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Birkun A, Böttiger BW, Baldi E. Discussing the research on public interest in cardiac arrest and cardiopulmonary resuscitation based on the web search traffic analysis. Public Health 2023; 222:e21-e22. [PMID: 36503673 DOI: 10.1016/j.puhe.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022]
Affiliation(s)
- A Birkun
- Department of General Surgery, Anaesthesiology, Resuscitation and Emergency Medicine, Medical Academy Named After S.I. Georgievsky of V.I. Vernadsky Crimean Federal University, Simferopol, Russian Federation.
| | - B W Böttiger
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Cologne, Germany
| | - E Baldi
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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2
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Corona G, Vena W, Pizzocaro A, Pallotti F, Paoli D, Rastrelli G, Baldi E, Cilloni N, Gacci M, Semeraro F, Salonia A, Minhas S, Pivonello R, Sforza A, Vignozzi L, Isidori AM, Lenzi A, Maggi M, Lombardo F. Andrological effects of SARS-Cov-2 infection: a systematic review and meta-analysis. J Endocrinol Invest 2022; 45:2207-2219. [PMID: 35527294 PMCID: PMC9080963 DOI: 10.1007/s40618-022-01801-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/04/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The short- and long-term andrological effects of coronavirus disease 2019 (COVID-19) have not been clarified. Our aim is to evaluate the available evidence regarding possible andrological consequences of COVID-19 either on seminal or hormonal parameters. The safety of the COVID-19 vaccines in terms of sperm quality was also investigated. METHODS All prospective and retrospective observational studies reporting information on severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) mRNA semen and male genitalia tract detection (n = 19), as well as those reporting data on semen analysis (n = 5) and hormonal parameters (n = 11) in infected/recovered patients without any arbitrary restriction were included. RESULTS Out of 204 retrieved articles, 35 were considered, including 2092 patients and 1138 controls with a mean age of 44.1 ± 12.6 years, and mean follow-up 24.3 ± 18.9 days. SARS-CoV-2 mRNA can be localized in male genitalia tracts during the acute phase of the disease. COVID-19 can result in short-term impaired sperm and T production. Available data cannot clarify long-term andrological effects. Low T observed in the acute phase of the disease is associated with an increased risk of being admitted to the Intensive Care Unit or death. The two available studies showed that the use of mRNA COVID-19 vaccines does not affect sperm quality. CONCLUSIONS The results of our analysis clearly suggest that each patient recovering from COVID-19 should be monitored to rule out sperm and T abnormalities. The specific contribution of reduced T levels during the acute phase of the infection needs to be better clarified.
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Affiliation(s)
- G Corona
- Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - W Vena
- Unit of Endocrinology, Diabetology and Medical Andrology, IRCSS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Pizzocaro
- Unit of Endocrinology, Diabetology and Medical Andrology, IRCSS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - F Pallotti
- Department of Experimental Medicine, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - D Paoli
- Department of Experimental Medicine, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - G Rastrelli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - E Baldi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - N Cilloni
- Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital Bologna, Bologna, Italy
| | - M Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy
| | - F Semeraro
- Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital Bologna, Bologna, Italy
| | - A Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - S Minhas
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile, Università Federico II di Napoli, Naples, Italy
- Staff of UNESCO Chair for Health Education and Sustainable Development Baldi E, Federico II University, Naples, Italy
| | - A Sforza
- Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - L Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - A M Isidori
- Department of Experimental Medicine, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - A Lenzi
- Department of Experimental Medicine, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - M Maggi
- Endocrinology Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
| | - F Lombardo
- Department of Experimental Medicine, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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3
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Gentile FR, Compagnoni S, Baldi E, Primi R, Bendotti S, Currao A, Aramendi E, Isasi I, Contri E, Palo A, Savastano S. Ventricular fibrillation amplitude spectral area as a guide to deliver the optimal energy level for defibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
In case of cardiac arrest due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), the optimal energy should be the lowest energy effective to achieve defibrillation minimizing the current-induced myocardial damage. Therefore, it would be ideal to minimize the energy level as well as the number of shocks during resuscitation. ECG-based VF waveform analysis features such as amplitude spectral area have been recently introduced as predictors of shock success, but their predictivity for shock success with low energy level is not known.
Purpose
To assess whether amplitude spectral area (AMSA) of VF is able to predict the efficacy of low energy level defibrillation in out-of-hospital cardiac arrest (OHCA) patients.
Methods
All the OHCAs with at least one shockable rhythm that occurred from January 2015 to December 2020 were considered. AMSA values were calculated by retrospectively analyzing the data collected by the Corpuls 3 monitors/defibrillators and by using a 2-second-pre-shock ECG interval.
Results
Among 4619 OHCAs, resuscitation was attempted in 2982 (64%) and at least one shock was delivered in 697 (15%). AMSA values and defibrillation energy were available for 791 shocks, of which 45% received shock at low energy (>150J) and 55% at high energy (>150J). The rate of efficacy between the two groups was similar (44% vs 38%, p=0.102). However, in patients efficaciously treated with shock at low energy, AMSA was higher compared to those treated with shock at high energy [13.2 mV Hz (IQR 10.2–17) vs 10.8 mV Hz (IQR 8–13.8), p<0.001]. Moreover, AMSA values were significantly different when comparing ineffective shock at low energy with effective shock at high energy [6.6 mV Hz (IQR 4.6–10) vs 10.8 mV Hz (IQR 8.1–13.8), p<0.001] and similar when comparing ineffective shock at low and high energy [6.6 mV Hz (IQR 4.6–10) vs 6.3 mV Hz (IQR 4.5–8.7), p=0.21]. By dividing AMSA values into three tertiles, the rate of shock success at low energy was statistically different: [T1 (0.7–6.2 mV Hz) 4.2%; T2 (6.2–10.8 mV Hz) 13%; T3 (10.8–63.2 mV Hz) 42%; Chi-squared p<0.001 and p for trend <0.001]. After correction for age, sex, amiodarone use and call to shock time, AMSA values corresponding to the third and second tertile were associated with higher probability of shock success at low energy compared to the lowest tertile [T3 OR 15 (95% CI 7–30), p<0.001; T2 OR 3 (95% CI 1–7), p=0.002].
Conclusion
Ventricular fibrillation amplitude spectral area is a predictor of shock success at a low energy level. This could be useful to optimize both time and dose-energy to patients, yielding the highest chance for successful defibrillation while reducing the number of futile shocks and thus limiting the total current myocardial energy as well as CPR interruptions.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - E Baldi
- Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - R Primi
- Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - S Bendotti
- Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - A Currao
- Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - E Aramendi
- University of the Basque Country , Bilbao , Spain
| | - I Isasi
- University of the Basque Country , Bilbao , Spain
| | - E Contri
- Agenzia Regionale dell'Emergenza Urgenza , Pavia , Italy
| | - A Palo
- Agenzia Regionale dell'Emergenza Urgenza , Pavia , Italy
| | - S Savastano
- Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
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4
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Quilico F, Vicini Scajola L, Gentile FR, Compagnoni S, Baldi E, Aramendi E, Isasi I, Lopiano C, Primi R, Bendotti S, Currao A, Contri E, Palo A, Savastano S. Gender differences in amplitude spectral area (AMSA) of ventricular fibrillation in patients with out-of-hospital cardiac arrest. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Ventricular fibrillation (VF) Amplitude Spectral Area (AMSA) is a well-established predictor of successful defibrillation and return of spontaneous circulation (ROSC). Attending to the limited evidence on the topic, gender seems to affect AMSA, and higher values have been reported in females. The aim of this work was to investigate the effect of gender in AMSA values for patients suffering out-of-hospital cardiac arrest (OHCA).
Methods
We enrolled 4619 consecutive OHCA patients from January 2015 to December 2020 in the LombardiaCare Registry. We considered only those subjects with attempted cardio-pulmonary resuscitation (697 patients) and at least one shock delivered. A total of 250 patients were considered (40 F/ 210 M) with 830 shocks (100 F/ 730 M). AMSA values were computed for the ventricular fibrillation in the 2-s pre-shock interval of the ECG recorded by the Corpuls3 defibrillator (Corpuls, Kaufering, Germany).
Results
Female patients were older than male [median (IQR): 70.5 (62–72) vs 67 (55–75) years, p=0.01], with cardiac arrest more frequently at home (84% vs 76%, p=0.003), fewer shocks [2 (1–4) vs 4 (2–7), p=0.004] and higher percentage of success (53% vs 40%, p=0.009). On the contrary, cardiac arrest duration [ 58.7 (31–69) vs 57.6 (41.4–77.3) min, p=0.366] and the rate of ROSC (32% vs 33%, p=0.88) were similar in both groups.
Higher AMSA values were found in female patients [10.3 Hz-mV (6.6–13.5) vs 7.9 Hz-mV (5.2–12.1), p=0.0007]. At a multivariable analysis, after correction for witnessed status, bystanders CPR, amiodarone administration, age and call-to shock time, male sex was found to be independently associated with the probability of having low values of AMSA, below the median value of 8.3 Hz-mV [OR 2.15 (95% CI1.35–3.43), p=0.001].
Despite gender stratification ROC curve analysis confirmed AMSA as a predictor of shock success [AUC-F: 0.75 (95% CI 0.65–0.83), p<0.001; AUC-M: 0.78 (95% CI 0.74–0.81)] and ROSC [AUC-F: 0.69 (95% CI 0.59–0.68), p=0.008; AUCM: 0.84 (95% CI 0.81–0.87)].
Conclusion
Female sex is related to higher AMSA values. As AMSA reflects the energetical status and the ATP levels in the myocardial cells during cardiac arrest, this difference may be due to lower incidence and lower severity of cardiac ischemic disease in women. AMSA remains a valid predictor of both shock success and ROSC for female and male patients. Further investigations are needed to support and comprehend these conclusions.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | | | | | - E Baldi
- Policlinic Foundation San Matteo IRCCS , Pavia , Italy
| | - E Aramendi
- University of the Basque Country , Bilbao , Spain
| | - I Isasi
- University of the Basque Country , Bilbao , Spain
| | | | - R Primi
- Policlinic Foundation San Matteo IRCCS , Pavia , Italy
| | - S Bendotti
- Policlinic Foundation San Matteo IRCCS , Pavia , Italy
| | - A Currao
- Policlinic Foundation San Matteo IRCCS , Pavia , Italy
| | - E Contri
- Agenzia Regionale dell'Emergenza Urgenza , Pavia , Italy
| | - A Palo
- Agenzia Regionale dell'Emergenza Urgenza , Pavia , Italy
| | - S Savastano
- Policlinic Foundation San Matteo IRCCS , Pavia , Italy
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5
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Carrozzi C, Baldi E, Seganti A, Spolverini M, Pignalosa L, Petracci B, Sanzo A, Savastano S, Rordorf R, Vicentini A. How arrhythmic risk changes over time in patients with low risk Brugada syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Brugada Syndrome (BrS) is an inherited disorder associated with an increased risk of sudden cardiac death (SCD) and is diagnosed by the presence of a Brugada type I ECG pattern, either spontaneous or drug-induced. A spontaneous ECG pattern is one of the two main risk factors for SCD, along with syncope. However, there is still no clear evidence on how and how often to screen patients with drug-induced BrS to detect a spontaneous ECG pattern, therefore allowing to reassess their arrhythmic risk.
Purpose
To determine how many subjects develop a spontaneous ECG pattern among a pool of patients with low risk BrS (drug-induced pattern without history of syncope at the time of diagnosis) observed through systematic ECG Holter monitoring.
Methods
We retrospectively collected data for all patients with low risk BrS treated at our center for at least 12 months between 2016 and 2021. Each patient was tested yearly with at least one 12-lead 24-hour ECG Holter monitoring with high precordial leads (V1-V2, V3-V4, V5-V6 respectively in 2nd, 3rd and 4th intercostal space parasternal left and right). In case of spontaneous pattern detection at two recordings, patients underwent electrophysiological study (EPS) and in case of inducible ventricular arrhythmias, implantable cardiac defibrillator (ICD) placement.
Results
We included 63 patients with low risk BrS. During a median follow-up of 48 months: 1 patient died for SCD (1.6%), 1 experienced syncope (1.6%) and 19 exhibited a spontaneous ECG pattern (30.2%). Of these 19 patients: 18 were males and 5 had a mutation of SCN5A; the average age at the time of spontaneous pattern detection was 48.1±11.5 years. The average number of ECG holters/per patient/per year was 1.1±0.6, the average number of ECG Holters until the detection of a spontaneous pattern was 3.3±1.8, whilst the average number of months in between the diagnosis and the detection of a spontaneous pattern was 43.2±41.1.
After the observation of a spontaneous pattern: 6 patients were excluded from further investigation (as they had already undergone EPS or refused), 1 was directly treated with ICD and 12 underwent EPS, 4 of whom consequently underwent ICD placement. Among these 5 patients who underwent ICD placement – 7.9% of the original 63 patients – we observed 1 appropriate ICD intervention (antitachycardia pacing), 1 inappropriate ICD shock and 1 ICD related complication.
Conclusions
In our population of patients with low risk BrS the detection of a spontaneous ECG pattern is the most common determinant of risk reclassification. Systematic ECG Holter monitoring disclosed the presence of a spontaneous ECG pattern in a relevant number of subjects, allowing to reassess their arrhythmic risk and indication for ICD placement. Our study stresses the importance of periodic evaluation of low risk BrS patients with ECG Holter monitoring and the need for further investigation to define the optimal monitoring strategy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Carrozzi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia and Cardiac Intensive C , Pavia , Italy
| | - E Baldi
- I.R.C.C.S. San Matteo Polyclinic, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology , Pavia , Italy
| | - A Seganti
- Department of Molecular Medicine, Section of Cardiology, University of Pavia and Cardiac Intensive C , Pavia , Italy
| | - M Spolverini
- Department of Molecular Medicine, Section of Cardiology, University of Pavia and Cardiac Intensive C , Pavia , Italy
| | - L Pignalosa
- I.R.C.C.S. San Matteo Polyclinic, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology , Pavia , Italy
| | - B Petracci
- I.R.C.C.S. San Matteo Polyclinic, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology , Pavia , Italy
| | - A Sanzo
- I.R.C.C.S. San Matteo Polyclinic, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology , Pavia , Italy
| | - S Savastano
- I.R.C.C.S. San Matteo Polyclinic, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology , Pavia , Italy
| | - R Rordorf
- I.R.C.C.S. San Matteo Polyclinic, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology , Pavia , Italy
| | - A Vicentini
- I.R.C.C.S. San Matteo Polyclinic, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology , Pavia , Italy
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6
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Gentile FR, Compagnoni S, Baldi E, Primi R, Bendotti S, Currao A, Aramendi E, Isasi I, Contri E, Palo A, Savastano S. Amiodarone and ventricular fibrillation amplitude of spectral area in patients with out-of-hospital cardiac arrest. Is there an effect? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The use of antiarrhythmic drug therapy is usually recommended in addition to defibrillation in shockable cardiac arrest. The role of the amplitude spectral area (AMSA) of ventricular fibrillation as a predictor of defibrillation efficacy has been established, but little is known about how amiodarone could affect AMSA values.
Purpose
The aim of our study was to evaluate whether the administration of amiodarone during resuscitation could affect AMSA and to verify if AMSA preserves its predictive role of shock success in OHCA patients treated with amiodarone.
Material
All the OHCAs with an attempted resuscitation and at least one shockable rhythm which occurred from January 2015 to December 2020 in the province of Pavia were considered. AMSA values were calculated by retrospectively analyzing the data collected by the Corpuls 3 monitors/defibrillators (Corpuls, Kaufering, Germany) used in the field and by considering a pre-shock interval of 2 seconds.
Results
Of 4619 OHCAs, 697 underwent attempted CPR with at least one shock delivered. Of these, AMSA was available on 250 patients (male 84%, median age 67 years), for a total of 830 shocks, of which 534 (64%) shocks were in patients receiving amiodarone. The success rate of each single shock was similar in the two groups (amiodarone 42% vs no amiodarone 41%, p=0.68). The AMSA median values were significantly lower in the amiodarone group as compared to the non-amiodarone group when shocks were delivered to patients older than 67 years old [median difference: 1.55 mV Hz (95% CI 0.6–2.5), p=0.0013] or receiving bystander CPR [median difference 0.9 mV Hz (95% CI 0.1–1.8), p=0.03] or after more than 33 minutes from the emergency call to each single shock [median difference: 0.91 mV Hz (95% CI 1.9–0.01), p=0.047]. AMSA value lower than the median (8.3 Hz mV) was associated with a lower probability of shock success (19% vs 64%, p<0.001). According to a multivariate analysis corrected for age, sex, witnessed status, call to shock time and bystander CPR, the probability of having AMSA lower than the median was independently associated with the administration of amiodarone [OR 1.5 (95% CI 1.1–2.1) p=0.009]. At ROC curves analysis, amongst patients receiving amiodarone, AMSA was confirmed to be a predictor of both shock success and ROSC [AUC 0.755 (95% CI 0.72–0.79), p<0.001 and AUC 0.826 (95% CI 0.79–0.86), p<0.001 respectively], similarly to the general population [AUC 0.778 (95% CI0.75–0.81), p<0.001; AUC 0.817 (95% CI 0.79–0.84), p<0.001].
