsala SZ. Spontaneous intracranial hypotension: a case series and literature review. Folia Neuropathol 2023; 61:225-234. [PMID: 37818683 DOI: 10.5114/fn.2023.126209] [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: 10/12/2023] Open
Abstract
Spontaneous intracranial hypotension (SIH) is a condition of negative intracranial pressure resulting from cerebrospinal fluid (CSF) leakage from the dural sac and is a well-known cause of orthostatic headache. Diagnosis and management can be difficult, often requiring coordination between multiple disciplines. Low CSF pressure and diffuse meningeal enhancement on brain MRI are the major instrumental features of the classic syndrome. Neuroimaging plays a key role in diagnosing SIH, particularly in atypical clinical presentations, by recognizing the specific findings of brain sagging on MRI and detecting the level of CSF leak on spinal imaging, thus guiding therapy accordingly. Since SIH could present with such a heterogeneous clinical picture, careful history taking and increased awareness of atypical presentations are of utmost importance. We review the existing SIH literature, illustrate management, clinical and neuroimaging findings of four consecutive patients with atypical SIH, who were recently referred to our hospital for evaluation to simplify and streamline the management of SIH.
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Affiliation(s)
| | | | - Roberta Rudà
- San Giacomo Hospital, Castelfranco Veneto (TV), Italy
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Nuzzi V, Porcari A, Gigli M, Pezzato A, Zaja F, Dore F, Bussani R, Sinagra G, Merlo M. 116 A CASE REPORT OF ISOLATED CARDIAC LIGHT CHAIN AMYLOIDOSIS WITHOUT HEART FAILURE: AN UNDER-RECOGNISED PRESENTATION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.470] [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
Background
Cardiac involvement in light-chain amyloidosis (AL) usually represents a brick in the wall of a multi-system disease. The presence of cardiac deposition of free light chains (FLCs) is the main determinant of survival. Isolated cardiac AL is un uncommon scenario characterised by a challenging diagnostic and therapeutic work-up.
Case Summary
A 57-year-old asymptomatic man presented for an incidental finding of myocardial necrosis at the ECG performed for newly-diagnosed arterial hypertension. Alongside signs of previous myocardial infarction, transthoracic echocardiography showed a severely increased left ventricular (LV) wall thickness not consistent with ECG voltages, segmental akinesia with normal LV systolic function with ‘apical sparing’ pattern. Laboratory assessment showed an unexpectedly high level of natriuretic peptide and persistently abnormal troponin in the absence of symptoms or signs of heart failure or ongoing ischemia. Coronary angiogram confirmed the coronary artery disease. Before revascularization, a complete diagnostic work-up was carried. Serum electrophoresis detected a monoclonal gammopathy that was further investigated by serum immunofixation, revealing high lambda FLCs concentration. Fat pad, bone marrow and salivary glands biopsies resulted negative for amyloid deposition. Finally, endomyocardial biopsy was consistent with AL amyloidosis. Urgent percutaneous revascularization was performed and the patients was timely started on chemotherapy.
Discussion
The diagnosis of isolated cardiac AL amyloidosis is challenging and carries important therapeutic implications. As the short-term prognosis might be severely compromised, an accurate diagnostic flow-chart have to be systematically pursued to obtain a precise diagnosis and address the optimal, tailored management.
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Affiliation(s)
- Vincenzo Nuzzi
- Azienda Sanitaria Giuliano-Isontina, Università Di Trieste
| | | | - Marta Gigli
- Azienda Sanitaria Giuliano-Isontina, Università Di Trieste
| | - Andrea Pezzato
- Azienda Sanitaria Giuliano-Isontina, Università Di Trieste
| | - Francesco Zaja
- Azienda Sanitaria Giuliano-Isontina, Università Di Trieste
| | - Franca Dore
- Azienda Sanitaria Giuliano-Isontina, Università Di Trieste
| | | | | | - Marco Merlo
- Azienda Sanitaria Giuliano-Isontina, Università Di Trieste
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13
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Marcori S, Pezzato A, Cano Ana KH, Gant A, Uliana A, Koni M, Rakar S, Aneta A, Sinagra G, Merlo M. 466 OUT-OF-HOSPITAL CARDIAC ARREST: UNIVERSITY OF TRIESTE STUDENTS’ KNOWLEDGE OF CARDIOPULMONARY RESUSCITATION AND DEFIBRILLATOR USE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.009] [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
Background
Out-of-hospital cardiac arrest (OHCA) is the third leading cause of death in industrialized countries. Although most cardiac arrests are witnessed, survival is only 2-10%, since bystanders are often unable to correctly perform cardio-pulmonary resuscitation (CPR). This study aims to assess the theoretical and practical knowledge of CPR and the use of the automatic external defibrillator (AED) in university students.
Materials and methods
The study involved a total of 1686 students from 21 different faculties of the University of Trieste, 662 students from health faculties and 1024 from non-health faculties. Basic life support and early defibrillation (BLSD) courses have been included in health faculties and made mandatory for students in their final years. Through the platform “EUSurvey” from March to June 2021, they were given an online questionnaire of 25 multiple choice questions to investigate the performance of BLSD.
Results
In the overall population, only 68.7% knew how to diagnose a cardiac arrest and the 47.5% knew the time frame after which irreversible brain damage occurs. Practical knowledge was analysed by evaluating the correct answers to all four questions on performing CPR (hand position during compressions, frequency of compressions, depth of compressions, and ventilations-compressions ratio). Health faculties students have better theoretical and practical knowledge of CPR than their colleagues in non-health faculties (11,2% vs 4,3%; p value <0.001). Final-year medical students, who attended the BLSD course and underwent retraining, have achieved better results than first year medical students (38,1% vs 2,7%; p value <0.001).
Discussion
The knowledge of cardiac arrest needs to be improved in the overall university population. The obligatory inclusion of BLSD courses in healthcare degree courses has led to a significant increase in knowledge on the issue. Given this, we believe it is important to extend these courses to all university students.
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Affiliation(s)
- Sara Marcori
- Nurse Of Complex Structure Of Emergency Room, Azienda Sanitaria Giuliano Isontina, Trieste - Italy
| | - Andrea Pezzato
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Karina Hinojosa Cano Ana
- Nurse Educator, Degree Course In Nursing, Department Of Medical, Surgical And Health Sciences, University Of Trieste - Italy
| | - Alessia Gant
- Nurse Of Complex Structure Of Emergency Medicine , Azienda Sanitaria Giuliano Isontina, Trieste - Italy
| | - Andrea Uliana
- Nurse Of Emergency Medical Services , Azienda Sanitaria Giuliano Isontina, Trieste - Italy
| | - Miranda Koni
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Serena Rakar
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Aleksova Aneta
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Gianfranco Sinagra
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Marco Merlo
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
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14
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Pezzato A, De Luca A, Radesich C, Saro R, Korcova R, Pagnan L, Dore F, Altinier A, Massa L, Zecchin M, Perkan A, Bussani R, Merlo M, Sinagra G. 941 SARCOIDOSIS: THE IMPORTANCE OF MULTIMODALITY IMAGING. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.651] [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
A 55-years old sporty man, without any cardiovascular risk factors nor previously known cardiological history, presented for a cardiological evaluation due to extra-systolic palpitations and dyspnea. The ECG documented a new onset of right bundle branch block, left anterior fascicular block and first degree of atrio-ventricular block. Echocardiography revealed severe left ventricular (LV) systolic dysfunction (LV ejection fraction -EF- 34%), showing also right ventricular (RV) dilatation and disfunction. A 24-hour Holter monitoring did not show any significant arrhythmias and maximal stress test did not reveal any ECG changes nor arrhythmias. Cardiac magnetic resonance (CMR) confirmed the presence of severe biventricular dysfunction; multiple areas of edema and late gadolinium enhancement (LGE) were observed, with ischemic and nonischemic pattern and extensive involvement of the RV and the interventricular septum. In the suspicion of cardiac sarcoidosis a 18-fluorodeoxyglucose positron emission tomography (PET) was performed, confirming the presence of an inflammatory cardiomyopathy in an active phase. A subsequent endomyocardial biopsy was performed, which demonstrated the presence of non-caseating granulomas, signs of inflammation and fibrosis, consistent with the diagnosis of cardiac sarcoidosis. No signs of extra-cardiac involvement were present.
The patient started anti-inflammatory therapy with Prednisone and Metotrexate, along with anti-neurohormonal therapy. However, due to a significant increase in ventricular arrhythmic burden, an implantable cardioverter defibrillator was placed during early follow-up, and Amiodarone therapy was started.
After 5 months of medical therapy, PET scan showed a marked reduction of cardiac inflammation and echocardiography showed a significant LVEF improvement (from 34% to 43%). After slow tapering of steroid therapy Prednisone was stopped, whereas Metotrexate, Amiodarone and anti-neurohormonal therapy were maintained. Follow-up is still ongoing without clinical events.
Sarcoidosis is a systemic inflammatory disease characterized by the presence of non-caseating granulomas in multiple organs. Cardiac involvement is associated with higher incidence of heart failure, ventricular arrhythmias and all-cause mortality. Isolated cardiac involvement is rare but associated with worse prognosis. Multimodality imaging is of paramount importance for the diagnosis and monitoring therapy.
