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Ferrannini E, Manca ML, Ferrannini G, Andreotti F, Andreini D, Latini R, Magnoni M, Williams SA, Maseri A, Maggioni AP. Differential Proteomics of Cardiovascular Risk and Coronary Artery Disease in Humans. Front Cardiovasc Med 2022; 8:790289. [PMID: 35187107 PMCID: PMC8855064 DOI: 10.3389/fcvm.2021.790289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundProteomics of atypical phenotypes may help unravel cardiovascular disease mechanisms.AimWe aimed to prospectively screen the proteome of four types of individuals: with or without coronary artery disease (CAD), each with or without multiple risk factors. Associations with individual risk factors and circulating biomarkers were also tested to provide a functional context to the protein hits.Materials and MethodsThe CAPIRE study (ClinicalTrials.gov Identifier: NCT02157662) is a cross-sectional study aimed at identifying possible new mechanisms promoting or protecting against atherothrombosis. Quantification (by aptamer technology), ranking (using partial least squares), and correlations (by multivariate regression) of ~5000 plasma proteins were performed in consecutive individuals aged 45–75 years, without previous cardiovascular disease, undergoing computed tomography angiography for suspected CAD, showing either >5/16 atherosclerotic segments (CAD+) or completely clean arteries (CAD−) and either ≤ 1 risk factor (RF+) or ≥3 risk factors (RF−) (based on history, blood pressure, glycemia, lipids, and smoking).ResultsOf 544 individuals, 39% were atypical (93 CAD+/RF−; 120 CAD−/RF+) and 61% typical (102 CAD+/RF+; 229 CAD−/RF−). In the comparison with CAD+/RF− adjusted for sex and age, CAD−/RF+ was associated with increased atrial myosin regulatory light chain 2 (MYO) and C-C motif chemokine-22 (C-C-22), and reduced protein shisa-3 homolog (PS-3) and platelet-activating factor acetylhydrolase (PAF-AH). Extending the analysis to the entire cohort, an additional 8 proteins were independently associated with CAD or RF; by logistic regression, the 12-protein panel alone discriminated the four groups with AUCROC's of 0.72–0.81 (overall p = 1.0e−38). Among them, insulin-like growth factor binding protein-3 is positively associated with RF, lower BMI, and HDL-cholesterol, renin with CAD higher glycated hemoglobin HbA1c, and smoking.ConclusionsIn a CCTA-based cohort, four proteins, involved in opposing vascular processes (healing vs. adverse remodeling), are specifically associated with low CAD burden in high CV-risk individuals (high MYO and C-C-22) and high CAD burden in low-risk subjects (high PS-3 and PAF-AH), in interaction with BMI, smoking, diabetes, HDL-cholesterol, and HbA1c. These findings could contribute to a deeper understanding of the atherosclerotic process beyond traditional risk profile assessment and potentially constitute new treatment targets.
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Affiliation(s)
- Ele Ferrannini
- Consiglio Nazionale Delle Ricerche (CNR) Institute of Clinical Physiology, Pisa, Italy
- *Correspondence: Ele Ferrannini
| | - Maria Laura Manca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Ferrannini
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Felicita Andreotti
- Institute of Cardiology, Fondazione Policlinico Universitario Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Roberto Latini
- Mario Negri Institute of Pharmacological Research-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Marco Magnoni
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Stephen A. Williams
- Clinical Research and Development, SomaLogic Inc., Boulder, CO, United States
| | | | - Aldo P. Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) Research Center, Heart Care Foundation, Florence, Italy
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Ferrannini E, Marx N, Andreini D, Campi B, Saba A, Gorini M, Ferrannini G, Milzi A, Magnoni M, Maseri A, Maggioni AP, Burgmaier M. Mannose as a biomarker of coronary artery disease: Angiographic evidence and clinical significance. Int J Cardiol 2022; 346:86-92. [PMID: 34800594 DOI: 10.1016/j.ijcard.2021.11.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND High mannose has previously associated with insulin resistance and cardiovascular disease (CVD). Our objective is to establish whether mannose is associated with anatomical evidence of coronary artery disease (CAD). METHODS Plasma mannose concentrations were measured by liquid chromatography/tandem mass spectrometry in a discovery cohort (n = 513) and a validation cohort (n = 221) of carefully phenotyped individuals. In both cohorts CAD was quantitated using state-of-the-art imaging techniques (coronary computed coronary tomography angiography (CCTA), invasive coronary angiography and optical coherence tomography). Information on subsequent CVD events/death was collected. Associations of mannose with angiographic variables and biomarkers were tested using univariate and multivariate regression models. Survival analysis was performed using the Kaplan-Meier estimator. RESULTS Mannose was related to indices of CAD and features of plaque vulnerability. In the discovery cohort, mannose was a marker of quantity and quality of CCTA-proven CAD and subjects with a mannose level in the top quartile had a significantly higher risk of CVD events/death (p = 3.6e-5). In the validation cohort, mannose was significantly associated with fibrous cap thickness < 65 μm (odds ratio = 1.32 per each 10 μmol/L mannose change [95% confidence interval, 1.05-1.65]) and was an independent predictor of death (hazard ratio for mannose≥vs < 84.6 μmol/L: 4.0(95%CI, 1.4-11.3), p = 0.006). CONCLUSION The current data add novel evidence that high mannose is a signature of CAD with a vulnerable plaque phenotype, consistently across measures of severity of vessel involvement and independent of the traditional correlates of CVD, and that it is an independent predictor of incident adverse outcomes.
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Affiliation(s)
| | | | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Italy
| | | | - Alessandro Saba
- Laboratory of Biochemistry, Department of Surgical, Medical, Molecular & Critical Area Pathology, University of Pisa, Italy
| | - Marco Gorini
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Giulia Ferrannini
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Marco Magnoni
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Attilio Maseri
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
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Deidda M, Noto A, Cadeddu Dessalvi C, Andreini D, Andreotti F, Ferrannini E, Latini R, Maggioni AP, Magnoni M, Maseri A, Mercuro G. Metabolomic correlates of coronary atherosclerosis, cardiovascular risk, both or neither. Results of the 2 × 2 phenotypic CAPIRE study. Int J Cardiol 2021; 336:14-21. [PMID: 34022320 DOI: 10.1016/j.ijcard.2021.05.033] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Traditional cardiovascular risk factors (RFs) and coronary artery disease (CAD) do not always run parallel. We investigated functional-metabolic correlations of CAD, RFs, or neither in the CAPIRE (Coronary Atherosclerosis in Outlier Subjects: Protective and Novel Individual Risk Factors Evaluation) 2 × 2 phenotypic observational study. METHODS Two hundred and fortyone subjects were included based on RF burden, presence/absence of CAD (assessed by computed tomography angiography), age and sex. Participants displayed one of four phenotypes: CAD with ≥3 RFs, no-CAD with ≥3 RFs, CAD with ≤1 RF and no-CAD with ≤1 RF. Metabolites were identified by gas chromatography-mass spectrometry and pathways by metabolite set enrichment analysis. RESULTS Characteristic patterns and specific pathways emerged for each phenotypic group: amino sugars for CAD/high-RF; urea cycle for no-CAD/high-RF; glutathione for CAD/low-RF; glycine and serine for no-CAD/low-RF. Presence of CAD correlated with ammonia recycling; absence of CAD with the transfer of acetyl groups into mitochondria; high-risk profile with alanine metabolism (all p < 0.05). The comparative case-control analyses showed a statistically significant difference for the two pathways of phenylalanine, tyrosine and tryptophan biosynthesis and phenylalanine metabolism in the CAD/Low-RF vs NoCAD/Low-RF comparison. CONCLUSIONS The present 2 × 2 observational study identified specific metabolic pathways for each of the four phenotypes, providing novel functional insights, particularly on CAD with low RF profiles and on the absence of CAD despite high-risk factor profiles.
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Affiliation(s)
- Martino Deidda
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Noto
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Italy
| | - Felicita Andreotti
- Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Roberto Latini
- Mario Negri Institute of Pharmacological Research, IRCCS, Milan, Italy
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Marco Magnoni
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
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Ferrannini G, Manca ML, Magnoni M, Andreotti F, Andreini D, Latini R, Maseri A, Maggioni AP, Ostroff RM, Williams SA, Ferrannini E. Erratum. Coronary Artery Disease and Type 2 Diabetes: A Proteomic Study. Diabetes Care 2020;43:843-851. Diabetes Care 2021; 44:1071. [PMID: 33483359 DOI: 10.2337/dc21-er04a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Andreotti F, Crea F, Patti G, Shoulders CC, Navarese EP, Robishaw J, Maseri A, Hennekens CH. Family history in first degree relatives of patients with premature cardiovascular disease. Int J Cardiol 2021; 333:215-218. [PMID: 33737169 DOI: 10.1016/j.ijcard.2021.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Family history (FH) of cardiovascular disease (CVD) in first degree relatives (FDR) is a major risk factor, especially for premature events. Data are sparse on FH of different manifestations of CVD among FDRs of patients with premature myocardial infarction (MI), chronic stable angina (CSA) or peripheral vascular disease (PVD). METHODS We obtained FHs from first degree relatives (parents or siblings) of 230 consecutive patients with premature (men < 60 and women < 65 years) CVD, including 79 wth MI, 39 CSA, 51 PVD and 61 blood donors. Among 1225 parents or siblings, 421 had MI, 222 CSA, 261PVD and 321 were among blood donors. RESULTS FH of MI were 5.6% (18/321) among blood donors, 14.0% (59/421) among patients with premature MI, 14.4% (32/222) CSA, and 8.0% (21/261) PVD. (all p < 0.05). For FH of CSA the corresponding frequencies were 3.7% 5.2%, 11.3%, and 6.9%. (all p < 0.05). For PVD, the corresponding frequencies were 2.1%, 3.4%, 0.9% and 0.7%, respectively. (p = ns). CONCLUSIONS These data are compatible with the hypothesis that FH of MI, CSA and PVD are significantly different for patients with premature MI or CSA but not PVD.
