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D'Amato M, Ambrosino P, Simioli F, Adamo S, Stanziola AA, D'Addio G, Molino A, Maniscalco M. A machine learning approach to characterize patients with asthma exacerbation attending an acute care setting. Eur J Intern Med 2022; 104:66-72. [PMID: 35922367 DOI: 10.1016/j.ejim.2022.07.019] [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: 05/24/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND One of the main problems in poorly controlled asthma is the access to the Emergency Department (ED). Using a machine learning (ML) approach, the aim of our study was to identify the main predictors of severe asthma exacerbations requiring hospital admission. METHODS Consecutive patients with asthma exacerbation were screened for inclusion within 48 hours of ED discharge. A k-means clustering algorithm was implemented to evaluate a potential distinction of different phenotypes. K-Nearest Neighbor (KNN) as instance-based algorithm and Random Forest (RF) as tree-based algorithm were implemented in order to classify patients, based on the presence of at least one additional access to the ED in the previous 12 months. RESULTS To train our model, we included 260 patients (31.5% males, mean age 47.6 years). Unsupervised ML identified two groups, based on eosinophil count. A total of 86 patients with eosinophiles ≥370 cells/µL were significantly older, had a longer disease duration, more restrictions to daily activities, and lower rate of treatment compared to 174 patients with eosinophiles <370 cells/μL. In addition, they reported lower values of predicted FEV1 (64.8±12.3% vs. 83.9±17.3%) and FEV1/FVC (71.3±9.3 vs. 78.5±6.8), with a higher amount of exacerbations/year. In supervised ML, KNN achieved the best performance in identifying frequent exacerbators (AUROC: 96.7%), confirming the importance of spirometry parameters and eosinophil count, along with the number of prior exacerbations and other clinical and demographic variables. CONCLUSIONS This study confirms the key prognostic value of eosinophiles in asthma, suggesting the usefulness of ML in defining biological pathways that can help plan personalized pharmacological and rehabilitation strategies.
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Affiliation(s)
- Maria D'Amato
- Department of Respiratory Medicine, Federico II University, Naples, Italy.
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, Telese Terme, Italy
| | - Francesca Simioli
- Department of Respiratory Medicine, Federico II University, Naples, Italy
| | - Sarah Adamo
- Department of Information Technology and Electrical Engineering, University of Naples "Federico II", Napoli, Italy
| | | | - Giovanni D'Addio
- Istituti Clinici Scientifici Maugeri IRCCS, Bioengineering Unit of Telese Terme Institute, Telese Terme, Italy
| | - Antonio Molino
- Department of Respiratory Medicine, Federico II University, Naples, Italy
| | - Mauro Maniscalco
- Department of Respiratory Medicine, Federico II University, Naples, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, Telese Terme, Italy.
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Stanziola AA, Salzano A, D’Angelo R, Marra AM, Gallotti L, D’Assante R, Pentangelo D, Ranieri B, Bossone E, Cittadini A. Idiopathic pulmonary fibrosis telemedicine management during COVID-19 outbreak. Open Med (Wars) 2022; 17:689-693. [PMID: 35480400 PMCID: PMC8990874 DOI: 10.1515/med-2022-0466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 02/21/2022] [Accepted: 03/09/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
The present report investigates the impact of a Telemedicine Service (TMS) on the management of Idiopathic Pulmonary Fibrosis (IPF) during coronavirus disease of 2019 (COVID-19) outbreak in Italy. The TMS comprised 3 phone numbers, active 12 h per day, and an email address, monitored every 4 h by trained physicians; chat- and videoconference-services were also offered. At the end of the study period, our staff contacted all patients, to get information about the final outcome (i.e. composite hospitalisations/all causes of death). Outcomes were compared with a cohort of patients who attended our unit in the same period of the previous year (when no TMS was available). 189 patients participated in the present study. From 11th March to 4th May 2020, 61% of patients made at least one TMS access, mostly by emails (53%), followed by phone calls (33%). With regard to the primary outcome, TMS patients experienced a significant lower rate of events of the 182 patients of the no-TMS cohort (p < 0.001). Specifically, a significant difference was observed for IPF hospitalisation (p < 0.001) whereas no differences were observed with regard to deaths (p = 0.64). TMS permits patients to be followed up even during COVID-19 lockdown, with an encouraging impact on outcomes.
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Affiliation(s)
- Anna Agnese Stanziola
- Section of Respiratory Disease, Department of Clinical Medicine and Surgery, Monaldi Hospital, Federico II University , 80131 Naples , Italy
| | - Andrea Salzano
- IRCCS Synlab SDN, Diagnostic and Nuclear Research Institute , 80143, Naples , Italy
| | - Rossella D’Angelo
- Section of Respiratory Disease, Department of Clinical Medicine and Surgery, Monaldi Hospital, Federico II University , 80131 Naples , Italy
| | - Alberto Maria Marra
- Department of Translational Medical Sciences, Federico II University , Naples , Italy
| | - Lorena Gallotti
- Section of Respiratory Disease, Department of Clinical Medicine and Surgery, Monaldi Hospital, Federico II University , 80131 Naples , Italy
| | - Roberta D’Assante
- Department of Translational Medical Sciences, Federico II University , Naples , Italy
| | - Danilo Pentangelo
- Section of Respiratory Disease, Department of Clinical Medicine and Surgery, Monaldi Hospital, Federico II University , 80131 Naples , Italy
| | - Brigida Ranieri
- IRCCS Synlab SDN, Diagnostic and Nuclear Research Institute , 80143, Naples , Italy
| | - Eduardo Bossone
- Department of Cardiology, AORN A Cardarelli , Naples , Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University , Naples , Italy
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Vriz O, Palatini P, Rudski L, Frumento P, Kasprzak JD, Ferrara F, Cocchia R, Gargani L, Wierzbowska-Drabik K, Capone V, Ranieri B, Salzano A, Stanziola AA, Marra AM, Annunziata R, Chianese S, Rega S, Saltalamacchia T, Maramaldi R, Sepe C, Limongelli G, Cademartiri F, D’Andrea A, D’Alto M, Izzo R, Ferrara N, Mauro C, Cittadini A, Ekkehard G, Guazzi M, Bossone E. Right Heart Pulmonary Circulation Unit Response to Exercise in Patients with Controlled Systemic Arterial Hypertension: Insights from the RIGHT Heart International NETwork (RIGHT-NET). J Clin Med 2022; 11:jcm11020451. [PMID: 35054145 PMCID: PMC8778233 DOI: 10.3390/jcm11020451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background. Systemic arterial hypertension (HTN) is the main risk factor for the development of heart failure with preserved ejection fraction (HFpEF). The aim of the study was was to assess the trends in PASP, E/E’ and TAPSE during exercise Doppler echocardiography (EDE) in hypertensive (HTN) patients vs. healthy subjects stratified by age. Methods. EDE was performed in 155 hypertensive patients and in 145 healthy subjects (mean age 62 ± 12.0 vs. 54 ± 14.9 years respectively, p < 0.0001). EDE was undertaken on a semi-recumbent cycle ergometer with load increasing by 25 watts every 2 min. Left ventricular (LV) and right ventricular (RV) dimensions, function and hemodynamics were evaluated. Results. Echo-Doppler parameters of LV and RV function were lower, both at rest and at peak exercise in hypertensives, while pulmonary hemodynamics were higher as compared to healthy subjects. The entire cohort was then divided into tertiles of age: at rest, no significant differences were recorded for each age group between hypertensives and normotensives except for E/E’ that was higher in hypertensives. At peak exercise, hypertensives had higher pulmonary artery systolic pressure (PASP) and E/E’ but lower tricuspid annular plane systolic excursion (TAPSE) as age increased, compared to normotensives. Differences in E/E’ and TAPSE between the 2 groups at peak exercise were explained by the interaction between HTN and age even after adjustment for baseline values (p < 0.001 for E/E’, p = 0.011 for TAPSE). At peak exercise, the oldest group of hypertensive patients had a mean E/E’ of 13.0, suggesting a significant increase in LV diastolic pressure combined with increased PASP. Conclusion. Age and HTN have a synergic negative effect on E/E’ and TAPSE at peak exercise in hypertensive subjects.
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Affiliation(s)
- Olga Vriz
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia;
- School of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Paolo Palatini
- Department of Medicine, University of Padova, 35122 Padova, Italy;
| | - Lawrence Rudski
- Azrieli Heart Center and Center for Pulmonary Vascular Diseases, Jewish General Hospital, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, 56126 Pisa, Italy;
| | - Jarosław D. Kasprzak
- Department of Cardiology, Bieganski Hospital, Medical University, 91-347 Lodz, Poland; (J.D.K.); (K.W.-D.)
| | - Francesco Ferrara
- Heart Department, University Hospital of Salerno, 84131 Salerno, Italy;
| | - Rosangela Cocchia
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (R.C.); (V.C.); (R.A.); (S.C.); (C.S.)
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (L.G.); (C.M.)
| | - Karina Wierzbowska-Drabik
- Department of Cardiology, Bieganski Hospital, Medical University, 91-347 Lodz, Poland; (J.D.K.); (K.W.-D.)
| | - Valentina Capone
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (R.C.); (V.C.); (R.A.); (S.C.); (C.S.)
| | - Brigida Ranieri
- IRCCS Synlab SDN, 80143 Naples, Italy; (B.R.); (A.S.); (F.C.)
| | - Andrea Salzano
- IRCCS Synlab SDN, 80143 Naples, Italy; (B.R.); (A.S.); (F.C.)
| | - Anna Agnese Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University “Federico II”, 80131 Naples, Italy;
| | - Alberto Maria Marra
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80138 Naples, Italy; (A.M.M.); (S.R.); (T.S.); (R.M.); (N.F.); (A.C.)
| | - Roberto Annunziata
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (R.C.); (V.C.); (R.A.); (S.C.); (C.S.)
| | - Salvatore Chianese
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (R.C.); (V.C.); (R.A.); (S.C.); (C.S.)
| | - Salvatore Rega
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80138 Naples, Italy; (A.M.M.); (S.R.); (T.S.); (R.M.); (N.F.); (A.C.)
| | - Teresa Saltalamacchia
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80138 Naples, Italy; (A.M.M.); (S.R.); (T.S.); (R.M.); (N.F.); (A.C.)
| | - Renato Maramaldi
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80138 Naples, Italy; (A.M.M.); (S.R.); (T.S.); (R.M.); (N.F.); (A.C.)
| | - Chiara Sepe
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (R.C.); (V.C.); (R.A.); (S.C.); (C.S.)
| | - Giuseppe Limongelli
- Division of Cardiology, Monaldi Hospital, Second University of Naples, 81100 Naples, Italy; (G.L.); (M.D.)
| | | | - Antonello D’Andrea
- Department of Cardiology and Intensive Coronary Unit, “Umberto I” Hospital, 84014 Nocera Inferiore, Italy;
| | - Michele D’Alto
- Division of Cardiology, Monaldi Hospital, Second University of Naples, 81100 Naples, Italy; (G.L.); (M.D.)