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Affiliation(s)
- Andrea Pezzato
- Cardiovascular Department, University Of Trieste , Trieste , Italy
| | - Antonio De Luca
- Cardiovascular Department, University Of Trieste , Trieste , Italy
| | - Cinzia Radesich
- Cardiovascular Department, University Of Trieste , Trieste , Italy
| | - Riccardo Saro
- Cardiovascular Department, University Of Trieste , Trieste , Italy
| | - Renata Korcova
- Cardiovascular Department, University Of Trieste , Trieste , Italy
| | - Lorenzo Pagnan
- Department Of Radiology, University Of Trieste , Trieste , Italy
| | - Franca Dore
- Department Of Nuclear Medicine, University Of Trieste , Trieste , Italy
| | | | - Laura Massa
- Cardiovascular Department, University Of Trieste , Trieste , Italy
| | - Massimo Zecchin
- Cardiovascular Department, University Of Trieste , Trieste , Italy
| | - Andrea Perkan
- Cardiovascular Department, University Of Trieste , Trieste , Italy
| | - Rossana Bussani
- Institute Of Pathological Anatomy And Histology, University Of Trieste , Trieste , Italy
| | - Marco Merlo
- Cardiovascular Department, University Of Trieste , Trieste , Italy
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15
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Radesich C, Pezzato A, Saro R, Luca AD, Ferro MD, Dore F, Sinagra G. 411 AN UNEXPECTED (AND UNDESIRED) ECHOCARDIOGRAPHIC FINDING IN A PATIENT WITH RIGHT-SIDED CHEST PAIN. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.125] [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
A 71-year-old man, former smoker, without other cardiovascular risk factors nor previously known cardiological history, was admitted to our emergency department for nonproductive cough and right-sided chest pain, worsened by inspiration. ECG documented reduced peripheral QRS voltages. Echocardiography was performed, revealing the presence of an inhomogeneous, hyperechoic neoformation involving the lateral wall of the right ventricle (RV), dislocating the right coronary artery, protruding into the cavity towards the intraventricular septum and reaching the sub-valvular apparatus of the tricuspid valve, without any hemodynamic interference. Pericardial effusion was also documented (maximum 20 mm around the atrioventricular groove), without signs of cardiac tamponade. For better mass characterization, a computed tomography (CT) scan and a cardiac magnetic resonance (CMR) were performed, confirming the presence of a solid neoformation involving the RV and pericardial effusion, also showing right pleural effusion. Furthermore, right hilar and subcarinal lymphadenomegaly with compression of the bronchi was observed. A positron emission tomography (PET) scan showed areas of increased 18-fluorodeoxyglucose (18FDG) uptake in supra- and infra diaphragmatic lymph nodes, adrenal glands, bones, and lungs. Due to the clinical suspicion of a lymphoproliferative neoplasm, corticosteroid therapy was started.
Before a diagnostic lymph node biopsy could be performed, the patient had a syncopal episode due to cardiac tamponade, requiring pericardiocentesis. During hospitalization, continuous heart monitoring revealed intermittent third-degree atrioventricular block, so a permanent pacemaker was implanted. Finally, an excisional lymph node biopsy was obtained, and a diagnosis of diffuse large B-cell lymphoma was established. Treatment with Prednisone, Cyclophosphamide, Vincristine, nonpegylated liposomal Doxorubicin, and Rituximab (R-COMP) was promptly started. Seven months later, after five cycles of chemotherapy, complete remission was documented by PET scan, and the cardiac mass was no longer evident at echocardiography.
Metastatic involvement of the heart is a relatively frequent event in oncologic patients, with an estimated prevalence of 8% at autopsy. Lymphoproliferive neoplasms have a not negligible rate of heart mestastatization (9,4%). Neoplastic invasion secondary to lymphoma tends to infiltrate the myocardium, typically causing arrhythmias and conduction disturbances.
Diagnostic evaluation relies upon echocardiography, CT and CMR. PET/TC is of paramount importance to assess the malignant nature of the mass, to stage the disease and to evaluate the response to chemotherapy. Metastatic cardiac involvement typically occurs as a late manifestation of disseminated lymphoma and the prognosis is usually poor; however, survival is increasing thanks to new chemo-immunotherapy strategies.
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Affiliation(s)
- Cinzia Radesich
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Andrea Pezzato
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Riccardo Saro
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Antonio De Luca
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Matteo Dal Ferro
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Franca Dore
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Gianfranco Sinagra
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
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16
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Boldrin C, Fabris E, Gregorio C, Pezzato A, Gagno G, Vitrella G, Rakar S, Perkan A, Sinagra G. 485 PROGNOSTIC IMPACT OF TREATMENTS EVOLUTION IN STEMI: INSIGHTS FROM A PRIMARY PCI REGISTRY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.347] [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
Objective
We aimed to evaluate in a real world primary percutaneous coronary intervention (pPCI) registry the impact of the evolution of evidence-based treatments on prognosis, comparing different decades of treatment.
Methods
Consecutive STEMI patients undergoing pPCI at University Hospital of Trieste, Italy, were enrolled in a pPCI registry. Outcomes were evaluated during two successive periods: the first cohort (old treatments cohort) included STEMI patients treated between January 2007 and December 2012, and the second cohort (new treatments cohort), included STEMI patients treated between January 2013 and December 2020. Cox regression models were performed to predict the risk of the study primary endpoint (PE) a composite of all cause death, reinfarction and re-PCI at 5 years. The secondary endpoint was all cause of mortality at 5 years. Moreover, we evaluated the incidence of stent thrombosis at 12 months.
Results
A total of 2425 STEMI patients, 947 in the old treatments cohort and 1478 in the new treatments cohort were analysed. The mean age of the population was 66 ± 12.5 years, most were males (74.3%), 20.2% were diabetics, and 12% presented in Killip class III-IV. At 5-years of follow-up the new treatments cohort compared to the old treatments cohort presented a lower rate of primary outcome (18.5% vs 23.1%, p=0.006) and mortality (15.5% vs 19.9%, p=0.006). At Cox regression model adjusted for baseline differences between the two cohorts, patients in the new treatments cohort had lower risk of PE (HR 0.717, 95% CI 0.567–0.907, p=0.006) and mortality (HR 0.662, 95% CI 0.509–0.860, p=0.002). When considering both clinical and procedural variables, complete revascularization (HR 0.459, 95% CI 0.265–0.796, p=0.006) and the administration of prasugrel or ticagrelor (HR 0.721, 95% CI 0.524–0.992, p=0.013) were independent predictors of PE as well as of 5 years mortality. The new treatments cohort compared to the old treatments cohort had more frequent use of radial approach (83.1% vs 24.4%, p<0.001) and had lower ischaemia time (3.05 vs 3.45 hours, p>0.001), however they were not associated with PE. Patients receiving prasugrel or ticagrelor or drug eluting stent (DES) were at lower risk of stent thrombosis at 12 months (HR 0.502, 95% CI 0.280–0.900, p=0.021).
Conclusions
In a real-word STEMI population the prognosis of patients is improved in the last decades, and this was associated to the use of new antithrombotic treatments and to the implementation of complete revascularization. The application of new evidence-based therapies in clinical practise is fundamental to improve patient prognosis because the benefits demonstrated by clinical trials have translated into a benefit in the real-world population.
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Affiliation(s)
- Claudia Boldrin
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Enrico Fabris
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Caterina Gregorio
- Biostatistics Unit, Department Of Medical Sciences, University Of Trieste , Trieste , Italy
- Mox - Modeling And Scientific Computing Laboratory, Department Of Mathematics , Politecnico Di Milano, Milan , Italy
| | - Andrea Pezzato
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Giulia Gagno
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Giancarlo Vitrella
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Serena Rakar
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Andrea Perkan
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Gianfranco Sinagra
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
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17
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Pezzato A, Fabris E, Korcova R, Belgrano M, Sinagra G. 180 LONG TERM FOLLOW UP OF A NON-PROGRESSIVE LEFT MAIN CORONARY ARTERY FISTULA TO RIGHT ATRIUM. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.210] [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
A 63 years old man, with multiple cardiovascular risk factor, presented at the emergency department with a transient ischemic attack during an hypertensive crisis. Electrocardiogram revealed a sinus rhythm and no sign of ischemia. No critical stenosis were detected at ultrasonography of the supra-aortic trunks. Brain CT showed an arachnoid cyst in right posterior cerebellar site. Transthoracic echocardiographic showed normal wall motion with a left ventricular ejection fraction of 66%. The transesophageal echocardiography, performed for searching possible emboligenic heart disease, revealed a fistulous aneurysmal formation arising from the left main coronary artery. Angio-CT confirmed a CAF between distal left main coronary artery and right atrium, with a retro-aortic serpiginous course and an ectasic vascular structure (above 8.35 mm), this pathological vessel also had an aneurismatic formation of maximum diameter of 1 cm. CT scan detected also a 50% soft eccentric plaque in mid circumflex coronary artery and a less than 50% soft eccentric plaque in the right coronary artery.