Conclusions
Amiodarone administration is independently associated with lower values of AMSA. This could justify the lack of benefit from amiodarone administration in term of defibrillation success which would be expected by the administration of an antiarrhythmic drug during the resuscitation. Moreover, AMSA maintains its predictive value for shock success and ROSC rate in patients receiving amiodarone as well as in the general population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - E Baldi
- Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - R Primi
- Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - S Bendotti
- Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - A Currao
- Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - E Aramendi
- University of the Basque Country , Bilbao , Spain
| | - I Isasi
- University of the Basque Country , Bilbao , Spain
| | - E Contri
- Agenzia Regionale dell'Emergenza Urgenza , Pavia , Italy
| | - A Palo
- Agenzia Regionale dell'Emergenza Urgenza , Pavia , Italy
| | - S Savastano
- Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
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7
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Compagnoni S, Gentile FR, Baldi E, Sanzo A, Rordorf R, Savastano S. Anatomical-based percutaneous left stellate ganglion block in patients with refractory electrical storm: efficacy and safety. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The autonomic system plays a pivotal role in ventricular arrhythmogenesis. Percutaneous stellate ganglion block (PSGB) is a technique known since many years for analgesic purposes, which has recently proven its antiarrhythmic effect suitable for an emergency setting. However, evidences are limited and heterogeneous.
Purpose
To assess the efficacy and safety of PSGB performed with an anterior paratracheal approach using anatomical landmarks in consecutive patients with electrical storm refractory to conventional treatment.
Methods
Patients with electrical storm were consecutively enrolled from November 2017 to January 2022. Left PSGB (PLSGB) was performed after failure of at least one intravenous antiarrhythmic drug. Its repetition or a continuous infusion of the local anaesthetic were considered in selected cases. Clinical data, the characteristics of the block and the occurrence of complications were collected. The efficacy was evaluated by comparing the number of arrhythmias treated with ATP or DC-shocks by external or internal defibrillator in the hour before the block with that in the hour after the procedure. Per-patient efficacy was assessed by comparing the number of ATP/shocks in the 24 hours before the procedure with that in the 24 hours after the last procedure.
Results
28 patients were enrolled: 78% male, mean age 65.4±14.2 years; 9 with dilated cardiomyopathy, 8 with chronic ischemic heart disease, 7 with ST-elevation myocardial infarction, 2 with non-ST-elevation myocardial infarction, 1 with arrhythmogenic right ventricular dysplasia and 1 with drug intoxication; the average ejection fraction was 24.2±15%. A total of 44 PLSGBs were performed: 18 for ventricular tachycardia (VT), 11 for ventricular fibrillation (VF) and 15 for both VT and VF episodes; 7 on intubated patients, 3 in extracorporeal circulation, 7 in cardiogenic/septic shock, 22 on patients on single antiplatelet therapy, 7 on dual antiplatelet therapy, 25 on anticoagulant therapy. PLSGBs were performed during intravenous infusion of antiarrhythmics (amiodarone in 24, lidocaine in 27 procedures). The local anaesthetic used was lidocaine 200 mg in 16/44 PLSGB, bupivacaine 50 mg in 4/44 and both in 24/44. The per-procedure analysis showed a significant reduction of the number of ATP/shocks in the hour after PLSGB compared with the hour before [0 (0–0) vs 5 (1–8) p<0.001]. Similarly, in the per-patient analysis, the number of ATP/shocks significantly decreased in the 24 hours after the PLSGB compared with that in the 24 hours before [0 (0–1.5) vs 6.5 (4.5–15.5) p<0.001]. No complications occurred.
Conclusions
This is the largest case series so far in which PLSGB has proven to be highly effective and safe in the treatment of challenging patients with refractory electrical storm. Its safety and the exiguity of the equipment required for the anatomical approach make PLSGB a technique that can be easily performed by cardiologists at the bedside.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - E Baldi
- Policlinic Foundation San Matteo IRCCS , Pavia , Italy
| | - A Sanzo
- Policlinic Foundation San Matteo IRCCS , Pavia , Italy
| | - R Rordorf
- Policlinic Foundation San Matteo IRCCS , Pavia , Italy
| | - S Savastano
- Policlinic Foundation San Matteo IRCCS , Pavia , Italy
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8
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Gacci M, Coppi M, Baldi E, Sebastianelli A, Zaccaro C, Morselli S, Pecoraro A, Manera A, Nicoletti R, Liaci A, Bisegna C, Gemma L, Giancane S, Pollini S, Antonelli A, Lagi F, Marchiani S, Dabizzi S, Degl'Innocenti S, Annunziato F, Maggi M, Vignozzi L, Bartoloni A, Rossolini GM, Serni S. O-001 Semen impairment and occurrence of SARS-CoV-2 virus in semen after recovery from COVID-19. Hum Reprod 2022. [PMCID: PMC9384383 DOI: 10.1093/humrep/deac104.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in human semen and its role in virus contagion and semen quality after recovery from coronavirus disease 2019 (COVID-19) is still unclear. Recent reports evidence that, after SARS-CoV-2 infection, male reproductive function and semen quality may be damaged. Aim To evaluate the semen parameters and inflammation of sexually active men following recovery from SARS-CoV-2 infection at 1 month and 3 months follow-up after the second negative nasopharyngeal swab. Materials and methods A prospective cross-sectional study on sexually active men recovered from SARS-CoV-2 infection was performed. For previously hospitalized COVID-19 patients, data on serum inflammatory markers were retrospectively collected. One month after the second SARS-CoV-2 negative nasopharyngeal swab and 3 months later, four biological fluid samples, namely saliva, pre-ejaculation urine, semen, and post-ejaculation urine, were collected. The occurrence of SARS-CoV-2 RNA in the specimen was evaluated in all the biological fluids collected by RT-PCR. Female partners were retested if any specimen was found to be SARS-CoV-2 positive. Semen parameters were evaluated according to the World Health Organization manual edition V. Furthermore, semen inflammation was assessed by quantification of semen leukocytes and interleukin-8 (IL-8) levels and evaluation of a panel of sperm cytokine levels by a two-step ELISA method. Results A total of 43 men were enrolled in the study. Three patients (7%) tested positive for at least one sample (one saliva; one pre-ejaculation urine; one semen and one post-ejaculation urine), so the next day new nasopharyngeal swabs were collected. The results from these 3 patients and their partners were all negative for SARS-CoV-2. At 1-month follow-up, 25% of the men with recent SARS-Cov-2 infections and proven healing were oligo-cryptoazoospermic, despite the absence of virus RNA in semen. Of the 11 men with semen impairment, 8 were azoospermic and 3 were oligospermic. Serum inflammatory markers (procalcitonin and C-reactive protein) were analyzed in previously hospitalized patients both at admission and at peak of infection. Levels at admission were statistically significantly higher in patients resulting in crypto-azoospermic with respect to those resulting in normozoospermic (p = 0.05; p = 0.03 and p = 0.02, respectively) after healing. Oligo-crypto-azoospermia was significantly related to COVID-19 severity (P < 0.001). A total of 33 patients (76.7%) showed pathological levels of IL-8 in semen. Interleukin-1β and tumor necrosis factor-α levels were significantly negatively related to sperm total number and concentration, whereas interleukin-4 was correlated with sperm motility. At 3-months follow-up, 8/10 men with semen impairment showed an overall increase of semen parameters compared to levels assessed after 1 month. Of the 4 crypto-/azoo-spermic men 1 month after healing, 2 resulted oligozoospermic, 1 normozoospermic and only 1 remained azoospermic. Two of the 3 oligozoospermic men turned normozoozpermic. Semen cytokine levels remained elevated after 3 months, except for IL-6. Discussion and conclusion SARS-CoV-2 can be detected in saliva, urine, and semen in a small percentage of men who recovered from COVID-19. 25% of men who recovered from COVID-19 demonstrated oligo-crypto-azoospermia. Negative correlations between interleukin-1β and tumor necrosis factor-α and sperm number and the overall high levels of semen cytokines indicate a potential detrimental role of SARS-CoV-2 driven inflammation on spermatogenesis. An overall tendency to an improvement of semen parameters was found although a genital tract inflammatory condition appears to persist at least 3 months after COVID-19 recovery. Despite the low number of enrolled patients may limit the statistical power of study and the fact that the previous semen quality of these men was unknown, our results indicate that male of reproductive age recovering from COVID-19 deserve accurate follow-up for their fertility status.
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Affiliation(s)
- M Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - M Coppi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence , Italy
| | - E Baldi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
- Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe
| | - A Sebastianelli
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - C Zaccaro
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - S Morselli
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - A Pecoraro
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - A Manera
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - R Nicoletti
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - A Liaci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - C Bisegna
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - L Gemma
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - S Giancane
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
| | - S Pollini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence , Italy
| | - A Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence , Italy
| | - F Lagi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence , Italy
| | - S Marchiani
- Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe
| | - S Dabizzi
- Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe
| | | | - F Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
| | - M Maggi
- Endocrinology Unit and Department of Experimental, Clinical and Biomedical Sciences, University of Florence
| | - L Vignozzi
- Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe
| | - A Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence , Italy
| | - G M Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence , Italy
| | - S Serni
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC) University of Florence, 50134 Florence , Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence , Italy
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9
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Baldi E, Traini G, Tamburrino L, Bini F, Raffaelli G, Vignozzi L, Marchiani S. P-037 A fluorescent probe for Reactive Oxygen Species (ROS) detection identifies spermatozoa with a better reporductive performance. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Could Reactive Oxygen Species (ROS) detected in human spermatozoa represent a predictive marker of fertilization ability?
Summary answer
ROS detected by CellROX® Orange probe is related to a better sperm quality and function, indicating the sensitivity of the probe to identify physiological ROS.
What is known already
Oxidative stress (OS), defined as an unbalance between ROS production and antioxidant defenses, is one of the causes of male infertility. A small amount of ROS is necessary for the physiological sperm function, however high ROS levels could impair fertility potential inducing damages at membrane, protein and DNA levels.
Previous studies performed by using different methods and probes for OS evaluation in semen or in spermatozoa highlighted the negative role of ROS on sperm functions. However, such studies were not conclusive because of the small number of included subjects and of high variability in the cohorts.
Study design, size, duration
Observational study conducted on 73 male partners of infertile couples attended consecutively to the Andrology Laboratory of Careggi University Hospital of Florence from September to December 2021. Analyses were performed on both washed and Swim-up selected spermatozoa.
Participants/materials, setting, methods
After routine semen analysis, washed and Swim-up selected spermatozoa were incubated with CellRox®Orange (a fluorescent probe able to reveal OS in viable cells), at the concentration of 1 µM for 30 minutes at 37°C, 5%CO2, and revealed by flow cytometry. Sperm DNA fragmentation (by TUNEL/PI method), sperm kinematic parameters and hyperactivated motility (by C.A.S.A. system) were also assessed. In some samples a double staining with CellRox®Orange and Annexin V (which stains phosphatidylserine externalization) was performed.
Main results and the role of chance
We found that the percentage of spermatozoa positive to CellRox® Orange is positively correlated with routine seminal parameters. Although this result appears in contrast with most studies in literature reporting negative correlations between OS and semen parameters, it can be explained by the fact that the probe is specific for viable spermatozoa characterized by a better motility and morphology. Considering the importance of distinguishing between positive and negative ROS in spermatozoa, we further investigated the significance of ROS detected by this probe. To understand whether the probe marks spermatozoa with a better quality, CellRox® Orange positivity was evaluated in Swim-up selected spermatozoa finding significantly higher levels of CellRox® Orange positivity respect to unselected samples. Furthermore, the fact that most of the CellRox® Orange positive spermatozoa were negative for Annexin V (which reveals cells with early signs of apoptosis) is a further confirmation of the good quality of CellRox® Orange positive spermatozoa.
Another evidence is represented by the finding that we observed a negative correlation between OS detected by CellRox® Orange and sperm DNA fragmentation, although several studies have shown a positive relationship between these two parameters (when OS is measured by different probes).
Limitations, reasons for caution
Up to now, the study involved a limited number of subjects. Further experiments should be performed to increase the number of subjects in order to confirm the results.
Wider implications of the findings
Results of this study together with those previously published evidence that different OS is detected depending on which probe is used. CellRox® Orange seems to be sensible for physiological ROS detection, therefore, it could be employed in future studies aimed to evaluate the association between OS and assisted reproduction outcomes.
Trial registration number
not applicable
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Affiliation(s)
- E Baldi
- University of Florence, Medicina Sperimentale e Clinica , Florence, Italy
| | - G Traini
- University of Florence, Scienze Biomediche Sperimentali E Cliniche Mario Serio , Florence, Italy
| | - L Tamburrino
- University of Florence, Medicina Sperimentale e Clinica , Florence, Italy
| | - F Bini
- University of Florence, Medicina Sperimentale e Clinica , Florence, Italy
| | - G Raffaelli
- University of Florence, Medicina Sperimentale e Clinica , Florence, Italy
| | - L Vignozzi
- University of Florence, Scienze Biomediche Sperimentali E Cliniche Mario Serio , Florence, Italy
| | - S Marchiani
- University of Florence, Scienze Biomediche Sperimentali E Cliniche Mario Serio , Florence, Italy
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10
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Caputo ML, Baldi E, Krull JD, Cresta R, Benvenuti C, Primi R, Currao A, Bendotti S, Compagnoni S, Gentile FR, Savastano S, Klersy C, Auricchio A. Impact of gender on survival of out-of-hospital cardiac arrest presenting with refractory ventricular arrhythmias and role of coronary artery disease. Europace 2022. [DOI: 10.1093/europace/euac053.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Clinical presentation and outcome of out-of-hospital cardiac arrest (OHCA) presenting with shockable rhythm may vary between males and females. Very limited data exist on gender-related differences in OHCAs with refractory ventricular arrhythmias (VA) and, in particular, on distribution and prevalence of coronary artery disease (CAD).
Purpose
The aim of this study was to characterize gender-related outcome, prevalence and severity of CAD in OHCA victims presenting with shockable rhythm and refractory VA.
Methods
All OHCAs presenting with shockable rhythm occurred between 2015 and 2019 in the province of Pavia (Italy) and in the Canton Ticino (Switzerland) were included.
Results
Out of 3592 OHCAs, 685 presented with shockable rhythm and, of them, 212 had a refractory VA. Overall, male gender was independently associated with a lower probability of survival both at hospital admission and at 30-days (OR 0.63, 95% CI 0.58-0.67, p <0.001 and OR 0.82 95% CI 0.74-0.91, p <0.001, respectively) and presented with a more severe CAD. Male gender was 5-times more frequently associated with OHCA presenting with refractory VA. Despite of a more favourable OHCA presentation (i.e. more often OHCA witnessed, public place occurrence and CPR initiated by bystander) male patients with refractory VA had a lower likelihood of survival (OR 0.25, 95% CI 0.21-0.30). A higher prevalence (81%) of CAD was observed in OHCAs presenting with refractory VA but not a higher number of diseased vessels.
Conclusions
Male gender is more frequently associated with refractory VA, lower probability of survival and higher prevalence and severity of CAD. CAD severity, however, does not significantly affect refractory VA presentation.
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Affiliation(s)
- ML Caputo
- Cardiocentro Ticino Institute, Lugano, Switzerland
| | - E Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia and Cardiac Intensive C, Pavia, Italy
| | - JD Krull
- Cardiocentro Ticino Institute, Lugano, Switzerland
| | - R Cresta
- Ticino Cuore Foundation, Lugano, Switzerland
| | - C Benvenuti
- Ticino Cuore Foundation, Lugano, Switzerland
| | - R Primi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia and Cardiac Intensive C, Pavia, Italy
| | - A Currao
- Department of Molecular Medicine, Section of Cardiology, University of Pavia and Cardiac Intensive C, Pavia, Italy
| | - S Bendotti
- Department of Molecular Medicine, Section of Cardiology, University of Pavia and Cardiac Intensive C, Pavia, Italy
| | - S Compagnoni
- Department of Molecular Medicine, Section of Cardiology, University of Pavia and Cardiac Intensive C, Pavia, Italy
| | - FR Gentile
- Department of Molecular Medicine, Section of Cardiology, University of Pavia and Cardiac Intensive C, Pavia, Italy
| | - S Savastano
- Department of Molecular Medicine, Section of Cardiology, University of Pavia and Cardiac Intensive C, Pavia, Italy
| | - C Klersy
- Policlinic Foundation San Matteo IRCCS, Service of Biometry and Clinical Epidemiology, Pavia, Italy
| | - A Auricchio
- Cardiocentro Ticino Institute, Lugano, Switzerland
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11
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Compagnoni S, Baldi E, Primi R, Gentile F, Bendotti S, Currao A, Bertona R, Buratti S, Raimondi Cominesi I, Taravelli E, Fava C, Moschini L, Savastano S. C8 THE CEREBRAL PERFORMANCE CATEGORY IN THE DECISION–MAKING PROCESS OF IMPLANTING AN ICD IN OUT–OF–HOSPITAL CARDIAC ARREST SURVIVORS WITH BAD NEUROLOGICAL OUTCOME. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
According to the European Society of Cardiology guidelines secondary prevention ICD implantation is a class I indication only for those patients with an estimated survival > 1 year with a good functional status. However, it is not specified how to assess the functional status and its evaluation could be quite difficult in the case of out–of–hospital cardiac arrest (OHCA) survivors with major neurological outcomes. Cerebral Performance Category (CPC) is the most widespread scale to define the neurological and functional outcome of OHCA survivors, but it is not known if it can be used to guide ICD implantation.