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80131 Naples, Italy;
| | - Nicola Ferrara
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80138 Naples, Italy; (A.M.M.); (S.R.); (T.S.); (R.M.); (N.F.); (A.C.)
| | - Ciro Mauro
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (L.G.); (C.M.)
| | - Antonio Cittadini
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80138 Naples, Italy; (A.M.M.); (S.R.); (T.S.); (R.M.); (N.F.); (A.C.)
| | - Grünig Ekkehard
- Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), 69120 Heidelberg, Germany;
| | - Marco Guazzi
- Heart Failure Unit, Cardiopulmonary Laboratory, University Cardiology Department, IRCCS Policlinico San Donato University Hospital, 20097 Milan, Italy;
| | - Eduardo Bossone
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (R.C.); (V.C.); (R.A.); (S.C.); (C.S.)
- Correspondence:
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Caminati M, Camiciottoli G, Baiardini I, Antonicelli L, Beghè B, Crimi N, Favero E, Stanziola AA, Valenti G, Visca D, Del Giacco S. Patients and doctors group meetings: an innovative way to explore severe asthma backstage. Multidiscip Respir Med 2022; 17:854. [PMID: 36158780 PMCID: PMC9491102 DOI: 10.4081/mrm.2022.854] [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: 04/15/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022] Open
Abstract
Severe asthma patients' life is heavily influenced by the disease, which has impact on personal and professional choices or general lifestyle. Despite the available tools to help physicians investigating the patient-reported outcomes there is a need for a more standardised and structured approach to include the evaluation of quality of life together with the emotions of patients into the routine clinical interaction. We hereby report the use of an active listening and insight approach to understand the emotions of patients with severe asthma through dedicated in-person meetings involving a group of patients with their doctors, caregivers and an external moderator. The initiative "Patients insight meeting" was organized within 17 specialist referral centres for severe asthma in Italy in 2019 and involved 149 patients. Insights related to 4 different items were collected and a task force composed by the external moderators produced a general report including the suggestions from the participating centres. This experience of group-meetings involving both patients and doctors together represents an innovative way to investigate real life experience and the emotions of asthmatic patients, highlighting unmet needs related to patient's experience of his/her disease that need to be included in severe asthmatics' management strategy.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, Allergy and Clinical Immunology Section, University of Verona
| | - Gianna Camiciottoli
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence.,Cardio-Thoraco-Vascular Department, AOUC Azienda Ospedaliero-Universitaria Careggi, Florence
| | - Ilaria Baiardini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI)
| | | | - Bianca Beghè
- Department of Medicine, Section of Respiratory Diseases, University of Modena and Reggio Emilia, Modena
| | - Nunzio Crimi
- Respiratory Medicine Unit, AOU "Policlinico-Vittorio Emanuele" and Department of Clinical and Experimental Medicine, University of Catania
| | - Elisabetta Favero
- Department of Medicine-DIMED, Immunological and Respiratory Rare Disease, Allergy Clinic Ca' Foncello Hospital, Treviso
| | | | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo
| | - Dina Visca
- Department of Medicine and Surgery, University of Insubria, Varese and Department of Medicine and Cardiopulmonary Rehabilitation, ICS Maugeri IRCCS, Institute of Tradate (VA)
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato-Cagliari, Italy
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5
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Vriz O, Veldman G, Gargani L, Ferrara F, Frumento P, D'Alto M, D'Andrea A, Radaan SA, Cocchia R, Marra AM, Ranieri B, Salzano A, Stanziola AA, Voilliot D, Agoston G, Cademartiri F, Cittadini A, Kasprzak JD, Grünig E, Bandera F, Guazzi M, Rudski L, Bossone E. Age-changes in right ventricular function-pulmonary circulation coupling: from pediatric to adult stage in 1899 healthy subjects. The RIGHT Heart International NETwork (RIGHT-NET). Int J Cardiovasc Imaging 2021; 37:3399-3411. [PMID: 34227030 DOI: 10.1007/s10554-021-02330-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/25/2021] [Indexed: 01/30/2023]
Abstract
The present study analyzes age-specific changes in RV function and RV-PA coupling in a large cohort of apparently healthy subjects with a wide age-range, to identify reference values and to study the influence of clinical and echocardiographic cofactors. 1899 Consecutive healthy subjects underwent a standardized transthoracic echocardiographic examination. Tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (SPAP) were measured. Ventriculo-arterial coupling was then inferred from the TAPSE/SPAP ratio. A quantile regression analysis was used to estimate quantiles 0.05, 0.10, 0.50 (median), 0.90, and 0.95 of TAPSE, SPAP and TAPSE/SPAP. The association between age and each of these values was determined. The mean age of the group was 45.2 ± 18.5 years (range 1 to 102 years), 971 were males. SPAP increased with age, whereas TAPSE and TAPSE/SPAP ratio decreased. Upon multivariate modeling, the most significant positive associations for TAPSE were body surface area (BSA) driven by the pediatric group, stroke volume (SV), E/A and negatively heart rate and E/e' ratio. SPAP was positively associated with increasing age, SV, E/A, E/e' and negatively with BSA. TAPSE/SPAP ratio was negatively associated with age, female sex, and E/e' and positively with BSA. A preserved relationship between TAPSE and SPAP was found across the different age groups. TAPSE, SPAP and TAPSE/SPAP demonstrate important trends and associations with advancing age, impaired diastolic function, affected by female sex and BSA However the relationship between TAPSE and SPAP is relatively well preserved across the age spectrum.
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Affiliation(s)
- Olga Vriz
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Zahrawi St, Al Maather, Al Maazer, Riyadh, 12713, Saudi Arabia. .,School of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Gruschen Veldman
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Zahrawi St, Al Maather, Al Maazer, Riyadh, 12713, Saudi Arabia
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Michele D'Alto
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonello D'Andrea
- Division of Cardiology, Umberto I° Hospital Nocera Inferiore, Salerno, Italy
| | - Sarah Aldosari Radaan
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Zahrawi St, Al Maather, Al Maazer, Riyadh, 12713, Saudi Arabia
| | - Rosangela Cocchia
- Division of Cardiac Rehabilitation-Echo Lab, A Cardarelli Hospital, Naples, Italy
| | - Alberto Maria Marra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | | | - Anna Agnese Stanziola
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.,Centre for Rare Respiratory Diseases, A.O. dei Colli Monaldi Hospital, Naples, Italy
| | - Damien Voilliot
- Centre Hospitalier Lunéville, Service de Cardiologie, Lunéville, France
| | - Gergely Agoston
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | | | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Ekkehard Grünig
- Center of Pulmonary Hypertension, Thoraxklinik Heidelberg at Heidelberg University Hospital, Heidelberg, Germany
| | - Francesco Bandera
- Heart Failure Unit, Cardiopulmonary Laboratory, University Cardiology Department, IRCCS Policlinico San Donato University Hospital, Milan, Italy
| | - Marco Guazzi
- Heart Failure Unit, Cardiopulmonary Laboratory, University Cardiology Department, IRCCS Policlinico San Donato University Hospital, Milan, Italy
| | - Lawrence Rudski
- Azrieli Heart Center and Center for Pulmonary Vascular Diseases, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Eduardo Bossone
- Division of Cardiac Rehabilitation-Echo Lab, A Cardarelli Hospital, Naples, Italy
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6
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Limongelli G, Iucolano S, Monda E, Elefante P, De Stasio C, Lubrano I, Caiazza M, Mazzella M, Fimiani F, Galdo M, De Marchi G, Esposito M, Rubino M, Cirillo A, Fusco A, Esposito A, Trama U, Esposito S, Scarano G, Sepe J, Andria G, Orlando V, Menditto E, Chiodini P, Iolascon A, Franzese A, Sanduzzi Zamparelli A, Tessitore A, Romano A, Venosa A, Nunzia Olivieri A, Bianco A, La Manna A, Cerbone AM, Spasiano A, Agnese Stanziola A, Colao A, De Bellis A, Gambale A, Toriello A, Tufano A, Ciampa A, Maria Risitano A, Pisani A, Russo A, Volpe A, De Martino B, Amato B, De Fusco C, Piscopo C, Selleri C, Tucci C, Pignata C, Cioffi D, Melis D, Pasquali D, De Brasi D, Spitaleri D, De Brasi D, Russo D, Martellotta D, De Michele E, Varricchio E, Miraglia Del Giudice E, Coscioni E, Cimino E, Pane F, Tranfa F, Pollio F, Lonardo F, Nuzzi F, Simonelli F, Trojsi F, Habetswallner F, Valentini G, Cerbone G, Parenti G, Tedeschi G, Capasso G, Battista Rossi G, Gaglione G, Sarnelli G, Argenziano G, Bellastella G, De Michele G, Fiorentino G, Spadaro G, Scala I, Santoro L, Zeppa L, Auricchio L, Elio Adinolfi L, Alessio M, Amitrano M, Savanelli MC, Russo MG, Ferrucci MG, Carbone MT, Pellecchia MT, Salerno M, Melone M, Del Donno M, Vitale M, Triggiani M, Della Monica M, Lo Presti M, Tenuta M, Mignogna MD, Schiavulli M, Zacchia M, Brunetti-Pierri N, Iovino P, Moscato P, Iandoli R, Scarpa R, Russo R, Troisi S, Sbordone S, Perrotta S, Fecarotta S, Sampaolo S, Cicalese V. Diagnostic issues faced by a rare disease healthcare network during Covid-19 outbreak: data from the Campania Rare Disease Registry. J Public Health (Oxf) 2021; 44:586-594. [PMID: 33982102 PMCID: PMC8194710 DOI: 10.1093/pubmed/fdab137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/06/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 12/16/2022] Open
Abstract
Background The aims of this study were: to investigate the capacity of the rare disease healthcare network in Campania to diagnose patients with rare diseases during the outbreak of Covid-19; and to shed light on problematic diagnoses during this period. Methods To describe the impact of the Covid-19 pandemic on the diagnosis of patients with rare diseases, a retrospective analysis of the Campania Region Rare Disease Registry was performed. A tailored questionnaire was sent to rare disease experts to investigate major issues during the emergency period. Results Prevalence of new diagnoses of rare disease in March and April 2020 was significantly lower than in 2019 (117 versus 317, P < 0.001 and 37 versus 349, P < 0.001, respectively) and 2018 (117 versus 389, P < 0.001 and 37 versus 282, P < 0.001, respectively). Eighty-two among 98 rare disease experts completed the questionnaire. Diagnostic success (95%), access to diagnosis (80%) and follow-up (72%), lack of Personal Protective Equipment (60%), lack of Covid-19 guidelines (50%) and the need for home therapy (78%) were the most important issues raised during Covid-19 outbreak. Conclusions This study describes the effects of the Covid-19 outbreak on the diagnosis of rare disease in a single Italian region and investigates potential issues of diagnosis and management during this period.