An elective hospitalization was performed in order to better assess the CAF. Coronary angiography revealed no significant coronary atherosclerotic disease and confirmed the CAF with its convoluted course. No left to right shunt was found either in cardiac magnetic resonance (Qp/Qs close to 1) or in right heart catheterization. Maximal stress test with cycloergometer was negative for clinical and electrocardiographic inducible ischemia (120W).
CAF is a rare vascular abnormality, occurring in only 0.002% of the general population. The majority of CAFs have a congenital origin, but occasionally they may be acquired after cardiac surgery or repeated myocardial biopsies in cardiac transplantation. The CAFs may increase in size over time, although this does not occur invariably, and complications include: myocardial ischemia (due to myocardial ‘steal’), thrombosis and embolism, heart failure, atrial fibrillation, rupture, endocarditis/endarteritis, arrhythmias and also spontaneous rupture of the CAF causing hemopericardium. Current treatment options for CAF include surgery or transcatheter closure.
Considered the age of the patient, the absence of clinical symptoms and the absence of left to right shunt, a conservative strategy was chosen. The patient had strict follow up, with clinical and echocardiographic assessment every 6 months, and with annually CT scan and stress test. During these 9 years of follow up the CAF remained stable, and the patients clinically asymptomatic.
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Affiliation(s)
- Andrea Pezzato
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Enrico Fabris
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Renata Korcova
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Manuel Belgrano
- Department Of Radiology, Azienda Sanitaria Universitaria Integrata Of Trieste, University Of Trieste , Italy
| | - Gianfranco Sinagra
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
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18
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Pezzato A, Fabris E, Gregorio C, Cittar M, Contessi S, Carriere C, Lardieri G, Zecchin M, Perkan A, Sinagra G. 480 ICD AFTER STEMI: WHEN AND HOW FREQUENTLY IS IMPLANTED AND WHICH IS THE RATE OF APPROPRIATE INTERVENTIONS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.525] [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
Background
there are limited data of implantable-cardioverter-defibrillator (ICD) implantation after STEMI treated with primary percutaneous coronary intervention (pPCI). This study sought to evaluate when and how frequently is ICD implanted after STEMI, the rate of appropriate ICD-interventions, and the independent predictors of ICD implantation.
Methods
We analyzed STEMI patients treated with pPCI at the University Hospital of Trieste, Italy, between January 2010 and December 2019. We cross-matched patients data with those present in the Trieste ICD registry.
Results
1805 consecutive patients treated with pPCI were analyzed. During a median follow-up of 6.7 (IQR 4.3-9.2) years, the probability of ICD implantation at 12 months was 2.3% (95%CI: 1.7-3.1) and it remained stable overtime (at 24 months: 2.5%, 95%CI 2.0-3.5 and at 36 months: 2.6%, 95%CI 2.3-3.8). Mean time before ICD implantation was 35.5 months (95%CI: 34.8-36) . 83.1% of implanted ICD were for primary prevention, and more than half (55%) were implanted in patients with ejection fraction (EF)>35% at the moment of STEMI discharge. During a median follow-up of 5.7 (IQR 3.3-8.3) years after ICD implantation, the probability of appropriate ICD intervention was 9% and 11% after 12 and 24 months respectively. In patients with EF>35% at STEMI discharge (median EF 43%; IQR 40-48), predictors of ICD implantation were male sex, anterior STEMI and troponin peak >100.000 ng/dl.
Conclusions
The rate of ICD implantation after pPCI is low, however the rate of appropriate ICD interventions is high. A relevant subgroup of patients received ICD implantation at follow-up despite a non-severe EF at discharge after STEMI. Among these patients those with high troponin release deserve strict follow-up and full optimal medical treatment.
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Affiliation(s)
- Andrea Pezzato
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Enrico Fabris
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Caterina Gregorio
- Biostatistics Unit, Department Of Medical Sciences, University Of Trieste , Trieste , Italy
- Mox - Modeling And Scientific Computing Laboratory, Department Of Mathematics , Politecnico Di Milano, Milano , Italy
| | - Marco Cittar
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Stefano Contessi
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Cosimo Carriere
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Gerardina Lardieri
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Massimo Zecchin
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Andrea Perkan
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
| | - Gianfranco Sinagra
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University Of Trieste , Italy
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19
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Saro R, De Luca A, Radesich C, Pezzato A, Restivo L, Korcova R, Mazzaro E, Bardari S, Rauber E, Merlo M, Sinagra G. 738 A RARE CASE OF UNICUSPID AORTIC VALVE WITH SEVERE STENOSIS AND REGURGITATION: CLINICAL PRESENTATION AND MANAGEMENT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.737] [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
A 19-year-old Pakistani migrant, who arrived in our country on foot, presented at emergency department with angina and worsening dyspnoea on exertion. The patient reported an unclear history of aortic valve disease.
Clinical examination revealed a 6/6L systolic murmur with thrill. The electrocardiogram showed sinus rhythm and signs of left ventricular hypertrophy. Chest X-ray reported cardiomegaly and signs of congestion. Troponin I HS was mildly elevated (39 ng/L, n.v. < 18 ng/L).
The patient was admitted to our Cardiology department. Transthoracic echocardiography revealed a mildly dilated left ventricle (LV), with severe hypertrophy, normal kinetics and systolic function (EF 63%), dilated ascending aorta (diam. 41 mm) and severe aortic steno-insufficiency. Transesophageal echocardiography was then performed, revealing a highly calcified, unicuspid unicommissural aortic valve with severe stenosis and regurgitation. A separate origin of left coronary ostia was also documented.
The patient was referred to urgent cardiac surgery. A modified Bentall procedure (mechanical valve and prosthetic conduit) was performed with reimplantation of the coronary ostia. Due to a post-surgical complete atrioventricular block, a dual-chamber pacemaker (DDD) was implanted.
Follow-up echocardiography showed reduction of LV volumes and wall thickness and normal prosthetic function.
Unicuspid aortic valve is a very rare congenital disease, with a prevalence of about 0.02% in the adult population and is frequently associated with ascending aorta dilatation. The treatment is aortic valve replacement. Complete atrioventricular block can occur after surgery, requiring cardiac pacing.
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Affiliation(s)
- Riccardo Saro
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Antonio De Luca
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Cinzia Radesich
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Andrea Pezzato
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Luca Restivo
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Renata Korcova
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Enzo Mazzaro
- Cardiovascular Department, Division Of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Stefano Bardari
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Elisabetta Rauber
- Cardiovascular Department, Division Of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Marco Merlo
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
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20
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Indolfi C, Barillà F, Basile C, Basso C, Cantaluppi V, Capasso G, Ciccone MM, Contessi S, Curcio A, De Nicola L, Esposito C, Imeraj A, Lecis D, Mancone M, Marengo M, Mercuro G, Merlo M, Metra M, Adamo M, Muscoli S, Nodari S, Pagura L, Paoletti E, Paolillo S, Pedrinelli R, Perrone Filardi P, Pertosa GB, Pezzato A, Pontremoli R, Romeo F, Ruggenenti P, Ronco C, Santoro A, Sinagra G, Spaccarotella C, Zippo D, Zoccali C, Messa P. [Italian Society of Cardiology-Italian Society of Nephrology Consensus document: The cardio-renal interaction in the prevention and treatment of cardiovascular diseases - Part II: From preventive strategies to treatment of patients with cardio-renal damage]. G Ital Cardiol (Rome) 2022; 23:793-812. [PMID: 36169130 DOI: 10.1714/3881.38645] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Chronic kidney disease and cardiovascular disease are strictly connected each other with a bidirectional interaction. Thus, the prevention of cardio-renal damage, as its appropriate treatment, are essential steps for a correct management of long-term patients' prognosis. Several preventive and therapeutic strategies, pharmacological and not, are now available for cardio-renal damage prevention and treatment, and for the management of its complications. The second part of this consensus document focuses on the management and treatment of cardio-renal damage, directing the attention on the correct use of drugs that may slow renal disease progression, on the application of preventive strategies in case of invasive cardiac procedures with the use of contrast agents, and on the accurate use of cardiological drugs in patients with chronic kidney disease.