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Affiliation(s)
- Felicita Andreotti
- Dept of Cardiovascular Sciences, Catholic University Hospital, Scientific Directorate, FPUG IRCCS, Rome, Italy.
| | - Filippo Crea
- Institute of Cardiology, Catholic University Hospital, FPUG IRCCS, Rome, Italy.
| | - Giuseppe Patti
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.
| | | | - Eliano Pio Navarese
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland.
| | - Janet Robishaw
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
| | - Attilio Maseri
- Fondazione per il Tuo Cuore, Associazione Nazionale Medici Cardiologi Ospedalieri, Florence, Italy.
| | - Charles H Hennekens
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
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Conte E, Andreini D, Magnoni M, Masson S, Mushtaq S, Berti S, Canestrari M, Casolo G, Gabrielli D, Latini R, Marraccini P, Moccetti T, Modena MG, Pontone G, Gorini M, Maggioni AP, Maseri A. Association of high-risk coronary atherosclerosis at CCTA with clinical and circulating biomarkers: Insight from CAPIRE study. J Cardiovasc Comput Tomogr 2020; 15:73-80. [PMID: 32563713 DOI: 10.1016/j.jcct.2020.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 09/20/2019] [Revised: 02/28/2020] [Accepted: 03/23/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND High-risk coronary atherosclerosis features evaluated coronary CT angiography (CCTA) were suggested to have a prognostic role. The present study aimed to evaluate the association of circulating biomarkers with high-risk plaque features assessed by CCTA. METHODS A consecutive cohort of subjects who underwent CCTA because of suspected CAD was screened for inclusion in the CAPIRE study. Based on risk factors (RF) burden patients were defined as having a low clinical risk (0-1 RF with the exclusion of patients with diabetes mellitus as single RF) or an high clinical risk (≥3 RFs). In all patients, measurement of inflammatory biomarkers and CCTA analysis focused on high-risk plaque features were performed. Univariate and multivariate logistic regression analysis were used to evaluate the relationship between clinical and biological variables with CCTA advanced plaque features. RESULTS 528 patients were enrolled in CAPIRE study. Older age and male sex appeared to be predictors of qualitative high-risk plaque features and associated with the presence of elevated total, non-calcified and low-attenuation plaque volume. Among circulating biomarkers only hs-CRP was found to be associated with qualitative high-risk plaque features (OR 2.02, p = 0.004 and 2.02, p = 0.012 for LAP and RI > 1.1, respectively) with borderline association with LAP-Vol (OR 1.52, p = 0.076); HbA1c and PTX-3 resulted to be significantly associated with quantitative high-risk plaque features (OR 1.71, p = 0.003 and 1.04, p = 0.002 for LAP-Vol, respectively). CONCLUSIONS Our results support the association between inflammatory biomarkers (hs-CRP, PTX- 3), HbA1c and high-risk atherosclerotic features detected by CCTA. Male sex and older age are significant predictors of high-risk atherosclerosis.
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Affiliation(s)
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Italy.
| | | | - Serge Masson
- Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | | | - Sergio Berti
- FTGM - Stabilimento di Massa, UO Adult Cardiology, Massa, Italy
| | | | - Giancarlo Casolo
- Department of Cardiology, Nuovo Ospedale Versilia, Lido di Camaiore, Italy
| | | | - Roberto Latini
- Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Paolo Marraccini
- IFC CNR - Fondazione Toscana G. Monasterio, S.A. Emodinamica, Pisa, Italy
| | | | | | | | - Marco Gorini
- ANMCO Research Center, Heart Care Foundation Onlus, Florence, Italy
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation Onlus, Florence, Italy
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Magnoni M, Scarano P, Vergani V, Berteotti M, Gallone G, Cristell N, Maseri A, Cianflone D. Impact of adherence to a Mediterranean Diet pattern on patients with first acute myocardial infarction. Nutr Metab Cardiovasc Dis 2020; 30:574-580. [PMID: 32007333 DOI: 10.1016/j.numecd.2019.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/21/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS The Mediterranean diet (MD) affects the risk of myocardial infarction and long-term prognosis after a coronary event. Limited data are available regarding the influence of MD on short-term prognosis. We assessed the impact of the MD adherence on in-hospital and short-term outcome in patients with first ST-elevation Myocardial Infarction (STEMI). METHODS AND RESULTS As many as 533 European patients with STEMI and no previous history of coronary artery disease were included in this analysis. Previous dietary habits of each patient were collected with a food frequency questionnaire from which we calculated the FAMI Mediterranean Diet Score (FAMI MD Score), according to the MD adherence. A blood sample was drawn to each patient within 6 h of symptoms onset. Levels of high-sensitivity C-Reactive Protein (hsCRP), Interleukin-6 (IL-6) were measured. Clinical outcome at 180 days and myocardial reperfusion were assessed. Patients with higher FAMI MD Score had lower levels of hsCRP; there were no differences between IL-6 level among FAMI MD Score quintiles. There were no associations between adherence to MD and 180-day adverse events. Lower FAMI MD Score was associated with a higher risk of ineffective myocardial reperfusion after thrombolysis or percutaneous coronary intervention. Similar results were observed for daily consumption of ≥4 portions of fruit and vegetable. CONCLUSIONS A positive effect of the Mediterranean diet, and fruit and vegetable intake was observed on hsCRP and the occurrence of effective myocardial reperfusion. These findings confirm the favorable impact of Mediterranean diet adherence not only in primary but also in secondary prevention.
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Affiliation(s)
- Marco Magnoni
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy.
| | - Paola Scarano
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Vittoria Vergani
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Martina Berteotti
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Guglielmo Gallone
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Nicole Cristell
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Domenico Cianflone
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
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Ferrannini G, Manca ML, Magnoni M, Andreotti F, Andreini D, Latini R, Maseri A, Maggioni AP, Ostroff RM, Williams SA, Ferrannini E. Coronary Artery Disease and Type 2 Diabetes: A Proteomic Study. Diabetes Care 2020; 43:843-851. [PMID: 31988066 DOI: 10.2337/dc19-1902] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Coronary artery disease (CAD) is a major challenge in patients with type 2 diabetes (T2D). Coronary computed tomography angiography (CCTA) provides a detailed anatomic map of the coronary circulation. Proteomics are increasingly used to improve diagnostic and therapeutic algorithms. We hypothesized that the protein panel is differentially associated with T2D and CAD. RESEARCH DESIGN AND METHODS In CAPIRE (Coronary Atherosclerosis in Outlier Subjects: Protective and Novel Individual Risk Factors Evaluation-a cohort of 528 individuals with no previous cardiovascular event undergoing CCTA), participants were grouped into CAD- (clean coronaries) and CAD+ (diffuse lumen narrowing or plaques). Plasma proteins were screened by aptamer analysis. Two-way partial least squares was used to simultaneously rank proteins by diabetes status and CAD. RESULTS Though CAD+ was more prevalent among participants with T2D (HbA1c 6.7 ± 1.1%) than those without diabetes (56 vs. 30%, P < 0.0001), CCTA-based atherosclerosis burden did not differ. Of the 20 top-ranking proteins, 15 were associated with both T2D and CAD, and 3 (osteomodulin, cartilage intermediate-layer protein 15, and HTRA1) were selectively associated with T2D only and 2 (epidermal growth factor receptor and contactin-1) with CAD only. Elevated renin and GDF15, and lower adiponectin, were independently associated with both T2D and CAD. In multivariate analysis adjusting for the Framingham risk panel, patients with T2D were "protected" from CAD if female (P = 0.007), younger (P = 0.021), and with lower renin levels (P = 0.02). CONCLUSIONS We concluded that 1) CAD severity and quality do not differ between participants with T2D and without diabetes; 2) renin, GDF15, and adiponectin are shared markers by T2D and CAD; 3) several proteins are specifically associated with T2D or CAD; and 4) in T2D, lower renin levels may protect against CAD.
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Affiliation(s)
- Giulia Ferrannini
- Department of Medical Sciences, Postgraduate School of Internal Medicine, University of Turin, Turin, Italy.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Maria Laura Manca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Magnoni
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Felicita Andreotti
- Institute of Cardiology, FPG IRCCS, Catholic University Medical School, Rome, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Roberto Latini
- Mario Negri Institute of Pharmacological Research-IRCCS, Milan, Italy
| | | | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
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Pileggi S, De Chiara B, Magnoli M, Franzosi MG, Merlanti B, Bianchini F, Moreo A, Romeo G, Russo CF, Rizzo S, Basso C, Martinelli L, Maseri A. Sequencing of NOTCH1 gene in an Italian population with bicuspid aortic valve: Preliminary results from the GISSI OUTLIERS VAR study. Gene 2019; 715:143970. [PMID: 31330235 DOI: 10.1016/j.gene.2019.143970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/13/2019] [Accepted: 07/08/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bicuspid aortic valve (BAV) formation is genetically determined, with reduced penetrance and variable expressivity. NOTCH1 is a proven candidate gene and its mutations have been found in familial and sporadic cases of BAV. METHODS 66 BAV patients from the GISSI VAR study were genotyped for the NOTCH1 gene. RESULTS We identified 63 variants, in heterozygous and homozygous states. Fifty-two are common polymorphisms present in almost all patients. Eleven variants are new and never yet reported: two are non-synonymous substitutions, Gly540Asp in exon 10 and Glu851Gln in exon 16; one is in the 3'UTR region and seven in introns, one corresponds to a T allele insertion in intron 27. We selected four statistically noteworthy and seven new variants identified in six BAV patients and correlated them with clinical and demographic variables and with imaging and histological parameters. Preliminary data show that four were BAV patients with isolated stenosis in patients over 60 aged. These variants may correlate with a later need for surgery for the presence of stenosis and not aortic valve regurgitation or ascending aortic aneurysm. CONCLUSIONS Completing the genotyping of 62 BAV patients we found 11 new variants in the NOTCH1 gene never yet reported. These findings confirm that the identification of new, clinically remarkable biomarkers for BAV requires a deeper genetic understanding of the NOTCH1 gene variants, which could be targeted by future diagnostic and therapeutic strategies.
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Affiliation(s)
- Silvana Pileggi
- Department of Cardiovascular Research, IRCCS Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - Benedetta De Chiara
- Cardiology IV, "A.De Gasperis" Department, ASST GOM Niguarda, Milan, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Michela Magnoli
- Department of Cardiovascular Research, IRCCS Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Maria Grazia Franzosi
- Department of Cardiovascular Research, IRCCS Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Bruno Merlanti
- Cardiac Surgery, "A.De Gasperis" Department, ASST GOM Niguarda, Milan, Italy
| | | | - Antonella Moreo
- Cardiology IV, "A.De Gasperis" Department, ASST GOM Niguarda, Milan, Italy
| | - Gabriella Romeo
- Department of Cardiac, Vascular and Thoracic Sciences, University of Padua, Padua
| | | | - Stefania Rizzo
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua
| | - Luigi Martinelli
- Cardiothoracic Surgery, ICLAS-Istituto Clinico Ligure Alta Specialità, Rapallo
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Canepa M, Ameri P, Lucci D, Nicolosi GL, Marchioli R, Porcu M, Tognoni G, Franzosi MG, Latini R, Maseri A, Tavazzi L, Maggioni AP. Modes of death and prognostic outliers in chronic heart failure. Am Heart J 2019; 208:100-109. [PMID: 30580128 DOI: 10.1016/j.ahj.2018.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/18/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The impact of incident sudden cardiac death (SCD) on the predictive accuracy of prognostic risk scores for patients with chronic heart failure (HF) has rarely been examined. We assessed the relationship between estimated probability of death and modes of death in this population, as well as the predictors of death and survival in prognostic outliers. METHODS AND RESULTS The MAGGIC 3-year probability of death was estimated in 6,859 participants of the GISSI-HF trial (mean age 67±11 years, 78% men, 91% with ejection fraction <40%, mean follow-up 3.5±1.3 years, observed mortality 28.4%). The incidence of SCD progressively decreased with increased probability of death, and occurred in 52.5% of patients estimated at low-risk (N = 61 with probability <14%) vs. in 23.5% of the high-risk ones (N = 375 with probability >56%, P < .0001). On the contrary, death from worsening HF was significantly more frequent in the latter group (19.7% vs. 46.1%, P < .0001). The overall predictive accuracy of the MAGGIC model improved after excluding deaths from SCD (AUC from 0.731 to 0.760, P = .0034). Among patients estimated at low-risk (N = 61 dead, 743 alive), independent predictors of death were older age, longer history of HF, higher serum uric acid and chronic obstructive pulmonary disease. The only predictor of survival in patients estimated at high-risk (N = 210 alive, 375 dead) was higher systolic blood pressure. CONCLUSIONS The MAGGIC risk score demonstrated its scarce ability to capture SCD, particularly in chronic HF patients estimated at low risk of death. Newer and better prognostic tools in the evolving horizon of HF are needed.