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Affiliation(s)
| | - Stefano Iucolano
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Emanuele Monda
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Pasquale Elefante
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Chiara De Stasio
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Imma Lubrano
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Martina Caiazza
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | | | - Fabio Fimiani
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Maria Galdo
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Giulia De Marchi
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Martina Esposito
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Marta Rubino
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Annapaola Cirillo
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Adelaide Fusco
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Augusto Esposito
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Ugo Trama
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Salvatore Esposito
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Gioacchino Scarano
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Joseph Sepe
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Generoso Andria
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Valentina Orlando
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Enrica Menditto
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Paolo Chiodini
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
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7
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Ferrara F, Gargani L, Naeije R, Rudski L, Armstrong WF, Wierzbowska-Drabik K, Argiento P, Bandera F, Cademartiri F, Citro R, Cittadini A, Cocchia R, Contaldi C, D'Alto M, D'Andrea A, Grünig E, Guazzi M, Kolias TJ, Limongelli G, Marra AM, Mauro C, Moreo A, Ranieri B, Saggar R, Salzano A, Stanziola AA, Vriz O, Vannan M, Kasprzak JD, Bossone E. Feasibility of semi-recumbent bicycle exercise Doppler echocardiography for the evaluation of the right heart and pulmonary circulation unit in different clinical conditions: the RIGHT heart international NETwork (RIGHT-NET). Int J Cardiovasc Imaging 2021; 37:2151-2167. [PMID: 33866467 DOI: 10.1007/s10554-021-02243-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/09/2021] [Indexed: 11/29/2022]
Abstract
Exercise Doppler echocardiography (EDE) is a well-validated tool in ischemic and valvular heart diseases. However, its use in the assessment of the right heart and pulmonary circulation unit (RH-PCU) is limited. The aim of this study is to assess the semi-recumbent bicycle EDE feasibility for the evaluation of RH-PCU in a large multi-center population, from healthy individuals and elite athletes to patients with overt or at risk of developing pulmonary hypertension (PH). From January 2019 to July 2019, 954 subjects [mean age 54.2 ± 16.4 years, range 16-96, 430 women] underwent standardized semi-recumbent bicycle EDE with an incremental workload of 25 watts every 2 min, were prospectively enrolled among 7 centers participating to the RIGHT Heart International NETwork (RIGHT-NET). EDE parameters of right heart structure, function and pressures were obtained according to current recommendations. Right ventricular (RV) function at peak exercise was feasible in 903/940 (96%) by tricuspid annular plane systolic excursion (TAPSE), 667/751 (89%) by tissue Doppler-derived tricuspid lateral annular systolic velocity (S') and 445/672 (66.2%) by right ventricular fractional area change (RVFAC). RV-right atrial pressure gradient [RV-RA gradient = 4 × tricuspid regurgitation velocity2 (TRV)] was feasible in 894/954 patients (93.7%) at rest and in 816/954 (85.5%) at peak exercise. The feasibility rate in estimating pulmonary artery pressure improved to more than 95%, if both TRV and/or right ventricular outflow tract acceleration time (RVOT AcT) were considered. In high specialized echocardiography laboratories semi-recumbent bicycle EDE is a feasible tool for the assessment of the RH-PCU pressure and function.
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Affiliation(s)
- Francesco Ferrara
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni Di Dio E Ruggi D'Aragona", Salerno, Italy
| | - Luna Gargani
- Institute of Clinical Physiology - C.N.R, Pisa, Italy
| | | | - Lawrence Rudski
- Azrieli Heart Center and Center for Pulmonary Vascular Diseases, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - William F Armstrong
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | | | - Paola Argiento
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Bandera
- Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato University Hospital, Milan, Italy.,Department for Biomedical Sciences for Health, University of Milano, Milan, Italy
| | | | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni Di Dio E Ruggi D'Aragona", Salerno, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Carla Contaldi
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni Di Dio E Ruggi D'Aragona", Salerno, Italy
| | - Michele D'Alto
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital Nocera Inferiore, Nocera Inferiore, Italy
| | - Ekkehard Grünig
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA.,Center of Pulmonary Hypertension, Thoraxklinik Heidelberg at Heidelberg University Hospital, Heidelberg, Germany
| | - Marco Guazzi
- Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato University Hospital, Milan, Italy.,Department for Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Theodore John Kolias
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Giuseppe Limongelli
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alberto Maria Marra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Ciro Mauro
- Cardiology Division, A Cardarelli Hospital, Naples, Italy
| | - Antonella Moreo
- A. De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Rajan Saggar
- Lung & Heart-Lung Transplant and Pulmonary Hypertension Programs, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Andrea Salzano
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Anna Agnese Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University "Federico II", Naples, Italy
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mani Vannan
- Piedmont Heart Institute, Marcus Heart Valve Center, Atlanta, USA
| | - Jaroslaw D Kasprzak
- I Department and Chair of Cardiology, Bieganski Hospital, Medical University of Lodz, Lodz, Poland
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8
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Contaldi C, Capuano F, Romano L, Ranieri B, Ferrara F, Mirto G, Rega S, Cocchia R, Stanziola AA, Ostenfeld E, Dellegrottaglie S, Bossone E, Bonow RO. Cardiovascular Magnetic Resonance in Right Heart and Pulmonary Circulation Disorders. Heart Fail Clin 2021; 17:57-75. [PMID: 33220887 DOI: 10.1016/j.hfc.2020.08.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Right heart and pulmonary circulation disorders are generally caused by right ventricle (RV) pressure overload, volume overload, and cardiomyopathy, and they are associated with distinct clinical courses and therapeutic approaches, although they often may coexist. Cardiac magnetic resonance (CMR) provides a noninvasive accurate and reproducible multiplanar anatomic and functional assessment, tissue characterization, and blood flow evaluation of the right heart and pulmonary circulation. This article reviews the current status of the CMR, the most recent techniques, the new parameters and their clinical utility in diagnosis, prognosis, and therapeutic management in the right heart and pulmonary circulation disorders.
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Affiliation(s)
- Carla Contaldi
- Department of Cardiology, University Hospital of Salerno, Via Enrico de Marinis, Cava de' Tirreni, Salerno 84013, Italy.
| | - Francesco Capuano
- Department of Industrial Engineering, Federico II University of Naples, Via Claudio 21, Naples 80125, Italy
| | - Luigia Romano
- General and Emergency Radiology Division, A Cardarelli Hospital, Via Cardarelli 9, Naples I-80131, Italy
| | | | - Francesco Ferrara
- Department of Cardiology, University Hospital of Salerno, Via Enrico de Marinis, Cava de' Tirreni, Salerno 84013, Italy
| | - Gaetano Mirto
- Clinical Engineering Division, A Cardarelli Hospital, Via Cardarelli 9, Naples I-80131, Italy
| | - Salvatore Rega
- Medical School, Federico II University of Naples, Via Pansini 5, Naples I-80131, Italy
| | - Rosangela Cocchia
- Cardiology Division, A Cardarelli Hospital, Via Cardarelli 9, Naples I-80131, Italy
| | - Anna Agnese Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University "Federico II", Via Leonardo Bianchi, Naples 80131, Italy
| | - Ellen Ostenfeld
- Department of Medical Imaging and Physiology, Cardiac Imaging, Skåne University Hospital, Entrégatan 7, Lund 222 42, Sweden
| | - Santo Dellegrottaglie
- Division of Cardiology, Clinica Villa dei Fiori, C.so Italia 157, 80011, Acerra, Naples, Italy
| | - Eduardo Bossone
- Cardiology Division, A Cardarelli Hospital, Via Cardarelli 9, Naples I-80131, Italy
| | - Robert O Bonow
- Department of Medicine-Cardiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Arkes Suite 2330, Chicago, IL 60611, USA
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9
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Ferrara F, Gargani L, Contaldi C, Agoston G, Argiento P, Armstrong WF, Bandera F, Cademartiri F, Citro R, Cittadini A, Cocchia R, D'Alto M, D'Andrea A, Douschan P, Ghio S, Grünig E, Guazzi M, Guida S, Kasprzak JD, Kolias TJ, Limongelli G, Marra AM, Mazzola M, Mauro C, Moreo A, Pieri F, Pratali L, Pugliese NR, Raciti M, Ranieri B, Rudski L, Saggar R, Salzano A, Serra W, Stanziola AA, Vannan M, Voilliot D, Vriz O, Wierzbowska-Drabik K, Naeije R, Bossone E. A multicentric quality-control study of exercise Doppler echocardiography of the right heart and the pulmonary circulation. The RIGHT Heart International NETwork (RIGHT-NET). Cardiovasc Ultrasound 2021; 19:9. [PMID: 33472662 PMCID: PMC7819251 DOI: 10.1186/s12947-021-00238-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/13/2020] [Accepted: 01/05/2021] [Indexed: 01/17/2023] Open
Abstract
Purpose This study was a quality-control study of resting and exercise Doppler echocardiography (EDE) variables measured by 19 echocardiography laboratories with proven experience participating in the RIGHT Heart International NETwork. Methods All participating investigators reported the requested variables from ten randomly selected exercise stress tests. Intraclass correlation coefficients (ICC) were calculated to evaluate the inter-observer agreement with the core laboratory. Inter-observer variability of resting and peak exercise tricuspid regurgitation velocity (TRV), right ventricular outflow tract acceleration time (RVOT Act), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler tricuspid lateral annular systolic velocity (S’), right ventricular fractional area change (RV FAC), left ventricular outflow tract velocity time integral (LVOT VTI), mitral inflow pulsed wave Doppler velocity (E), diastolic mitral annular velocity by TDI (e’) and left ventricular ejection fraction (LVEF) were measured. Results The accuracy of 19 investigators for all variables ranged from 99.7 to 100%. ICC was > 0.90 for all observers. Inter-observer variability for resting and exercise variables was for TRV = 3.8 to 2.4%, E = 5.7 to 8.3%, e’ = 6 to 6.5%, RVOT Act = 9.7 to 12, LVOT VTI = 7.4 to 9.6%, S’ = 2.9 to 2.9% and TAPSE = 5.3 to 8%. Moderate inter-observer variability was found for resting and peak exercise RV FAC (15 to 16%). LVEF revealed lower resting and peak exercise variability of 7.6 and 9%. Conclusions When performed in expert centers EDE is a reproducible tool for the assessment of the right heart and the pulmonary circulation.