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Affiliation(s)
- Ciro Indolfi
- Istituto di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro - Mediterranea Cardiocentro, Napoli
| | - Francesco Barillà
- Dipartimento di Medicina dei Sistemi, Università degli Studi "Tor Vergata", Roma
| | - Christian Basile
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli
| | - Cristina Basso
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari e di Sanità Pubblica, Università degli Studi, Padova
| | - Vincenzo Cantaluppi
- Nefrologia, Dialisi e Trapianto, Ospedale Maggiore della Carità, Università del Piemonte Orientale, Novara
| | - Giovambattista Capasso
- Sezione di Nefrologia, Dipartimento di Scienze Mediche Traslazionali, Università degli Studi della Campania "L. Vanvitelli", Napoli
| | - Marco Matteo Ciccone
- Cardiologia Universitaria, Azienda Universitario-Ospedaliera Policlinico di Bari, Bari
| | - Stefano Contessi
- Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Università degli Studi, Trieste
| | - Antonio Curcio
- Istituto di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro
| | - Luca De Nicola
- Nefrologia, Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania "Luigi Vanvitelli", Napoli
| | - Ciro Esposito
- U.O.C. Nefrologia e Dialisi, ICS Maugeri S.p.A. SB, Università degli Studi, Pavia
| | - Amantia Imeraj
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro di Ricerche Cliniche per le Malattie Rare "Aldo e Cele Daccò", Ranica (BG)
| | - Dalgisio Lecis
- Dipartimento di Cardiologia, Università degli Studi "Tor Vergata", Roma
| | - Massimo Mancone
- Dipartimento di Scienze Cardiovascolari, Medina Interna e Anestesiologia, Sapienza Università di Roma, Roma
| | | | - Giuseppe Mercuro
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi, Cagliari
| | - Marco Merlo
- Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Università degli Studi, Trieste
| | - Marco Metra
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi, Brescia
| | - Marianna Adamo
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi, Brescia
| | - Saverio Muscoli
- U.O.C. Cardiologia, Fondazione Policlinico "Tor Vergata", Roma
| | - Savina Nodari
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi, Brescia
| | - Linda Pagura
- Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Università degli Studi, Trieste
| | - Ernesto Paoletti
- Clinica Nefrologica, Dialisi e Trapianto, Policlinico San Martino, Genova
| | - Stefania Paolillo
- Mediterranea Cardiocentro, Napoli - Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli
| | - Roberto Pedrinelli
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università degli Studi, Pisa
| | - Pasquale Perrone Filardi
- Mediterranea Cardiocentro, Napoli - Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli
| | - Giovanni Battista Pertosa
- U.O.C. Nefrologia, Dialisi e Trapianto, Dipartimento dell'Emergenza e dei Trapianti di Organo (DETO), Università degli Studi "Aldo Moro", Bari
| | - Andrea Pezzato
- Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Università degli Studi, Trieste
| | - Roberto Pontremoli
- Università degli Studi di Genova ed IRCCS Ospedale Policlinico San Martino, Genova
| | - Francesco Romeo
- Dipartimento di Cardiologia, International University "Unicamillus", Roma
| | - Piero Ruggenenti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro di Ricerche Cliniche per le Malattie Rare "Aldo e Cele Daccò", Ranica (BG) - Unità di Nefrologia ed Avvio al Trapianto, ASST Papa Giovanni XXIII, Bergamo
| | - Claudio Ronco
- U.O.C. Nefrologia Dialisi e Trapianto, Ospedale San Bortolo, Vicenza
| | - Antonio Santoro
- U.O.C. Nefrologia, Dialisi ed Ipertensione, Policlinico S. Orsola-Malpighi, Bologna
| | - Gianfranco Sinagra
- Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Università degli Studi, Trieste
| | - Carmen Spaccarotella
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli
| | - Dauphine Zippo
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi, Brescia
| | - Carmine Zoccali
- CNR-IFC Epidemiologia Clinica e Fisiopatologia delle Malattie Renali e dell'Ipertensione Arteriosa, Azienda Ospedaliera di Reggio Calabria
| | - Piergiorgio Messa
- U.O.C. Nefrologia, Dialisi e Trapianti di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano
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21
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Messa P, Barillà F, Basile C, Basso C, Cantaluppi V, Capasso G, Ciccone MM, Contessi S, Curcio A, De Nicola L, Esposito C, Imeraj A, Lecis D, Mancone M, Marengo M, Mercuro G, Merlo M, Metra M, Adamo M, Muscoli S, Nodari S, Pagura L, Paoletti E, Paolillo S, Pedrinelli R, Filardi PP, Pertosa GB, Pezzato A, Pontremoli R, Romeo F, Ruggenenti P, Ronco C, Santoro A, Sinagra G, Spaccarotella C, Zippo D, Zoccali C, Indolfi C. [Italian Society of Cardiology-Italian Society of Nephrology Consensus document: The cardio-renal interaction in the prevention and treatment of cardiovascular diseases - Part I: From cardiovascular risk factors to the mechanisms of cardio-renal syndrome]. G Ital Cardiol (Rome) 2022; 23:716-727. [PMID: 36039723 DOI: 10.1714/3860.38456] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Chronic kidney disease (CKD) and cardiovascular (CV) disease are highly prevalent conditions in the general population and are strictly connected to each other with a bidirectional interaction. In patients affected by CKD, the leading cause of morbidity and mortality is represented by CV disease, since CKD promotes the atherosclerotic process increasing inflammation, and modifying lipid and bone mineral metabolism. On the other side, a strict relationship exists between CKD and CV risk factors, which are prevalent in nephropathic patients and impose a stringent assessment of the risk of CV events in this population together with an optimized pharmacological approach, complicated by the coexistence of the two pathological conditions. The first part of this consensus document focuses on the mechanisms of cardio-renal damage and on the impact, as well as the management, of the main CV risk factors in the context of CKD.
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Affiliation(s)
- Piergiorgio Messa
- U.O.C. Nefrologia, Dialisi e Trapianti di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano
| | - Francesco Barillà
- Dipartimento di Medicina dei Sistemi, Università degli Studi "Tor Vergata", Roma
| | - Christian Basile
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli
| | - Cristina Basso
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari e di Sanità Pubblica, Università degli Studi, Padova
| | - Vincenzo Cantaluppi
- Nefrologia, Dialisi e Trapianto, Ospedale Maggiore della Carità, Università del Piemonte Orientale, Novara
| | - Giovambattista Capasso
- Sezione di Nefrologia, Dipartimento di Scienze Mediche Traslazionali, Università degli Studi della Campania "L. Vanvitelli", Napoli
| | - Marco Matteo Ciccone
- Cardiologia Universitaria, Azienda Universitario-Ospedaliera Policlinico di Bari, Bari
| | - Stefano Contessi
- Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Università degli Studi, Trieste
| | - Antonio Curcio
- Istituto di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro
| | - Luca De Nicola
- Nefrologia, Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università della Campania "Luigi Vanvitelli", Napoli
| | - Ciro Esposito
- U.O.C. Nefrologia e Dialisi, ICS Maugeri S.p.A. SB, Università di Pavia, Pavia
| | - Amantia Imeraj
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro di Ricerche Cliniche per le Malattie Rare "Aldo e Cele Daccò", Ranica (BG)
| | - Dalgisio Lecis
- Dipartimento di Cardiologia, Università degli Studi "Tor Vergata", Roma
| | - Massimo Mancone
- Dipartimento di Scienze Cardiovascolari, Medina Interna, e Anestesiologia, Sapienza Università di Roma, Roma
| | | | - Giuseppe Mercuro
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi, Cagliari
| | - Marco Merlo
- Cardiologia Universitaria, Azienda Universitario-Ospedaliera Policlinico di Bari, Bari
| | - Marco Metra
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi, Brescia
| | - Marianna Adamo
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi, Brescia
| | - Saverio Muscoli
- U.O.C. Cardiologia, Fondazione Policlinico "Tor Vergata", Roma
| | - Savina Nodari
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi, Brescia
| | - Linda Pagura
- Cardiologia Universitaria, Azienda Universitario-Ospedaliera Policlinico di Bari, Bari
| | - Ernesto Paoletti
- Clinica Nefrologica, Dialisi e Trapianto, Policlinico San Martino, Genova
| | - Stefania Paolillo
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli - Mediterranea Cardiocentro, Napoli
| | - Roberto Pedrinelli
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università degli Studi, Pisa
| | - Pasquale Perrone Filardi
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli - Mediterranea Cardiocentro, Napoli
| | - Giovanni Battista Pertosa
- U.O.C. Nefrologia, Dialisi e Trapianto, Dipartimento dell'Emergenza e dei Trapianti di Organo (DETO), Università degli Studi "Aldo Moro", Bari
| | - Andrea Pezzato
- Nefrologia, Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università della Campania "Luigi Vanvitelli", Napoli
| | - Roberto Pontremoli
- Università degli Studi di Genova ed IRCCS Ospedale Policlinico San Martino, Genova
| | - Francesco Romeo
- Dipartimento di Cardiologia, International University "Unicamillus", Roma
| | - Piero Ruggenenti
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli - Unità di Nefrologia ed Avvio al Trapianto, ASST Papa Giovanni XXIII, Bergamo
| | - Claudio Ronco
- U.O.C. Nefrologia Dialisi e Trapianto, Ospedale San Bortolo, Vicenza
| | - Antonio Santoro
- U.O.C. Nefrologia, Dialisi ed Ipertensione, Policlinico S. Orsola-Malpighi, Bologna
| | - Gianfranco Sinagra
- Cardiologia Universitaria, Azienda Universitario-Ospedaliera Policlinico di Bari, Bari
| | - Carmen Spaccarotella
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli
| | - Dauphine Zippo
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi, Brescia
| | - Carmine Zoccali
- CNR-IFC Epidemiologia Clinica e Fisiopatologia delle Malattie Renali e dell'Ipertensione Arteriosa, Azienda Ospedaliera di Reggio Calabria
| | - Ciro Indolfi
- Istituto di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro - Mediterranea Cardiocentro, Napoli
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22
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Falco L, Fabris E, Gregorio C, Pezzato A, Milo M, Massa L, Lardieri G, Korcova R, Cominotto F, Vitrella G, Rakar S, Perkan A, Sinagra G. Early prognostic stratification and identification of irreversibly shocked patients despite primary percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2022; 23:247-253. [PMID: 34907143 PMCID: PMC10414156 DOI: 10.2459/jcm.0000000000001282] [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: 07/09/2021] [Revised: 10/18/2021] [Accepted: 10/31/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Despite prognostic improvements in ST-elevation myocardial infarction (STEMI), patients presenting with cardiogenic shock (CS) have still high mortality. Which are the relevant early prognostic factors despite revascularization in this high-risk population is poorly investigated. METHODS We analyzed STEMI patients treated with primary percutaneous coronary intervention (PCI) and enrolled at the University Hospital of Trieste between 2012 and 2018. A decision tree based on data available at first medical contact (FMC) was built to stratify patients for 30-day mortality. Multivariate analysis was used to explore independent factors associated with 30-day mortality. RESULTS Among 1222 STEMI patients consecutively enrolled, 7.5% presented with CS. CS compared with no-CS patients had worse 30-day mortality (33% vs 3%, P < 0.01). Considering data available at FMC, CS patients with a combination of age ≥76 years, anterior STEMI and an expected ischemia time > 3 h and 21 min were at the highest mortality risk, with a 30-day mortality of 85.7%. In CS, age (OR 1.246; 95% CI 1.045-1,141; P = 0.003), final TIMI flow 2-3 (OR 0.058; 95% CI 0.004-0.785; P = 0.032) and Ischemia Time (OR = 1.269; 95% CI 1.001-1.609; P = 0.049) were independently associated with 30-day mortality. CONCLUSIONS In a contemporary real-world population presenting with CS due to STEMI, age is a relevant negative factor whereas an early and successful PCI is positively correlated with survival. However, a subgroup of elderly patients had severe prognosis despite revascularization. Whether pPCI may have an impact on survival in a very limited number of irreversibly critically ill patients remains uncertain and the identification of irreversibly shocked patients remains nowadays challenging.