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Affiliation(s)
- Marco Canepa
- Cardiovascular Disease Unit, Policlinic Hospital San Martino IRCCS & Department of Internal Medicine, University of Genova, Genova, Italy
| | - Pietro Ameri
- Cardiovascular Disease Unit, Policlinic Hospital San Martino IRCCS & Department of Internal Medicine, University of Genova, Genova, Italy
| | - Donata Lucci
- ANMCO Research Centre, Florence, Fondazione per il Tuo cuore - HCF onluse, Florence, Italy
| | - Gian Luigi Nicolosi
- Department of Cardiology, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | | | - Maurizio Porcu
- Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy
| | - Gianni Tognoni
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Maria Grazia Franzosi
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Roberto Latini
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Attilio Maseri
- Fondazione per il Tuo cuore - HCF onlus, Florence, Italy
| | - Luigi Tavazzi
- Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy
| | - Aldo Pietro Maggioni
- ANMCO Research Centre, Florence, Fondazione per il Tuo cuore - HCF onluse, Florence, Italy.
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11
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Andreotti F, Hackett DR, Haider AW, Roncaglioni MC, Davies GJ, Beacham JL, Kluft C, Maseri A. Von Willebrand Factor, Plasminogen Activator Inhibitor-1 and C-Reactive Protein Are Markers of Thrombolytic Efficacy in Acute Myocardial Infarction. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1646343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryPlasma von Willebrand factor, plasminogen activator inhibitor activity and C-reactive protein were assessed as markers of coronary recanalisation in 30 patients with acute myocardial infarction receiving tissue-type plasminogen activator (t-PA). Blood samples were taken before t-PA (time 0), 4-hourly for 24 h and daily up to 72 h. A continuous electrocardiogram was recorded in the first 24 h. Coronary arteriography was performed 90 min and 24 h after the start of t-PA. Patients with a patent infarct artery (n = 17), compared to those with occluded artery (n = 13), showed a fall in von Willebrand factor from 0 to 24 h (p = 0.001), a greater fall in plasminogen activator inhibitor from 24 to 48 h (p = 0.04) and a fall in C-reactive protein from 48 to 72 h (p = 0.002). The accuracy of these indices compared favourably with time to peak plasma MB creatine kinase and ≥ 50% resolution of maximal ST-deviation on the electrocardiogram.Thus, changes in plasma von Willebrand factor, plasminogen activator inhibitor and C-reactive protein during the first 3 days of myocardial infarction are indicative of thrombolytic efficacy. Their concordant behaviour may reflect a common regulatory mechanism.
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Affiliation(s)
- F Andreotti
- The Royal Postgraduate Medical School, Hammersmith Hospital, London, U.K
| | - D R Hackett
- The Royal Postgraduate Medical School, Hammersmith Hospital, London, U.K
| | - A W Haider
- The Royal Postgraduate Medical School, Hammersmith Hospital, London, U.K
| | - M C Roncaglioni
- The Royal Postgraduate Medical School, Hammersmith Hospital, London, U.K
| | - G J Davies
- The Royal Postgraduate Medical School, Hammersmith Hospital, London, U.K
| | - J L Beacham
- The Royal Postgraduate Medical School, Hammersmith Hospital, London, U.K
| | - C Kluft
- The Gaubius Laboratory, IVVO-TNO, Leiden, The Netherlands
| | - A Maseri
- The Royal Postgraduate Medical School, Hammersmith Hospital, London, U.K
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12
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Vejar M, Fragasso G, Hackett D, Lipkin DP, Maseri A, Born GVR, Ciabattoni G, Patrono C. Dissociation of Platelet Activation and Spontaneous Myocardial Ischemia in Unstable Angina. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1645038] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryA dynamic thrombotic process, coronary spasm or both can be responsible for recurrent episodes of transient reduction of coronary blood flow in unstable angina. We have investigated the temporal relationship between episodic platelet activation, as detected by increased urinary excretion of 11-dehydro-TXB2, and spontaneous myocardial ischemia, assessed by continuous electrocardiographic monitoring and recording in 21 patients with unstable angina pectoris. In order to validate measurements of metabolite excretion as a reflection of intracoronary platelet activation, we have also performed repeated urine sampling from 8 patients undergoing PTCA and from 6 patients with peripheral vascular disease. The latter showed a 16% coefficient of variation in 3 consecutive 8-h urine samples. 11-dehydro-TXB2 increased significantly, by up to 15-fold, in the 2.5- to 5.0-h urine collection encompassing PTCA and decreased by > 50% during the following 2-h period. Patients with unstable angina were characterized by episodic increases (>2 SD of controls) in metabolite excretion, in successive 6-8 h specimens. Paired measurements of 11-dehydro-TXB2 and 2, 3-dinor-TXB2 in 15 urine samples did not reveal evidence of altered metabolic disposition of endogenously released TXB2. A total of 125 ECG ischemic episodes were recorded, of which 64% asymptomatic. We have compared these biochemical and ECG changes in patients randomized to i. v. low-dose aspirin or i.v. isosorbide dinitrate and oral diltiazem. Twenty-five of 56 (i.e. 45%) urine samples obtained in aspirin-free periods showed increased metabolite excretion as compared to 15 of 88 (i.e. 17%) samples collected during aspirin. Of the former, only 3 episodes of enhanced 11-dehydro-TXB2 excretion were associated with ST-segment changes, 7 with chest pain, and 15 with no ECG or clinical changes. Metabolite excretion was approximately 70% lower during aspirin administration than during coronary dilators. However, despite > 95% suppression of platelet cyclooxygenase activity, as monitored ex vivo, incomplete suppression of in vivo TXB2 biosynthesis was occasionally seen during low-dose aspirin therapy. We conclude that in unstable angina, episodic platelet activation is infrequently associated with spontaneous myocardial ischemia. Although the two events may represent functional expressions of the same coronary lesion, they are likely to be triggered by independent mechanisms through different mediators.
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Affiliation(s)
- Margarita Vejar
- The Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, United Kingdom
| | - Gabriele Fragasso
- The Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, United Kingdom
| | - David Hackett
- The Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, United Kingdom
| | - David P Lipkin
- The Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, United Kingdom
| | - Attilio Maseri
- The Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, United Kingdom
| | - Gustav V R Born
- The Department of Pharmacology, King′s College, London, United Kingdom
| | - Giovanni Ciabattoni
- The Department of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | - Carlo Patrono
- The Department of Pharmacology, Catholic University School of Medicine, Rome, Italy
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13
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Erne P, Wardle J, Sanders K, Lewis SM, Maseri A. Mean Platelet Volume and Size Distribution and Their Sensitivity to Agonists in Patients with Coronary Artery Disease and Congestive Heart Failure. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1642766] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
SummaryMean platelet volume was related to platelet count in patients with myocardial infarction (n = 55) and patients with congestive heart failure (n = 9). 18 patients with acute myocardial infarction were tested at admission and 4-7 days later, together with 13 patients with chronic stable angina and 10 patients with chest pain which was not related to coronary artery disease. In citrated blood a relative reduced frequency of large platelets (>13 fl) occured in patients with acute myocardial infarction at admission but was not seen during recovery or in patients with chronic stable angina. This suggests consumption of large platelets at time of thrombus formation. No relation was found between plasma catecholamine levels and mean platelet volumes. Effects of serotonine, adrenaline and CGP 28392, a calcium agonist, on platelet volume distributions were determined. Sensitivity of platelets to adrenaline was increased in patients with acute myocardial infarction on admission and reduced 4-7 days later, while in patients with congestive heart failure reactivity to both serotonine and adrenaline were reduced. This indicates a fast down-regulation during the early recovery phase of myocardial infarction and chronically in congestive heart failure.
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Affiliation(s)
- P Erne
- The Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
| | - J Wardle
- Department of Haematology, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
| | - K Sanders
- Department of Haematology, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
| | - S M Lewis
- Department of Haematology, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
| | - A Maseri
- The Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
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14
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Moccetti T, Maseri A, Maggioni AP. Lugano perspectives: final considerations. Eur Heart J Suppl 2018. [DOI: 10.1093/eurheartj/suy007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Tiziano Moccetti
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
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15
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Cannistraci CV, Nieminen T, Nishi M, Khachigian LM, Viikilä J, Laine M, Cianflone D, Maseri A, Yeo KK, Bhindi R, Ammirati E. "Summer Shift": A Potential Effect of Sunshine on the Time Onset of ST-Elevation Acute Myocardial Infarction. J Am Heart Assoc 2018; 7:JAHA.117.006878. [PMID: 29626152 PMCID: PMC6015398 DOI: 10.1161/jaha.117.006878] [Citation(s) in RCA: 14] [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] [Indexed: 12/22/2022]
Abstract
Background ST‐elevation acute myocardial infarction (STEMI) represents one of the leading causes of death. The time of STEMI onset has a circadian rhythm with a peak during diurnal hours, and the occurrence of STEMI follows a seasonal pattern with a salient peak of cases in the winter months and a marked reduction of cases in the summer months. Scholars investigated the reason behind the winter peak, suggesting that environmental and climatic factors concur in STEMI pathogenesis, but no studies have investigated whether the circadian rhythm is modified with the seasonal pattern, in particular during the summer reduction in STEMI occurrence. Methods and Results Here, we provide a multiethnic and multination epidemiological study (from both hemispheres at different latitudes, n=2270 cases) that investigates whether the circadian variation of STEMI onset is altered in the summer season. The main finding is that the difference between numbers of diurnal (6:00 to 18:00) and nocturnal (18:00 to 6:00) STEMI is markedly decreased in the summer season, and this is a prodrome of a complex mechanism according to which the circadian rhythm of STEMI time onset seems season dependent. Conclusions The “summer shift” of STEMI to the nocturnal interval is consistent across different populations, and the sunshine duration (a measure related to cloudiness and solar irradiance) underpins this season‐dependent circadian perturbation. Vitamin D, which in our results seems correlated with this summer shift, is also primarily regulated by the sunshine duration, and future studies should investigate their joint role in the mechanisms of STEMI etiogenesis.