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Affiliation(s)
- Francesco Ferrara
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Luna Gargani
- Institute of Clinical Physiology, C.N.R, Pisa, Italy
| | - Carla Contaldi
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Gergely Agoston
- Department of Family Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Paola Argiento
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - William F Armstrong
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Francesco Bandera
- Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato University Hospital, Milan, Italy Heart Failure Unit, Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy.,Department for Biomedical Sciences for Health, University of Milano, Milan, Italy
| | | | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Michele D'Alto
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonello D'Andrea
- Division of Cardiology, Umberto I° Hospital Nocera Inferiore, Nocera Inferiore, Italy
| | - Philipp Douschan
- Medical University of Graz, Graz, Austria and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ekkehard Grünig
- Center of Pulmonary Hypertension, Thoraxklinik Heidelberg at Heidelberg University Hospital, Heidelberg, Germany
| | - Marco Guazzi
- Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato University Hospital, Milan, Italy Heart Failure Unit, Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy.,Department for Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Stefania Guida
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jaroslaw D Kasprzak
- I Dept. and Chair of Cardiology, Bieganski Hospital, Medical University of Lodz, Lodz, Poland
| | - Theodore John Kolias
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Giuseppe Limongelli
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alberto Maria Marra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Ciro Mauro
- Cardiology Division, A Cardarelli Hospital, Naples, Italy
| | - Antonella Moreo
- A. De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Pieri
- Cardiology Department, Careggi University Hospital, Florence, Italy
| | | | | | - Mauro Raciti
- Institute of Clinical Physiology, C.N.R, Pisa, Italy
| | | | - Lawrence Rudski
- Azrieli Heart Center and Center for Pulmonary Vascular Diseases, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Rajan Saggar
- Lung & Heart-Lung Transplant and Pulmonary Hypertension Programs David Geffen School of Medicine, UCLA, Los Angeles, USA
| | | | - Walter Serra
- Cardiology Division, University Hospital, Parma, Italy
| | - Anna Agnese Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University "Federico II", Naples, Italy
| | - Mani Vannan
- Piedmont Heart Institute, Marcus Heart Valve Center, Atlanta, USA
| | - Damien Voilliot
- Centre Hospitalier Lunéville, Service de Cardiologie, Lunéville, France
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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10
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Faverio P, Bocchino M, Caminati A, Fumagalli A, Gasbarra M, Iovino P, Petruzzi A, Scalfi L, Sebastiani A, Stanziola AA, Sanduzzi A. Nutrition in Patients with Idiopathic Pulmonary Fibrosis: Critical Issues Analysis and Future Research Directions. Nutrients 2020; 12:nu12041131. [PMID: 32316662 PMCID: PMC7231241 DOI: 10.3390/nu12041131] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/12/2020] [Accepted: 04/15/2020] [Indexed: 02/07/2023] Open
Abstract
In idiopathic pulmonary fibrosis (IPF), several factors may have a negative impact on the nutritional status, including an increased respiratory muscles load, release of inflammation mediators, the coexistence of hypoxemia, and physical inactivity. Nutritional abnormalities also have an impact on IPF clinical outcomes. Given the relevance of nutritional status in IPF patients, we sought to focus on some critical issues, highlighting what is known and what should be further learned about these issues. We revised scientific literature published between 1995 and August 2019 by searching on Medline/PubMed and EMBASE databases including observational and interventional studies. We conducted a narrative review on nutritional assessment in IPF, underlining the importance of nutritional evaluation not only in the diagnostic process, but also during follow-up. We also highlighted the need to keep a high level of attention on cardiovascular comorbidities. We also focused on current clinical treatment in IPF with Nintedanib and Pirfenidone and management of gastrointestinal adverse events, such as diarrhea, induced by these antifibrotic drugs. Finally, we concentrated on the importance of pulmonary rehabilitation program, including nutritional assessment, education and behavioral change, and psychological support among its essential components. More attention should be devoted to the assessment of the undernutrition and overnutrition, as well as of muscle strength and physical performance in IPF patients, taking also into account that an adequate clinical management of gastrointestinal complications makes IPF drug treatments more feasible.
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Affiliation(s)
- Paola Faverio
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy;
- Respiratory Unit, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
| | - Marialuisa Bocchino
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy;
| | - Antonella Caminati
- Unit of Pneumology and Respiratory Semi-Intensive Care Unit, Respiratory Pathophysiology and Pulmonary Hemodynamics Service, San Giuseppe Hospital—MultiMedica IRCCS, 20123 Milan, Italy;
| | - Alessia Fumagalli
- Unit of Pulmonary Rehabilitation, IRCCS INRCA (Italian National Research Centre on Aging), 23880 Casatenovo, Italy;
| | - Monica Gasbarra
- Association “Un Respiro di Speranza” in Collaboration with the Department of Pulmonary Diseases of San Camillo-Forlanini Hospital, 00152 Rome, Italy;
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Salerno, Italy;
| | - Alessandra Petruzzi
- MEDICA—Editoria e Diffusione Scientifica, 20124 Milan, Italy
- Correspondence: ; Tel.: +39-02-76281337
| | - Luca Scalfi
- Applied Nutrition and Health-Related Fitness, Department of Public Health, School of Medicine, Federico II University, 80131 Naples, Italy;
| | - Alfredo Sebastiani
- Department of Respiratory Diseases, San Camillo-Forlanini Hospital, 00152 Rome, Italy;
| | - Anna Agnese Stanziola
- Section of Respiratory Disease, Department of Clinical Medicine and Surgery, Monaldi Hospital, Federico II University, 80131 Naples, Italy; (A.A.S.); (A.S.)
| | - Alessandro Sanduzzi
- Section of Respiratory Disease, Department of Clinical Medicine and Surgery, Monaldi Hospital, Federico II University, 80131 Naples, Italy; (A.A.S.); (A.S.)
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11
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Vitale C, D’Amato M, Calabrò P, Stanziola AA, Mornile M, Molino A. Venous thromboembolism and lung cancer: a review. Multidiscip Respir Med 2019. [DOI: 10.4081/mrm.2015.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Venous thromboembolism (VTE) is a common complication of malignancies and epidemiological studies suggest that lung cancer belonged to the group of malignancies with the highest incidence rates of VTE. Risk factors for VTE in lung cancer patients are adenocarcinoma, NSCLC in comparison with SCLC, advanced disease, pneumonectomy, chemotherapy including antiangiogenic therapy. Other risk factors are pretreatment platelet counts and increased release of TF-positive microparticles. Elevated D-dimer levels do not necessarily indicate an increased risk of VTE but have been shown to be predictive for a worse clinical outcome in lung cancer patients. Mechanisms responsible for the increase in venous thrombosis in patients with lung cancer are not understood. Currently no biomarker is recognized as a predictor for VTE in lung cancer patients. Although several clinical trials have reported the efficacy of antithrombotic prophylaxis in patients with lung cancer who are receiving chemotherapy, further trials are needed to assess the clinical benefit since these patients are at an increased risk of developing a thromboembolism.
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12
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Ferrara F, Zhou X, Gargani L, Wierzbowska-Drabik K, Vriz O, Fadel BM, Stanziola AA, Kasprzak J, Vannan M, Bossone E. Echocardiography in Pulmonary Arterial Hypertension. Curr Cardiol Rep 2019; 21:22. [DOI: 10.1007/s11886-019-1109-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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D'Andrea A, Stanziola AA, Saggar R, Saggar R, Sperlongano S, Conte M, D'Alto M, Ferrara F, Gargani L, Lancellotti P, Bossone E. Right Ventricular Functional Reserve in Early-Stage Idiopathic Pulmonary Fibrosis: An Exercise Two-Dimensional Speckle Tracking Doppler Echocardiography Study. Chest 2018; 155:297-306. [PMID: 30543808 DOI: 10.1016/j.chest.2018.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 05/23/2018] [Revised: 09/30/2018] [Accepted: 11/05/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The most important determinant of long-term survival in patients with idiopathic pulmonary fibrosis is the right ventricular (RV) adaptation to the increased pulmonary vascular resistance. Our aim was to explore RV contractile reserve during stress echocardiography in early-stage IPF. METHODS Fifty early-stage patients with IPF and 50 healthy control patients underwent rest and stress echocardiography, including RV two-dimensional speckle tracking echocardiography. At peak exertion, blood gas analysis and spirometry were also assessed. RESULTS At rest, RV diameters were mildly increased in IPF; however, although RV conventional systolic function indexes were similar between the IPF and control groups, RV global longitudinal strain and RV lateral wall longitudinal strain (LWLS) were significantly reduced in the IPF cohort. During physical exercise, patients with IPF showed a reduced exercise tolerance with lower maximal workload (P < .01), level of oxygen saturation (P < .001), and peak heart rate (P < .01). Systolic and diastolic BP values were similar in both groups. Systolic pulmonary artery pressure (PAPs) increase (ΔPAPs) during exertion was higher in IPF vs healthy subjects (P < .0001); RV LWLS increase (ΔRV LWLS) during exercise was lower in patients with IPF vs control patients (P < .00001). By multivariable analysis, RV LWLS at rest and ΔRV LWLS were directly related to peak exertion capacity, PAPs, and blood oxygen saturation level (Spo2; P < .0001). Δ RV LWLS was directly related to diffusion lung carbon monoxide (P < .0001). CONCLUSIONS RV myocardial dysfunction is already present at rest in early-stage IPF and worsens during exertion as detected by two-dimensional speckle-tracking echocardiography. The RV altered contractile reserve appears to be related to reduced exercise tolerability and impaired pulmonary hemodynamic.