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Affiliation(s)
| | | | - Caterina Gregorio
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste
| | | | | | | | - Gerardina Lardieri
- Division of Cardiology, Emergency Department, Gorizia–Monfalcone Hospital
| | | | - Franco Cominotto
- Emergency Department, University Hospital of Trieste, Trieste, Italy
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23
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Fabris E, Menzio S, Gregorio C, Pezzato A, Stolfo D, Aleksova A, Vitrella G, Rakar S, Perkan A, Van't Hof AW, Sinagra G. Effect of prehospital treatment in STEMI patients undergoing primary PCI. Catheter Cardiovasc Interv 2022; 99:1500-1508. [PMID: 35289471 PMCID: PMC9546098 DOI: 10.1002/ccd.30153] [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: 01/14/2022] [Accepted: 02/21/2022] [Indexed: 12/03/2022]
Abstract
Background The appropriate timing to administer antithrombotic therapies in ST‐elevation myocardial infarction (STEMI) remains uncertain. This study aims to evaluate the role of antithrombotic therapy administration at first medical contact (FMC) compared with the administration in the Cathlab. Methods We conducted a “before‐after” observational study enrolling STEMI undergoing primary percutaneous coronary intervention (PCI). Outcomes were evaluated during two successive periods, before (control group: aspirin only at FMC) and after (pretreated intervention group: heparin, aspirin plus ticagrelor at FMC) the introduction of a new regional pretreatment protocol. Results A total of 537 consecutive patients (300 in control vs. 237 in intervention group) were enrolled. The pretreated compared with no pretreated population showed better basal reperfusion, expressed as basal Thrombolysis in Myocardial Infarction (TIMI)‐flow (p for trend p < 0.001). Pretreated population showed lower frequency of TIMI 0 (56.5% vs. 73.7%, odds ratio [OR]: 0.46, 95% confidence interval [CI]: 0.32–0.67, p < 0.001) and higher frequency of TIMI 2‐3 (33.3% vs. 19.3% OR: 2.0, 95% CI: 1.38–2.00, p < 0.001) and TIMI 3 (14.3% vs. 9.7%, OR: 1.56, 95% CI: (0.92–2.65), p = 0.094). Pretreated compared with no pretreated population showed reduced infarct size expressed as Troponin Peak (20,286 (8726–75,027) versus 48,676 (17,229–113,900), p = 0.001), and higher left ventricular ejection fraction at discharge (53% (44–59) vs. 50% (44–56), p = 0.027). In‐hospital BARC ≥ 2 bleeding were similar (2.1% vs. 2.0%, p = 0.929, in pretreated versus no pretreated population, respectively). Conclusion This study provides support for an early pretreatment strategy in STEMI patients and confirmed the importance of an efficient organization of STEMI networks which allow initiation of antithrombotic treatment at FMC.
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Affiliation(s)
- Enrico Fabris
- Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy
| | - Sara Menzio
- Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy
| | - Caterina Gregorio
- Department of Medical Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy
| | - Andrea Pezzato
- Postgraduate School in Cardiovascular Sciences, University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy
| | - Aneta Aleksova
- Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy
| | - Giancarlo Vitrella
- Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy
| | - Serena Rakar
- Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy
| | - Andrea Perkan
- Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy
| | - Arnoud Wj Van't Hof
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy
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24
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Fabris E, Pezzato A, Gregorio C, Barbati G, Falco L, Stolfo D, Vitrella G, Rakar S, Perkan A, Sinagra G. 86 STEMI and multivessel disease: medical therapy amplifies the benefit of complete myocardial revascularization. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.032] [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
Aims
Patients with ST-elevation myocardial infarction (STEMI) with multivessel disease (MVD) may be treated with different revascularization strategies. However, the potential predictors of outcomes on top of different revascularization strategies are poorly studied. This study aimed to evaluate the prognostic impact of two different revascularization strategies and the potential impact of medical therapy.
Methods and results
Using a propensity score approach, the impact of two treatment strategies was analysed—staged non-culprit revascularization group vs. culprit-lesion-only percutaneous coronary intervention (PCI) group—on a composite outcome of cardiovascular death (CVD), myocardial infarction, and repeated revascularization. Moreover, models were further adjusted for medication at discharge. Among 1385 STEMI patients treated with primary PCI, a subgroup of 433 with MVD was analysed. At the median follow-up of 41 (IQR, 21–65) months, after propensity-score adjustment, the multivariable Cox proportional hazard analysis showed that the staged non-culprit revascularization group was associated with a lower composite endpoint (HR, 0.44; 95% CI, 0.24–0.82; P = 0.01), lower CVD (HR, 0.34; 95% CI, 0.14–0.82; P = 0.02), and lower all-cause death (HR, 0.46; 95% CI, 0.24–0.86; P = 0.02). Use of renin–angiotensin inhibitors was associated with lower CVD (HR, 0.51; 95% CI, 0.27–0.95; P = 0.03), and both renin–angiotensin inhibitors (HR, 0.52; 95% CI, 0.32–0.86; P = 0.01) and beta blockers (HR, 0.48; 95% CI, 0.29–0.79; P = 0.01) were associated with lower all-cause death.
Conclusions
In a real-word STEMI population with multivessel disease, staged non-culprit revascularization was associated with lower cardiovascular mortality compared with a culprit-only PCI strategy. However, both revascularization and medical therapy played a role in the improvement of mortality outcomes. Medical therapy amplified the benefit of myocardial revascularization.
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Affiliation(s)
- Enrico Fabris
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano Isontina e Università di Trieste, Trieste, Italy
| | - Andrea Pezzato
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano Isontina e Università di Trieste, Trieste, Italy
| | - Caterina Gregorio
- Unità di Biostatistica, Dipartimento di Scienze Mediche, Università di Trieste, Trieste, Italy
| | - Giulia Barbati
- Unità di Biostatistica, Dipartimento di Scienze Mediche, Università di Trieste, Trieste, Italy
| | - Luca Falco
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano Isontina e Università di Trieste, Trieste, Italy
| | - Davide Stolfo
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano Isontina e Università di Trieste, Trieste, Italy
| | - Giancarlo Vitrella
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano Isontina e Università di Trieste, Trieste, Italy
| | - Serena Rakar
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano Isontina e Università di Trieste, Trieste, Italy
| | - Andrea Perkan
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano Isontina e Università di Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Dipartimento Cardiovascolare, Azienda Sanitaria Universitaria Giuliano Isontina e Università di Trieste, Trieste, Italy
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25
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Fabris E, Menzio S, Gregorio C, Pezzato A, Stolfo D, Aleksova A, Vitrella G, Rakar S, Perkan A, Van’t Hof AWJ, Sinagra G. 350 Effect of pre-hospital treatment for STEMI patients undergoing primary PCI. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.032] [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: 11/15/2022]
Abstract
Abstract
Aims
The appropriate timing to administer antithrombotic therapies in ST-elevation myocardial infarction (STEMI) remains uncertain. This study aims to evaluate the role of antithrombotic therapy administration at first medical contact (FMC) compared to the administration in the Cathlab.