Objective
To evaluate whether the presence of a bad neurological outcome (CPC > 2) at discharged could be used as a prognostic index in order to evaluate the implantation of an ICD in OHCA survivors. Materials and Methods. We considered all the patients who had a cardiac arrest from 01/10/2014 to 30/09/2019 presenting a CPC> 2 at discharge. The territory included was that of the Province of Pavia (550000 inhabitants) from 2014 to 2018 and of the Provinces of Pavia, Lodi, Cremona and Mantua (1550000 inhabitants) from 2019. We assessed the survival and the neurological status variation at 1–year.
Results
In the study period, CPR was attempted in 2998 confirmed OHCAs. 227 patients (7.6%) were discharged alive and in 218 of these, CPC was available. 51 patients (23.4%) had a CPC>2 at discharge (22 CPC = 3, 24 CPC = 4 and 5 CPC = A). 1–year follow–up was available in 200 patients: among 158 alive, 12 (7.6%) had CPC>2 (7 CPC = 3 and 5 CPC = 4). 1–year survival of patients with CPC>2 at discharge was significantly lower those discharged with CPC≤2 (39.6% vs 91.6% p < 0.001). Only 19/48 patients discharged with CPC>2 survived at 1 year: a good cerebral performance was recovered in 6 patients (31.6%), while CPC>2 persisted in 11 (58%) and the CPC value was unknown in 2 of them.
Conclusions
Our results highlight that 1–year survival is quite low in patients with CPC>2 at discharge and that an improvement in cerebral performance occurs only in a minority of them. This evidence suggests the need for clinical re–evaluation after the event in order to carefully evaluate whether to implant an ICD in this kind of patients.
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Affiliation(s)
- S Compagnoni
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, ASST DI PAVIA, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, ASST DI PAVIA, VOGHERA; OSPEDALE MAGGIORE DI LODI, ASST DI LODI, LODI; OSPEDALE MAGGIORE DI CREMA, ASST DI CREMA, CREMA; A
| | - E Baldi
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, ASST DI PAVIA, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, ASST DI PAVIA, VOGHERA; OSPEDALE MAGGIORE DI LODI, ASST DI LODI, LODI; OSPEDALE MAGGIORE DI CREMA, ASST DI CREMA, CREMA; A
| | - R Primi
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, ASST DI PAVIA, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, ASST DI PAVIA, VOGHERA; OSPEDALE MAGGIORE DI LODI, ASST DI LODI, LODI; OSPEDALE MAGGIORE DI CREMA, ASST DI CREMA, CREMA; A
| | - F Gentile
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, ASST DI PAVIA, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, ASST DI PAVIA, VOGHERA; OSPEDALE MAGGIORE DI LODI, ASST DI LODI, LODI; OSPEDALE MAGGIORE DI CREMA, ASST DI CREMA, CREMA; A
| | - S Bendotti
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, ASST DI PAVIA, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, ASST DI PAVIA, VOGHERA; OSPEDALE MAGGIORE DI LODI, ASST DI LODI, LODI; OSPEDALE MAGGIORE DI CREMA, ASST DI CREMA, CREMA; A
| | - A Currao
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, ASST DI PAVIA, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, ASST DI PAVIA, VOGHERA; OSPEDALE MAGGIORE DI LODI, ASST DI LODI, LODI; OSPEDALE MAGGIORE DI CREMA, ASST DI CREMA, CREMA; A
| | - R Bertona
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, ASST DI PAVIA, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, ASST DI PAVIA, VOGHERA; OSPEDALE MAGGIORE DI LODI, ASST DI LODI, LODI; OSPEDALE MAGGIORE DI CREMA, ASST DI CREMA, CREMA; A
| | - S Buratti
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, ASST DI PAVIA, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, ASST DI PAVIA, VOGHERA; OSPEDALE MAGGIORE DI LODI, ASST DI LODI, LODI; OSPEDALE MAGGIORE DI CREMA, ASST DI CREMA, CREMA; A
| | - I Raimondi Cominesi
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, ASST DI PAVIA, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, ASST DI PAVIA, VOGHERA; OSPEDALE MAGGIORE DI LODI, ASST DI LODI, LODI; OSPEDALE MAGGIORE DI CREMA, ASST DI CREMA, CREMA; A
| | - E Taravelli
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, ASST DI PAVIA, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, ASST DI PAVIA, VOGHERA; OSPEDALE MAGGIORE DI LODI, ASST DI LODI, LODI; OSPEDALE MAGGIORE DI CREMA, ASST DI CREMA, CREMA; A
| | - C Fava
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, ASST DI PAVIA, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, ASST DI PAVIA, VOGHERA; OSPEDALE MAGGIORE DI LODI, ASST DI LODI, LODI; OSPEDALE MAGGIORE DI CREMA, ASST DI CREMA, CREMA; A
| | - L Moschini
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, ASST DI PAVIA, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, ASST DI PAVIA, VOGHERA; OSPEDALE MAGGIORE DI LODI, ASST DI LODI, LODI; OSPEDALE MAGGIORE DI CREMA, ASST DI CREMA, CREMA; A
| | - S Savastano
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; OSPEDALE CIVILE DI VIGEVANO, ASST DI PAVIA, VIGEVANO; OSPEDALE CIVILE DI VOGHERA, ASST DI PAVIA, VOGHERA; OSPEDALE MAGGIORE DI LODI, ASST DI LODI, LODI; OSPEDALE MAGGIORE DI CREMA, ASST DI CREMA, CREMA; A
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12
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Kajana V, Primi R, Gentile F, Compagnoni S, Baldi E, Mandurino Mirizzi A, Repetto A, Ferrario M, Ferlini M, Marinoni B, Bendotti S, Currao A, Oltrona Visconti L, Savastano S. C26 COMPLETE REVASCULARISATION IMPROVES SURVIVAL OF PATIENTS RESUSCITATED AFTER AN OUT–OF–HOSPITAL CARDIAC ARREST. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Sudden cardiac death is a major issue in industrialised countries and survival of patients after out–of–hospital cardiac arrest (OHCA) remains low. Acute myocardial infarction (AMI) is the principal cause of OHCA and myocardial revascularisation plays a positive role on survival. In this setting little is known about the role of complete (CR) versus culprit–only revascularisation (IR) on survival.
Purpose
The aim of this study was to assess whether CR could lead to a better one–year survival as compared to IR. Methods. Among patients prospectively enrolled in the Lombardia CARe OHCA registry from January 1 2015 to May 1 2021, who underwent a coronary angiography (CAG) at the Fondazione IRCCS Policlinico San Matteo were enrolled in this study. CAGs were retrospectively reviewed by two interventional cardiologists. Prehospital and survival data were retrieved from the registry.
Results
We enrolled 239 patients [mean age 63.7±12.4 years; male 79.9%; shockable presenting rhythm 84.1%; AMI at post ROSC ECG 67.9%; ejection fraction 37% (30–45), circulatory support with ECMO 10.9%]. Among the 119 (50%) patients with multi–vessel disease, 82 (69%) received IR whereas 37 (31%) received CR [8 during the first procedure, 29 in a second procedure with a median time after OHCA of 5 (2.5–10) days]. This latter group showed significantly higher one–year survival (54.9% vs 16.2%, p < 0.001). At univariable logistic regression only a shockable presenting rhythm and the presence of chronic total occlusion (CTO) were significantly associated with the probability of receiving a CR [OR 5.1 (95%CI 1.1–22), p = 0.03; OR 0.37 (95%CI 0.16–0.85), p = 0.02 respectively]. However, at multivariable regression analysis only CTO was significantly associated with the probability of receiving a CR [OR 0.36 (95%CI 0.15–0.9), p = 0.007]. At Cox multivariable regression model cardiac arrest duration (longer that the median value of 24 min) and CR were independently associated with the probability of death [HR 3.6 (95%CI 1.9–6.9), p < 0.001; HR 0.2 (95%CI 0.1–0.9), p = 0.02]. Similarly, cardiac arrest duration, CR and a shockable presenting rhythm were associated with the probability of death or poor neurologic outcome [HR 3.3 (95%CI 1.8–6), p < 0.001; HR 0.5 (95%CI 0.3–0.9), p = 0.03 and HR 0.2 (95%CI 0.1–0.5), p < 0.001].
Conclusions
Complete revascularisation is independently associated with a better one–year survival in patients resuscitated from an out–of–hospital cardiac arrest.
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Affiliation(s)
- V Kajana
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | - R Primi
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | - F Gentile
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | | | - E Baldi
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | | | - A Repetto
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | - M Ferrario
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | - M Ferlini
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | - B Marinoni
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | - S Bendotti
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | - A Currao
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | | | - S Savastano
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
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13
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Gentile F, Baldi E, Schnaubelt S, Caputo M, Clodi C, Bruno J, Compagnoni S, Benvenuti C, Domanovits H, Burkart R, Primi R, Ruzicka G, Holzer M, Auricchio A, Savastano S. C60 12–LEAD POST–ROSC ELECTROCARDIOGRAM DISCRIMINATES SURVIVAL TO HOSPITAL DISCHARGE. A SUB–ANALYSIS OF THE PEACE STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Once the return of spontaneous circulation (ROSC) after an out–of–hospital cardiac arrest (OHCA) is achieved in patients with an ST–elevation myocardial infarction, the acquisition of a 12–lead electrocardiogram (ECG) is strongly recommended in order to determine candidates for urgent coronary angiography. However, little is known so far about the association of ECG features and survival to hospital discharge in OHCA patients.
Methods
We analysed all the post–ROSC ECGs collected from January 2015 to December 2018 in three European centres (Pavia, Lugano and Vienna). For every ECG, the main features were analysed and filed in the database together with the pre–hospital data collected for every patient according to the Utstein style.
Results
We collected 370 ECGs: 287 males (77.6%); median age 62 years old (IQR 53–70 years); 121 from Pavia (32.7%), 38 from Lugano (10.3%) and 211 from Vienna (57.0%). In Cox univariable regression, age older than 62 years [HR 1.7 (95% IC 1.1–2.4), p = 0.007], QRS wider than 120 msec [HR 1.87 (95% IC 1.3–2.7), p < 0.001], ST elevation in more than one segment [HR 1.7(95% IC 1.2–2.5),p=0.003], the presence of left bundle branch block (LBBB) [HR 1.7 (95% IC 1.1–2.9), p = 0.03] and a right bundle branch block [HR 1.8 (95% IC 1.1–2.8), p = 0.01] were all associated with death before hospital discharge. In multivariable Cox regression, adjusted for the ROSC–to–ECG time, age older than 62 years [HR 1.6 (95% IC 1.1–2.3), p = 0.01], QRS wider than 120 msec [HR 1.7 (95%IC 1.2–2.5), p = 0.004] and the presence of ST elevation in more than one segment [HR 1.7 (95%IC 1.2–2.5), p = 0.004] were independently associated with death before hospital discharge. By considering these latter three risk factors, the rate of survival to hospital discharge was significantly influenced by their number [no risk factor: 80.8%; 1 factor: 71.2%; 2 factors: 61.9%; 3 factors: 34.4%; p < 0.001, p for trend <0.001]. With a Cox regression model, considering the absence of risk factor as a reference, we confirmed that having 2 or 3 risk factors was significantly associated with death before hospital discharge [HR 1.9 (95%IC 1–3.5), p = 0.037 e HR 5.1(95%IC 2.6–10.1), p < 0.001 respectively].
Conclusions
Our study confirms the central role of ECG in STEMI patients resuscitated after an OHCA and proves that post–ROSC ECG features can be used for both the selection of patients who may benefit from urgent coronary angiography as well as for prognostic stratifications.
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Affiliation(s)
- F Gentile
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - E Baldi
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - S Schnaubelt
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - M Caputo
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - C Clodi
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - J Bruno
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - S Compagnoni
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - C Benvenuti
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - H Domanovits
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - R Burkart
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - R Primi
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - G Ruzicka
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - M Holzer
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - A Auricchio
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - S Savastano
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
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14
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Compagnoni S, Gentile F, Baldi E, Mare C, Primi R, Bendotti S, Currao A, Contri E, Reali F, Bussi D, Facchin F, Centineo P, Savastano S. P30 CARDIAC ARRESTS IN SPORTS: WHAT IS DIFFERENT COMPARED TO OTHER PUBLIC PLACES? Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Cardiac arrests in sports can involve professional athletes, amateurs, but also spectators of sports competitions. Sports facilities are the only ones for which the current law provides for the presence of an automatic external defibrillator (AED) and trained personnel, unlike other public places (schools, work, street, station, general public buildings) where it is only recommended.
Objective
To compare patient characteristics, presentation rhythm, bystander cardiopulmonary resuscitation (CPR), AED use before emergency medical services (EMS) arrival, and return of spontaneous circulation (ROSC) longer than 30 seconds in the Utstein category of out–of–hospital cardiac arrests (OHCAs) in sports compared to events in other public places.
Materials and Methods
We considered all the OHCAs occurred from 01/01/2015 to 31/12/2020 in the provinces of Pavia, Lodi, Cremona, Mantua and Varese (2400000 inhabitants), excluding the OHCAs occurred at home, in long–term care facilities and witnessed by the EMS.
Results
During the study period, 22 OHCAs occurred in sports and 552 in other public places (school, work, street, station, public buildings). The age is similar in the two groups [sport 59 years (IQR 53.5–66.7) vs other 63 years (IQR 51–75), p = 0.2]. In sports, there is a trend in favor of shockable rhythms (13/22=59% vs 185/552=33%, p = 0.1). The percentage of CPR performed by bystanders in sports is significantly higher than in other public places (20/22=91% vs 299/552=54%, p = 0.003), as the bystander AED use (11/22=50% vs 64/552=12%, p < 0.001) and bystander AED shock (7/22=31% vs 27/552=5%, p < 0.001) before EMS arrival. A ROSC greater than 30 seconds was obtained in 59% of OHCAs in sports, with a statistically significant difference compared to events in other public places (13/22=59% vs 166/552=30%, p = 0.015).
Conclusions
During sports competitions there is a greater ability to intervene in case of cardiac arrest, which determines a higher probability of obtaining ROSC, although in terms of age or presentation rhythm the patients are comparable to OHCA victims in other places public. These results suggest the need for an AED and trained personnel in other public places as well.
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Affiliation(s)
- S Compagnoni
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - F Gentile
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - E Baldi
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - C Mare
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - R Primi
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - S Bendotti
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - A Currao
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - E Contri
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - F Reali
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - D Bussi
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - F Facchin
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - P Centineo
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - S Savastano
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
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15
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Marchiani S, Dabizzi S, Degl'Innocenti S, Fino MG, Torcia MG, Paoli D, Lombardo F, Ciccone N, Pollini S, Rossolini GM, Vignozzi L, Krausz C, Baldi E. Safety issues in semen banks during the COVID-19 pandemic: data from a European survey. J Endocrinol Invest 2022; 45:973-980. [PMID: 35075607 PMCID: PMC8786452 DOI: 10.1007/s40618-021-01728-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/16/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE We performed a survey among European semen banks enquiring safety protocols during the COVID-19 pandemic. We report the experience from a center searching SARS-CoV-2 mRNA in semen of patients undergoing cryopreservation from May 2020 to January 2021. METHODS A questionnaire was submitted to accredited semen banks of the European Academy of Andrology (EAA) and the Italian Society of Andrology and Sexual Medicine (SIAMS). A total of 22 centers answered to the survey. SARS-CoV-2 mRNA in semen was evaluated by RT-PCR in 111 subjects banking in the Semen Bank of Careggi University Hospital (Florence, Italy). RESULTS No particularly drastic safety measures were adopted by the majority of the centers to prevent the risk of contamination or transmission of the virus. The most common strategy (77.3%) was the administration of an anamnestic questionnaire. About half of the centers request a negative nasopharyngeal swab (NPS) before cryopreservation. Few centers use a quarantine tank, in case of late response of NPS, and only 4 store in a dedicated tank in case of infection. SARS-CoV-2 mRNA was not found in 111 semen samples cryopreserved in the Florentine bank. CONCLUSIONS European semen banks use different measures to handle semen samples for cryopreservation during COVID-19 pandemic. The request of NPS is advised to better manage couples undergoing ART and to protect the personnel operating in the bank/ART center. Finally, due to the areas of uncertainties of an almost unknown virus, it is absolutely recommended the use of safe devices for sample handling and storage.
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Affiliation(s)
- S Marchiani
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, 50139, Florence, Italy.