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Affiliation(s)
- Antonello D'Andrea
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli," A.O. dei Colli Monaldi Hospital, Naples, Italy.
| | - Anna Agnese Stanziola
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Rajan Saggar
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Rajeev Saggar
- Department of Medicine, University of Arizona, Phoenix, AZ
| | - Simona Sperlongano
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli," A.O. dei Colli Monaldi Hospital, Naples, Italy
| | - Marianna Conte
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli," A.O. dei Colli Monaldi Hospital, Naples, Italy
| | - Michele D'Alto
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli," A.O. dei Colli Monaldi Hospital, Naples, Italy
| | - Francesco Ferrara
- Division of Cardiology, Heart Department, 'Cava de' Tirreni and Amalfi Coast' Hospital, University Hospital, Salerno, Italy
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège, University Hospital Sart Tilman, Liège, Belgium
| | - Eduardo Bossone
- Division of Cardiology, Heart Department, 'Cava de' Tirreni and Amalfi Coast' Hospital, University Hospital, Salerno, Italy
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14
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Tseng S, Stanziola AA, Sultan S, Henry K, Saggar R, Saggar R. Pulmonary Hypertension Related to Chronic Obstructive Pulmonary Disease and Diffuse Parenchymal Lung Disease: A Focus on Right Ventricular (Dys)Function. Heart Fail Clin 2018; 14:403-411. [PMID: 29966637 DOI: 10.1016/j.hfc.2018.03.006] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Diffuse pulmonary lung disease and chronic obstructive pulmonary disease is a heterogeneous population that can manifest pulmonary hypertension. These subgroups are classified as primarily World Health Organization group 3. Available data suggest that the impact of pulmonary hypertension targeted therapy in diffuse pulmonary lung disease and chronic obstructive pulmonary disease is limited and survival is poor despite attempted treatment.
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Affiliation(s)
- Steve Tseng
- Lung Institute, University of Arizona, Banner University Medical Center, 755 E. McDowell Road, 3rd Floor, Phoenix, AZ 85006, USA
| | | | - Samir Sultan
- Lung Institute, University of Arizona, Banner University Medical Center, 755 E. McDowell Road, 3rd Floor, Phoenix, AZ 85006, USA
| | - Kyle Henry
- Lung Institute, University of Arizona, Banner University Medical Center, 755 E. McDowell Road, 3rd Floor, Phoenix, AZ 85006, USA
| | - Rajeev Saggar
- Lung Institute, University of Arizona, Banner University Medical Center, 755 E. McDowell Road, 3rd Floor, Phoenix, AZ 85006, USA
| | - Rajan Saggar
- Pulmonary and Critical Care Medicine, University of California, Los Angeles, David Geffen School of Medicine, 10833 Le Conte Avenue, Room 37-131 CHS, Box 951690, Los Angeles, CA 90095, USA.
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15
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Abstract
Despite advances in targeted medical therapy, pulmonary arterial hypertension (PAH) remains a fatal disease because of progressive right ventricular dysfunction. For patients who are refractory to medical therapy, heart-lung and lung transplantation are important treatment options. Because of longer waiting time, surgical interventions including extracorporeal lung support and atrial septostomy can be used in PAH patients bridging to transplantation.
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Affiliation(s)
- Samir Sultan
- Lung Institute, University of Arizona, Banner University Medical Center, 755 E. McDowell Road, 3rd Floor, Phoenix, AZ 85006, USA
| | - Steve Tseng
- Lung Institute, University of Arizona, Banner University Medical Center, 755 E. McDowell Road, 3rd Floor, Phoenix, AZ 85006, USA
| | | | - Tony Hodges
- Lung Institute, University of Arizona, Banner University Medical Center, 755 E. McDowell Road, 3rd Floor, Phoenix, AZ 85006, USA
| | - Rajan Saggar
- Pulmonary and Critical Care Medicine, University of California, Los Angeles, David Geffen School of Medicine, 10833 Le Conte Avenue, Room 37-131 CHS, Box 951690, Los Angeles, CA 90095, USA
| | - Rajeev Saggar
- Lung Institute, University of Arizona, Banner University Medical Center, 755 E. McDowell Road, 3rd Floor, Phoenix, AZ 85006, USA.
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16
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Ferrara F, Gargani L, Armstrong WF, Agoston G, Cittadini A, Citro R, D'Alto M, D'Andrea A, Dellegrottaglie S, De Luca N, Di Salvo G, Ghio S, Grünig E, Guazzi M, Kasprzak JD, Kolias TJ, Kovacs G, Lancellotti P, La Gerche A, Limongelli G, Marra AM, Moreo A, Ostenfeld E, Pieri F, Pratali L, Rudski LG, Saggar R, Saggar R, Scalese M, Selton-Suty C, Serra W, Stanziola AA, Voilliot D, Vriz O, Naeije R, Bossone E. The Right Heart International Network (RIGHT-NET): Rationale, Objectives, Methodology, and Clinical Implications. Heart Fail Clin 2018; 14:443-465. [PMID: 29966641 DOI: 10.1016/j.hfc.2018.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The Right Heart International Network is a multicenter international study aiming to prospectively collect exercise Doppler echocardiography tests of the right heart pulmonary circulation unit (RHPCU) in large cohorts of healthy subjects, elite athletes, and individuals at risk of or with overt pulmonary hypertension. It is going to provide standardization of exercise stress echocardiography of RHPCU and explore the full physiopathologic response.
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Affiliation(s)
| | - Luna Gargani
- Institute of Clinical Physiology-C.N.R., Pisa, Italy
| | - William F Armstrong
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Gergely Agoston
- Department of Family Medicine, University of Szeged, Szeged, Hungary
| | - Antonio Cittadini
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Rodolfo Citro
- Heart Department, University Hospital of Salerno, Salerno, Italy
| | - Michele D'Alto
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonello D'Andrea
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Santo Dellegrottaglie
- Division of Cardiology, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, Acerra, Naples, Italy; Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicola De Luca
- Hypertension Research Center "CIRIAPA", Federico II University, Napoli, Italy
| | | | - Stefano Ghio
- Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Ekkehard Grünig
- Centre for Pulmonary Hypertension, Thoraxclinic, Heidelberg University Hospital, Heidelberg, Germany
| | - Marco Guazzi
- Heart Failure Unit, Cardiopulmonary Laboratory, University Cardiology Department, IRCCS Policlinico San Donato University Hospital, Milan, Italy
| | | | - Theodore John Kolias
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Gabor Kovacs
- Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Liege, Belgium; Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | | | - Giuseppe Limongelli
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy; Institute of Cardiovascular Sciences, University College of London, London, UK
| | | | | | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Francesco Pieri
- Department of Heart, Thorax and Vessels, Azienda Ospedaliero Universitaria, Florence, Italy
| | | | - Lawrence G Rudski
- Azrieli Heart Center and Center for Pulmonary Vascular Diseases, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Rajan Saggar
- Lung and Heart-Lung Transplant Program, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Pulmonary Hypertension Program, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Rajeev Saggar
- Lung Institute Banner University Medical Center-Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Marco Scalese
- Institute of Clinical Physiology-C.N.R., Pisa, Italy
| | | | - Walter Serra
- Cardiology Unit, Surgery Department, University Hospital of Parma, Italy
| | - Anna Agnese Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University "Federico II", Naples, Italy
| | - Damien Voilliot
- Centre Hospitalier Lunéville, Service de Cardiologie, Lunéville, France
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | - Eduardo Bossone
- Cardiology Division, Heart Department, "Cava de' Tirreni and Amalfi Coast" Hospital, University of Salerno, Salerno, Italy.
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17
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Marra AM, Naeije R, Ferrara F, Vriz O, Stanziola AA, D'Alto M, D'Andrea A, Carannante L, Eichstaedt CA, Cittadini A, Benjamin N, Grünig E, Bossone E. Reference Ranges and Determinants of Tricuspid Regurgitation Velocity in Healthy Adults Assessed by Two-Dimensional Doppler-Echocardiography. Respiration 2018; 96:425-433. [PMID: 30021211 DOI: 10.1159/000490191] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/16/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tricuspid regurgitation velocity (TRV) is the most widely used parameter by transthoracic echocardiography (TTE) in the evaluation of patients with suspected pulmonary hypertension (PH). OBJECTIVES To explore the physiologic range of TRV in healthy adults and to investigate its clinical determinants. METHODS In the first part of the study, 614 healthy individuals (age 45.7± 14.7 years, 60.26% women) were prospectively assessed by TTE. In the second part, a pooled meta-analysis of 16 already published studies with TRV values in healthy subjects (n = 981) was performed. Statistical analysis included the calculation of 95% quantiles for defining reference ranges. RESULTS In the prospectively enrolled cohort, mean TRV was 2.01 ± 0.29 m/s (5-95% CI 1.987-2.033 m/s). It was significantly but weakly positively correlated with age, body mass index, systolic blood pressure, diastolic blood pressure, left atrial volume and negative with mitral inflow E/A ratio. No significant differences were found between males and females. The prospectively enrolled data revealed similar values to the literature-based datasets resulting in a mean TRV of 1.96 m/s (95% CI 1.91-2.02 m/s) and a 95% quantile of 2.55 m/s. CONCLUSIONS To the best of our knowledge, this is the largest dataset to describe reference ranges of TRV and their clinical determinants in healthy adults years. The determined cut-off value of 2.55 m/s of this study has to be confirmed in specific pathologies such as patients at risk of PH.