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Affiliation(s)
- Carlo Vittorio Cannistraci
- Biomedical Cybernetics Group, Biotechnology Center (BIOTEC), Center for Molecular and Cellular Bioengineering (CMCB), Center for Systems Biology Dresden (CSBD), Department of Physics, Technische Universität Dresden, Dresden, Germany .,Brain Bio-Inspired Computing (BBC) Lab, IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Tuomo Nieminen
- Internal Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,South Karelia Central Hospital, Lappeenranta, Finland
| | - Masahiro Nishi
- Department of Cardiology, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Levon M Khachigian
- Vascular Biology and Translational Research, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Juho Viikilä
- Cardiology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Laine
- Cardiology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | | | | | | | | | - Enrico Ammirati
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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16
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Scarano P, Magnoni M, Cristell N, Berteotti M, Gallone G, Camici P, Maseri A, Cianflone D. IMPACT OF THE MEDITERRANEAN DIET ON PATIENTS WITH A FIRST ACUTE MYOCARDIAL INFARCTION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30628-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Maseri A, Mancini P, Pesola A, L’Abbate A, Bedini R, Pisani P, Michelassi C, Contini C, Marzilli M, De Nes DM. Method for the Study of Regional Myocardial Perfusion in Patients with Atherosclerotic Coronary Artery Disease. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1624922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryIn patients with ischemic heart disease the evaluation of regional myocardial perfusion by 133Xenon intra-coronary injection using a gamma camera computer system allows the detection of regional alterations of myocardial perfusion. While at rest a minority of the patients studied shows large alterations, during pacing induced angina a severe reduction of regional myocardial perfusion can be evidenced both in initial distribution scintigrams, when the injection is performed during angina, and on the washout curves when angina is induced immediately after the injection, during the course of the washout.
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18
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Abstract
SummaryPreinfarction angina and early reperfusion of the infarct-related artery are major determinants of reduced infarct-size in patients with acute myocardial infarction. The beneficial effects of preinfarction angina on infarct size have been attributed to the development of collateral vessels and/or to post-ischemic myocardial protection. However, recently, a relation has been found between prodromal angina, faster coronary recanalization, and smaller infarcts in patients treated with rt-PA: those with preinfarction angina showed earlier reperfusion (p = 0.006) and a 50% reduction of CKMB-estimated infarct-size (p = 0.009) compared to patients without preinfarction angina. This intriguing observation is consistent with a subsequent observation of higher coronary recanalization rates following thrombolysis in patients with prodromal preinfarction angina compared to patients without antecedent angina. Recent findings in dogs show an enhanced spontaneous lysis of plateletrich coronary thrombi with ischemic preconditioning, which is prevented by adenosine blockade, suggesting an antithrom-botic effect of ischemic metabolites. Understanding the mechanisms responsible for earlier and enhanced coronary recanalization in patients with preinfarction angina may open the way to new reperfusion strategies.A vast number of studies, globally involving ≈17,000 patients with acute myocardial infarction, have unequivocally shown that an infarction preceded by angina evolves into a smaller area of necrosis compared to an infarct not preceded by angina (Table 1) (1). So far, preinfarction angina has been thought to have cardioprotective effects mainly through two mechanisms: collateral perfusion of the infarctzone (2-4), and ischemic preconditioning of the myocardium (5-7). Here we discuss a further mechanism of protection represented by improved reperfusion of the infarct-related artery.
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19
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Peretto G, Giorgio D, Magnoni M, Berteotti M, Vergani V, Angeloni G, Crea F, Lanza G, Ceriotti F, Maseri A, Cianflone D. P3672High-sensitivity troponin: the challenge of improving classification and prognostic stratification of NSTE-ACS. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Gulizia MM, Colivicchi F, Ricciardi G, Giampaoli S, Maggioni AP, Averna M, Graziani MS, Ceriotti F, Mugelli A, Rossi F, Medea G, Parretti D, Abrignani MG, Arca M, Perrone Filardi P, Perticone F, Catapano A, Griffo R, Nardi F, Riccio C, Di Lenarda A, Scherillo M, Musacchio N, Panno AV, Zito GB, Campanini M, Bolognese L, Faggiano PM, Musumeci G, Pusineri E, Ciaccio M, Bonora E, Cantelli Forti G, Ruggieri MP, Cricelli C, Romeo F, Ferrari R, Maseri A. ANMCO/ISS/AMD/ANCE/ARCA/FADOI/GICR-IACPR/SICI-GISE/SIBioC/SIC/SICOA/SID/SIF/SIMEU/SIMG/SIMI/SISA Joint Consensus Document on cholesterol and cardiovascular risk: diagnostic-therapeutic pathway in Italy. Eur Heart J Suppl 2017; 19:D3-D54. [PMID: 28751833 PMCID: PMC5526476 DOI: 10.1093/eurheartj/sux029] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Atherosclerotic cardiovascular disease still represents the leading cause of death in Western countries. A wealth of scientific evidence demonstrates that increased blood cholesterol levels have a major impact on the outbreak and progression of atherosclerotic plaques. Moreover, several cholesterol-lowering pharmacological agents, including statins and ezetimibe, have proved effective in improving clinical outcomes. This document focuses on the clinical management of hypercholesterolaemia and has been conceived by 16 Italian medical associations with the support of the Italian National Institute of Health. The authors discuss in detail the role of hypercholesterolaemia in the genesis of atherosclerotic cardiovascular disease. In addition, the implications for high cholesterol levels in the definition of the individual cardiovascular risk profile have been carefully analysed, while all available therapeutic options for blood cholesterol reduction and cardiovascular risk mitigation have been explored. Finally, this document outlines the diagnostic and therapeutic pathways for the clinical management of patients with hypercholesterolaemia.
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Affiliation(s)
- Michele Massimo Gulizia
- Italian Association of Hospital Cardiologists (ANMCO)
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione ‘Garibaldi’, Via Palermo 636, 95122 Catania, Italy
| | | | | | | | | | | | | | - Ferruccio Ceriotti
- Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC)
| | | | | | | | | | | | - Marcello Arca
- Italian Society for the Study of Arteriosclerosis (SISA)
| | | | | | | | - Raffaele Griffo
- Italian Group of Rehabilitation and Preventative Cardiology (GICR-IACPR)
| | | | | | | | | | | | | | | | | | | | | | | | - Enrico Pusineri
- Italian Society of Accredited Cardiology Hospital Care (SICOA)
| | - Marcello Ciaccio
- Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC)
| | | | | | | | | | | | | | - Attilio Maseri
- Fondazione ‘per il Tuo cuore’ Heart Care Foundation Onlus
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21
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Magnoni M, Berteotti M, Ceriotti F, Mallia V, Vergani V, Peretto G, Angeloni G, Cristell N, Maseri A, Cianflone D. Serum uric acid on admission predicts in-hospital mortality in patients with acute coronary syndrome. Int J Cardiol 2017; 240:25-29. [PMID: 28476518 DOI: 10.1016/j.ijcard.2017.04.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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: 02/09/2017] [Revised: 03/30/2017] [Accepted: 04/10/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite the association between uric acid and cardiovascular disease has been known for decades, the prognostic value of serum uric acid (UA) in all clinical manifestations of acute coronary syndrome (ACS), namely ST-elevation myocardial infarction (STEMI), NSTEMI and unstable angina, has not been definitively assessed. METHODS This retrospective analysis included patients from previous SPAI and FAMI studies with the aim to investigate the association between serum uric acid and major adverse cardiovascular events at 180days from hospital admission. RESULTS 1548 patients were considered and divided in four groups, according UA concentration. Uricemia was significantly associated with gender, BMI, arterial hypertension, HDL-cholesterol, triglycerides, metabolic syndrome and glomerular filtration rate in univariate analysis. Multivariate logistic regression indicated that UA >6.0mg/dL on admission increased the risk of in-hospital mortality in overall population (OR 2.9, 95%CI 1.4-6.1; p=0.0057) and in patients with de novo ACS (OR 3.2, 95%CI 1.5-6.8; p=0.0033). Comparable results were also obtained after adjusting the model for age, gender, body mass index, glomerular filtration rate, metabolic syndrome, acute revascularization and ethnicity. A positive correlation was observed between UA and C reactive protein concentrations in in-hospital deaths only (rho 0.41, p=0.027). CONCLUSION In patients with acute coronary syndrome, uricemia levels above the current international reference limit (6.0mg/dl) were associated with in-hospital mortality, independently from ethnicity and renal function.
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Affiliation(s)
- Marco Magnoni
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Martina Berteotti
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Ferruccio Ceriotti
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Vincenzo Mallia
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Vittoria Vergani
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Giovanni Peretto
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Giulia Angeloni
- Department of Heart and Vessels, Careggi Hospital, University of Florence, Florence, Italy
| | - Nicole Cristell
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Domenico Cianflone
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy.