Methods and results
We conducted a ‘before-after’ observational study enrolling STEMI undergoing primary percutaneous coronary intervention (PCI). Outcomes were evaluated during two successive periods, before (control group: aspirin only at FMC) and after (pre-treated intervention group: heparin, aspirin plus ticagrelor at FMC) the introduction of a new regional pre-treatment protocol. 537 consecutive patients (300 in control vs. 237 in intervention group) were enrolled. The pre-treated compared to no pre-treated population showed better basal reperfusion, expressed as basal thrombolysis in myocardial Infarction (TIMI)-flow (p for trend P < 0.001). Pre-treated population showed lower frequency of TIMI 0 (56.5% vs. 73.7%, OR: 0.46, 95% CI: 0.32–0.67, P < 0.001) and higher frequency of TIMI 2–3 (33.3% vs. 19.7%; OR: 2.0; 95% CI: 1.38–2.00, P < 0.001) and TIMI 3 [14.3% vs. 9.7%, OR: 1.56, 95% CI: (0.92–2.65), P = 0.094]. Pre-treated compared to no pre-treated population showed reduced infarct size expressed as Troponin Peak [20 286 (8726–75027) vs. 48 676 (17229–113900), P = 0.001], and higher left ventricular ejection fraction at discharge [53% (44–59) vs. 50% (44–56), P = 0.027]. In-Hospital BARC ≥2 bleeding were similar (2.1% vs. 2.0%, P = 0.929, in pre-treated vs. no pre-treated population, respectively).
Conclusions
This study provides support for an early pre-treatment strategy in STEMI patients and confirmed the importance of an efficient organization of STEMI networks which allow initiation of antithrombotic treatment at FMC.
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Affiliation(s)
- Enrico Fabris
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
| | - Sara Menzio
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
| | - Caterina Gregorio
- Department of Medical Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy
| | - Andrea Pezzato
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
| | - Aneta Aleksova
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
| | - Giancarlo Vitrella
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
| | - Serena Rakar
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
| | - Andrea Perkan
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
| | - Arnoud W. J Van’t Hof
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Gianfranco Sinagra
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
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Fabris E, Pezzato A, Gregorio C, Barbati G, Falco L, Albani S, Stolfo D, Vitrella G, Rakar S, Perkan A, Sinagra G. STEMI and Multivessel Disease: Medical Therapy Amplifies the Benefit of Complete Myocardial Revascularisation. Heart Lung Circ 2021; 30:1846-1853. [PMID: 34393047 DOI: 10.1016/j.hlc.2021.06.522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/27/2020] [Revised: 04/13/2021] [Accepted: 06/24/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients with ST-elevation myocardial infarction (STEMI) with multivessel disease (MVD) may be treated with different revascularisation strategies. However, the potential predictors of outcomes on top of different revascularisation strategies are poorly studied. This study aimed to evaluate the prognostic impact of two different revascularisation strategies and the potential impact of medical therapy. METHODS Using a propensity score approach, the impact of two treatment strategies was analysed -staged non-culprit revascularisation group vs culprit-lesion-only percutaneous coronary intervention (PCI) group -- on a composite outcome of cardiovascular death (CVD), myocardial infarction, and repeated revascularisation. Moreover, models were further adjusted for medication at discharge. RESULTS Among 1,385 STEMI patients treated with primary PCI, a subgroup of 433 with MVD was analysed. At the median follow-up of 41 (IQR, 21-65) months, after propensity-score adjustment, the multivariable Cox proportional hazard analysis showed that the staged non-culprit revascularisation group was associated with a lower composite endpoint (HR, 0.44; 95% CI, 0.24-0.82; p=0.01), lower CVD (HR, 0.34; 95% CI, 0.14-0.82; p=0.02), and lower all-cause death (HR, 0.46; 95% CI, 0.24-0.86; p=0.02). Use of renin-angiotensin inhibitors was associated with lower CVD (HR, 0.51; 95% CI, 0.27-0.95; p=0.03), and both renin-angiotensin inhibitors (HR, 0.52; 95% CI, 0.32-0.86; p=0.01) and beta blockers (HR, 0.48; 95% CI, 0.29-0.79; p=0.01) were associated with lower all-cause death. CONCLUSIONS In a real-word STEMI population with multivessel disease, staged non-culprit revascularisation was associated with lower cardiovascular mortality compared with a culprit-only PCI strategy. However, both revascularisation and medical therapy played a role in the improvement of mortality outcomes. Medical therapy amplified the benefit of myocardial revascularisation.
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Affiliation(s)
- Enrico Fabris
- Cardiovascular Department, University of Trieste, Trieste, Italy.
| | - Andrea Pezzato
- Cardiovascular Department, University of Trieste, Trieste, Italy
| | - Caterina Gregorio
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Luca Falco
- Cardiovascular Department, University of Trieste, Trieste, Italy
| | - Stefano Albani
- Cardiovascular Department, University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardiovascular Department, University of Trieste, Trieste, Italy
| | | | - Serena Rakar
- Cardiovascular Department, University of Trieste, Trieste, Italy
| | - Andrea Perkan
- Cardiovascular Department, University of Trieste, Trieste, Italy
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27
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Wagensveld IM, Blokker BM, Pezzato A, Wielopolski PA, Renken NS, von der Thüsen JH, Krestin GP, Hunink MGM, Oosterhuis JW, Weustink AC. Diagnostic accuracy of postmortem computed tomography, magnetic resonance imaging, and computed tomography-guided biopsies for the detection of ischaemic heart disease in a hospital setting. Eur Heart J Cardiovasc Imaging 2019; 19:739-748. [PMID: 29474537 DOI: 10.1093/ehjci/jey015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/15/2018] [Indexed: 11/12/2022] Open
Abstract
Aims The autopsy rate worldwide is alarmingly low (0-15%). Mortality statistics are important, and it is, therefore, essential to perform autopsies in a sufficient proportion of deaths. The imaging autopsy, non-invasive, or minimally invasive autopsy (MIA) can be used as an alternative to the conventional autopsy in an attempt to improve postmortem diagnostics by increasing the number of postmortem procedures. The aim of this study was to determine the diagnostic accuracy of postmortem magnetic resonance imaging (MRI), computed tomography (CT), and CT-guided biopsy for the detection of acute and chronic myocardial ischaemia. Methods and results We included 100 consecutive adult patients who died in hospital, and for whom next-of-kin gave permission to perform both conventional autopsy and MIA. The MIA consists of unenhanced total-body MRI and CT followed by CT-guided biopsies. Conventional autopsy was used as reference standard. We calculated sensitivity and specificity and receiver operating characteristics curves for CT and MRI as the stand-alone test or combined with biopsy for detection of acute and chronic myocardial infarction (MI). Sensitivity and specificity of MRI with biopsies for acute MI was 0.97 and 0.95, respectively and 0.90 and 0.75, respectively for chronic MI. MRI without biopsies showed a high specificity (acute: 0.92; chronic: 1.00), but low sensitivity (acute: 0.50; chronic: 0.35). CT (total Agatston calcium score) had a good diagnostic value for chronic MI [area under curve (AUC) 0.74, 95% confidence interval (CI) 0.64-0.84], but not for acute MI (AUC 0.60, 95% CI 0.48-0.72). Conclusion We found that the combination of MRI with biopsies had high sensitivity and specificity for the detection of acute and chronic myocardial ischaemia.
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Affiliation(s)
- Ivo M Wagensveld
- Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands.,Department of Pathology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Britt M Blokker
- Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands.,Department of Pathology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Andrea Pezzato
- Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands
| | - Piotr A Wielopolski
- Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands
| | - Nomdo S Renken
- Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands
| | - Jan H von der Thüsen
- Department of Pathology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands
| | - M G Myriam Hunink
- Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands.,Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, Boston, 02115 MA, USA
| | - J Wolter Oosterhuis
- Department of Pathology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Annick C Weustink
- Department of Radiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CD, Rotterdam, The Netherlands.,Department of Pathology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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Tam E, Bruseghini P, Capelli C, Oliboni E, Pezzato A, Pogliaghi S, Pozzi Mucelli R, Schena F, Calabria E. Effect of Endurance and Strength Training on the Slow Component of O 2 Kinetics in Elderly Humans. Front Physiol 2018; 9:1353. [PMID: 30356819 PMCID: PMC6190757 DOI: 10.3389/fphys.2018.01353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 06/21/2018] [Accepted: 09/07/2018] [Indexed: 11/13/2022] Open
Abstract
We compared the effects of 8 weeks of high intensity, aerobic interval training (HIT) and isoinertial resistance training (IRT) on: (i) O2 kinetics during heavy (HiEx) intensity exercise and; (ii) work economy during moderate (ModEx) intensity exercise in 12 healthy elderly men (69.3 ± 4.2 years). Breath-by-breath O2 and muscle deoxygenation ([HHb] by means of NIRS) were measured in HiEx and ModEx at identical workloads before and after trainings. In HiEx, O2 and HHb responses were modeled as tri-exponential and mono-exponential increasing functions, respectively. A two-way ANOVA for repeated measures analysis was made; Effect size (η2) was also evaluated. After HIT the amplitude and the time delay of the slow component of O2 uptake (O2sc) during HiEx were smaller (−32%; P = 0.045) and longer (+19.5%; P = 0.001), respectively. At Post IRT: (i) during ModEx, gain was lower (−5%; P = 0.050); (ii) during HiEx, τ2 (+14.4%; P = 0.050), d3 (+8.6%; P = 0.050), and τ3 (+17.2%; P = 0.050) were longer than at Pre IRT. After HIT, the decrease of the O2sc amplitude was likely induced by the beneficial effects of training on a more responsive O2 delivery and consumption cascade leading to a better muscle metabolic stability. IRT training was able to increase exercise economy during ModEx and to reduce the amplitude and delay the onset of O2sc during HiEx. These effects should be due to the reduction and the delayed recruitment of Type II muscle fibers. The better exercise economy and the delayed appearance of O2sc induced by IRT suggests that strength training might be included in endurance training programs to improve exercise economy and resistance to fatigue in this population of old subjects.