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Affiliation(s)
| | - Robert Naeije
- Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium
| | - Francesco Ferrara
- Department of Heart, Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, University of Salerno, Salerno, Italy
| | - Olga Vriz
- Cardiology and Emergency Department, Hospital of San Daniele del Friuli, San Daniele del Friuli, Italy
| | - Anna Agnese Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University "Federico II,", Naples, Italy
| | - Michele D'Alto
- Department of Cardiology, "Luigi Vanvitelli" University of Naples, Napoli, Italy
| | - Antonello D'Andrea
- Department of Cardiology, "Luigi Vanvitelli" University of Naples, Napoli, Italy
| | - Luca Carannante
- Department of Heart, Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, University of Salerno, Salerno, Italy
| | - Christina Alessandra Eichstaedt
- Centre for Pulmonary Hypertension, Thoraxclinic at Heidelberg University Hospital, Heidelberg, Germany.,German Center of Lung Research (DZL), Giessen, Germany
| | - Antonio Cittadini
- Department of Translational Medical Sciences, University "Federico II", Naples, Italy
| | - Nicola Benjamin
- Centre for Pulmonary Hypertension, Thoraxclinic at Heidelberg University Hospital, Heidelberg, Germany.,German Center of Lung Research (DZL), Giessen, Germany
| | - Ekkehard Grünig
- Centre for Pulmonary Hypertension, Thoraxclinic at Heidelberg University Hospital, Heidelberg, Germany.,German Center of Lung Research (DZL), Giessen, Germany
| | - Eduardo Bossone
- Department of Heart, Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, University of Salerno, Salerno, Italy
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18
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Ferrara F, Gargani L, Ruohonen S, Vriz O, Scalese M, Russo V, Marra AM, Stanziola AA, Cittadini A, D'Andrea A, Naeije R, Bossone E. Reference values and correlates of right atrial volume in healthy adults by two-dimensional echocardiography. Echocardiography 2018; 35:1097-1107. [PMID: 29756642 DOI: 10.1111/echo.14015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Right atrial (RA) volume is an important parameter in the evaluation of patients with pulmonary hypertension. Aim of this study was to define reference ranges for RA volume by two-dimensional echocardiography (2DE) in healthy adults. METHODS A total of 596 healthy subjects [mean age 45.7 ± 14.6 years, range 18-88 years; 60.1% women] underwent a transthoracic echocardiography. In addition, a meta-analysis was performed of published studies measuring RA volume in healthy subjects, using 2DE single plane area-length (A-L) and/or method of disks (MOD) at end-systole in apical four-chamber view. RESULTS In our cohort, RA volume was higher in men than women but did not vary with age. Body surface area (BSA), stroke volume (SV), and tricuspid annular plane systolic excursion (TAPSE) were the only independent variables associated with RA volume (β coefficient 0.569, 0.123, and 0.131, respectively; all P < .001). In the pooled analysis, normalized RA volume was 25.7 ± 7.0 mL/m2 in men and 21.2 ± 5.8 mL/m2 in women for A-L, 21.6 ± 5.6 mL/m2 in men and 18.2 ± 5.4 mL/m2 in women for MOD (all P values < .0001). The upper limit was about 36 mL/m2 in men and 31 mL/m2 in women for A-L and 31 mL/m2 in men and 27 mL/m2 in women for MOD. CONCLUSIONS RA volume was found to be higher in men but not influenced by age. It was mainly correlated with larger BSA, indices of preload (SV) and RV longitudinal function (TAPSE). A statistically significant difference was found between A-L and MOD.
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Affiliation(s)
- Francesco Ferrara
- Cardiology Division, Heart Department, University Hospital of Salerno, "Cava de' Tirreni and Amalfi Coast" Hospital, Salerno, Italy
| | - Luna Gargani
- Institute of Clinical Physiology - C.N.R., Pisa, Italy
| | - Saku Ruohonen
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Olga Vriz
- Cardiology and Emergency Department, Hospital of San Daniele del Friuli, Udine, Italy
| | - Marco Scalese
- Institute of Clinical Physiology - C.N.R., Pisa, Italy
| | - Valentina Russo
- Cardiology Division, Heart Department, University Hospital of Salerno, "Cava de' Tirreni and Amalfi Coast" Hospital, Salerno, Italy
| | | | - Anna Agnese Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University "Federico II,", Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, University Federico II of Naples, Naples, Italy
| | | | | | - Eduardo Bossone
- Cardiology Division, Heart Department, University Hospital of Salerno, "Cava de' Tirreni and Amalfi Coast" Hospital, Salerno, Italy
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19
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Stanziola AA, Caccavo G, De Rosa N, D'Amato M, Saggar R, Spadaro G, Ponticiello A. Sarcoidosis and colon cancer: a possible association. Sarcoidosis Vasc Diffuse Lung Dis 2018; 35:376-380. [PMID: 32476926 PMCID: PMC7170125 DOI: 10.36141/svdld.v35i4.7191] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/24/2018] [Indexed: 11/02/2022]
Abstract
Sarcoidosis is a multisystem inflammatory disease characterized by non-caseating granulomas which mainly affect the pulmonary lymphatic system and lungs; although any organs can be interested. The association between sarcoidosis and cancer is still controversial, but many studies demonstrated an increased risk of cancer in patients with sarcoidosis, whereas few cases of sarcoidosis occurring after cancer have been reported. This report outlines and describes clinical, biologic and radiologic features of 3 patients with a history of surgical treatment and adjuvant chemotherapy for colon cancer, followed by a diagnosis of sarcoidosis some years later. The history of cancer and the lymph nodes positivity found through PET scan induced us to hypothesize a relapsing cancer disease. However, this hypothesis was not confirmed by the lymph nodes biopsy, which is the core method of diagnosis of sarcoidosis. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 376-380).
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Affiliation(s)
| | - Giovanna Caccavo
- Univ Naples Federico II, Dept Clin Med and Surg, Sect Resp Dis, Naples, Italy
| | | | - Maria D'Amato
- Univ Naples Federico II, Dept Clin Med and Surg, Sect Resp Dis, Naples, Italy
| | - Rajeev Saggar
- Advanced Lung Disease Institute Banner University Medical Center-Phoenix, Univ. of Arizona, Phoenix
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples. Italy
| | - Antonio Ponticiello
- Univ Naples Federico II, Dept Clin Med and Surg, Sect Resp Dis, Naples, Italy
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20
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Molino A, Simioli F, Stanziola AA, Mormile M, Martino M, D'Amato M. Effects of combination therapy indacaterol/glycopyrronium versus tiotropium on moderate to severe COPD: evaluation of impulse oscillometry and exacerbation rate. Multidiscip Respir Med 2017; 12:25. [PMID: 28959443 PMCID: PMC5615797 DOI: 10.1186/s40248-017-0105-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 05/16/2017] [Accepted: 08/31/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Small airways are considered the major site of airflow limitation in COPD. Impulse oscillometry (IOS) is a forced oscillation technique, which provides passive measurement of lung mechanics. It can differentiate small airway from large airway obstruction and is more sensitive than spirometry for peripheral airway disease. In this study the efficacy of the combination of Indacaterol/Glycopirronium (IND/GLY) versus Tiotropium on airway resistance (R5, R20, R5-20), lung reactance (X) and resonant frequency in moderate to severe COPD patients has been evaluated. We also evaluated inspiratory capacity (IC), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), exacerbation rate and quality of life. METHODS Forty patients were monitored with forced oscillation technique and spirometry. Patients were randomized in 2 groups: 20 received fixed dose once daily Indacaterol/Glycopyrronium (Group A) and 20 received single Tiotropium (Group B). The oscillometry parameters were the measure of resistance in the airways at 5 Hz (R5), at 20 Hz (R20) and the lung reactance (X). RESULTS There was a statistically significant difference between pre-dosing at V1 and at follow up visits in R5, R20 and X values in patients receiving dual bronchodilation but not in control group. Pre-dosing IC value at follow up visits in patients receiving dual bronchodilation had a statistical significant variation. CONCLUSIONS The "new" bronchodilator combination LABA/LAMA significantly reduces bronchial obstruction in small airways too. The oscillometry demonstrated greater sensitivity compared with spirometry for monitoring outcome measures of airway obstruction and the effect of long-term therapy.
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Affiliation(s)
- Antonio Molino
- Respiratory Department Federico II University- A.O. "Dei Colli", Via D Fontana, 134, 80128 Naples, Italy
| | - Francesca Simioli
- Respiratory Department Federico II University- A.O. "Dei Colli", Via D Fontana, 134, 80128 Naples, Italy
| | - Anna Agnese Stanziola
- Respiratory Department Federico II University- A.O. "Dei Colli", Via D Fontana, 134, 80128 Naples, Italy
| | - Mauro Mormile
- Respiratory Department Federico II University- A.O. "Dei Colli", Via D Fontana, 134, 80128 Naples, Italy
| | - Maria Martino
- Respiratory Department Federico II University- A.O. "Dei Colli", Via D Fontana, 134, 80128 Naples, Italy
| | - Maria D'Amato
- Respiratory Department Federico II University- A.O. "Dei Colli", Via D Fontana, 134, 80128 Naples, Italy
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Molino A, Simioli F, Stanziola AA, Mormile M, Martino M, D’Amato M. Effects of combination therapy indacaterol/ glycopyrronium versus tiotropium on moderate to severe COPD: evaluation of impulse oscillometry and exacerbation rate. Multidiscip Respir Med 2017. [DOI: 10.4081/mrm.2017.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Small airways are considered the major site of airflow limitation in COPD. Impulse oscillometry (IOS) is a forced oscillation technique, which provides passive measurement of lung mechanics. It can differentiate small airway from large airway obstruction and is more sensitive than spirometry for peripheral airway disease. In this study the efficacy of the combination of Indacaterol/Glycopirronium (IND/GLY) versus Tiotropium on airway resistance (R5, R20, R5–20), lung reactance (X) and resonant frequency in moderate to severe COPD patients has been evaluated. We also evaluated inspiratory capacity (IC), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), exacerbation rate and quality of life. Methods: Forty patients were monitored with forced oscillation technique and spirometry. Patients were randomized in 2 groups: 20 received fixed dose once daily Indacaterol/Glycopyrronium (Group A) and 20 received single Tiotropium (Group B). The oscillometry parameters were the measure of resistance in the airways at 5 Hz (R5), at 20 Hz (R20) and the lung reactance (X). Results: There was a statistically significant difference between pre-dosing at V1 and at follow up visits in R5, R20 and X values in patients receiving dual bronchodilation but not in control group. Pre-dosing IC value at follow up visits in patients receiving dual bronchodilation had a statistical significant variation. Conclusions: The “new” bronchodilator combination LABA/LAMA significantly reduces bronchial obstruction in small airways too. The oscillometry demonstrated greater sensitivity compared with spirometry for monitoring outcome measures of airway obstruction and the effect of long-term therapy.