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50134, Florence, Italy.
| | - S Dabizzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, 50139, Florence, Italy
| | - S Degl'Innocenti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, 50139, Florence, Italy
| | - M G Fino
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, 50139, Florence, Italy
| | - M G Torcia
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, 50139, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy
| | - D Paoli
- Laboratory of Seminology-"Loredana Gandini" Sperm Bank, Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - F Lombardo
- Laboratory of Seminology-"Loredana Gandini" Sperm Bank, Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - N Ciccone
- Clinical Microbiology and Virology Unit, Careggi University Hospital, 50139, Florence, Italy
| | - S Pollini
- Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy
- Clinical Microbiology and Virology Unit, Careggi University Hospital, 50139, Florence, Italy
| | - G M Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy
- Clinical Microbiology and Virology Unit, Careggi University Hospital, 50139, Florence, Italy
| | - L Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, 50139, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50134, Florence, Italy
| | - C Krausz
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, 50139, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50134, Florence, Italy
| | - E Baldi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, 50139, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy
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16
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Gentile FR, Primi R, Baldi E, Compagnoni S, Mare C, Contri E, Reali F, Bussi D, Facchin F, Currao A, Bendotti S, Savastano S. Out-of-hospital cardiac arrest and ambient air pollution: a dose-effect relationship and a predictive role in OHCA risk. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Pollution has been suggested as a precipitating factor for cardiovascular diseases via a series of different mechanisms. However, data about the link between the different air pollutants and the risk of out-of-hospital cardiac arrest (OHCA) are limited and controversial.
Purpose
The primary aim of this study is to examine the impact of short-term exposure to particulate and gaseous pollutants on the incidence of OHCA in a vast metropolitan and rural area that encompasses four provinces of the Po Valley in Northern Italy, one of the most polluted areas in Italy and Europe due to its levels of industrialization and high population density. The secondary aim of this study is to look for a dose-effect curve, which could help predict OHCA incidence based on the concentration of pollutants in a specific area.
Methods
This is a retrospective analysis of prospectively collected data both in the OHCA registry (Lombardia CARe) and in the database of the regional agency for environmental protection (ARPA) of the Lombardy region. All medical OHCAs and the mean daily concentration of pollutants including fine particulate matter (PM10, PM2.5), benzene (C6H6), carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2) and ozone (O3) were considered from January 1st to December 31st, 2019 in the southern part of the Lombardy region (provinces of Pavia, Lodi, Cremona and Mantua; 7863 km2; about 155ehab724.2654 inhabitants). Days were divided into high or low incidence of OHCA according to the median daily incidence. A Probit dose-response analysis and both uni- and multivariable logistic regression models were provided for each pollutant.
Results
The median daily incidence of OHCA was 0.3 cases/100,000 inhabitants. Benzene was the pollutant with the greatest difference between days at high and low incidence of OHCA [0.7 (IQR 0.4–1.2) vs 0.4 (IQR 0.3–0.7), p<0.001], whereas SO2 had the lowest and least significant difference between the two periods [3.2 (IQR 2.8–3.6) vs 3.1 (IQR 2.7–3.5), p=0.046]. O3 showed a countertrend, being significantly higher in the low-incidence period [29.9 (IQR 10.9–61.7) vs 56.1 (IQR 25.5–74.1), p<0.001] as well as temperature [10.1— (IQR 5.2–14.8) vs 15.1 (IQR 8.9–23.3), p<0.001]. By using the Probit regression analysis and after adjusting for temperature, a dose-response relationship was demonstrated for all the tested pollutants.
Conclusions
Our results clarify the link between pollutants and the acute risk of cardiac arrest suggesting the need of both improving the air quality and integrating pollution data in future models.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F R Gentile
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - R Primi
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Baldi
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Compagnoni
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Mare
- Agenzia Regionale dell'Emergenza Urgenza, Milano, Italy
| | - E Contri
- Agenzia Regionale dell'Emergenza Urgenza, Milano, Italy
| | - F Reali
- Agenzia Regionale dell'Emergenza Urgenza, Milano, Italy
| | - D Bussi
- Agenzia Regionale dell'Emergenza Urgenza, Milano, Italy
| | - F Facchin
- Agenzia Regionale dell'Emergenza Urgenza, Milano, Italy
| | - A Currao
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Bendotti
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Savastano
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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17
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Gentile FR, Compagnoni S, Baldi E, Aramendi E, Primi R, Bendotti S, Currao A, Contri E, Palo A, Savastano S. Amiodarone and amplitude spectral area of ventricular fibrillation in patients with out-of-hospital cardiac arrest. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Ventricular fibrillation is the most common cause of out-of-hospital cardiac arrest (OHCA) and the use of antiarrhythmic drug therapy is usually recommended in addition to defibrillation. The role of the amplitude spectral area (AMSA) of ventricular fibrillation as a predictor of defibrillation efficacy has been established, while the existing data in favour of the use of amiodarone has been assessed with poor evidence and controversy.
Purpose
The aim of our study is to evaluate whether the administration of amiodarone during resuscitation could affect AMSA values.
Materials
All the OHCAs with a shockable presenting rhythm and attempted resuscitation which occurred from January 2015 to June 2019 in the province of Pavia were considered. Both the end-tidal CO2 (ETCO2) and AMSA values were calculated by retrospectively analyzing the data collected by the Corpuls 3 monitors/defibrillators (Corpuls, Kaufering, Germany) used in the territory and by considering a pre-shock interval of 2 seconds.
Results
Among a total of 3413 OHCAs, resuscitation was attempted in 2195 cases (64%), 377 (17%) had a shockable presenting rhythm and in 112 cases (3.4%) it was possible to obtain the values of ETCO2 and AMSA for a total of 391 shocks. Among these, 301 shocks (77%) were delivered to patients who received amiodarone during resuscitation. The success rate of each single shock was similar in the two groups but with an unfavorable trend for amiodarone (amiodarone 43.5% vs no amiodarone 54.4%, p=0.07). AMSA was significantly lower in patients treated with amiodarone (7.9 mV·Hz, IQR 5.4–12.2 vs 10.6 mV·Hz, IQR 7.1–14.1; p<0.001). According to a multivariate analysis, the administration of amiodarone and the time to shock were independent predictors of AMSA values. Lastly, on a sample of 124 shocks, homogeneous for age, sex, ETCO2, outcome of resuscitation and randomly matched, the AMSA of patients who received amiodarone was significantly lower (7.2 mV·Hz, IQR 7.2–11.7 vs 9.7 mV·Hz, IQR 6.7–12.5; p=0.02).
Conclusions
Our results indicate that amiodarone administration is associated with lower values of AMSA. Since higher AMSA values are known to be associated with a higher probability of shock rate success, this could help to better clarify the controversial role of amiodarone administration in patients with OHCA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F R Gentile
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Compagnoni
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Baldi
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Aramendi
- University of the Basque Country, Bilbao, Spain
| | - R Primi
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Bendotti
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Currao
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Contri
- Agenzia Regionale dell'Emergenza Urgenza, Milano, Italy
| | - A Palo
- Agenzia Regionale dell'Emergenza Urgenza, Milano, Italy
| | - S Savastano
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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18
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Baldi E, Camporotondo R, Gnecchi M, Totaro R, Guida S, Costantino I, Repetto A, Savastano S, Sacchi MC, Bollato C, Giglietta F, Tua L, Galazzi M, Oltrona Visconti L, Leonardi S. Barriers associated with emergency medical service activation in Italian patients with ST-segment elevation acute coronary syndromes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Many ST-segment elevation acute coronary syndrome (STEACS) patients fail to activate the Emergency Medical System (EMS), with possible dramatic consequences. Prior studies focusing on barriers to EMS activation include patients with any acute coronary syndrome (ACS) without representation of southern European populations. However, barriers are influenced by the ACS type and by socio-demographic and racial factors.
Purpose
We aimed to investigate the barriers to EMS call for patients diagnosed for STEACS in Italy.
Methods
A prospective, single-center, survey-based study, including all the patients treated with primary percutaneous coronary intervention for STEACS in a tertiary hospital in northern Italy from 1st June 2018 to 31st May 2020.
Results
The questionnaire was filled out by 293 patients. The majority of the participants were males (74%), married (70.4%), with a high-school degree (38.4%) and with a median age of 62 years. Chest pain as a possible symptom related to a cardiovascular attack is known by most of the respondents (89%), and left arm pain/shake by 53.7% of them, whilst the other possible signs and symptoms (i.e. dyspnea, asthenia, sweating, nausea, vomiting, dizziness) were unknown to the majority of the participants. Only 191 (65.2%) of the participants activated the EMS after symptoms onset. The main reasons for not calling EMS were the perception that symptoms were not related to an important health problem (45.5%) and that a private vehicle is faster than EMS to reach the hospital (34.7%). The median time to first medical contact was 60 minutes, and it was significantly higher in the patients who did not called EMS compared to those who did (180 [60–420] mins vs 35 [15–120] mins, p<0.001). The patients who called a private doctor after symptoms onset did not called EMS more frequently than those who did not (5.9% vs 8.2%, p=0.3). Moreover, 30% of the patients who did not call the EMS would still act in the same way if a new episode occurred and the main reasons for this were that they think to be faster than EMS (57.1%) and to live close to the hospital (17.9%). Analyzing predictors of EMS activation, only prior history of cardiovascular disease has been demonstrated to be a predictor of calling the EMS in case of symptoms suspected for STEACS.
Conclusions
Our study, from the southern Europe, showed that a substantial percentage of patients with symptoms suspected for STEACS preferred private vehicle rather than activating the EMS. Our results highlight the need for information campaigns targeted to both the general population and medical doctors, stressing that the EMS is faster than a private vehicle to direct the patient to the right hospital and increasing the awareness of the people on the type of possible heart attack symptoms, which seem to be the most neglected issues by patients who did not call the EMS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Baldi
- University of Pavia - Fondazione IRCCS Policlinico San Matteo, Section of Cardiology - Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology, Pavia, Italy
| | - R Camporotondo
- Fondazione IRCCS Policlinico San Matteo, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology, Pavia, Italy
| | - M Gnecchi
- University of Pavia - Fondazione IRCCS Policlinico San Matteo, Section of Cardiology - Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology, Pavia, Italy
| | - R Totaro
- Fondazione IRCCS Policlinico San Matteo, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology, Pavia, Italy
| | - S Guida
- Fondazione IRCCS Policlinico San Matteo, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology, Pavia, Italy
| | - I Costantino
- Fondazione IRCCS Policlinico San Matteo, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology, Pavia, Italy
| | - A Repetto
- Fondazione IRCCS Policlinico San Matteo, Division of Cardiology, Pavia, Italy
| | - S Savastano
- Fondazione IRCCS Policlinico San Matteo, Division of Cardiology, Pavia, Italy
| | - M C Sacchi
- Fondazione IRCCS Policlinico San Matteo, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology, Pavia, Italy
| | - C Bollato
- Fondazione IRCCS Policlinico San Matteo, Anestesia e Rianimazione II Cardiopolmonare, Pavia, Italy
| | | | - L Tua
- University of Pavia - Fondazione IRCCS Policlinico San Matteo, Section of Cardiology - Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology, Pavia, Italy
| | - M Galazzi
- University of Pavia - Fondazione IRCCS Policlinico San Matteo, Section of Cardiology - Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology, Pavia, Italy
| | - L Oltrona Visconti
- Fondazione IRCCS Policlinico San Matteo, Division of Cardiology, Pavia, Italy
| | - S Leonardi
- University of Pavia - Fondazione IRCCS Policlinico San Matteo, Section of Cardiology - Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology, Pavia, Italy
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Dusi V, Masiello L, Vicentini A, Savastano S, Petracci B, Sanzo A, Baldi E, Greco A, Turco A, Raineri C, Scelsi L, Ghio S, Serio A, Arbustini E, Rordorf R. Long-term outcome of patients with cardiolaminopathy undergoing defibrillator implantation: single-center experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Mutations in the LMNA gene are associated with a high arrhythmic risk. The history of the disease in patients undergoing ICD implantation is poorly characterized.
Purpose
To evaluate the phenotype of patients with cardiolaminopathy at the time of first ICD implantation, the incidence, characteristics and timing of ventricular arrhythmias (VAs) during follow up and the predictive value of the European score (that assigns a point each to non-sustained VT (NSVT), left ventricular ejection fraction (LVEF)<45% at first contact, male sex and non-missense mutations) and of the Wahbi score (that also includes conduction disturbances) for both VAs and heart failure (HF) related outcomes.
Methods
Patients were identified retrospectively. Clinical and device data were collected at baseline and during follow-up.
Results
We identified 26 patients (54% male, 42±8 years, 31% with familial history of sudden cardiac death, 31% with non-missense mutation) undergoing ICD implantation, 96% in primary prevention, 47% with single chamber ICD, 38% with dual chamber ICD. At the time of implantation, 30% had skeletal muscle involvement, 15% history of syncope, 4% of cardiac arrest, 62% previous NSVT. Also, 38% had a history of supraventricular arrhythmias and 61% had AV conduction disturbances. LVEF was 41±11%, 35% were in NYHA class ≥2, the mean European and Wahbi scores were 2.1±0.8 and 18.2±8.9, respectively. During 8.3±5 years, 15% were transplanted, 8% died due to HF, 4% underwent LVAD implantation, despite 31% having received an upgrade to CRT-D. Appropriate device interventions occurred in 46% of patients with a median time to first event of 29 months (IQR 13–93), for a total of 137 ATP, 51% of which effective (median 3ATP/patient, IQR 1–8) and of 26 shocks, 96% of which effective (median 2 shocks/patient, IQR 1–3); 12% had an arrhythmic storm. The first treated arrhythmia was a polymorphic VT/VF in 17%, a monomorphic VT in the others (medium cycle length 293±37 msec). Survival free from appropriate ICD interventions at 1 and at 5 years was 75% and 19% respectively in case of a European score ≥3 vs 94% and 82% in case of a score <3 (Logrank test p<0.01), 72% and 46% in case of Wahbi score ≥30 vs 100% and 86% with score <30 (p<0.01), with no differences in terms of death/transplant (figure). At last follow-up, 92% of patients a were taking beta-blocker, 42% amiodarone, 8% sotalol, 4% flecainide, 8% mexiletine. Also, 4% had undergone invasive VT ablation, 8% bilateral cardiac sympathetic denervation.
Conclusions
Patients with cardiolaminopathy are at a high risk of both arrhythmic and heart failure progression over the first decade after implantation of the first ICD. A European score ≥3 identifies patients with 5-year shock/ATP free survival of less than 20% but does not predict death/transplantation. The first arrhythmic event in these patients is more frequently a rapid monomorphic VT with modest ATP efficacy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Dusi
- Policlinic Foundation San Matteo IRCCS, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Pavia, Italy
| | - L.C Masiello
- University of Pavia, Department of Molecular Medicine, Pavia, Italy
| | - A Vicentini
- Policlinic Foundation San Matteo IRCCS, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Pavia, Italy
| | - S Savastano
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - B Petracci
- Policlinic Foundation San Matteo IRCCS, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Pavia, Italy
| | - A Sanzo
- Policlinic Foundation San Matteo IRCCS, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Pavia, Italy
| | - E Baldi
- University of Pavia, Department of Molecular Medicine, Pavia, Italy
| | - A Greco
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - A Turco
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - C Raineri
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - L Scelsi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - S Ghio
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - A Serio
- Policlinic Foundation San Matteo IRCCS, Center for Cardiovascular Genetic Diseases, Pavia, Italy
| | - E Arbustini
- Policlinic Foundation San Matteo IRCCS, Center for Cardiovascular Genetic Diseases, Pavia, Italy
| | - R Rordorf
- Policlinic Foundation San Matteo IRCCS, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Pavia, Italy
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Montalto C, Ghio S, Pagnesi M, Cappelletti A, Baldetti L, Baldi E, Lombardi C, Lupi L, Metra M, Perlini S, Oltrona-Visconti L. Myocardial injury in patients hospitalized for SARS-CoV19: a maker or a marker of prognosis? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, literature data are progressively accumulating, attesting to the possible prognostic role of cardiac troponins in patients who need hospitalization because of COVID-19 infection.
Purpose
To assess whether myocardial injury (measured by high sensitivity troponins) is an independent cause of disease severity and prognosis.
Methods
We performed a patient-level metanalysis (PROSPERO ID: CRD42020213209) in unselected patients hospitalized because of COVID-19 infection in whom the severity of respiratory failure was also evaluated at admission. To allow for comparison, troponin values were normalized to their threshold levels to obtain a normalized troponin (nTn) value which was used as a continuous variable in all analysis.
Results
A total of 722 patients were included in the analysis. Of note, patients who had elevated troponins at hospital admission had a significantly lower oxygenation status than those with normal nTn (PaO2/FiO2 232±215 vs. 276±124 mmHg/%; p<0.001). On the contrary, those with cardiovascular comorbidities had similar PaO2/FiO2 but higher nTn than those without (5.6817 vs. 2.1110 ng/mL; p=0.002).
After a median follow-up of 14 days, 180 deaths were observed. At multivariable regression analysis, age, male sex, moderate-severe renal dysfunction (eGFR <30 mL/min/m2) and lower PaO2/FiO2, were independent predictor of death (igure 1). The restricted cubic spline curves in Figure 2A and 2B show the hazard ratios (HRs) and 95% confidence interval for death according to nTn and PaO2/FiO2 levels as continuous variables. A linear increase in the HR is observed with lower PaO2/FiO2 values below the normal value of 300. On the contrary, the nTn spline curve is near-flat with large confidence interval for values above the normality thresholds.