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Andreotti F, Coluzzi G, Pafundi T, Rio T, Navarese EP, Crea F, Pistolesi M, Maseri A, Hennekens CH. Last Word on Viewpoint: Anemia contributes to cardiovascular disease through reductions in nitric oxide. J Appl Physiol (1985) 2017; 122:420-421. [DOI: 10.1152/japplphysiol.01095.2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Giulio Coluzzi
- Institute of Cardiology, Catholic University Hospital, Rome, Italy
| | - Teodosio Pafundi
- Institute of Cardiology, Catholic University Hospital, Rome, Italy
| | - Teresa Rio
- Institute of Cardiology, Catholic University Hospital, Rome, Italy
| | | | - Filippo Crea
- Institute of Cardiology, Catholic University Hospital, Rome, Italy
| | - Massimo Pistolesi
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | | | - Charles H. Hennekens
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
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23
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Andreotti F, Coluzzi G, Pafundi T, Rio T, Navarese EP, Crea F, Pistolesi M, Maseri A, Hennekens CH. Anemia contributes to cardiovascular disease through reductions in nitric oxide. J Appl Physiol (1985) 2016; 122:414-417. [PMID: 27687564 DOI: 10.1152/japplphysiol.00995.2015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 08/25/2016] [Accepted: 09/27/2016] [Indexed: 12/25/2022] Open
Affiliation(s)
| | - Giulio Coluzzi
- Institute of Cardiology, Catholic University Hospital, Rome, Italy
| | - Teodosio Pafundi
- Institute of Cardiology, Catholic University Hospital, Rome, Italy
| | - Teresa Rio
- Institute of Cardiology, Catholic University Hospital, Rome, Italy
| | | | - Filippo Crea
- Institute of Cardiology, Catholic University Hospital, Rome, Italy
| | - Massimo Pistolesi
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | | | - Charles H Hennekens
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
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Affiliation(s)
- Attilio Maseri
- Sir John McMichael Professor of Cardiovascular Medicine Royal Postgraduate Medical School, London
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Gulizia MM, Colivicchi F, Ricciardi G, Giampaoli S, Maggioni AP, Averna M, Graziani MS, Ceriotti F, Mugelli A, Rossi F, Medea G, Parretti D, Abrignani MG, Arca M, Filardi PP, Perticone F, Catapano A, Griffo R, Nardi F, Riccio C, Di Lenarda A, Scherillo M, Musacchio N, Panno AV, Zito GB, Campanini M, Bolognese L, Faggiano PM, Musumeci G, Pusineri E, Ciaccio M, Bonora E, Cantelli Forti G, Ruggieri MP, Cricelli C, Romeo F, Ferrari R, Maseri A. [ANMCO/ISS/AMD/ANCE/ARCA/FADOI/GICR-IACPR/SICI-GISE/SIBioC/SIC/SICOA/SID/SIF/SIMEU/SIMG/SIMI/SISA Consensus document. Hypercholesterolemia and cardiovascular risk: diagnostic and therapeutic pathways in Italy]. G Ital Cardiol (Rome) 2016; 17:3S-57. [PMID: 27312138 DOI: 10.1714/2264.24358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Atherosclerotic cardiovascular disease still represents the leading cause of death in western countries. A wealth of scientific evidence demonstrates that increased blood cholesterol levels have a major impact on the outbreak and progression of atherosclerotic plaques. Moreover, several cholesterol-lowering pharmacological agents, including statins and ezetimibe, have proven effective in improving clinical outcomes. This document is focused on the clinical management of hypercholesterolemia and has been conceived by 16 Italian medical associations with the support of the Italian National Institute of Health. The authors have considered with particular attention the role of hypercholesterolemia in the genesis of atherosclerotic cardiovascular disease. Besides, the implications of high cholesterol levels in the definition of the individual cardiovascular risk profile have been carefully analyzed, while all available therapeutic options for blood cholesterol reduction and cardiovascular risk mitigation have been considered. Finally, this document outlines the diagnostic and therapeutic pathways for the clinical management of patients with hypercholesterolemia.
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Affiliation(s)
| | | | | | | | | | | | | | - Ferruccio Ceriotti
- Società Italiana di Biochimica Clinica e Biologia Molecolare Clinica (SIBioC)
| | | | | | | | | | | | - Marcello Arca
- Società Italiana per lo Studio della Arteriosclerosi (SISA)
| | | | | | | | - Raffaele Griffo
- Gruppo Italiano di Cardiologia Riabilitativa e Preventiva (GICR-IACPR)
| | - Federico Nardi
- Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)
| | - Carmine Riccio
- Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)
| | | | | | | | | | | | - Mauro Campanini
- Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI)
| | | | | | | | | | - Marcello Ciaccio
- Società Italiana di Biochimica Clinica e Biologia Molecolare Clinica (SIBioC)
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Magnoni M, Masson S, Andreini D, Moccetti T, Modena MG, Canestrari M, Berti S, Casolo G, Gabrielli D, Marraccini P, Pontone G, Latini R, Maggioni AP, Maseri A. Usefulness of High-Sensitivity Cardiac Troponin T for the Identification of Outlier Patients With Diffuse Coronary Atherosclerosis and Low-Risk Factors. Am J Cardiol 2016; 117:1397-404. [PMID: 26976791 DOI: 10.1016/j.amjcard.2016.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 12/01/2022]
Abstract
Novel high-sensitivity assay can detect very low levels of circulating cardiac troponin (hs-cTnT) in apparently healthy subjects. Within normal range, higher levels are associated with coronary artery disease (CAD) and cardiac abnormalities commonly associated to traditional risk factors (RFs) for CAD. Therefore, we investigated the relation between circulating hs-cTnT and CAD in patients with a spectrum of RF burden aiming to assess the added value of hs-cTnT to identify "outlier" patients with CAD despite a low RF burden. Hs-cTnT was measured in 525 stable patients without previous diagnosis of ischemic heart disease with 0 to 1 RF, excluded diabetes, (low-RF group, n = 263) or ≥2 RFs (multiple-RF group, n = 262) and without CAD (segment involvement score = 0) or diffuse CAD (segment involvement score >5) at coronary computed tomography angiography. Outlier patients with diffuse CAD despite low-RF burden had similar extent, severity, and plaque composition than patients with multiple RFs. Overall, hs-cTnT was measurable in 81% of patients with median value of 6.0 ng/L. In both groups, hs-cTnT concentration was higher in patients with CAD than in patients with normal coronary arteries (p <0.0001). Hs-cTnT was more accurate to detect patients with CAD in the low-RF group than in the multiple-RF group (p = 0.04). In multivariate analysis, higher level of hs-cTnT (>6 ng/L) was independently associated with CAD in low-RF group only. Despite very low circulating concentrations, hs-cTnT may identify with a good accuracy the outlier patients with diffuse CAD despite low-RF burden.
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Affiliation(s)
| | - Serge Masson
- Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | - Tiziano Moccetti
- Servizio di Ricerca Cardiovascolare, Cardiocentro Ticino, Lugano, Switzerland
| | | | | | - Sergio Berti
- Fondazione Toscana Gabriele Monasterio, Stabilimento di Massa, Unità Operativa Adult Cardiology, Massa, Italy
| | - Giancarlo Casolo
- Department of Cardiology, Nuovo Ospedale Versilia, Lido di Camaiore, Italy
| | | | - Paolo Marraccini
- Istituto di Fisiologia Clinica-Consiglio Nazionale delle Ricerche, Fondazione Toscana G. Monasterio, S.A. Emodinamica, Pisa, Italy
| | | | - Roberto Latini
- Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Aldo Pietro Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy
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Magnoni M, Andreini D, Gorini M, Moccetti T, Modena MG, Canestrari M, Berti S, Casolo G, Gabrielli D, Marraccini P, Pontone G, Masson S, Latini R, Maggioni AP, Maseri A. Coronary atherosclerosis in outlier subjects at the opposite extremes of traditional risk factors: Rationale and preliminary results of the Coronary Atherosclerosis in outlier subjects: Protective and novel Individual Risk factors Evaluation (CAPIRE) study. Am Heart J 2016; 173:18-26. [PMID: 26920592 DOI: 10.1016/j.ahj.2015.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
Abstract
Although it is generally accepted that cardiac ischemic events develop when coronary atherosclerosis (coronary artery disease [CAD]) has reached a critical threshold, this is true only to a first approximation. Indeed, there are patients with severe CAD who do not develop ischemic events; conversely, at the other extreme, individuals with minimal CAD may do. Similar exceptions to this paradigm include patients with diffuse CAD with a low risk factor (RF) profile and others with multiple RFs who develop only mild or no CAD. Therefore, the CAPIRE project was designed to investigate whether the specific study of these extreme outlier populations could provide clues for identification of yet unknown risk or protective factors for CAD and ischemic events. In the CAPIRE study, 481 subjects without previous symptoms or history of ischemic heart disease and normal left ventricular systolic function undergoing coronary computed tomography angiography have been selected based on coronary computed tomography angiography findings and cardiovascular RF profile. Therefore, in the whole population, 2 extreme outlier populations have been identified: (1) subjects with no CAD despite multiple RFs, and (2) at the opposite extreme, subjects with diffuse CAD despite a low-risk profile. Each subject has been characterized by clinical, anatomical imaging variables of CAD and baseline circulating biomarkers. Blood samples were collected and stored in a biological bank for further advanced investigations. The project is designed as a prospective, observational, international multicenter study with an initial cross-sectional analysis of clinical, imaging, and biomolecular variables in the selected groups and a longitudinal 5-year follow-up.
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Manfredi AA, Baldini M, Camera M, Baldissera E, Brambilla M, Peretti G, Maseri A, Rovere-Querini P, Tremoli E, Sabbadini MG, Maugeri N. Anti-TNFα agents curb platelet activation in patients with rheumatoid arthritis. Ann Rheum Dis 2016; 75:1511-20. [PMID: 26819099 DOI: 10.1136/annrheumdis-2015-208442] [Citation(s) in RCA: 52] [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: 08/19/2015] [Accepted: 01/01/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cardiovascular disease is important in rheumatoid arthritis (RA). Tissue factor (TF) is expressed upon platelet activation and initiates coagulation. Anti-tumour necrosis factor-α (TNFα) agents seem to decrease RA-associated cardiovascular events. We investigated whether (1) TNFα activates human platelets and (2) TNFα pharmacological blockade modulates the platelet-leucocyte reciprocal activation in RA. DESIGN The expression of platelet TNFα receptors has been assessed by flow cytometry and immunogold electron microscopy. Platelet and leucocyte activation has been assessed also in the presence of antibodies against the TNFα receptors 1 and 2 and of infliximab. TF expression, binding to fibrinogen and phosphatidylserine exposure, has been assessed by flow cytometry, TF activity by coagulation time and by endogenous thrombin generation. Markers of platelet and leucocyte activation have been assessed in 161 subjects: 42 patients with RA, 12 with osteoarthritis, 37 age-matched and sex-matched patients with chronic stable angina and 70 age-matched and sex-matched healthy subjects. RESULTS TNFα elicited the platelet activation and the expression of TF, which in turn prompted thrombin generation and clot formation. Inhibition of the TNFα-induced activation restricted platelet ability to activate leucocytes and to induce leucocyte TF. TNFα inhibition did not influence platelet activation induced by collagen, ADP or thrombin receptor activating peptide-6. Platelets of patients with RA were more activated than those of controls. Activation was reduced in patients treated with TNFα inhibitors. CONCLUSIONS TNFα-dependent pathways control platelet activation and TF expression in RA. Further studies will verify whether the protective effect of TNFα inhibitors on cardiovascular events involves their ability to modulate platelet function.