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Affiliation(s)
- Enrico Tam
- Department of Neurological and Movement Sciences, School of Sport and Exercise Sciences, University of Verona, Verona, Italy
| | - Paolo Bruseghini
- Department of Neurological and Movement Sciences, School of Sport and Exercise Sciences, University of Verona, Verona, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Carlo Capelli
- Department of Neurological and Movement Sciences, School of Sport and Exercise Sciences, University of Verona, Verona, Italy.,Department of Physical Performances, Norwegian School of Sport Sciences, Oslo, Norway
| | - Eugenio Oliboni
- Institute of Radiology, School of Medicine, Policlinico "GB Rossi", Department of Pathology and Diagnostics, School of Medicine, University of Verona, Verona, Italy
| | - Andrea Pezzato
- Institute of Radiology, School of Medicine, Policlinico "GB Rossi", Department of Pathology and Diagnostics, School of Medicine, University of Verona, Verona, Italy
| | - Silvia Pogliaghi
- Department of Neurological and Movement Sciences, School of Sport and Exercise Sciences, University of Verona, Verona, Italy
| | - Roberto Pozzi Mucelli
- Institute of Radiology, School of Medicine, Policlinico "GB Rossi", Department of Pathology and Diagnostics, School of Medicine, University of Verona, Verona, Italy
| | - Federico Schena
- Department of Neurological and Movement Sciences, School of Sport and Exercise Sciences, University of Verona, Verona, Italy
| | - Elisa Calabria
- Department of Neurological and Movement Sciences, School of Sport and Exercise Sciences, University of Verona, Verona, Italy
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Blokker BM, Weustink AC, Wagensveld IM, von der Thüsen JH, Pezzato A, Dammers R, Bakker J, Renken NS, den Bakker MA, van Kemenade FJ, Krestin GP, Hunink MGM, Oosterhuis JW. Conventional Autopsy versus Minimally Invasive Autopsy with Postmortem MRI, CT, and CT-guided Biopsy: Comparison of Diagnostic Performance. Radiology 2018; 289:658-667. [PMID: 30251930 DOI: 10.1148/radiol.2018180924] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To compare the diagnostic performance of minimally invasive autopsy with that of conventional autopsy. Materials and Methods For this prospective, single-center, cross-sectional study in an academic hospital, 295 of 2197 adult cadavers (mean age: 65 years [range, 18-99 years]; age range of male cadavers: 18-99 years; age range of female cadavers: 18-98 years) who died from 2012 through 2014 underwent conventional autopsy. Family consent for minimally invasive autopsy was obtained for 139 of the 295 cadavers; 99 of those 139 cadavers were included in this study. Those involved in minimally invasive autopsy and conventional autopsy were blinded to each other's findings. The minimally invasive autopsy procedure combined postmortem MRI, CT, and CT-guided biopsy of main organs and pathologic lesions. The primary outcome measure was performance of minimally invasive autopsy and conventional autopsy in establishing immediate cause of death, as compared with consensus cause of death. The secondary outcome measures were diagnostic yield of minimally invasive autopsy and conventional autopsy for all, major, and grouped major diagnoses; frequency of clinically unsuspected findings; and percentage of answered clinical questions. Results Cause of death determined with minimally invasive autopsy and conventional autopsy agreed in 91 of the 99 cadavers (92%). Agreement with consensus cause of death occurred in 96 of 99 cadavers (97%) with minimally invasive autopsy and in 94 of 99 cadavers (95%) with conventional autopsy (P = .73). All 288 grouped major diagnoses were related to consensus cause of death. Minimally invasive autopsy enabled diagnosis of 259 of them (90%) and conventional autopsy 224 (78%); 200 (69%) were found with both methods. At clinical examination, the cause of death was not suspected in 17 of the 99 cadavers (17%), and 124 of 288 grouped major diagnoses (43%) were not established. There were 219 additional clinical questions; 189 (86%) were answered with minimally invasive autopsy and 182 (83%) were answered with conventional autopsy (P = .35). Conclusion The performance of minimally invasive autopsy in the detection of cause of death was similar to that of conventional autopsy; however, minimally invasive autopsy has a higher yield of diagnoses. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Krombach in this issue.
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Affiliation(s)
- Britt M Blokker
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Annick C Weustink
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Ivo M Wagensveld
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Jan H von der Thüsen
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Andrea Pezzato
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Ruben Dammers
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Jan Bakker
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Nomdo S Renken
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Michael A den Bakker
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Folkert J van Kemenade
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - Gabriel P Krestin
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - M G Myriam Hunink
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
| | - J Wolter Oosterhuis
- From the Departments of Pathology (B.M.B., A.C.W., I.M.W., J.H.v.d.T., M.A.d.B., F.J.v.K., J.W.O.), Radiology and Nuclear Medicine (B.M.B., A.C.W., I.M.W., A.P., G.P.K., M.G.M.H., J.W.O.), Neurosurgery, Brain Tumor Center (R.D.), Intensive Care Adults (J.B.), and Clinical Epidemiology (M.G.M.H.), Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Mass (M.G.M.H.); Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, NY (J.B.); Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands (N.S.R.); and Department of Pathology, Maasstad Ziekenhuis, Rotterdam, the Netherlands (M.A.d.B.)
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Bruseghini P, Calabria E, Tam E, Milanese C, Oliboni E, Pezzato A, Pogliaghi S, Salvagno GL, Schena F, Mucelli RP, Capelli C. Effects of eight weeks of aerobic interval training and of isoinertial resistance training on risk factors of cardiometabolic diseases and exercise capacity in healthy elderly subjects. Oncotarget 2016; 6:16998-7015. [PMID: 26046575 PMCID: PMC4627287 DOI: 10.18632/oncotarget.4031] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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: 05/06/2015] [Accepted: 05/14/2015] [Indexed: 02/05/2023] Open
Abstract
We investigated the effect of 8 weeks of high intensity interval training (HIT) and isoinertial resistance training (IRT) on cardiovascular fitness, muscle mass-strength and risk factors of metabolic syndrome in 12 healthy older adults (68 yy ± 4). HIT consisted in 7 two-minute repetitions at 80%–90% of V˙O2max, 3 times/w. After 4 months of recovery, subjects were treated with IRT, which included 4 sets of 7 maximal, bilateral knee extensions/flexions 3 times/w on a leg-press flywheel ergometer. HIT elicited significant: i) modifications of selected anthropometrical features; ii) improvements of cardiovascular fitness and; iii) decrease of systolic pressure. HIT and IRT induced hypertrophy of the quadriceps muscle, which, however, was paralleled by significant increases in strength only after IRT. Neither HIT nor IRT induced relevant changes in blood lipid profile, with the exception of a decrease of LDL and CHO after IRT. Physiological parameters related with aerobic fitness and selected body composition values predicting cardiovascular risk remained stable during detraining and, after IRT, they were complemented by substantial increase of muscle strength, leading to further improvements of quality of life of the subjects.