Conclusion
In patients hospitalized for COVID-19, mortality is mainly driven by gender, age and respiratory failure while myocardial damage is not an independent predictor of worse survival when respiratory function is accounted for.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
| | - S Ghio
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - M Pagnesi
- IRCCS San Raffaele Hospital, Milan, Italy
| | | | - L Baldetti
- IRCCS San Raffaele Hospital, Milan, Italy
| | - E Baldi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - C Lombardi
- Civil Hospital of Brescia, Brescia, Italy
| | - L Lupi
- Civil Hospital of Brescia, Brescia, Italy
| | - M Metra
- Civil Hospital of Brescia, Brescia, Italy
| | | | - L Oltrona-Visconti
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
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Casula M, Pignalosa L, Fortuni F, Baldi E, Sanzo A, Savastano S, Petracci B, Vicentini A, Rordorf R. Catheter ablation versus antiarrhythmic drugs as first-line therapy for symptomatic atrial fibrillation: a systematic review and meta-analysis. Europace 2021. [DOI: 10.1093/europace/euab116.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
In patients with symptomatic atrial fibrillation (AF), current international guidelines favor the use of antiarrhythmic drugs (AAD) as initial therapy for the maintenance of sinus rhythm. Previous studies have compared catheter ablation for pulmonary vein isolation versus AAD in this clinical scenario but the best first-line therapeutic option in patients with symptomatic AF candidates for rhythm control strategy remains an open issue.
Aim
To compare efficacy and safety of catheter ablation versus AAD as first-line therapy in patients with symptomatic AF.
Methods
We searched electronic databases for randomized controlled trials (RCTs) comparing catheter ablation versus AAD as first-line therapy for symptomatic AF. The primary efficacy outcome was any recurrence of atrial tachyarrhythmias. The secondary efficacy outcomes were symptomatic arrhythmic recurrences. The safety outcomes were serious adverse events related to the therapeutic regimen. Outcome events were defined according to the definition used in each original study. The effect size was estimated using a random-effect model as risk ratio (RR) and relative 95% confidence interval (CI) with the statistical software Review Manager 5.3.
Results
Five RCTs counting 997 patients (503 treated with catheter ablation and 494 with AAD) were included in the analysis. Mean age was 57 ± 3 years, 30% were female. Mean left ventricle ejection fraction was 60%±4% and mean left atrial diameter was 40 mm ± 1 mm. At baseline 52% of patients were treated with a beta-blocker and 11% with a calcium channel blocker. In the catheter ablation group 258 patients (51%) underwent cryoablation and 245 (49%) radiofrequency ablation. Median follow-up was 12 months (IQR 12-24 months). Patients treated with catheter ablation had statistically significant lower risk of atrial tachyarrhythmias recurrences (RR 0.59; 95%CI 0.45-0.76; p < 0.0001 – Figure A) and of symptomatic arrhythmia recurrences (RR 0.45; 95%CI 0.25-0.80; p = 0.007 – Figure B) compared with those treated with AAD. The risk of serious adverse events related to the therapeutic regimen did not differ significantly between patients undergoing catheter ablations and those treated with AAD (RR 0.85; 95%CI 0.45-1.59 – Figure C).
Conclusions
In patients with symptomatic AF, catheter ablation as first-line therapy is associated with a reduced risk of atrial tachyarrhythmias recurrences compared with AAD, without statistically significant differences in the risk of serious adverse events related to the treatment. Abstract Figure.
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Affiliation(s)
- M Casula
- University of Pavia, Pavia, Italy
| | | | | | - E Baldi
- University of Pavia, Pavia, Italy
| | - A Sanzo
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlin, Pavia, Italy
| | - S Savastano
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlin, Pavia, Italy
| | - B Petracci
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlin, Pavia, Italy
| | - A Vicentini
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlin, Pavia, Italy
| | - R Rordorf
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlin, Pavia, Italy
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Gacci M, Coppi M, Baldi E, Sebastianelli A, Zaccaro C, Morselli S, Pecoraro A, Manera A, Nicoletti R, Liaci A, Bisegna C, Gemma L, Giancane S, Pollini S, Antonelli A, Lagi F, Marchiani S, Dabizzi S, Degl’Innocenti S, Annunziato F, Maggi M, Vignozzi L, Bartoloni A, Rossolini GM, Serni S. Semen impairment and occurrence of SARS-CoV-2 virus in semen after recovery from COVID-19. Hum Reprod 2021; 36:1520-1529. [PMID: 33522572 PMCID: PMC7953947 DOI: 10.1093/humrep/deab026] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/28/2020] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION How is the semen quality of sexually active men following recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection? SUMMARY ANSWER Twenty-five percent of the men with recent SARS-Cov-2 infections and proven healing were oligo-crypto-azoospermic, despite the absence of virus RNA in semen. WHAT IS KNOWN ALREADY The presence of SARS-CoV-2 in human semen and its role in virus contagion and semen quality after recovery from coronavirus disease 2019 (COVID-19) is still unclear. So far, studies evaluating semen quality and the occurrence of SARS-CoV-2 in semen of infected or proven recovered men are scarce and included a limited number of participants. STUDY DESIGN, SIZE, DURATION A prospective cross-sectional study on 43 sexually active men who were known to have recovered from SARS-CoV2 was performed. Four biological fluid samples, namely saliva, pre-ejaculation urine, semen, and post-ejaculation urine, were tested for the SARS-CoV-2 genome. Female partners were retested if any specimen was found to be SARS-CoV-2 positive. Routine semen analysis and quantification of semen leukocytes and interleukin-8 (IL-8) levels were performed. PARTICIPANTS/MATERIALS, SETTING, METHODS Questionnaires including International Index of Erectile Function and Male Sexual Health Questionnaire Short Form were administered to all subjects. The occurrence of virus RNA was evaluated in all the biological fluids collected by RT-PCR. Semen parameters were evaluated according to the World Health Organization manual edition V. Semen IL-8 levels were evaluated by a two-step ELISA method. MAIN RESULTS AND THE ROLE OF CHANCE After recovery from COVID-19, 25% of the men studied were oligo-crypto-azoospermic. Of the 11 men with semen impairment, 8 were azoospermic and 3 were oligospermic. A total of 33 patients (76.7%) showed pathological levels of IL-8 in semen. Oligo-crypto-azoospermia was significantly related to COVID-19 severity (P < 0.001). Three patients (7%) tested positive for at least one sample (one saliva; one pre-ejaculation urine; one semen and one post-ejaculation urine), so the next day new nasopharyngeal swabs were collected. The results from these three patients and their partners were all negative for SARS-CoV-2. LIMITATIONS, REASONS FOR CAUTION Although crypto-azoospermia was found in a high percentage of men who had recovered from COVID-19, clearly exceeding the percentage found in the general population, the previous semen quality of these men was unknown nor is it known whether a recovery of testicular function was occurring. The low number of enrolled patients may limit the statistical power of study. WIDER IMPLICATIONS OF THE FINDINGS SARS-CoV-2 can be detected in saliva, urine, and semen in a small percentage of men who recovered from COVID-19. One-quarter of men who recovered from COVID-19 demonstrated oligo-crypto-azoospermia indicating that an assessment of semen quality should be recommended for men of reproductive age who are affected by COVID-19. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - M Coppi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence, Italy
| | - E Baldi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe, University of Florence, 50134 Florence, Italy
| | - A Sebastianelli
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - C Zaccaro
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - S Morselli
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - A Pecoraro
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - A Manera
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - R Nicoletti
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - A Liaci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - C Bisegna
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - L Gemma
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - S Giancane
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - S Pollini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence, Italy
| | - A Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence, Italy
| | - F Lagi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - S Marchiani
- Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe, University of Florence, 50134 Florence, Italy
| | - S Dabizzi
- Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe, University of Florence, 50134 Florence, Italy
| | | | - F Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - M Maggi
- Endocrinology Unit and Department of Experimental, Clinical and Biomedical Sciences, University of Florence, 50134 Florence, Italy
| | - L Vignozzi
- Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe, University of Florence, 50134 Florence, Italy
| | - A Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - G M Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence, Italy
| | - S Serni
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
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23
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Federighi G, Bernardi R, Baldi E, Bucherelli C, Scuri R. The exploration of a new environment leads to the modulation of gene expression for prolonged times in the rat. Arch Ital Biol 2021; 158:67-73. [PMID: 33821468 DOI: 10.12871/000398292020341] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In the present study we performed a transcriptional analysis in order to evaluate changes in gene expression induced by exploration in prolonged times. The analysis was carried out 3, 10 and 20 days after exploration. We analyzed the modulation of the expression levels of Pfn2, Casp3, Pdrg1, Pea15, Ywhaz genes which previously were found not modulated 2 days after exploration. Our data show that the expression of Pfn2, Casp3, Pdrg1, Pea15, Ywhaz genes was modulated at 10 or 20 days. The transcript, whose expression had been evaluated with the qRT-PCR, code for proteins which belong to the following functional categories: synaptic modulation, apoptosis, signal transduction. It is interesting to note that the modulation of the expression of these genes was evident some days after environmental exploration, and not previously at 2 days after conditioning as occurred after contextual fear conditioning (CFC). Hence it is possible to hypothesize that the spatial memory processes require a longer period of elaboration than the emotional ones, fundamental for the survival of the species.
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Affiliation(s)
| | | | | | | | - R Scuri
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Via S. Zeno 31, 56127 Pisa, Italy -
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24
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Lotti F, Frizza F, Balercia G, Barbonetti A, Behre HM, Calogero AE, Cremers JF, Francavilla F, Isidori AM, Kliesch S, La Vignera S, Lenzi A, Marcou M, Pilatz A, Poolamets O, Punab M, Peraza Godoy MF, Rajmil O, Salvio G, Shaeer O, Weidner W, Maseroli E, Cipriani S, Baldi E, Degl'Innocenti S, Danza G, Caldini AL, Terreni A, Boni L, Krausz C, Maggi M. The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: Scrotal ultrasound reference ranges and associations with clinical, seminal, and biochemical characteristics. Andrology 2021; 9:559-576. [PMID: 33244893 DOI: 10.1111/andr.12951] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Scrotal color Doppler ultrasound (CDUS) still suffers from lack of standardization. Hence, the European Academy of Andrology (EAA) has promoted a multicenter study to assess the CDUS characteristics of healthy fertile men (HFM) to obtain normative parameters. OBJECTIVES To report and discuss the scrotal organs CDUS reference ranges and characteristics in HFM and their associations with clinical, seminal, and biochemical parameters. METHODS A cohort of 248 HFM (35.3 ± 5.9years) was studied, evaluating, on the same day, clinical, biochemical, seminal, and scrotal CDUS following Standard Operating Procedures. RESULTS The CDUS reference range and characteristics of the scrotal organs of HFM are reported here. CDUS showed a higher accuracy than physical examination in detecting scrotal abnormalities. Prader orchidometer (PO)- and US-measured testicular volume (TV) were closely related. The US-assessed TV with the ellipsoid formula showed the best correlation with the PO-TV. The mean TV of HFM was ~ 17 ml. The lowest reference limit for right and left testis was 12 and 11 ml, thresholds defining testicular hypotrophy. The highest reference limit for epididymal head, tail, and vas deferens was 12, 6, and 4.5 mm, respectively. Mean TV was associated positively with sperm concentration and total count and negatively with gonadotropins levels and pulse pressure. Subjects with testicular inhomogeneity or calcifications showed lower sperm vitality and concentration, respectively, than the rest of the sample. Sperm normal morphology and progressive motility were positively associated with epididymal head size/vascularization and vas deferens size, respectively. Increased epididymis and vas deferens sizes were associated with MAR test positivity. Decreased epididymal tail homogeneity/vascularization were positively associated with waistline, which was negatively associated with intratesticular vascularization. CDUS varicocele was detected in 37.2% of men and was not associated with seminal or hormonal parameters. Scrotal CDUS parameters were not associated with time to pregnancy, number of children, history of miscarriage. CONCLUSIONS The present findings will help in better understanding male infertility pathophysiology, improving its management.
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Affiliation(s)
- F Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - F Frizza
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - G Balercia
- Endocrinology Unit, Ospedali Riuniti Ancona, Polytechnic University of Marche, Ancona, Italy
| | - A Barbonetti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - H M Behre
- Center for Reproductive Medicine and Andrology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - J F Cremers
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, Münster University Hospital, Münster, Germany
| | - F Francavilla
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, Münster University Hospital, Münster, Germany
| | - S La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M Marcou
- Center for Reproductive Medicine and Andrology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - A Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - O Poolamets
- Andrology Unit, Tartu University Hospital, Tartu, Estonia
| | - M Punab
- Andrology Unit, Tartu University Hospital, Tartu, Estonia
| | - M F Peraza Godoy
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - O Rajmil
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - G Salvio
- Endocrinology Unit, Ospedali Riuniti Ancona, Polytechnic University of Marche, Ancona, Italy
| | - O Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - W Weidner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - E Maseroli
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - S Cipriani
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - E Baldi
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - S Degl'Innocenti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - G Danza
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - A L Caldini
- Department of Laboratory, Careggi Hospital, Florence, Italy
| | - A Terreni
- Department of Laboratory, Careggi Hospital, Florence, Italy
| | - L Boni
- Clinical Trials Coordinating Center, Toscano Cancer Institute, University Hospital Careggi, Florence, Italy
| | - C Krausz
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - M Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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25
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De Bastiani R, Sanna G, Bertolusso L, Casella G, De Polo M, Zamparella M, Cottone C, Tosetti C, Mancuso M, Pirrotta E, Lanzarotto L, Napoli L, De Bastiani M, Disclafani G, Gambaro P, Scoglio R, Belvedere A, Fasulo S, D'Urso M, Benedetto E, Baldi E, Marchesan F, Abagnale G, Turnava L, Salomè E, Ingravalle F, Tursi A. General practitioners' management of symptomatic uncomplicated diverticular disease of the colon by using rifaximin, a non-adsorbable antibiotic. Eur Rev Med Pharmacol Sci 2021; 25:423-430. [PMID: 33506932 DOI: 10.26355/eurrev_202101_24410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Symptomatic uncomplicated diverticular disease of the colon (SUDD) is generally managed by gastroenterologists rather than General Practitioners (GPs). The aim of this study was to assess the efficacy of the treatment of SUDD with rifaximin, a non-absorbable antibiotic, in a primary care setting by GPs. PATIENTS AND METHODS This retrospective, observational study investigated the use of rifaximin at a dose of 400 mg b.i.d. for 5, 7 or 10 days monthly, up to 3 months. The symptoms were reported by the patients using a visual analogic scale (VAS) of 0-10. RESULTS 286 SUDD patients were enrolled (44.4% of men, average age 70.92±10.98). Respectively, 15 (5.2%) patients received the treatment for 5 days, 205 (71.7%) for 7 days and 66 (23.1%) for 10 days. After three months, a significant reduction of VAS score was observed in almost all symptoms assessed: 135 (47.2%) patients reported no abdominal pain (p<0.001) and 23 (8.1%) reported no symptom. Adverse events related to the treatment were recorded in 3 (1.04%) patients, all of them mild and not requiring interruption of the treatment. Acute diverticulitis occurred in 9 (3.1%) patients, but only 2 of them [0.7% (n=2)] underwent surgery due to complicated diverticulitis. Analysis within the different treatment groups (5, 7 and 10 days) shows that rifaximin treatment is effective in reducing the severity of symptoms in almost all groups except for the constipation in the 5-day group. CONCLUSIONS Rifaximin can be effectively used by GPs in real-life for the management of SUDD.
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Affiliation(s)
- R De Bastiani
- General Practitioner, Italian Association for Gastroenterology in Primary Care (GIGA-CP), Feltre (BL), Italy.
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26
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Baldi E, Schnaubelt S, Caputo M, Klersy C, Clodi C, Bruno J, Compagnoni S, Benvenuti C, Burkart R, Fracchia R, Holzer M, Auricchio A, Savastano S. Post-ROSC electrocardiogram timing in the management of out-of-hospital cardiac arrest: results of an international multicentric study (PEACE study). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Electrocardiogram (ECG) is a key tool to triage out-of-hospital cardiac arrest (OHCA) patients after achieving a sustained return of spontaneous circulation (ROSC). According to current guidelines, an immediate coronary angiography is indicated only when the post-ROSC ECG discloses a ST-elevation myocardial Infarction (STEMI). Moreover, the 12-lead ECG should be recorded as soon as possible after ROSC, although it is reasonable that in the early post-ROSC stages ECG could reflect the ischemia secondary to cardiac arrest besides that of coronary origin possibly causing an overdiagnosis of STEMI (false positive).
Purpose
To assess whether the time from ROSC to ECG acquisition could affect the percentage of false positive ECG for STEMI.
Methods
We performed a retrospective, international, multicenter study (PEACE Study - NCT04096079). We included all patients over 18 years of age hospitalized after an OHCA due to medical cause at one of the three participating high-volume hospitals of three different European countries between 2015, 1st January and 2018, 31st December. We considered for the present study only patients who underwent coronary angiography and in whom a post-ROSC ECG was available. For the electrocardiographic diagnosis of STEMI the criteria established by the ESC 2017 guidelines were used, while the execution of a percutaneous coronary angioplasty (PTCA) was evaluated as an angiographic endpoint. We used logistic regression to evaluate the association of time to acquisition and the endpoint. We computed odds ratios and 95% confidence intervals (OR, 95% CI).