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Affiliation(s)
- Angelo A Manfredi
- Università Vita-Salute San Raffaele and IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Mattia Baldini
- Università Vita-Salute San Raffaele and IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Marina Camera
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Elena Baldissera
- Università Vita-Salute San Raffaele and IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | - Giuseppe Peretti
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Attilio Maseri
- Università Vita-Salute San Raffaele and IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Patrizia Rovere-Querini
- Università Vita-Salute San Raffaele and IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Elena Tremoli
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Maria Grazia Sabbadini
- Università Vita-Salute San Raffaele and IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Norma Maugeri
- Università Vita-Salute San Raffaele and IRCCS San Raffaele Scientific Institute, Milano, Italy
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Magnoni M, Berteotti M, Norata GD, Limite LR, Peretto G, Cristell N, Maseri A, Cianflone D. Applicability of the 2013 ACC/AHA Risk Assessment and Cholesterol Treatment Guidelines in the real world: results from a multiethnic case-control study. Ann Med 2016; 48:282-92. [PMID: 27052543 DOI: 10.3109/07853890.2016.1168934] [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: 11/13/2022] Open
Abstract
BACKGROUND The 2013 ACC/AHA cholesterol treatment guidelines have introduced a new cardiovascular risk assessment approach (PCE) and have revisited the threshold for prescribing statins. This study aims to compare the ex ante application of the ACC/AHA and the ATP-III guideline models by using a multiethnic case-control study. METHODS ATP-III-FRS and PCE were assessed in 739 patients with first STEMI and 739 age- and gender-matched controls; the proportion of cases and controls that would have been eligible for statin as primary prevention therapy and the discriminatory ability of both models were evaluated. RESULTS The application of the ACC/AHA compared to the ATP-III model, resulted in an increase in sensitivity [94% (95%CI: 91%-95%) vs. 65% (61%-68%), p< 0.0001], a reduction in specificity [19% (15%-22%) vs. 55% (51%-59%), p< 0.0001] with similar global accuracy [0.56 (0.53-0.59) vs.0.59 (0.57-0.63), p ns]. When stratifying for ethnicity, the accuracy of the ACC/AHA model was higher in Europeans than in Chinese (p = 0.003) and to identified premature STEMI patients within Europeans much better compared to the ATP-III model (p = 0.0289). CONCLUSION The application of the ACC/AHA model resulted in a significant reduction of first STEMI patients who would have escaped from preventive treatment. Age and ethnicity affected the accuracy of the ACC/AHA model improving the identification of premature STEMI among Europeans only. Key messages According to the ATP-III guideline model, about one-third of patients with STEMI would not be eligible for primary preventive treatment before STEMI. The application of the new ACC/AHA cholesterol treatment guideline model leads to a significant reduction of the percentage of patients with STEMI who would have been considered at lower risk before the STEMI. The global accuracy of the new ACC/AHA model is higher in the Europeans than in the Chinese and, moreover, among the Europeans, the application of the new ACC/AHA guideline model also improved identification of premature STEMI patients.
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Affiliation(s)
- Marco Magnoni
- a IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele , Milan , Italy ;,b Heart Care Foundation Onlus , Florence , Italy
| | - Martina Berteotti
- a IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele , Milan , Italy
| | - Giuseppe Danilo Norata
- c Department of Pharmacological and Biomolecular Sciences , Università degli Studi di Milano , Milan , Italy
| | - Luca Rosario Limite
- a IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele , Milan , Italy
| | - Giovanni Peretto
- a IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele , Milan , Italy
| | - Nicole Cristell
- a IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele , Milan , Italy
| | | | - Domenico Cianflone
- a IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele , Milan , Italy
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Achilli F, Malafronte C, Cesana F, Maggiolini S, Mauro C, De Ferrari GM, Lenatti L, Tespili M, Pasqualini P, Gentile F, Capogrossi MC, Maggioni A, Maseri A, Pontone G, Colombo GI, Pompilio G. Granulocyte-colony stimulating factor for large anterior ST-elevation myocardial infarction: rationale and design of the prospective randomized phase III STEM-AMI OUTCOME trial. Am Heart J 2015; 170:652-658.e7. [PMID: 26386788 DOI: 10.1016/j.ahj.2015.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 07/02/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Granulocyte-colony stimulating factor (G-CSF) has been clinically tested in ST-elevation myocardial infarction (STEMI) with mixed results. Our 3-year follow-up data from STEM-AMI trial documented a sustained benefit of G-CSF on adverse ventricular remodeling after large anterior STEMI, when administered early and at a high-dose in patients with left ventricular (LV) dysfunction. The Aim of the present trial is to establish whether G-CSF improves hard clinical long-term outcomes. METHODS The STEM-AMI OUTCOME is a prospective, multicenter, randomized, open-label, phase III trial. It will include 1,530 patients with anterior STEMI undergoing primary percutaneous coronary intervention 2 to 24 hours after symptoms onset and with LV ejection fraction ≤45% after successful reperfusion. Patients will be randomized 1:1 to G-CSF and/or standard treatment. The primary end point is a reduced occurrence of all-cause death, recurrence of myocardial infarction, or hospitalization due to heart failure in G-CSF-treated patients. Left ventricular remodeling will be assessed via cardiac ultrasound and a substudy with cardiac magnetic resonance will be carried out in 120 subjects. Accrual and follow-up periods will last 3 and 2 years, respectively. CONCLUSIONS The STEM-AMI OUTCOME study is designed to be a rigorous controlled phase III trial with adequate statistical power to conclusively assess efficacy of G-CSF treatment in STEMI.
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Affiliation(s)
- Felice Achilli
- Cardiology Unit and Intensive and Coronary Care Unit, San Gerardo Hospital, Monza, Italy.
| | - Cristina Malafronte
- Cardiology Unit and Intensive and Coronary Care Unit, San Gerardo Hospital, Monza, Italy
| | - Francesca Cesana
- Cardiology Unit and Intensive and Coronary Care Unit, San Gerardo Hospital, Monza, Italy
| | | | - Ciro Mauro
- Department of Cardiology, Cardarelli Hospital, Napoli, Italy
| | - Gaetano M De Ferrari
- Cardiology Unit and Intensive and Coronary Care Unit, Fondazione Policlinico San Matteo IRCCS, Pavia, Italy
| | - Laura Lenatti
- Department of Cardiology, Alessandro Manzoni Hospital, Lecco, Italy
| | | | | | - Francesco Gentile
- Department of Cardiology, Bassini Hospital, Cinisello Balsamo, Italy
| | - Maurizio C Capogrossi
- Laboratory of Vascular Pathology, Istituto Dermopatico dell'Immacolata IRCCS, Rome, Italy
| | - Aldo Maggioni
- Research Center of the Italian Association of Hospital Cardiologists (ANMCO), Florence, Italy
| | | | - Gianluca Pontone
- Department of Cardiovascular Imaging, Cardiac Magnetic Resonance Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gualtiero I Colombo
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giulio Pompilio
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS, and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Maseri A. Foreword of the President of the Fondazione per il Tuo Cuore (Heart Care Foundation), Florence. Eur J Prev Cardiol 2015. [DOI: 10.1177/2047487315591140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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32
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Merlanti B, De Chiara B, Maggioni AP, Moreo A, Pileggi S, Romeo G, Russo CF, Rizzo S, Martinelli L, Maseri A. Rationale and design of GISSI OUTLIERS VAR Study in bicuspid aortic valve patients: prospective longitudinal, multicenter study to investigate correlation between surgical, echo distinctive features, histologic and genetic findings in phenotypically homogeneous outlier cases. Int J Cardiol 2015. [PMID: 26197404 DOI: 10.1016/j.ijcard.2015.06.182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND/OBJECTIVES Bicuspid aortic valve (BAV) is the most common congenital heart disorder, affecting up to 2% of the population. Involvement of aortic root and ascending aorta (aneurysm or, eventually, dissection) is frequent in patients with pathologic or normal functioning BAV. Unfortunately, there are no well-known correlations between valvular and vascular diseases. In VAR protocol, with a new strategy of research, we analysemultiple aspects of BAV disease through correlation between surgical, echo, histologic and genetic findings in phenotypically homogeneous outlier cases. METHODS VAR protocol is a prospective, longitudinal, multicenter study. It observes 4 homogeneous small groups of BAV surgical patients (15 patients each): isolated aortic regurgitation, isolated ascending aortic aneurysm, aortic regurgitation associated with aortic aneurysm, isolated aortic stenosis in older patients (>60years). Echo analysis is extended to first-degree relatives and, in case of BAV, genetic test is performed. Patients and relatives are enrolled in 10 cardiac surgery/cardiologic centers throughout Italy. CONCLUSIONS The aim of the study is to identify predictors of favorable or unfavorable evolution of BAV in terms of valvular dysfunction and/or aortic aneurysm. Correlations between different features could help in identification of various BAV risk groups, rationalizing follow-up and treatment.
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Affiliation(s)
- Bruno Merlanti
- S.C. Cardiochirurgia, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Benedetta De Chiara
- S.C. Cardiologia IV, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | - Antonella Moreo
- S.C. Cardiologia IV, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Silvana Pileggi
- Department of Cardiovascular Research, IRCCS Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Gabriella Romeo
- Department of Cardiac, Vascular and Thoracic Sciences, University of Padua, Padua, Italy
| | - Claudio Francesco Russo
- S.C. Cardiochirurgia, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Stefania Rizzo
- Cardiovascular Pathology, Department of Cardiological, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Luigi Martinelli
- Cardiothoracic Surgery, ICLAS-Istituto Clinico Ligure Alta Specialità, Rapallo, Italy
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Maseri A, Caldini A, Permutt S, Zierler KL. Pressure Volume Relationship in the Pulmonary Circulation1. Pulm Circ 2015. [DOI: 10.1159/000391539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Maugeri N, Campana L, Gavina M, Covino C, De Metrio M, Panciroli C, Maiuri L, Maseri A, D'Angelo A, Bianchi ME, Rovere-Querini P, Manfredi AA. Activated platelets present high mobility group box 1 to neutrophils, inducing autophagy and promoting the extrusion of neutrophil extracellular traps. J Thromb Haemost 2014; 12:2074-88. [PMID: 25163512 DOI: 10.1111/jth.12710] [Citation(s) in RCA: 356] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 08/08/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Increasing evidence implicates both platelets and neutrophils in the formation, stabilization, and growth of peripheral and coronary thrombi. Neutrophil extracellular traps (NETs) play a key role. The early events in the deregulated cross-talk between platelets and neutrophils are poorly characterized. OBJECTIVES To identify at the molecular level the mechanism through which platelets induce the generation of NETs in sterile conditions. PATIENTS/METHODS The presence of NETs was determined in 26 thrombi from patients with acute myocardial infarction by immunohistochemistry and immunofluorescence and markers of NETs assessed in the plasma. In vitro NET generation was studied in static and in physiological flow conditions. RESULTS Coronary thrombi mainly consist of activated platelets, neutrophils, and NETs in close proximity of platelets. Activated platelets commit neutrophils to NET generation. The event abates in the presence of competitive antagonists of the high mobility group box 1 (HMGB1) protein. Hmgb1(-/-) platelets fail to elicit NETs, whereas the HMGB1 alone commits neutrophils to NET generation. Integrity of the HMGB1 receptor, Receptor for Advanced Glycation End products (RAGE), is required for NET formation, as assessed using pharmacologic and genetic tools. Exposure to HMGB1 prevents depletion of mitochondrial potential, induces autophagosome formation, and prolongs neutrophil survival. These metabolic effects are caused by the activation of autophagy. Blockade of the autophagic flux reverts platelet HMGB1-elicited NET generation. CONCLUSIONS Activated platelets present HMGB1 to neutrophils and commit them to autophagy and NET generation. This chain of events may be responsible for some types of thromboinflammatory lesions and indicates novel paths for molecular intervention.