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22
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Marra AM, D'Alto M, Stanziola AA, Cittadini A, Bossone E. [Clinical trials in pulmonary arterial hypertension: a glimpse of history]. G Ital Cardiol (Rome) 2016; 17:973-983. [PMID: 28151502 DOI: 10.1714/2612.26890] [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: 06/06/2023]
Abstract
Clinical trials have remarkably changed the natural history of pulmonary arterial hypertension (PAH). Despite the relevant progresses achieved in terms of prognosis, PAH is still burned by high mortality rates, disability and low levels of quality of life. The aim of this review is to look over the history of clinical trials in PAH, starting from the little studies with prostacyclin analogues to the recent large randomized placebo-controlled trials. Moreover, the future perspectives of PAH management are addressed.
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Affiliation(s)
| | - Michele D'Alto
- Dipartimento di Cardiologia, Seconda Università degli Studi, A.O.R.N. Monaldi, Napoli
| | - Anna Agnese Stanziola
- Dipartimento di Malattie dell'Apparato Respiratorio, Università degli Studi "Federico II", Napoli
| | - Antonio Cittadini
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi "Federico II", Napoli - Centro di Ricerca Interdipartimentale sui Biomateriali (CRIB), Università degli Studi "Federico II", Napoli
| | - Eduardo Bossone
- Dipartimento Medico-Chirurgico di Cardiologia, A.O.U. Scuola Medica Salernitana, Salerno
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23
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Marra AM, Benjamin N, Ferrara F, Vriz O, D'Alto M, D'Andrea A, Stanziola AA, Gargani L, Cittadini A, Grünig E, Bossone E. Reference ranges and determinants of right ventricle outflow tract acceleration time in healthy adults by two-dimensional echocardiography. Int J Cardiovasc Imaging 2016; 33:219-226. [PMID: 27714602 DOI: 10.1007/s10554-016-0991-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 08/11/2016] [Accepted: 09/30/2016] [Indexed: 12/25/2022]
Abstract
The right ventricular outflow tract acceleration time (RVOT-AT) has shown to progressively shorten with increasing degrees of pulmonary pressure. However, the physiologic ranges of RVOT AT are based on small sample sizes and have not been investigated regarding their determining factors. The aim of this study was to investigate reference values and determining factors of RVOT-AT in a large population of healthy subjects and by values described in the literature. In the first part of the study, 1029 healthy subjects (mean age 45.6 ± 16.0 years, 565 (54.7 %) females) were prospectively assessed by clinical examination including demography, vital signs and echocardiography. In the second part, we performed a pooled analysis of eight published studies describing RVOT-AT in healthy subjects (n = 450). Statistical analysis included the calculation of 5 % quantiles for defining reference values. RVOT-AT significantly but weakly correlated with age (r: -0.207; p < 0.001), body mass Index (r: -0.16), systolic (r: -0.158) and diastolic (r: -0.137) blood pressure, heart rate (r: -0.197) and left ventricular (LV) E/A ratio (r: 0.229) (all p < 0.001). No differences were found with regards to sex. In a synopsis of both prospective and literature-based data sets, RVOT-AT weighted means was 138.51 ms and the 5 % quantile was 104.7 ms (95 % confidence interval 98.2-110.1). This study delineates the range of RVOT-AT in healthy adults and it's determining factors. Our study is in line with the cut-off value stated by the European guidelines with an RVOT-AT ≤105 ms denoting abnormal values.
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Affiliation(s)
| | - Nicola Benjamin
- Pulmonary Hypertension Center, Thoraxclinic at University of Heidelberg, Heidelberg, Germany
| | - Francesco Ferrara
- Department of Cardiology and Cardiac Surgery, University Hospital "Scuola Medica Salernitana", Salerno, Italy
| | - Olga Vriz
- Department of Emergency and Cardiology, "S. Antonio" Community Hospital, San Daniele del Friuli, UD, Italy
| | - Michele D'Alto
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Anna Agnese Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University Federico II, Naples, Italy
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Ekkehard Grünig
- Pulmonary Hypertension Center, Thoraxclinic at University of Heidelberg, Heidelberg, Germany
| | - Eduardo Bossone
- Department of Cardiology and Cardiac Surgery, University Hospital "Scuola Medica Salernitana", Salerno, Italy.
- Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno - Italy, Via Pr. Amedeo, 36, 83023, Lauro, AV, Italy.
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24
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Ferrara F, Rudski LG, Vriz O, Gargani L, Afilalo J, D'Andrea A, D'Alto M, Marra AM, Acri E, Stanziola AA, Ghio S, Cittadini A, Naeije R, Bossone E. Physiologic correlates of tricuspid annular plane systolic excursion in 1168 healthy subjects. Int J Cardiol 2016; 223:736-743. [PMID: 27573598 DOI: 10.1016/j.ijcard.2016.08.275] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND TAPSE provides a simple, reproducible estimate of the longitudinal function of the right ventricle (RV). However, the normal limits and physiologic correlates of tricuspid annular plane systolic excursion (TAPSE) are not exactly known. The aim of this study was to explore the full spectrum of TAPSE values and determine the physiologic correlates of TAPSE. METHODS AND RESULTS From June 2007 to December 2013, 1168 healthy subjects [mean age 45.1±16years, range 16 to 92; 555 (47.5%) men] underwent comprehensive transthoracic echocardiography (TTE) as recommended by current guidelines. TAPSE values were higher in men than women (24.0±3.5 vs 23.2±3.0mm, p value<0.0001) but did not vary according to age. On multivariable linear regression analysis, cardiac output, RV basal and longitudinal dimensions were the only variables independently associated with TAPSE (β coefficient=0.161, 0.116 and 0.115 respectively). On the other hand echocardiographically-derived systolic pulmonary artery pressure (SPAP), pulmonary vascular resistance and mitral E/e' ratio were significantly higher in older subjects. Therefore a significant decrease of TAPSE/SPAP was detected in >60years old cohort (p=0.0001). CONCLUSIONS Our large cohort of healthy subjects provides sex and age-based TAPSE and TAPSE/SPAP normal cut-offs. TAPSE was found to be higher in men but not influenced by age. It was mainly correlated with echo-Doppler indices reflecting pre-load as opposed to afterload. On the other hand a significant decrease of TAPSE/SPAP with older age was registered as a direct consequence of increased SPAP with aging.
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Affiliation(s)
- Francesco Ferrara
- Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University Hospital of Salerno, Salerno, Italy
| | - Lawrence G Rudski
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Olga Vriz
- Hospital of San Daniele del Friuli, Cardiology and Emergency Department, Udine, Italy
| | - Luna Gargani
- Institute of Clinical Physiology - C.N.R., Pisa, Italy
| | - Jonathan Afilalo
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Michele D'Alto
- Second University of Naples, Department of Cardiology, Napoli, Italy
| | | | - Edvige Acri
- Cardiology Division, University of Messina, Italy
| | - Anna Agnese Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University "Federico II", Naples, Italy
| | - Stefano Ghio
- Cardiology Division, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, University Federico II of Naples, Naples, Italy
| | | | - Eduardo Bossone
- Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University Hospital of Salerno, Salerno, Italy.
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25
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Capolongo G, Xu LHR, Accardo M, Sanduzzi A, Stanziola AA, Colao A, Agostini C, Zacchia M, Capasso G, Adams-Huet B, Moe OW, Maalouf NM, Sakhaee K, Hsia CCW. Vitamin-D status and mineral metabolism in two ethnic populations with sarcoidosis. J Investig Med 2016; 64:1025-34. [PMID: 27053725 DOI: 10.1136/jim-2016-000101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2016] [Indexed: 01/23/2023]
Abstract
Vitamin-D insufficiency and sarcoidosis are more common and severe in African Americans (AA) than Caucasians. In sarcoidosis, substrate-dependent extrarenal 1,25-dihydroxyvitamin-D (1,25-(OH)2D) production is thought to contribute to hypercalciuria and hypercalcemia, and vitamin-D repletion is often avoided. However, the anti-inflammatory properties of vitamin-D may also be beneficial. We prospectively examined serum vitamin-D levels, calcium balance, and the effects of vitamin-D repletion in 86 AA and Caucasian patients with biopsy-proven active sarcoidosis from the USA (US) and Italy (IT) in university-affiliated outpatient clinics. Clinical features, pulmonary function, and calciotropic hormones were measured. 16 patients with vitamin-D deficiency and normal serum ionized calcium (Ca(2+)) were treated with oral ergocalciferol (50,000 IU/week) for 12 weeks. Baseline mineral parameters were similar in US (93% AA) and IT (95% Caucasian) patients irrespective of glucocorticoid treatment. Pulmonary dysfunction was less pronounced in IT patients. Nephrolithiasis (in 11% US, 17% IT patients) was associated with higher urinary calcium excretion. Vitamin-D deficiency was not more prevalent in patients compared to the respective general populations. As serum 25-hydroxyvitamin-D (25-OHD) rose postrepletion, serum 1,25-(OH)2D, γ-globulins, and the previously elevated angiotensin converting enzyme (ACE) levels declined. Asymptomatic reversible increases in Ca(2+) or urinary calcium/creatinine (Ca/Cr) developed in three patients during repletion. In conclusion, Caucasian and AA patients show similar calcium and vitamin D profiles. The higher prevalence of hypercalciuria and nephrolithiasis in sarcoidosis is unrelated to endogenous vitamin-D levels. Vitamin-D repletion in sarcoidosis is generally safe, although calcium balance should be monitored. A hypothesis that 25-OHD repletion suppresses granulomatous immune activity is provided.