Results
Population consisted of 370 patients (77.6% male, mean age 61±13 years, median ROSC-ECG time 15 minutes). Post-ROSC ECG was positive for STEMI in 198 patients and in 39 of them (10.5%) a PTCA was not performed during urgent coronary angiography, representing the false positive (FP) ECG. Dividing the population in three tertiles according to the time from ROSC to ECG (≤7 mins; 8–33 mins; >33 mins), the percentage of FP-ECG in the first tertile (18.5%) was statistically significantly higher than in the second (7.2%, OR 2.9 (95% CI 1.1–7.5) p=0.025) and third (5.8%, OR 3.7 (95% CI 2.2–6.5) p<0.001) as also shown in the Figure. These differences remained significant when adjusting for sex, age, number of segments involved at ECG (anterior, lateral, posterior, inferior and right), QRS duration >120 msec, ECG heart rate >100 bpm and adrenaline administered >1 mg.
Conclusion
Our study offers the first demonstration that the acquisition of the 12-leads ECG too early after ROSC can misleadingly lead to the diagnosis of STEMI. Despite further validation are required, our data suggest that it may be reasonable to delay the acquisition of the ECG at least 8 minutes after ROSC or to repeat the acquisition if the first ECG, resulting diagnostic for STEMI, was performed very early.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Baldi
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - S Schnaubelt
- Medical University of Vienna, Department of Emergency Medicine, Vienna, Austria
| | - M.L Caputo
- Cardiocentro Ticino, Lugano, Switzerland
| | - C Klersy
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | - C Clodi
- Medical University of Vienna, Department of Emergency Medicine, Vienna, Austria
| | - J Bruno
- Cardiocentro Ticino, Lugano, Switzerland
| | - S Compagnoni
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | | | - R Burkart
- Fondazione TicinoCuore, Lugano, Switzerland
| | - R Fracchia
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - M Holzer
- Medical University of Vienna, Department of Emergency Medicine, Vienna, Austria
| | | | - S Savastano
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
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27
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Mattesi G, Baldi E, Guerra F, Toniolo M, Cipriani A, Cauti F, Marcantoni L, Manfrin M, Lanzillo C, Savastano S, Zorzi A. Prognostic role of left ventricular late gadolinium enhancement (LV-LGE) in patients who received implantable cardioverter defibrillator (ICD) for secondary prevention. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
LV myocardial fibrosis detected as LGE on cardiac magnetic resonance (CMR) is a predictor of arrhythmic risk in primary prevention both in ischaemic and non-ischaemic cardiomyopathy. However, we still do not know the prognostic role of LV-LGE in patients who suffered cardiac arrest (CA).
Purpose
To evaluate the prognostic role of CMR, and in particular of LV-LGE suggesting myocardial scar, in predicting appropriate ICD interventions in secondary prevention patients.
Methods
Ninety-seven consecutive patients 1) aged ≥14 years 2) hospitalized for CA because of ventricular arrhythmias from 2009/01/01 3) who underwent/undergoing a CMR within one month from the event 4) who received/receiving an ICD for secondary prevention and 5) with at least 1 year-follow-up, were enrolled for this multicentric study.
Results
97 patients (68 males, 70%), mean age 46±16 years, were enrolled. Seventy-six percent of patients received bystander cardiopulmonary resuscitation (CPR) and ventricular fibrillation (VF) was the first rhythm in 86% of cases. ST elevation was present in 18% of cases at the admission; however, angiography was found negative in 80% of patients. Myocardial oedema and LGE were identified in 26% and 64% of patients respectively. A diagnosis was made in 83.5% of cases, while in the remaining 16.5% CA was considered idiopathic. During a four-year-follow-up, 25% of patients had appropriate ICD therapy (10% of which ATP only). A significant correlation between LGE and appropriate ICD intervention was not found (p=0.89).
Conclusions
One fourth of patients who received ICD for secondary prevention had appropriate ICD therapy during a four-year-follow-up. In this setting, LV-LGE does not provide a prognostic value.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Mattesi
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - E Baldi
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | - F Guerra
- Marche Polytechnic University of Ancona, Ancona, Italy
| | - M Toniolo
- University Hospital Santa Maria della Misericordia, Udine, Italy
| | - A Cipriani
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - F Cauti
- San Giovanni Calibita Hospital, Roma, Italy
| | - L Marcantoni
- Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | | | - S Savastano
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | - A Zorzi
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
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28
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Tsantes E, Curti E, Ferraro D, Lugaresi A, Baldi E, Montepietra S, Immovilli P, Simone AM, Mancinelli L, Strumia S, Vitetta F, Foschi M, Ferri C, Ferrarini C, Sola P, Granella F. Dimethyl fumarate-induced lymphocyte count drop is related to clinical effectiveness in relapsing-remitting multiple sclerosis. Eur J Neurol 2020; 28:269-277. [PMID: 32931130 DOI: 10.1111/ene.14538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Dimethyl fumarate (DMF) causes a mean lymphocyte count drop of approximately 30% in relapsing-remitting multiple sclerosis (RRMS) patients. The relationship between this reduction and DMF effectiveness is controversial. The objective was to investigate if the decrease in absolute lymphocyte count (ALC) from baseline during DMF treatment is associated with clinical and magnetic resonance imaging (MRI) disease activity. A secondary aim was to evaluate ALC variations over time in a real-life cohort of DMF-treated patients. METHODS Demographic, laboratory, clinical and MRI data were collected in this observational multicentre study, conducted on RRMS patients treated with DMF for at least 6 months. Multivariate Cox models were performed to evaluate the impact of 6-month ALC drop on time to no evidence of disease activity (NEDA-3) status loss. NEDA-3 is defined as absence of clinical relapses, MRI disease activity and confirmed disability progression. RESULTS In all, 476 patients (312 females, age at DMF start 38.4 ± 9.97 years) were analysed up to 5-year follow-up. A greater lymphocyte decrease was associated with a lower risk of NEDA-3 status loss (hazard ratio 0.87, P = 0.01). A worse outcome in patients with lower ALC drop (<11.5%), compared with higher tertiles (11.5%-40.5% and >40.5%), was observed (P = 0.008). The nadir of ALC drop (-33.6%) and 35% of grade III lymphopaenia cases occurred after 12 months of treatment. CONCLUSION A higher lymphocyte count drop at 6 months is related to better outcomes in DMF-treated patients. A careful ALC monitoring should be pursued up to 24 months of treatment.
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Affiliation(s)
- E Tsantes
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - E Curti
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - D Ferraro
- Department of Neurosciences, Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy.,Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - A Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - E Baldi
- Neurology Unit, Department of Neuroscience/Rehabilitation, Azienda Ospedaliera-Universitaria S. Anna, Ferrara, Italy
| | - S Montepietra
- Neurology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - P Immovilli
- Neurology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - A M Simone
- Neurology Unit, Carpi Hospital, AUSL Modena, Carpi (MO), Italy
| | - L Mancinelli
- UOC Neurologia Ospedale Bufalini, AUSL Romagna ambito di Cesena, Cesena, Italy
| | - S Strumia
- Neurology Unit, Ospedale G.B., Morgagni - L. Pierantoni, Forlì, Italy
| | - F Vitetta
- Department of Neurosciences, Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
| | - M Foschi
- Neurology Unit, S.Maria delle Croci Hospital, AUSL Romagna, Ambito di Ravenna, Italy
| | - C Ferri
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - C Ferrarini
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - P Sola
- Department of Neurosciences, Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
| | - F Granella
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.,Multiple Sclerosis Centre, Department of General Medicine, Parma University Hospital, Parma, Italy
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Corona G, Baldi E, Isidori AM, Paoli D, Pallotti F, De Santis L, Francavilla F, La Vignera S, Selice R, Caponecchia L, Pivonello R, Ferlin A, Foresta C, Jannini EA, Lenzi A, Maggi M, Lombardo F. SARS-CoV-2 infection, male fertility and sperm cryopreservation: a position statement of the Italian Society of Andrology and Sexual Medicine (SIAMS) (Società Italiana di Andrologia e Medicina della Sessualità). J Endocrinol Invest 2020; 43:1153-1157. [PMID: 32462316 PMCID: PMC7252417 DOI: 10.1007/s40618-020-01290-w] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/02/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The recent pandemic of severe acute respiratory syndrome (SARS) due to coronavirus (CoV) 2 (SARS-CoV-2) has raised several concerns in reproductive medicine. The aim of this review is to summarize available evidence providing an official position statement of the Italian Society of Andrology and Sexual Medicine (SIAMS) METHODS: A comprehensive Pubmed, Web of Science, Embase, Medline and Cochrane library search was performed. Due to the limited evidence and the lack of studies, it was not possible to formulate recommendations according to the Oxford 2011 Levels of Evidence criteria. RESULTS Several molecular characteristics of the SARS-CoV-2 can justify the presence of virus within the testis and possible alterations of spermatogenesis and endocrine function. Orchitis has been reported as a possible complication of SARS-CoV infection, but similar findings have not been reported for SARS-CoV-2. Alternatively, the orchitis could be the result of a vasculitis as COVID-19 has been associated with abnormalities in coagulation and the segmental vascularization of the testis could account for an orchitis-like syndrome. Finally, available data do not support the presence of SARS-CoV-2 in plasma seminal fluid of infected subjects. CONCLUSION Data derived from other SARS-CoV infections suggest that in patients recovered from COVID-19, especially for those in reproductive age, andrological consultation and evaluation of gonadal function including semen analysis should be suggested. Studies in larger cohorts of currently infected subjects are warranted to confirm (or exclude) the presence of risks for male gametes that are destined either for cryopreservation in liquid nitrogen or for assisted reproduction techniques.
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Affiliation(s)
- G. Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Largo Nigrisoli 2, 40133 Bologna, Italy
| | - E. Baldi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - A. M. Isidori
- Department of Experimental Medicine, ʺSapienzaʺ University of Rome, Rome, Italy
| | - D. Paoli
- Department of Experimental Medicine, ʺSapienzaʺ University of Rome, Rome, Italy
| | - F. Pallotti
- Department of Experimental Medicine, ʺSapienzaʺ University of Rome, Rome, Italy
| | - L. De Santis
- IVF Unit, Gynaecological-Obstetric Department, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - F. Francavilla
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environment Sciences, University of L’Aquila, L’Aquila, Italy
| | - S. La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - R. Selice
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - L. Caponecchia
- Andrology and Pathophysiology of Reproduction Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - R. Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli; Staff of Unesco Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - A. Ferlin
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Brescia, Italy
| | - C. Foresta
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - E. A. Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy
| | - A. Lenzi
- Department of Experimental Medicine, ʺSapienzaʺ University of Rome, Rome, Italy
| | - M. Maggi
- Endocrinology Unit, Department of Experimental Clinical and Biomedical Sciences ``Mario Serio’’, University of Florence, Florence, Italy
| | - F. Lombardo
- Department of Experimental Medicine, ʺSapienzaʺ University of Rome, Rome, Italy
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30
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Errigo D, Golzio PG, D"ascenzo F, Ragaglia E, Salizzoni S, Peyracchia M, Bruno F, Baldi E, Castagno D, Budano C, D"amico M, Giustetto C, De Ferrari GM. P513Electrocardiographic and clinical predictors for permanent pacemaker requirement after transcatheter aortic valve implantation: a 10-year single center experience. Europace 2020. [DOI: 10.1093/europace/euaa162.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
None of the author have conflict of interest to disclose.
Background
As transcatheter aortic-valve implantation (TAVI) procedures have increased, the need of a permanent pacemaker (PPM) is a complication to be taken into account.
Objective
The aim of this study is to identify clinical, electrocardiographic (ECG) and procedural predictors for PPM requirement after TAVI.
Methods
The present is a single centre, retrospective study. All consecutive patients with severe symptomatic aortic stenosis who underwent TAVI had continuous ECG monitoring. Pre and post TAVI 12-leads ECG were analysed. We arbitrarily divided the patients into early and late PPM implantation (beyond the 3rd day after TAVI). The primary endpoint of the study was to identify electrocardiographic predictors of PPM implantation after TAVI, and the secondary endpoint was to identify other clinical or procedure-related predictive factors.
Results
Of 431 patients who underwent TAVI, 77 (18%) required a PPM, and 30 (7%) had late PPM implantations. Pre-operative RBBB implies more than five-fold increase of the risk of PPM implantation after TAVI (OR 5,43, CI 2.11 - 13.99, P = 0.000), whereas the history of syncope is associated with a two-fold increase of the risk (OR 2.00, CI 1.01 - 3.96, P = 0.044), and maintains its predictive value also in the late PPM subgroup (OR 2.76, CI 1.11 – 6.82, P = 0.028).
Conclusions
It is hard to predict the need of a PPM in the individual patients, but careful evaluation of pre-operative 12-lead ECG looking for pre-existing RBBB and an history of syncope, can individuate the group of patients with an increased risk of PPM requirement.
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Affiliation(s)
- D Errigo
- CITTA" DELLA SALUTE E DELLA SCIENZA UNIVERSITY HOSPITAL, Turin, Italy
| | - P G Golzio
- CITTA" DELLA SALUTE E DELLA SCIENZA UNIVERSITY HOSPITAL, Turin, Italy
| | - F D"ascenzo
- CITTA" DELLA SALUTE E DELLA SCIENZA UNIVERSITY HOSPITAL, Turin, Italy
| | - E Ragaglia
- CITTA" DELLA SALUTE E DELLA SCIENZA UNIVERSITY HOSPITAL, Turin, Italy
| | - S Salizzoni
- CITTA" DELLA SALUTE E DELLA SCIENZA UNIVERSITY HOSPITAL, Turin, Italy
| | - M Peyracchia
- CITTA" DELLA SALUTE E DELLA SCIENZA UNIVERSITY HOSPITAL, Turin, Italy
| | - F Bruno
- CITTA" DELLA SALUTE E DELLA SCIENZA UNIVERSITY HOSPITAL, Turin, Italy
| | - E Baldi
- University of Pavia, Department of Medicine Science and Infective Disease, Cardiac Intensive Care Unit, Arrhythmia and El, Pavia, Italy
| | - D Castagno
- CITTA" DELLA SALUTE E DELLA SCIENZA UNIVERSITY HOSPITAL, Turin, Italy
| | - C Budano
- CITTA" DELLA SALUTE E DELLA SCIENZA UNIVERSITY HOSPITAL, Turin, Italy
| | - M D"amico
- CITTA" DELLA SALUTE E DELLA SCIENZA UNIVERSITY HOSPITAL, Turin, Italy
| | - C Giustetto
- CITTA" DELLA SALUTE E DELLA SCIENZA UNIVERSITY HOSPITAL, Turin, Italy
| | - G M De Ferrari
- CITTA" DELLA SALUTE E DELLA SCIENZA UNIVERSITY HOSPITAL, Turin, Italy
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31
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Demarchi A, Cornara S, Pontillo L, Astuti M, Baldi E, Sanzo A, Savastano S, Vicentini A, Petracci B, Buia V, Frigerio L, Rordorf R. P523Incidence of anti tachycardia therapies and mortality at one and two years in patients with and without persistent ICD indication at the time of generator replacement. Europace 2020. [DOI: 10.1093/europace/euaa162.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND ICD implantation with or without resynchronization is an established therapy for the prevention of sudden cardiac death in patients with LV dysfunction. However, when elective replacement interval (ERI) approaches most patients undergo generator replacement (GR) even in the absence of persistent indication to ICD therapy- Moreover, at the time of GR patients are usually older and with more comorbidities as compared to the time of first implantation.
AIM The aim of our work was to evaluate the rate and predictors of mortality and to analyze.the incidence of appropriate ICD therapies after GR.
METHODS Our registry includes 323 patients with structural heart disease (SHD) implanted with ICD in primary prevention who underwent GR. Our population was stratified based on the presence or absence of persistent indication to ICD at the time of GR, which was defined as: LVEF ≤ 35% and/o history of appropriate ICD therapies during the first generator"s life. In each group the incidence of appropriate ICD therapies after GR, 1 and 2 years mortality after GR and multivariate predictors of 1 year mortality. Were analyzed. Comparisons between categorical variables were made using χ2 or Fisher Exact test when required and continuous variables were compared using Mann Whitney test. Kaplan-Meier curves with Log Rank test were used to investigate 1 and 2 years mortality.
RESULTS In our population, 81% were male, 41% had ischemic heart disease, 60% had CRT-D. Median LVEF at the time of first implantation was 30% (25-35), whereas at the time of GR was 35% (25-45); median age at GR was 64 (56-73) years. Notably 33.6% of our population no longer met ICD indication at the time of GR; this subgroup showed a significantly lower mortality at one and two years as compared to patients with persistent ICD indication: 1% vs 9% and 2.1% vs 13.5% respectively (figure 1 and 2). At multivariable analysis permanent AF (HR: 3.6; 95% CI 1.9-8.6) chronic renal disease (HR 4; 2.3-8.9), and persistent ICD indication were independent predictors of 1-year mortality. When survival analysis was limited to patients implanted with single-chamber and dual-chamber devices only AF an renal insufficiency remained significantly predictors of mortality. Nevertheless, in this subgroup, the absence of persistent indication was associated with a significantly lower rate of appropriate ICD therapies after GR (0% vs 14.8%, p = 0.02).