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Affiliation(s)
- N Maugeri
- Division of Regenerative Medicine, Gene Therapy and Stem Cells, Department of Medicine, San Raffaele Scientific Institute and Vita Salute San Raffaele University, Milan, Italy
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Rutten B, Maseri A, Cianflone D, Laricchia A, Cristell NA, Durante A, Spartera M, Ancona F, Limite L, Hu D, Li H, Uren NG, de Groot PG, Mannucci PM, Roest M. Plasma levels of active Von Willebrand factor are increased in patients with first ST-segment elevation myocardial infarction: a multicenter and multiethnic study. Eur Heart J Acute Cardiovasc Care 2014; 4:64-74. [PMID: 24833640 DOI: 10.1177/2048872614534388] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Von Willebrand factor (VWF), a key player in hemostasis and thrombosis, is released from endothelial cells during inflammation. Upon release, VWF is processed by ADAMTS13 into an inactive conformation. The aim of our study was to investigate whether plasma levels of active VWF, total VWF, ADAMTS13, osteoprotegerin (OPG) and the ratios between VWF and ADAMTS13 are risk factors for first ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS We assessed 1026 patients with confirmed first STEMI and 652 control subjects from China, Italy and Scotland, within six hours after their cardiovascular event. Median plasma levels of total VWF, active VWF, OPG and ratios VWF/ADAMTS13 were increased, while plasma levels of ADAMTS13 were decreased in patients compared to controls. The odds ratio (OR) of STEMI in patients with high plasma levels of active VWF was 2.3 (interquartile range (IQR): 1.8-2.9), total VWF was 1.8 (1.4-2.3), ADAMTS13 was 0.6 (05-0.8), OPG was 1.6 (1.2-2.0) and high VWF/ADAMTS13 ratios was 1.5 (1.2-2.0). The OR for total VWF, active VWF and ratios VWF/ADAMTS13 remained significant after adjustment for established risk factors, medical treatment, C-reactive protein, total VWF, ADAMTS13 and OPG. When we adjusted for levels of active VWF, the significance of the OR for VWF and ratios VWF/ADAMTS13 disappeared while the OR for active VWF remained significant. CONCLUSIONS We found evidence that plasma levels of active VWF are an independent risk factor for first STEMI in patients from three different ethnic groups. Our findings confirm the presence of VWF abnormalities in patients with STEMI and may be used to develop new therapeutic approaches.
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Affiliation(s)
- B Rutten
- Laboratory of Clinical Chemistry and Haematology, University Medical Center Utrecht, The Netherlands
| | - A Maseri
- Heart Care Foundation, Florence, Italy
| | - D Cianflone
- Clinical Cardiovascular Biology Centre, Universita Vita-Salute San Raffaele, Italy
| | - A Laricchia
- Clinical Cardiovascular Biology Centre, Universita Vita-Salute San Raffaele, Italy
| | - N A Cristell
- Clinical Cardiovascular Biology Centre, Universita Vita-Salute San Raffaele, Italy
| | - A Durante
- Clinical Cardiovascular Biology Centre, Universita Vita-Salute San Raffaele, Italy
| | - M Spartera
- Clinical Cardiovascular Biology Centre, Universita Vita-Salute San Raffaele, Italy
| | - F Ancona
- Clinical Cardiovascular Biology Centre, Universita Vita-Salute San Raffaele, Italy
| | - L Limite
- Clinical Cardiovascular Biology Centre, Universita Vita-Salute San Raffaele, Italy
| | - D Hu
- The Heart Center, People's Hospital of Peking University, China
| | - H Li
- The Heart Center, People's Hospital of Peking University, China
| | - N G Uren
- Department of Cardiology, Royal Infirmary of Edinburgh, UK
| | - P G de Groot
- Laboratory of Clinical Chemistry and Haematology, University Medical Center Utrecht, The Netherlands
| | - P M Mannucci
- A Bianchi Bonomi Hemophilia and Thrombosis Center, Ospedale Maggiore Policlinico, Italy
| | - M Roest
- Laboratory of Clinical Chemistry and Haematology, University Medical Center Utrecht, The Netherlands
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36
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Affiliation(s)
- Enrico Ammirati
- San Raffaele Scientific Institute and Vita-Salute University, Heart Transplantation Division, Niguarda Ca' Grande Hospital, Milan, Italy
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37
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Ammirati E, Maseri A, Cannistraci CV. Still Need for Compelling Evidence to Support the Circadian Dependence of Infarct Size After ST-Elevation Myocardial Infarction. Circ Res 2013; 113:e43-4. [DOI: 10.1161/circresaha.113.301908] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Enrico Ammirati
- Cardiovascular Department, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | | | - Carlo V. Cannistraci
- Computational Bioscience Research Center, King Abdullah University for Science and Technology (KAUST), Thuwal, Kingdom of Saudi Arabia
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38
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Ammirati E, Cristell N, Cianflone D, Vermi AC, Marenzi G, De Metrio M, Uren NG, Hu D, Ravasi T, Maseri A, Cannistraci CV. Questing for Circadian Dependence in ST-Segment–Elevation Acute Myocardial Infarction. Circ Res 2013; 112:e110-4. [DOI: 10.1161/circresaha.112.300778] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Rationale:
Four monocentric studies reported that circadian rhythms can affect left ventricular infarct size after ST-segment–elevation acute myocardial infarction (STEMI).
Objective:
To further validate the circadian dependence of infarct size after STEMI in a multicentric and multiethnic population.
Methods and Results:
We analyzed a prospective cohort of subjects with first STEMI from the First Acute Myocardial Infarction study that enrolled 1099 patients (ischemic time <6 hours) in Italy, Scotland, and China. We confirmed a circadian variation of STEMI incidence with an increased morning incidence (from 6:00 am till noon). We investigated the presence of circadian dependence of infarct size plotting the peak creatine kinase against time onset of ischemia. In addition, we studied the patients from the 3 countries separately, including 624 Italians; all patients were treated with percutaneous coronary intervention. We adopted several levels of analysis with different inclusion criteria consistent with previous studies. In all the analyses, we did not find a clear-cut circadian dependence of infarct size after STEMI.
Conclusions:
Although the circadian dependence of infarct size supported by previous studies poses an intriguing hypothesis, we were unable to converge toward their conclusions in a multicentric and multiethnic setting. Parameters that vary as a function of latitude could potentially obscure the circadian variations observed in monocentric studies. We believe that, to assess whether circadian rhythms can affect the infarct size, future study design should not only include larger samples but also aim to untangle the molecular time–dynamic mechanisms underlying such a relation.
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Affiliation(s)
- Enrico Ammirati
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Nicole Cristell
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Domenico Cianflone
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Anna-Chiara Vermi
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Giancarlo Marenzi
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Monica De Metrio
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Neal G. Uren
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Dayi Hu
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Timothy Ravasi
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Attilio Maseri
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Carlo V. Cannistraci
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
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39
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Gregori D, Magnoni M, Masson S, Gorini M, Andreini D, Rossi MG, Soriani N, Maggioni AP, Maseri A. Nutrition & CORonary Artery Disease Prevention (N‐CORP) Study: preliminary results and future steps. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.615.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Dario Gregori
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of PadovaPadovaItaly
| | | | - Serge Masson
- Department of Cardiovascular Research, Serge MassonThe Mario Negri Institute for Pharmacological ResearchMilanItaly
| | | | | | | | - Nicola Soriani
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of PadovaPadovaItaly
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40
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Ammirati E, Cannistraci CV, Cristell NA, Vecchio V, Palini AG, Tornvall P, Paganoni AM, Miendlarzewska EA, Sangalli LM, Monello A, Pernow J, Björnstedt Bennermo M, Marenzi G, Hu D, Uren NG, Cianflone D, Ravasi T, Manfredi AA, Maseri A. Identification and Predictive Value of Interleukin-6
+
Interleukin-10
+
and Interleukin-6
−
Interleukin-10
+
Cytokine Patterns in ST-Elevation Acute Myocardial Infarction. Circ Res 2012; 111:1336-48. [DOI: 10.1161/circresaha.111.262477] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Rationale:
At the onset of ST-elevation acute myocardial infarction (STEMI), patients can present with very high circulating interleukin-6 (IL-6
+
) levels or very low-IL-6
–
levels.
Objective:
We compared these 2 groups of patients to understand whether it is possible to define specific STEMI phenotypes associated with outcome based on the cytokine response.
Methods and Results:
We compared 109 patients with STEMI in the top IL-6 level (median, 15.6 pg/mL; IL-6
+
STEMI) with 96 in the bottom IL-6 level (median, 1.7 pg/mL; IL-6
−
STEMI) and 103 matched controls extracted from the multiethnic First Acute Myocardial Infarction study. We found minimal clinical differences between IL-6
+
STEMI and IL-6
−
STEMI. We assessed the inflammatory profiles of the 2 STEMI groups and the controls by measuring 18 cytokines in blood samples. We exploited clustering analysis algorithms to infer the functional modules of interacting cytokines. IL-6
+
STEMI patients were characterized by the activation of 2 modules of interacting signals comprising IL-10, IL-8, macrophage inflammatory protein-1α, and C-reactive protein, and monocyte chemoattractant protein-1, macrophage inflammatory protein-1β, and monokine induced by interferon-γ. IL-10 was increased both in IL-6
+
STEMI and IL-6
−
STEMI patients compared with controls. IL-6
+
IL-10
+
STEMI patients had an increased risk of systolic dysfunction at discharge and an increased risk of death at 6 months in comparison with IL-6
−
IL-10
+
STEMI patients. We combined IL-10 and monokine induced by interferon-γ (derived from the 2 identified cytokine modules) with IL-6 in a formula yielding a risk index that outperformed any single cytokine in the prediction of systolic dysfunction and death.
Conclusions:
We have identified a characteristic circulating inflammatory cytokine pattern in STEMI patients, which is not related to the extent of myocardial damage. The simultaneous elevation of IL-6 and IL-10 levels distinguishes STEMI patients with worse clinical outcomes from other STEMI patients. These observations could have potential implications for risk-oriented patient stratification and immune-modulating therapies.