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Affiliation(s)
- Giovanna Capolongo
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA Charles & Jane Pak Center for Mineral Metabolism & Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA Department of Cardio-thoracic & Respiratory Sciences, Division of Nephrology, Second University of Naples, Naples, Italy
| | - Li Hao Richie Xu
- Charles & Jane Pak Center for Mineral Metabolism & Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mariasofia Accardo
- Department of Clinical Medicine & Surgery, Division of Respiratory disease, University Federico II of Naples, Naples, Italy
| | - Alessandro Sanduzzi
- Department of Clinical Medicine & Surgery, Division of Respiratory disease, University Federico II of Naples, Naples, Italy
| | - Anna Agnese Stanziola
- Department of Clinical Medicine & Surgery, Division of Respiratory disease, University Federico II of Naples, Naples, Italy
| | - Annamaria Colao
- Department of Clinical Medicine & Surgery, Unit of Endocrinology, University Federico II of Naples, Naples, Italy
| | - Carlo Agostini
- Department of Medicine (DIMED), Clinical Immunology Unit, Padua University, Italy
| | - Miriam Zacchia
- Department of Cardio-thoracic & Respiratory Sciences, Division of Nephrology, Second University of Naples, Naples, Italy
| | - Giovambattista Capasso
- Department of Cardio-thoracic & Respiratory Sciences, Division of Nephrology, Second University of Naples, Naples, Italy
| | - Beverley Adams-Huet
- Charles & Jane Pak Center for Mineral Metabolism & Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Orson W Moe
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA Charles & Jane Pak Center for Mineral Metabolism & Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Naim M Maalouf
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA Charles & Jane Pak Center for Mineral Metabolism & Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Khashayar Sakhaee
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA Charles & Jane Pak Center for Mineral Metabolism & Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Connie C W Hsia
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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26
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Vitale C, D'Amato M, Calabrò P, Stanziola AA, Mormile M, Molino A. Venous thromboembolism and lung cancer: a review. Multidiscip Respir Med 2015; 10:28. [PMID: 26380084 PMCID: PMC4570636 DOI: 10.1186/s40248-015-0021-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 07/27/2015] [Indexed: 12/03/2022] Open
Abstract
Venous thromboembolism (VTE) is a common complication of malignancies and epidemiological studies suggest that lung cancer belonged to the group of malignancies with the highest incidence rates of VTE. Risk factors for VTE in lung cancer patients are adenocarcinoma, NSCLC in comparison with SCLC, advanced disease, pneumonectomy, chemotherapy including antiangiogenic therapy. Other risk factors are pretreatment platelet counts and increased release of TF-positive microparticles. Elevated D-dimer levels do not necessarily indicate an increased risk of VTE but have been shown to be predictive for a worse clinical outcome in lung cancer patients. Mechanisms responsible for the increase in venous thrombosis in patients with lung cancer are not understood. Currently no biomarker is recognized as a predictor for VTE in lung cancer patients. Although several clinical trials have reported the efficacy of antithrombotic prophylaxis in patients with lung cancer who are receiving chemotherapy, further trials are needed to assess the clinical benefit since these patients are at an increased risk of developing a thromboembolism.
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Affiliation(s)
- Carolina Vitale
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Maria D'Amato
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Paolo Calabrò
- Department of Cardiology, High Speciality Hospital "V. Monaldi", Second University of Naples, Naples, Italy
| | - Anna Agnese Stanziola
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Mauro Mormile
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Antonio Molino
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
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27
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Galati D, De Martino M, Trotta A, Rea G, Bruzzese D, Cicchitto G, Stanziola AA, Napolitano M, Sanduzzi A, Bocchino M. Peripheral depletion of NK cells and imbalance of the Treg/Th17 axis in idiopathic pulmonary fibrosis patients. Cytokine 2014; 66:119-26. [PMID: 24418172 DOI: 10.1016/j.cyto.2013.12.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [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: 06/05/2013] [Revised: 10/31/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022]
Abstract
The immune response plays an unsettled role in the pathogenesis of idiopathic pulmonary fibrosis (IPF), the contribution of inflammation being controversial as well. Emerging novel T cell sub-populations including regulatory T lymphocytes (Treg) and interleukin (IL)-17 secreting T helper cells (Th17) may exert antithetical actions in this scenario. Phenotype and frequency of circulating immune cell subsets were assessed by multi-parametric flow cytometry in 29 clinically stable IPF patients and 17 healthy controls. The interplay between Treg lymphocytes expressing transforming growth factor (TGF)-β and Th17 cells was also investigated. Proportion and absolute number of natural killer (NK) cells were significantly reduced in IPF patients in comparison with controls (p<0.001). Conversely, the proportion and absolute number of CD3(+)CD4(+)CD25(high)Foxp-3(+) cells were significantly increased in IPF patients (p=0.000). As in controls, almost the totality of cells (>90%) expressed TGF-β upon stimulation. Interestingly, the frequency of Th17 cells was significantly compromised in IPF patients (p=0.000) leading to an increased TGF-β/IL-17 ratio (4.2±2.3 vs 0.5±0.3 in controls, p=0.000). Depletion of NK and Th17 cells along with a not compromised Treg compartment delineate the existence of an "immune profile" that argue against the recent hypothesis of IPF as an autoimmune disease. Our findings along with the imbalance of the Treg/Th17 axis more closely suggest these immune perturbations to be similar to those observed in cancer. Clinical relevance, limitations and perspectives for future research are discussed.
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Affiliation(s)
- Domenico Galati
- Dipartimento di Ematologia, IRCCS INT Fondazione Pascale, Napoli, Italy
| | - Marina De Martino
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli, Italy
| | - Annamaria Trotta
- UOSC Immunologia Oncologica, IRCCS INT Fondazione Pascale, Napoli, Italy
| | - Gaetano Rea
- Dipartimento dei Servizi Diagnostici e Generali, Ospedali dei Colli, Monaldi-Cotugno-CTO, Napoli, Italy
| | - Dario Bruzzese
- Dipartimento di Sanità Pubblica, Università Federico II, Napoli, Italy
| | | | | | - Maria Napolitano
- UOSC Immunologia Oncologica, IRCCS INT Fondazione Pascale, Napoli, Italy
| | - Alessandro Sanduzzi
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli, Italy
| | - Marialuisa Bocchino
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli, Italy.
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28
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Carlomagno G, Messalli G, Melillo RM, Stanziola AA, Visciano C, Mercurio V, Imbriaco M, Ghio S, Sofia M, Bonaduce D, Fazio S. Serum soluble ST2 and interleukin-33 levels in patients with pulmonary arterial hypertension. Int J Cardiol 2013; 168:1545-7. [PMID: 23290950 DOI: 10.1016/j.ijcard.2012.12.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 12/08/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Guido Carlomagno
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University - Naples, Italy
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29
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Iaselli F, Rea G, Cappabianca S, Fabozzi G, Montemarano M, Vitale C, Stanziola AA, Muto R, Rotondo A. Adult-onset pulmonary involvement in Niemann-Pick disease type B. Monaldi Arch Chest Dis 2012; 75:235-40. [PMID: 22462311 DOI: 10.4081/monaldi.2011.211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Niemann-Pick disease type B is caused by a deficiency in acid sphingomyelinase activity; among the six variants of Niemann-Pick disease known to date, it is the most frequently associated with lung involvement, a major cause of morbidity and mortality in this subtype in patients of all ages. Nevertheless, the vast majority of reports in the literature concern infantile forms, while less reported is, for several reasons, the onset in adults being consequently still poorly understood and characterized its clinical, radiographic and functional manifestations. We report a case of a 37 years-old female patient affected by subtype B since she was an infant, operated for aortic valve replacement two years before and came to our attention for the onset of a worsening exertional dyspnoea which proved, through a series of functional tests and radiological exams, to be a consequence of the diffuse lung involvement by the metabolic disorder; we performed a review on this topic through a Medline search of all the available "adult-onset" case reports published since the first description in 1964, also considering the possible association between NPDB and, more generally lysosomal storage disorders, and the valvular disease, already suggested by several Authors in previous works.
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Affiliation(s)
- F Iaselli
- Department of Clinical Internal Medicine F. Magrassi-L. Lanzara, Science Section of Radiology, Seconda Università degli Studi di Napoli, Primo Policlinico di Napoli, Italy.
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30
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Stanziola AA, Padula S, Carpentieri E, Rea G, Maniscalco M, Sofia M. Right heart and pulmonary thromboembolism from extensive splanchnic vein thrombosis after splenectomy for myeloproliferative disease. Heart Lung 2012; 41:188-91. [DOI: 10.1016/j.hrtlng.2011.03.003] [Citation(s) in RCA: 3] [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: 12/05/2010] [Revised: 03/23/2011] [Accepted: 03/25/2011] [Indexed: 01/07/2023]
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31
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Tamburrini M, Cerasuolo I, Carratore V, Stanziola AA, Zofra S, Romano L, Camardella L, Ciardiello MA. Kiwellin, a Novel Protein from Kiwi Fruit. Purification, Biochemical Characterization and Identification as an Allergen*. Protein J 2005; 24:423-9. [PMID: 16328735 DOI: 10.1007/s10930-005-7638-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Kiwellin is a novel protein of 28 kDa isolated from kiwi (Actinidia chinensis) fruit. It is one of the three most abundant proteins present in the edible part of this fruit. Kiwellin has been purified by ion exchange chromatography. Its N-terminal amino acid sequence revealed high identity with that previously reported for a 28 kDa protein described as one of the most important kiwi allergens. This observation prompted us to fully characterize this protein. The complete primary structure, elucidated by direct sequencing, indicated that kiwellin is a cysteine-rich protein. Serological tests and Western Blotting analysis showed that kiwellin is specifically recognized by IgE of patients allergic to kiwi fruit.
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Affiliation(s)
- Maurizio Tamburrini
- Institute of Protein Biochemistry, C.N.R., Via Pietro Castellino 111, I-80131, Napoli, Italy.
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32
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D'Amato G, Stanziola AA, Cocco G, Melillo G. Mold allergy: a three year investigation (1980-1982) of the airborne fungal spores in Naples, Italy. Ann Allergy 1984; 52:363-7. [PMID: 6721261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The purpose of the study was to examine the seasonal changes of the most important anemophilous species of molds, mainly those of allergenic interest. A spore-mold calendar for Naples, Italy was developed by continuous sampling over a 3-year period (January 1980-December 1982). The results reveal the climatic conditions are favorable for the growth of some fungi with dry spores in Naples and very high atmospheric concentrations of mold spores are to be found in summer months, particularly those of Cladosporium. Allergic sensitization with skin test reactivity and clinical signs of sensitivity to inhaled fungal spores is nevertheless found infrequently and generally not correlated with the seasonal patterns of presence of the spore molds in the atmosphere.
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