CONCLUSION The absence of persistent indication at the time of generator replacement was associated with a significantly better prognosis and a lower incidence of appropriate therapies after GR. Atrial fibrillation, renal insufficiency and persistent ICD indication significantly predicted 1 year mortality in our population. Our data suggest the importance of an arrhythmic vs. non-arrhythmic risk evaluation in the individual patient at the time of ICD generator replacement
Abstract Figure.
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Affiliation(s)
| | | | | | - M Astuti
- University of Pavia, Pavia, Italy
| | - E Baldi
- University of Pavia, Pavia, Italy
| | - A Sanzo
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Savastano
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Vicentini
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - B Petracci
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - V Buia
- University of Pavia, Pavia, Italy
| | | | - R Rordorf
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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32
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Cornara S, Rordorf R, Demarchi A, Somaschini A, Baldi E, Mandurino Mirizzi A, Camporotondo R, Crimi G, Ferlini M, Gnecchi M, Oltrona Visconti L, De Servi S, De Ferrari GM. P376Prognostic impact of atrial fibrillation in STEMI patients treated by primary percutaneous coronary intervention: a focus on cardiogenic shock. Europace 2020. [DOI: 10.1093/europace/euaa162.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is a common finding in patients with ST elevation myocardial infarction (STEMI). However, its prognostic influence in MI remains controversial. Almost all previous studies were performed before the era of primary percutaneous coronary intervention (pPCI), and there is a lack of data in patients with STEMI complicated by cardiogenic shock (CS). The aim of our study was to evaluate the prognostic impact of AF in a large real-world population of STEMI undergoing pPCI stratified by the presence of CS.
Methods
Our registry included 3017 consecutive patients with STEMI undergoing pPCI in our department in 2005-2017. The presence of a persistent (>30 min) systolic blood pressure < 90 mmHg associated with signs of pulmonary congestion/impaired end organ perfusion needing catecholamine infusion or mechanical support devices qualified for CS. Firstly we performed mortality analysis in all patients with AF during hospitalization; secondly, we compared patients with the first episode of AF and patients with AF during hospitalization but known AF in anamnesis. The analysis was stratified for the presence of CS. Univariate (cross-tables and Kaplan-Meier curves with log-rank test) and multivariate mortality analysis (Cox regressions) were performed. In STEMI patients without CS we also performed a propensity-matched analysis including all variables known before STEMI that could influence the occurrence of a first episode of AF.
Results
AF was present in 337 (11.3%) patients during hospitalization; in 193 (57.3%) of them was the first episode. CS occurred in 250 patients (8.4%), 27.2% of whom were affected by an AF episode (86.5% as the first episode). Among patients without CS, AF occurred in 269 patients (9.7%) and for the 77.5% was the first episode. In CS patients, AF was not associated with increased mortality, neither at 30 days (43.5% vs 43.7%, p = 0.867) nor at 1 year (47.5% vs 53.1%, p = 0.633). In the population without CS, AF was an independent predictor of mortality both at 30 days (HR 2.25 (1.05; 4.82), p = 0.037) and at 1 year (HR 1.87 (1.094; 3.18), p = 0.022); only new-onset AF was an independent predictor of mortality. We successfully matched 175 pairs of patients with similar propension to experience the first episode of AF. Among them the first episode of AF was confirmed to be an indipendent predictor of mortality (figure).
Conclusion
In the present large real-world cohort of unselected patients with STEMI, the presence of an episode of AF during hospitalization was an independent predictor of mortality in patients not complicated by cardiogenic shock. Conversely, AF did not show a significant prognostic impact in patients with STEMI complicated by CS. Furthermore, the presence of a first episode of AF was confirmed to be an independent predictor of mortality, while an AF episode in patients with known AF was not found to have prognostic impact.
Abstract Figure
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Affiliation(s)
- S Cornara
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | - R Rordorf
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | - A Demarchi
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | - A Somaschini
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | - E Baldi
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | | | - R Camporotondo
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | - G Crimi
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | - M Ferlini
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | - M Gnecchi
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | | | - S De Servi
- IRCCS MultiMedica Sesto San Giovanni, Cardiology, Sesto San Giovanni, Italy
| | - G M De Ferrari
- A.O.U. Citta della Salute e della Scienza di Torino, Cardiology, Turin, Italy
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Marchiani S, Tamburrino L, Farnetani G, Muratori M, Vignozzi L, Baldi E. Acute effects on human sperm exposed in vitro to cadmium chloride and diisobutyl phthalate. Reproduction 2020; 158:281-290. [PMID: 31437814 DOI: 10.1530/rep-19-0207] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/23/2019] [Indexed: 11/08/2022]
Abstract
Epidemiological studies reported a negative relationship between concentrations of heavy metals and phthalates in seminal fluid and semen quality, likely compromising male fertility potential. The aim of this study was to investigate the in vitro effects of cadmium chloride (CdCl2), a common heavy metal, and diisobutyl phthalate (DIBP), a common phthalate ester, on human sperm functions necessary for fertilization. After in vitro incubation of spermatozoa with 10 µM CdCl2 or 100 and 200 µM DIBP for 24 h, a significant decrease of sperm progressive and hyperactivated motility was observed. The exposure to each of the two toxic agents also induced spontaneous sperm acrosome reaction and blunted the physiological response to progesterone. Both agents induced an increase of caspase activity suggesting triggering of an apoptotic pathway. Our results suggest that acute exposure of spermatozoa to these pollutants may impair sperm ability to reach and fertilize the oocyte.
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Affiliation(s)
- S Marchiani
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - L Tamburrino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - G Farnetani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - M Muratori
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', Center of Excellence DeNothe, University of Florence, Florence, Italy
| | - L Vignozzi
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', Center of Excellence DeNothe, University of Florence, Florence, Italy
| | - E Baldi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Baldi E, Savastano S, Buratti S, Rordorf R, Vicentini A, Sanzo A, Petracci B, Demarchi A, Cornara S, Astuti M, Frigerio L, Marioni A, Oltrona Visconti L, De Ferrari GM. P5640How to decide to implant an ICD in out-of-hospital cardiac arrest survivors with bad neurological outcome. CPC is an option? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
According to the European Society of Cardiology guidelines secondary prevention ICD implantation is a class I indication only for those patients with an estimated survival >1 year with a good functional status. However, it is not specified how to assess the functional status and its evaluation could be quite difficult in the case of Out-of-Hospital Cardiac Arrest (OHCA) survivors. Cerebral Performance Category (CPC) scale is the most widespread scale to define the neurological and functional outcome, but it is not known if it can be used to guide ICD implantation.
Purpose
To evaluate whether the presence of a bad neurological outcome (CPC >2) in OHCA survivors at discharged could be used as a prognostic index in order to evaluate the implantation of an ICD.
Methods
We considered all the patients enrolled in the Cardiac Arrest Registry of our Province (55ehz746.0583 inhabitants in northern Italy) from the 1 October 2014 to the 31 January 2018 presenting a CPC >2 at discharge. We evaluated the survival and the neurological status variation at 1-year.
Results
In the study period CPR was attempted in 1565 confirmed OHCA (60.2% males, 73.4±15.8 years). Of these, 119 (7.6%) were discharged and 26 of them (21.8%) showed a CPC more than 2 (13 CPC = 3, 11 CPC = 4 and 2 CPC A). 1-year survival of CPC>2 patients was significantly lower than those with a CPC≤2 (46.1% vs 92.5% p<0.001). Only 12/26 patients discharged with a CPC >2 survived at 1 year; a good cerebral performance (CPC 1) was recovered in 2 of them, whilst a moderate cerebral disability (CPC 2) was present in 1 of them. A severe cerebral disability (CPC 3 or 4) persisted in the other 9 patients. The neurological prognosis of patients based on CPC at hospital discharge is presented in Figure 1.
Figure 1
Conclusions
Our results highlight that 1-year survival is quite low in patients with a CPC >2 at discharge and an improvement in cerebral performance occur in a minority of them. The prognosis of the patients was very variable and unpredictable for all the CPC scale values at hospital discharge. This evidence suggest that an ICD implantation should carefully evaluated in this kind of patients and a clinical and neurological re-evaluation can be reasonable some time after the event to decide if implant an ICD.
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Affiliation(s)
- E Baldi
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - S Savastano
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
| | - S Buratti
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - R Rordorf
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - A Vicentini
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - A Sanzo
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - B Petracci
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - A Demarchi
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - S Cornara
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - M Astuti
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - L Frigerio
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - A Marioni
- Salvatore Maugeri Foundation IRCCS, Unità Risvegli, Pavia, Italy
| | - L Oltrona Visconti
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
| | - G M De Ferrari
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
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35
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Baldi E, Buratti S, Rordorf R, Vicentini A, Sanzo A, Petracci B, Demarchi A, Cornara S, Astuti M, Frigerio L, Oltrona Visconti L, De Ferrari GM, Savastano S. P2825ICD implantation in secondary prevention after an out-of-hospital cardiac arrest. Does age really matter? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The implantation of an implantable cardioverter defibrillator (ICD) in secondary prevention is a class I indication for patients with an estimated survival more than 1 year with a good functional status. However, in the elderly population, it is often difficult to estimate the expected survival, especially after an acute event such as an out-of-hospital cardiac arrest (OHCA).
Purpose
To evaluate 1-year survival after OHCA of patients older than 80 compared to those younger than 80.
Methods
We considered all the patients who suffered an OHCA in our Province (55ehz748.1135 inhabitants in northern Italy) from October 1st 2014 to November 30th 2017 stratified in two groups accordingly to their age at the moment of OHCA: elderly group (≥80 years old) and non-elderly group (<80 years old).
Results
In the period analysis resuscitation was attempted in 1464 OHCA patients: 632 of the elderly group (mean age of 86.4±4.4 years) and 832 of the non-elderly group (mean age of 63.4±13.8 years). The two groups were different at baseline. In the non-elderly group there were more males (74.5% vs 42.4%, p<0.001), more cases of medical etiology (95.9% vs 91.2%, p<0.001), a higher rate of bystander CPR (39.4% vs 23.4%, p<0.001) and more shockable rhythms at presentation (25.5% vs 7.9%, p<0.001), whilst a home location of the event was more frequent in the elderly group (81.3% vs 77%, p=0.048). No differences were found regarding both the percentage of not witnessed cardiac arrest (27.5% in elderly and 26% in non-elderly, p=0.57) and the time of EMS arrival (11:36 mins in elderly and 11:23 mins in young, p=0.64). Non-elderly patients showed a significantly higher rate of survival both to hospital admission (25.2% vs 6.8%, p<0.001), to hospital discharge (12.1% vs 1.7%, p<0.001) and at 1 year after the event (10.2% vs 1.6%, p<0.001, Figure 1 - left) as compared to older ones. However, when considering only those patients discharged alive we found a non-significant difference in one-year survival (84.2% vs 90.9%, p=0.64, Figure 1 – right).
Conclusions
Elderly patients have a worst prognosis in the acute phase after an OHCA. However, after hospital discharge, older and younger patients showed a similar 1-year survival. This result highlights how age should not be considered alone to decide whether an ICD in secondary prevention could be indicated or not in older OHCA survivors.
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Affiliation(s)
- E Baldi
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - S Buratti
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - R Rordorf
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - A Vicentini
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - A Sanzo
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - B Petracci
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - A Demarchi
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - S Cornara
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - M Astuti
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - L Frigerio
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - L Oltrona Visconti
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
| | - G M De Ferrari
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - S Savastano
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
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Baldi E, Demarchi A, Mauri S, Di Giacomo C, Ferrario Ormezzano M, Ferlini M, Savastano S, Petracci B, Sanzo A, Aiello M, Gazzoli F, Pelenghi S, Oltrona Visconti L, De Ferrari GM, Rordorf R. 6118Mid- and long-term percentage of ventricular pacing in patients implanted with a pacemaker after a transcatheter aortic valve replacement procedure: potential clinical implications. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac conduction disturbances frequently occur following transcatheter aortic valve replacement (TAVR). As this procedure is getting more and more common, more research efforts should focus on post procedural rhythm disturbances and their evolution over time
Purpose
To evaluate the percentage of pacing in patients who underwent a TAVR procedure and developed a conduction disturbance requiring a transvenous pacemaker (PM) implantation
Methods
We considered all the patients who underwent a TAVR procedure between march 2009 and november 2018 in our centre. Patients implanted with a PM or an ICD before the TAVR procedure or 30 days after the TAVR were not considered eligible for our analysis, because likely not related to TAVR. The percentage of effective right ventricular pacing was assessed both at mid- and long-term follow-up
Results
265 patients underwent TAVR in the study period (45% males, 81±6 years). 20 patients already had a PM and were excluded. 39 of the 245 patients (16%) were implanted with a PM after TAVR, 26 of them were implanted within 30 days (median time TAVR-PM implant: 8±7 days). The rate of PM implant within 30 days after TAVR was 8% (20/246) for patients implanted with an Edward Sapien valve, 25% (4/16) for patients with an Evolute Pro valve and 66% (2/3) in patients with a Lotus Edge valve. The indication for PM implant was a permanent 3rd degree A-V block in 12 patients, a paroxysmal A-V block in 4, a bifascicular A-V block with an infra-hisian disease in 5, a II degree Mobitz II A-V block in 2, an atrial fibrillation with slow A-V conduction in 2 and a 2:1 A-V block with infra-hisian disease in 1. The first follow-up after the PM implantation was available in 24 patients (mean 78±87 days after PM implant) and the second in 15 patients (372±267 days after PM implant). The patients were divided into two groups based on the presence/absence of permanent 3rd degree AV block at the time of implantation. At the first follow-up the percentage of pacing was significantly higher in patients implanted with vs. without a permanent 3rd degree AV block (98.5% vs 11%, p<0.001). Notably, in none of the patients without a permanent 3rd AV block at baseline conduction disturbances progressed toward a permanent AV block during long-term follow-up. Accordingly, at the second follow-up patients without permanent 3rd AV block at baseline showed a significantly lower percentage of pacing (1% vs 100%; p<0.01)
Conclusion
Patients implanted with a PM after TAVR in the absence of a permanent 3rd AV block have a very low likelihood of progression to a permanent AV conduction disturbance and show a negligible percentage of pacing during follow-up. Our results may impact the choice of the correct timing of PM implantation after TAVR and the potential indication for a leadless PM.
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Affiliation(s)
- E Baldi
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - A Demarchi
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - S Mauri
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - C Di Giacomo
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | | | - M Ferlini
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
| | - S Savastano
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
| | - B Petracci
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - A Sanzo
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - M Aiello
- Foundation IRCCS Policlinic San Matteo, Department of Cardiothoracic Surgery, Pavia, Italy
| | - F Gazzoli
- Foundation IRCCS Policlinic San Matteo, Department of Cardiothoracic Surgery, Pavia, Italy
| | - S Pelenghi
- Foundation IRCCS Policlinic San Matteo, Department of Cardiothoracic Surgery, Pavia, Italy
| | - L Oltrona Visconti
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
| | - G M De Ferrari
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - R Rordorf
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
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Baldi E, Buratti S, Contri E, Canevari S, Molinari S, Pagani M, Lusona B, Mojoli F, Bertona R, Osti R, Palo A, Oltrona Visconti L, De Ferrari GM, Savastano S. P2828Survival after an out-of-hospital cardiac arrest decrease over time in all Utstein categories. The importance of a long follow-up. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Survival beyond 1-month after an out-of-hospital cardiac arrest (OHCA) is still considered a challenge for OHCA registries and it is often unexplored. However, a longer follow-up could help to better comprehend the long-term issues of OHCA survivors.
Purpose
Our aim was to evaluate the long-term outcome after OHCA via an Utstein-based cardiac arrest registry with a long follow-up (up to 5 years).
Methods
We enrolled all the people with an OHCA of any aetiology in our Province (about 55ehz748.1138 inhabitants in northern Italy) in whom CPR was attempted. The primary endpoint was the survival at 1 month, and the secondary endpoints were the survival at 6 months and then every year until 5 years after OHCA.
Results
In the first 45 months (October 2014–June 2018) 1774 resuscitation attempts for confirmed OHCAs were enrolled. Baseline characteristics: male 59.7%; mean age of 73.4±16 years; mean EMS response time was 11:31±5:09 mins; home location 78.8%; bystander-witnessed events were 56.1%; EMS witnessed event 15.6%; bystander CPR 39.5%; AED use before EMS arrival 2.5%; medical etiology 93%; first shockable rhythm 18.2% (90.7% VF, 2.5% VT without pulse, 6.8% AED shockable). When considering survival from the event (Figure 1 – left panel), survival was significantly higher for shockable Utstein categories (p<0.001). Considering only those patients discharged alive (Figure 1 – right panel) long term survival was significantly higher (p<0.01) once again for shockable rhythms. Interestingly, in this category survival continued to decrease over time ranging about from 90% in the first year to about 80% at four years.
Figure 1
Conclusions
Our results demonstrated that survival after OHCA can change over the time in all the Utstein categories, so we believe that a longer follow-up should be encouraged by next Utstein style revision.