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Affiliation(s)
- Enrico Ammirati
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Carlo V. Cannistraci
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Nicole A. Cristell
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Viviana Vecchio
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Alessio G. Palini
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Per Tornvall
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Anna M. Paganoni
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Ewa A. Miendlarzewska
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Laura M. Sangalli
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Alberto Monello
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - John Pernow
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Marie Björnstedt Bennermo
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Giancarlo Marenzi
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Dayi Hu
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Neal G. Uren
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Domenico Cianflone
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Timothy Ravasi
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Angelo A. Manfredi
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
| | - Attilio Maseri
- From the Clinical Cardiovascular Biology Centre (E.A., N.A.C., A.M., D.C.), Proteome Biochemistry Unit (C.V.C.), Flow Cytometry Resource Analytical Cytology Technical Applications Laboratory (V.V., A.G.P.), and Autoimmunity and Vascular Inflammation Unit (A.A.M.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; MOX, Politecnico di Milano, Milan, Italy (A.M.P., L.M.S.); Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS University of Milan,
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41
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Magnoni M, Malnati M, Cristell N, Coli S, Russo D, Ruotolo G, Cianflone D, Alfieri O, Lusso P, Maseri A. Molecular study of human herpesvirus 6 and 8 involvement in coronary atherosclerosis and coronary instability. J Med Virol 2012; 84:1961-6. [DOI: 10.1002/jmv.23355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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42
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Maseri A. Safety of provocative tests of coronary artery spasm and prediction of long-term outcome: need for an innovative clinical research strategy. Eur Heart J 2012; 34:252-4. [PMID: 23008507 DOI: 10.1093/eurheartj/ehs312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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43
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Canducci F, Saita D, Foglieni C, Piscopiello MR, Chiesa R, Colombo A, Cianflone D, Maseri A, Clementi M, Burioni R. Cross-reacting antibacterial auto-antibodies are produced within coronary atherosclerotic plaques of acute coronary syndrome patients. PLoS One 2012; 7:e42283. [PMID: 22879930 PMCID: PMC3412836 DOI: 10.1371/journal.pone.0042283] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 07/02/2012] [Indexed: 12/19/2022] Open
Abstract
Coronary atherosclerosis, the main condition predisposing to acute myocardial infarction, has an inflammatory component caused by stimuli that are yet unknown. We molecularly investigated the nature of the immune response within human coronary lesion in four coronary plaques obtained by endoluminal atherectomy from four patients. We constructed phage-display libraries containing the IgG1/kappa antibody fragments produced by B-lymphocytes present in each plaque. By immunoaffinity, we selected from these libraries a monoclonal antibody, arbitrarily named Fab7816, able to react both with coronary and carotid atherosclerotic tissue samples. We also demonstrated by confocal microscopy that this monoclonal antibody recognized human transgelin type 1, a cytoskeleton protein involved in atherogenesis, and that it co-localized with fibrocyte-like cells transgelin+, CD68+, CD45+ in human sections of coronary and carotid plaques. In vitro fibrocytes obtained by differentiating CD14+ cells isolated from peripheral blood mononuclear cells also interacted with Fab7816, thus supporting the hypothesis of a specific recognition of fibrocytes into the atherosclerotic lesions. Interestingly, the same antibody, cross-reacted with the outer membrane proteins of Proteus mirabilis and Klebsiella pneumoniae (and possibly with homologous proteins of other enterobacteriaceae present in the microbiota). From all the other three libraries, we were able to clone, by immunoaffinity selection, human monoclonal antibodies cross-reacting with bacterial outer membrane proteins and with transgelin. These findings demonstrated that in human atherosclerotic plaques a local cross-reactive immune response takes place.
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Affiliation(s)
- Filippo Canducci
- Laboratory of Microbiology and Virology, Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Diego Saita
- Laboratory of Microbiology and Virology, Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Chiara Foglieni
- University Vita-Salute San Raffaele, Milan, Italy
- Clinical Cardiovascular Biology Centre, Ospedale San Raffaele, Milan, Italy
| | - Maria Rosaria Piscopiello
- University Vita-Salute San Raffaele, Milan, Italy
- Istituto di Neurologia Sperimentale, Ospedale San Raffaele, Milan, Italy
| | - Roberto Chiesa
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Vascular Surgery, Ospedale San Raffaele, Milan, Italy
| | - Antonio Colombo
- University Vita-Salute San Raffaele, Milan, Italy
- Interventional Cardiology Unit, Department of Cardio-Thoracic and Vascular Diseases, Ospedale San Raffaele, Milan Italy
| | - Domenico Cianflone
- University Vita-Salute San Raffaele, Milan, Italy
- Clinical Cardiovascular Biology Centre, Ospedale San Raffaele, Milan, Italy
| | | | - Massimo Clementi
- Laboratory of Microbiology and Virology, Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Roberto Burioni
- Laboratory of Microbiology and Virology, Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
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Ammirati E, Cianflone D, Vecchio V, Banfi M, Vermi AC, De Metrio M, Grigore L, Pellegatta F, Pirillo A, Garlaschelli K, Manfredi AA, Catapano AL, Maseri A, Palini AG, Norata GD. Effector Memory T cells Are Associated With Atherosclerosis in Humans and Animal Models. J Am Heart Assoc 2012. [DOI: 10.1161/xjaha.111.000125] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Maugeri N, Rovere-Querini P, Evangelista V, Godino C, Demetrio M, Baldini M, Figini F, Coppi G, Slavich M, Camera M, Bartorelli A, Marenzi G, Campana L, Baldissera E, Sabbadini MG, Cianflone D, Tremoli E, D'Angelo A, Manfredi AA, Maseri A. An intense and short-lasting burst of neutrophil activation differentiates early acute myocardial infarction from systemic inflammatory syndromes. PLoS One 2012; 7:e39484. [PMID: 22761804 PMCID: PMC3382567 DOI: 10.1371/journal.pone.0039484] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 05/21/2012] [Indexed: 01/30/2023] Open
Abstract
Background Neutrophils are involved in thrombus formation. We investigated whether specific features of neutrophil activation characterize patients with acute coronary syndromes (ACS) compared to stable angina and to systemic inflammatory diseases. Methods and Findings The myeloperoxidase (MPO) content of circulating neutrophils was determined by flow cytometry in 330 subjects: 69 consecutive patients with acute coronary syndromes (ACS), 69 with chronic stable angina (CSA), 50 with inflammation due to either non-infectious (acute bone fracture), infectious (sepsis) or autoimmune diseases (small and large vessel systemic vasculitis, rheumatoid arthritis). Four patients have also been studied before and after sterile acute injury of the myocardium (septal alcoholization). One hundred thirty-eight healthy donors were studied in parallel. Neutrophils with normal MPO content were 96% in controls, >92% in patients undergoing septal alcoholization, 91% in CSA patients, but only 35 and 30% in unstable angina and AMI (STEMI and NSTEMI) patients, compared to 80%, 75% and 2% of patients with giant cell arteritis, acute bone fracture and severe sepsis. In addition, in 32/33 STEMI and 9/21 NSTEMI patients respectively, 20% and 12% of neutrophils had complete MPO depletion during the first 4 hours after the onset of symptoms, a feature not observed in any other group of patients. MPO depletion was associated with platelet activation, indicated by P-selectin expression, activation and transactivation of leukocyte β2-integrins and formation of platelet neutrophil and -monocyte aggregates. The injection of activated platelets in mice produced transient, P-selectin dependent, complete MPO depletion in about 50% of neutrophils. Conclusions ACS are characterized by intense neutrophil activation, like other systemic inflammatory syndromes. In the very early phase of acute myocardial infarction only a subpopulation of neutrophils is massively activated, possibly via platelet-P selectin interactions. This paroxysmal activation could contribute to occlusive thrombosis.
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Affiliation(s)
- Norma Maugeri
- Università Vita-Salute San Raffaele and San Raffaele Scientific Institute, Milano, Italy.
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Maseri A, Prati F, Ammirati E. [The PROSPECT study]. G Ital Cardiol (Rome) 2012; 13:143-146. [PMID: 22395104 DOI: 10.1714/1038.11318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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47
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Ammirati E, Cianflone D, Vecchio V, Banfi M, Vermi AC, De Metrio M, Grigore L, Pellegatta F, Pirillo A, Garlaschelli K, Manfredi AA, Catapano AL, Maseri A, Palini AG, Norata GD. Effector Memory T cells Are Associated With Atherosclerosis in Humans and Animal Models. J Am Heart Assoc 2012; 1:27-41. [PMID: 23130116 PMCID: PMC3487313 DOI: 10.1161/jaha.111.000125] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [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: 12/07/2011] [Accepted: 12/21/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND#ENTITYSTARTX02014;: Adaptive T-cell response is promoted during atherogenesis and results in the differentiation of naïve CD4(+)T cells to effector and/or memory cells of specialized T-cell subsets. Aim of this work was to investigate the relationship between circulating CD4(+)T-cell subsets and atherosclerosis. METHODS AND RESULTS#ENTITYSTARTX02014;: We analyzed 57 subsets of circulating CD4(+)T cells by 10-parameter/8-color polychromatic flow cytometry (markers: CD3/CD4/CD45RO/CD45RA/CCR7/CCR5/CXCR3/HLA-DR) in peripheral blood from 313 subjects derived from 2 independent cohorts. In the first cohort of subjects from a free-living population (n=183), effector memory T cells (T(EM): CD3(+)CD4(+)CD45RA(-)CD45RO(+)CCR7(-) cells) were strongly related with intima-media thickness of the common carotid artery, even after adjustment for age (r=0.27; P<0.001). Of note, a significant correlation between T(EM) and low-density lipoproteins was observed. In the second cohort (n=130), T(EM) levels were significantly increased in patients with chronic stable angina or acute myocardial infarction compared with controls. HLA-DR(+)T(EM) were the T(EM) subpopulation with the strongest association with the atherosclerotic process (r=0.37; P<0.01). Finally, in animal models of atherosclerosis, T(EM) (identified as CD4(+)CD44(+)CD62L(-)) were significantly increased in low-density lipoprotein receptor and apolipoprotein E deficient mice compared with controls and were correlated with the extent of atherosclerotic lesions in the aortic root (r=0.56; P<0.01). CONCLUSIONS#ENTITYSTARTX02014;: Circulating T(EM) cells are associated with increased atherosclerosis and coronary artery disease in humans and in animal models and could represent a key CD4(+)T-cell subset related to the atherosclerotic process. (J Am Heart Assoc. 2012;1:27-41.).
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Affiliation(s)
- Enrico Ammirati
- Clinical Cardiovascular Biology Centre, San Raffaele Scientific Institute and the Università Vita-Salute San Raffaele , Milan, Italy (E.A., D.C., M.B.) ; Heart Transplantation Division, Ospedale Niguarda Ca' Granda , Milan, Italy (E.A.) ; Heart Care Foundation , Florence, Italy (E.A., A.M.)
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Andreotti F, Pafundi T, Crea F, Coluzzi G, Maseri A. Polycythemia, vascular function, and hemoglobin-nitric oxide reactions. J Appl Physiol (1985) 2011; 111:331; author reply 332. [DOI: 10.1152/japplphysiol.00365.2011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Teodosio Pafundi
- Institute of Cardiology, Catholic University Hospital, Rome; and
| | - Filippo Crea
- Institute of Cardiology, Catholic University Hospital, Rome; and
| | - Giulio Coluzzi
- Institute of Cardiology, Catholic University Hospital, Rome; and
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Maugeri N, Rovere-Querini P, Slavich M, Coppi G, Doni A, Bottazzi B, Garlanda C, Cianflone D, Maseri A, Mantovani A, Manfredi AA. Early and Transient Release of Leukocyte Pentraxin 3 during Acute Myocardial Infarction. J I 2011; 187:970-9. [DOI: 10.4049/jimmunol.1100261] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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