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Affiliation(s)
- Paolo Bruseghini
- School of Sport and Exercise Sciences, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Elisa Calabria
- School of Sport and Exercise Sciences, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Enrico Tam
- School of Sport and Exercise Sciences, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Milanese
- School of Sport and Exercise Sciences, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Eugenio Oliboni
- Institute of Radiology, School of Medicine, Policlinico "GB Rossi", Department of Pathology and Diagnostics, School of Medicine, University of Verona, Verona, Italy
| | - Andrea Pezzato
- Institute of Radiology, School of Medicine, Policlinico "GB Rossi", Department of Pathology and Diagnostics, School of Medicine, University of Verona, Verona, Italy
| | - Silvia Pogliaghi
- School of Sport and Exercise Sciences, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Gian Luca Salvagno
- Section of Clinical Chemistry, School of Medicine Policlinico "GB Rossi", Department of Life and Reproduction Sciences, School of Medicine, University of Verona, Verona, Italy
| | - Federico Schena
- School of Sport and Exercise Sciences, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Roberto Pozzi Mucelli
- Institute of Radiology, School of Medicine, Policlinico "GB Rossi", Department of Pathology and Diagnostics, School of Medicine, University of Verona, Verona, Italy
| | - Carlo Capelli
- School of Sport and Exercise Sciences, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
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Malagò R, Pezzato A, Barbiani C, Tavella D, Vallerio P, Pasini AF, Cominacini L, Mucelli RP. Role of MDCT coronary angiography in the clinical setting: economic implications. Radiol Med 2013; 118:1294-308. [PMID: 23716289 DOI: 10.1007/s11547-013-0933-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Accepted: 02/14/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE This study evaluated the incremental value and cost-effectiveness ratio of introducing coronary angiography (CA) with multidetector computed tomography (MDCT-CA) in the diagnostic management of patients with suspected coronary artery disease (CAD) compared with the traditional diagnostic workup. MATERIAL AND METHODS Five hundred and fifty consecutive patients who underwent MDCT-CA between January 2009 and June 2011 were considered. Patients with atypical chest pain and suspected obstructive CAD were directed to one of two diagnostic pathways: the traditional protocol (examination, stress test, CA) and the current protocol (examination, stress test, MDCT-CA, and CA, if necessary). The costs of each protocol and for the individual method were calculated. Based on the results, the cost-effectiveness ratio of the two diagnostic pathways was compared. A third, modified, diagnostic pathway has been proposed with its relative cost-effectiveness ratio (examination, MDCT-CA, stress test, and CA, if necessary). RESULTS Stress test vs. MDCT-CA had an accuracy of 66%, a sensitivity and specificity of 21% and 87%, respectively, and a positive (PPV) and negative (NPV) predictive value of 40% and 70%, respectively. Comparison between conventional CA (CCA) and MDCT-CA showed a sensitivity and specificity of 92% and 89%, respectively, a PPV and NPV of 89%, and an accuracy of 92%. The traditional protocol has higher costs than the second protocol: 1,645 euro against 322 euro (mean), but it shows a better cost-effectiveness ratio. The new proposed protocol has lower costs, mean 261 euro, with a better costeffectiveness ratio than the traditional protocol. CONCLUSIONS The diagnostic protocol for patients with suspected CAD has been modified by the introduction of MDCT-CA. Our study confirms the greater diagnostic performance of MDCT-CA compared with stress test and its similar accuracy to CCA. The use of MDCT-CA to select patients for CCA has a favourable cost-effectiveness profile.
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Affiliation(s)
- Roberto Malagò
- Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy,
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Malagò R, Pezzato A, Barbiani C, Alfonsi U, D'Onofrio M, Tavella D, Benussi P, Pozzi Mucelli R. Role of coronary angiography MDCT in the clinical setting: changes in diagnostic workup in the real world. Radiol Med 2012; 117:939-52. [PMID: 22744347 DOI: 10.1007/s11547-012-0842-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 08/30/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE The authors sought to evaluate the incremental value of introducing coronary angiography with multidetector computed tomography (MDCT-CA) compared with the conventional diagnostic workup in managing patients with suspected coronary artery disease (CAD) workup. MATERIALS AND METHODS A total of 531 consecutive patients underwent MDCT-CA between April 2008 and August 2010. For each patient the pretest probability of CAD was obtained by using the Morise score as well as the diagnostic performance of the exercise test and of MDCT-CA, considering conventional coronary angiography (CCA) as the gold standard. Based on these results, we calculated the posttest likelihood of CAD after stress testing, comparing the incremental diagnostic value for each category of cardiovascular risk with data obtained with MDCT-CA. The conventional diagnostic workup (without MDCT-CA) was then compared with the modified workup (including MDCT-CA). RESULTS The diagnostic performance of the exercise test for identifying patients with significant lesions had a sensitivity and specificity of 20% and 88%, respectively, with positive (PPV) and negative (NPV) predictive value of 41% and 72%, respectively. Taking CA as the gold standard, MDCT-CA had 93% sensitivity, 89% specificity, 88% PPV and 93% NPV compared with CCA in evaluating significant stenoses in the per-patient analysis. The overall diagnostic accuracy of MDCT-CA was 91%. The exercise tests provided no significant incremental diagnostic value compared with cardiovascular history in patients with a low to intermediate risk. Comparison of the diagnostic accuracy of these protocols showed improved performance results for the modified protocol. CONCLUSIONS MDCT-CA is the reference modality for the noninvasive exclusion of critical CAD. It provides a very high incremental diagnostic value compared with exercise testing in patients with a low to intermediate risk of CAD. The use of diagnostic protocols based on MDCT-CA ensures improved diagnostic performance compared with those involving conventional exercise electrocardiograms.
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Affiliation(s)
- R Malagò
- Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata di Verona Policlinico G.B. Rossi, Piazzzale L.A. Scuro 10, Verona, Italy.
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Malagò R, Pezzato A, Barbiani C, Sala G, Zamboni GA, Tavella D, Mucelli RP. Non invasive cardiac vein mapping: role of multislice CT coronary angiography. Eur J Radiol 2012; 81:3262-9. [PMID: 22480417 DOI: 10.1016/j.ejrad.2012.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 03/01/2012] [Accepted: 03/05/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE Coronary venous anatomy is of primary importance when implanting a cardiac resynchronization therapy device, besides, the coronary sinus can be differently enlarged depending on chronic heart failure. The aim of this study is to evaluate the usefulness of Coronary CTA in describing the coronary venous tree and in particular the coronary sinus and detecting main venous system variants. MATERIALS AND METHODS 301 consecutive patients (196 ♂, mean age 63.74 years) studied for coronary artery disease with 64 slice Coronary CTA were retrospectively examined. The acquisition protocol was the standard acquisition one used for coronary artery evaluation but the cardiac venous system were visualized. The cardiac venous system was depicted using 3D, MPR, cMPR and MIP post-processing reconstructions on an off-line workstation. For each patient image quality, presence and caliber of the coronary sinus (CS), great cardiac vein (GCV), middle vein (MV), anterior interventricular vein (AIV), lateral cardiac vein (LCV), posterior cardiac vein (PCV), small cardiac vein (SCV) and presence of variant of the normal anatomy were examined and recorded. RESULTS CS, GCV, MV and AIV were visualized in 100% of the cases. The LCV was visualized in 255/301 (84%) patients, the PCV in 248/301 (83%) patients and the SCV in 69/301 (23%) patients. Mean diameter of the CS was 8.7 mm in 276/301 (91.7%) patients without chronic heart failure and 9.93 mm in 25/301 (8.3%) patients with chronic heart failure. CONCLUSIONS Coronary CTA allows non invasive mapping of the cardiac venous system and may represent a useful presurgical tool for biventricular pacemaker devices implantation.
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Affiliation(s)
- Roberto Malagò
- Radiology Department, University Hospital Policlinico G.B.Rossi, P.le L.A. Scuro 10, 37134 Verona, Italy.
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Malagò R, Pezzato A, Barbiani C, Mantovani W, Caliari G, Alfonsi U, Tavella D, Mucelli RP. Comparison between different kernel reformatting filters in 3D quantitative analysis of MDCT coronary angiography. Radiol Med 2011; 116:1203-16. [PMID: 21892715 DOI: 10.1007/s11547-011-0719-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 01/26/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE Coronary angiography with multidetector-row computed tomography (MDCT-CA) allows quantification of coronary artery stenosis with a high level of accuracy; however, a better estimation of stenosis can be achieved by using appropriate reformatting filters, especially in stents and calcified segments. Quantitative computed tomography angiography (QCTA) is intended to overcome the limitations of the visual score. The aim of this study was to evaluate the accuracy of QCTA with different filters in comparison with quantitative coronary angiography (QCA) and visual score. MATERIALS AND METHODS Two blinded operators visually scored 17 consecutive patients referred for MDCT-CA with a per-segment analysis. The degree of stenosis was classified as 0-20%, 20-50% (wall irregularities), 50-70% (significant disease) and 70-100% (vessel occlusion). Each segment was then analysed using the electronic callipers of the QCTA system with 15 different filters. No contour editing was performed. Data were compared with QCA and conventional coronary angiography (CCA). Comparison between QCTA, visual score and QCA were performed using Spearman's rank correlation. RESULTS Of 25 segments analysed (mean 1.4 diseased segment per patient), 375 measurements were considered. Good correlation was found between the visual score and QCA [Pearson correlation coefficient (rho=0.852; p<0.0001)] and between QCA and CCA (rho=0.804; p<0.0001). Moderate correlation was found between QCA and QCTA only using two filters (rho=0.444; p<0.0001 for YA filter and rho=0.450; p<0.0001 for YB filter). CONCLUSIONS Overall QCTA accuracy is low if contour editing is not applied, especially in calcified vessels. Certain filters can help to better estimate the exact percentage of stenosis.
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Affiliation(s)
- R Malagò
- Department of Radiology, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134, Verona, Italy.
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Malagò R, Tavella D, Mantovani W, D’Onofrio M, Caliari G, Pezzato A, Nicolì L, Benussi P, Pozzi Mucelli R. MDCT coronary angiography vs 2D echocardiography for the assessment of left ventricle functional parameters. Radiol Med 2011; 116:505-20. [DOI: 10.1007/s11547-011-0615-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Accepted: 03/05/2010] [Indexed: 10/18/2022]
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