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Affiliation(s)
- E Baldi
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - S Buratti
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - E Contri
- Foundation IRCCS Policlinic San Matteo, AAT 118, Pavia, Italy
| | - S Canevari
- Azienda Regionale Emergenza Urgenza (AREU), SOREU Pianura, Milano, Italy
| | - S Molinari
- Foundation IRCCS Policlinic San Matteo, AAT 118, Pavia, Italy
| | - M Pagani
- Foundation IRCCS Policlinic San Matteo, Intensive Care Unit, Pavia, Italy
| | - B Lusona
- Foundation IRCCS Policlinic San Matteo, Intensive Care Unit, Pavia, Italy
| | - F Mojoli
- Foundation IRCCS Policlinic San Matteo, Intensive Care Unit, Pavia, Italy
| | - R Bertona
- Azienda Ospedaliera della Provincia di Pavia, Division of Cardiology, Vigevano, Italy
| | - R Osti
- Azienda Ospedaliera della Provincia di Pavia, Division of Cardiology, Voghera, Italy
| | - A Palo
- Foundation IRCCS Policlinic San Matteo, AAT 118, Pavia, Italy
| | - L Oltrona Visconti
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
| | - G M De Ferrari
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - S Savastano
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
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Baldi E, Caputo ML, Savastano S, Burkart R, Benvenuti C, Palo A, Oltrona Visconti L, Auricchio A, De Ferrari GM. P2824A new Utstein-based model score to predict survival to hospital admission: the TICINUM score. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The prediction of the possibility of return of spontaneous circulation (ROSC) in the individual patient is one of the major challenges confronting resuscitation science. The RACA score has been proposed to predict the achievement of a ROSC longer than 20 seconds in field (out-of-hospital, OH). However, no score exists to predict a ROSC sustained until arrival at the emergency department, using the standardized Utstein-based categorization of variables.
Purpose
To create a new Utstein-based score to predict the survival to hospital admission of an OH cardiac arrest (CA) victim.
Methods
We performed a retrospective analysis of all prospectively collected OHCAs occurred between 2015 and 2017 in two regions, one in northern Italy and the other in southern Switzerland. All consecutive patients who suffered an OHCA of any aetiology between 01/01/2015 and 31/12/2017 in whom CPR was attempted were included. We used random effect logistic regression to model survival to hospital admission after an OHCA. We included the same variables used in the RACA score, re-categorized following Utstein recommendations. For model validation, we computed the model area under the ROC curve (AUC ROC) for discrimination. We derived the TICINUM score using the coefficients estimated in the regression model (multiplied by 10 and rounded to the nearest integer). We plotted the score against the probability of hospital ROSC.
Results
1961 patients were included in our analysis (62% males, mean age 73±16 years old). Age, aetiology, witnessed OHCA, site of OHCA, time of EMS arrival and shockable rhythm were independently associated with survival to hospital admission. The model showed a good discrimination (AUC 0.83, 95% CI 0.81–0.85) for predicting survival to hospital admission. The model variables and their odd ratios are presented in Figure 1 (left). The score value is obtained summing a coefficient calculated for each variable. The nomogram of the probability of survival to hospital admission associated to the different score values is presented in the Figure 1 (right).
Figure 1
Conclusion
The TICINUM score is a new score, which allows to predict with good discrimination the probability of survival to hospital admission of an OHCA victim. The simple calculation and the fact that it is Utstein based makes it easily applicable by EMS personnel during an OHCA scenario.
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Affiliation(s)
- E Baldi
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - M L Caputo
- University of Pavia - Cardiocentro Ticino, Pavia - Lugano, Italy
| | - S Savastano
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
| | - R Burkart
- Fondazione TicinoCuore, Lugano, Switzerland
| | | | - A Palo
- Foundation IRCCS Policlinic San Matteo, AAT 118, Pavia, Italy
| | - L Oltrona Visconti
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
| | | | - G M De Ferrari
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
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Lotti F, Corona G, Cocci A, Cipriani S, Baldi E, Degl’Innocenti S, Franco PN, Gacci M, Maggi M. The prevalence of midline prostatic cysts and the relationship between cyst size and semen parameters among infertile and fertile men. Hum Reprod 2018; 33:2023-2034. [DOI: 10.1093/humrep/dey298] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/14/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- F Lotti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - G Corona
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - A Cocci
- Department of Urology, Careggi Hospital, University of Florence, Largo Brambilla 3, Florence, Italy
| | - S Cipriani
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - E Baldi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - S Degl’Innocenti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - P N Franco
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - M Gacci
- Department of Urology, Careggi Hospital, University of Florence, Largo Brambilla 3, Florence, Italy
| | - M Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, Florence, Italy
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Baldi E, Cavani L, Margon A, Quartieri M, Sorrenti G, Marzadori C, Toselli M. Effect of compost application on the dynamics of carbon in a nectarine orchard ecosystem. Sci Total Environ 2018; 637-638:918-925. [PMID: 29763872 DOI: 10.1016/j.scitotenv.2018.05.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 06/08/2023]
Abstract
The aim of the present study was to compare the quantity and the type of carbon (C) stored during the 14-year lifetime of a commercial nectarine orchard ecosystem fertilized with mineral or organic fertilizers. The study was carried out in the Po valley, Italy, in a nectarine orchard of the variety Stark RedGold, grafted on GF677 hybrid peach × almond. Since orchard planting in August 2001, the following treatments were applied in a randomized complete block design with four replicates per block and compared: 1. unfertilized control; 2. mineral fertilization (including P and K at planting and N applied as NO3NH4 yearly at the rate of 70-130 kg ha-1); 3. compost application at a rate of 5 Mg DW ha-1 yr-1; 4. compost application at a rate of 10 Mg DW ha-1 yr-1. Compost was obtained from domestic organic wastes mixed with pruning material from urban ornamental trees and garden management after a 3-month stabilization period. Application of compost at the highest rate increased C in the soil; the amount of C sequestered was approximately 60% from amendment source and 40% from the net primary production of trees and grasses with a net increase of C compared to mineral fertilization. Compost application was found to be a win-win strategy to increase C storage in soil and, at the same time, to promote plant growth and yield to levels similar to those obtained with mineral fertilization. The rate of C application is crucial, indicated by the fact that compost supply at the rate of 10 Mg ha-1 yr-1 was the only fertilization strategy of the ones tested that resulted in higher C sequestration. This shows that compost amendment may stimulate an increase in the net primary production of plants.
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Affiliation(s)
- E Baldi
- Department of Agricultural and Food Sciences, University of Bologna, viale Fanin, 46 40127 Bologna, Italy.
| | - L Cavani
- Department of Agricultural and Food Sciences, University of Bologna, viale Fanin, 46 40127 Bologna, Italy
| | - A Margon
- Department of Agricultural and Food Sciences, University of Bologna, viale Fanin, 46 40127 Bologna, Italy
| | - M Quartieri
- Department of Agricultural and Food Sciences, University of Bologna, viale Fanin, 46 40127 Bologna, Italy
| | - G Sorrenti
- Department of Agricultural and Food Sciences, University of Bologna, viale Fanin, 46 40127 Bologna, Italy
| | - C Marzadori
- Department of Agricultural and Food Sciences, University of Bologna, viale Fanin, 46 40127 Bologna, Italy
| | - M Toselli
- Department of Agricultural and Food Sciences, University of Bologna, viale Fanin, 46 40127 Bologna, Italy
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Baldi E, Palo A, Danza AI, Canevari F, Mosca C, Molinari S, Pagani M, Lusona B, Mojoli F, Bertona R, Osti R, De Ferrari GM, Oltrona Visconti L, Savastano S. P264Long-term survival after an out-of-hospital cardiac arrest: beyond 1 month follow-up. Our three years experience. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Baldi
- IRCCS Polyclinic San Matteo Foundation, University of Pavia, School of Cardiovascular Disease, Pavia, Italy
| | - A Palo
- IRCCS Polyclinic San Matteo Foundation, AAT 118, Pavia, Italy
| | - A I Danza
- IRCCS Polyclinic San Matteo Foundation, University of Pavia, School of Cardiovascular Disease, Pavia, Italy
| | - F Canevari
- IRCCS Polyclinic San Matteo Foundation, AAT 118, Pavia, Italy
| | - C Mosca
- University of Pavia, Pavia, Italy
| | - S Molinari
- IRCCS Polyclinic San Matteo Foundation, AAT 118, Pavia, Italy
| | - M Pagani
- IRCCS Polyclinic San Matteo Foundation, Intensive Care Unit, Pavia, Italy
| | - B Lusona
- IRCCS Polyclinic San Matteo Foundation, Intensive Care Unit, Pavia, Italy
| | - F Mojoli
- IRCCS Polyclinic San Matteo Foundation, Intensive Care Unit, Pavia, Italy
| | - R Bertona
- Azienda Ospedaliera della Provincia di Pavia, Division of Cardiology, Vigevano, Italy
| | - R Osti
- Azienda Ospedaliera della Provincia di Pavia, Division of Cardiology, Voghera, Italy
| | - G M De Ferrari
- IRCCS Polyclinic San Matteo Foundation, Cardiac Intensive Care Unit, Pavia, Italy
| | - L Oltrona Visconti
- IRCCS Polyclinic San Matteo Foundation, Division of Cardiology, Pavia, Italy
| | - S Savastano
- IRCCS Polyclinic San Matteo Foundation, Division of Cardiology, Pavia, Italy
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Lotti F, Baldi E, Corona G, Lombardo F, Maseroli E, Degl’Innocenti S, Bartoli L, Maggi M. Epididymal more than testicular abnormalities are associated with the occurrence of antisperm antibodies as evaluated by the MAR test. Hum Reprod 2018; 33:1417-1429. [DOI: 10.1093/humrep/dey235] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/10/2018] [Accepted: 06/11/2018] [Indexed: 01/25/2023] Open
Affiliation(s)
- F Lotti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - E Baldi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - G Corona
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - F Lombardo
- Laboratory of Seminology-Sperm Bank ‘Loredana Gandini’, Department of Experimental Medicine, University of Rome ‘La Sapienza’, Viale Regina Elena 324, Rome, Italy
| | - E Maseroli
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - S Degl’Innocenti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - L Bartoli
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - M Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Viale Pieraccini 6, Florence, Italy
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Federighi G, Traina G, Bernardi R, Baldi E, Bucherelli C, Scuri R. Contextual fear conditioning modulates the gene expression over time. Arch Ital Biol 2018; 156:40-47. [PMID: 30039834 DOI: 10.12871/00039829201814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Contextual fear conditioning (CFC) is a quick cognitive test based on the association context-aversive stimulus in which a single training leads to a long-term memory. Previously, we showed that 2 days after conditioning the expression of the genes Napa, Pnf2, Casp3, Pdrg1, Ywhaz, Stmn1, Bpgm, were positively modulated in CFC rats respect to naïve rats, explor rats which had freely explored the experimental apparatus and SO rats to which the same number of aversive shocks used in CFC paradigm had been administered in the same CFC apparatus in less time to prevent the association between painful stimuli and apparatus, whereas the genes Actr3, Pea15 and Tiprl were more expressed in SO rats and Cplx1, Trim32 and Ran genes were more expressed in explor rats. At 2 days, Tomm20 gene expression resulted positively modulated in both CFC and explor rats. Herein, we have tested the expression of these genes for a period longer than 2 days, by monitoring the modulation of transcripts within 20 days after conditioning. The expression of the transcripts was assessed by qRT-PCR.We found that three days after CFC only the genes Tiprl and Trim32 were positively modulated in CFC rats whereas the gene Tomm20 was negatively modulated in CFC rats as well as in SO and explor rats. Ten days after CFC, the expression of Trim32 was still positively modulated whereas the genes Tiprl and Tomm20 returned to the constitutive level, and the gene Ran was significantly more expressed in CFC rats than in naïve, SO and explor rats. Interestingly, 20 days after CFC, the genes Stmn1 and Tiprl again became significantly more expressed in CFC rats compared with naïve, SO and explor rats.
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Affiliation(s)
| | | | | | | | | | - R Scuri
- Department of Translational Research and News Technologies in Medicine and Surgery, University of Pisa, 56127 Pisa, Italy -
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Marchiani S, Tamburrino L, Benini F, Fanfani L, Dolce R, Rastrelli G, Maggi M, Pellegrini S, Baldi E. Chromatin Protamination and Catsper Expression in Spermatozoa Predict Clinical Outcomes after Assisted Reproduction Programs. Sci Rep 2017; 7:15122. [PMID: 29123209 PMCID: PMC5680250 DOI: 10.1038/s41598-017-15351-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 06/15/2017] [Accepted: 10/19/2017] [Indexed: 01/19/2023] Open
Abstract
Identification of parameters predicting assisted reproductive technologies (ARTs) success is a major goal of research in reproduction. Quality of gametes is essential to achieve good quality embryos and increase the success of ARTs. We evaluated two sperm parameters, chromatin maturity and expression of the sperm specific calcium channel CATSPER, in relation to ART outcomes in 206 couples undergoing ARTs. Chromatin maturity was evaluated by Chromomycin A3 (CMA3) for protamination and Aniline Blue (AB) for histone persistence and CATSPER expression by a flow cytometric method. CMA3 positivity and CATSPER expression significantly predicted the attainment of good quality embryos with an OR of 6.6 and 14.3 respectively, whereas AB staining was correlated with fertilization rate. In the subgroup of couples with women ≤35 years, CATSPER also predicted achievement of clinical pregnancy (OR = 4.4). Including CMA3, CATSPER and other parameters affecting ART outcomes (female age, female factor and number of MII oocytes), a model that resulted able to predict good embryo quality with high accuracy was developed. CMA3 staining and CATSPER expression may be considered two applicable tools to predict ART success and useful for couple counseling. This is the first study demonstrating a role of CATSPER expression in embryo development after ARTs programs.
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Affiliation(s)
- S Marchiani
- Dept. of Experimental and Clinical Medicine, Center of Excellence DeNothe, University of Florence, Florence, Italy.
| | - L Tamburrino
- Dept. of Experimental and Clinical Medicine, Center of Excellence DeNothe, University of Florence, Florence, Italy
| | - F Benini
- Centro Procreazione Assistita "Demetra", Florence, Italy
| | - L Fanfani
- Centro Procreazione Assistita "Demetra", Florence, Italy
| | - R Dolce
- Dept. of Experimental and Clinical Medicine, Center of Excellence DeNothe, University of Florence, Florence, Italy
| | - G Rastrelli
- Dept. of Experimental and Clinical Biomedical Sciences "Mario Serio", Center of Excellence DeNothe, University of Florence, Florence, Italy
| | - M Maggi
- Dept. of Experimental and Clinical Biomedical Sciences "Mario Serio", Center of Excellence DeNothe, University of Florence, Florence, Italy
| | - S Pellegrini
- Centro Procreazione Assistita "Demetra", Florence, Italy
| | - E Baldi
- Dept. of Experimental and Clinical Medicine, Center of Excellence DeNothe, University of Florence, Florence, Italy.
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Baldi E, Ceriotti M, Tribello GA. Extracting the interfacial free energy and anisotropy from a smooth fluctuating dividing surface. J Phys Condens Matter 2017; 29:445001. [PMID: 28853711 DOI: 10.1088/1361-648x/aa893d] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Interfaces between different materials and phases play a crucial role in many physical and chemical phenomena. When performing simulations of matter at the atomic scale, however, it is often not trivial to characterize these interfaces, particularly when they are rough or diffuse. Here we discuss a generalization of a construction, due to Willard and Chandler, that allows one to obtain a smooth dividing surface that follows the irregular, ever changing shape of these fluctuating interfaces. We show how this construction can be used to study the surface that separates a solid material from its melt and how analyses of the Fourier modes for the capillary fluctuations of this instantaneous dividing surface can be performed. This particular analysis is useful as one can compute the specific free energy excess of the interface, and its dependence on orientation relative to the bulk phases, from the average amplitude of the Fourier modes. We therefore discuss the efficiency of this approach, both in terms of system size and statistical sampling.
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Affiliation(s)
- Edoardo Baldi
- Laboratory of Computational Science and Modelling, Institute of Materials, Ècole Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland
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Savastano S, Baldi E, Raimondi M, Guerci M, Canevari F, Danza A, Mosca C, Molinari S, Pagani M, Lusona B, Mojoli F, Bertona R, Osti R, Oltrona Visconti L. P2750The challenge of long-term survival after an out-of-hospital cardiac arrest: one month is not enough. Our two years experience. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S. Savastano
- Policlinic Foundation San Matteo IRCCS, Department of Cardiology, Pavia, Italy
| | - E. Baldi
- Policlinic Foundation San Matteo IRCCS, Department of Cardiology, Pavia, Italy
| | - M. Raimondi
- Policlinic Foundation San Matteo IRCCS, AAT 118, Pavia, Italy
| | - M. Guerci
- Policlinic Foundation San Matteo IRCCS, AAT 118, Pavia, Italy
| | - F. Canevari
- Policlinic Foundation San Matteo IRCCS, AAT 118, Pavia, Italy
| | - A.I. Danza
- Policlinic Foundation San Matteo IRCCS, Department of Cardiology, Pavia, Italy
| | - C. Mosca
- Policlinic Foundation San Matteo IRCCS, Department of Cardiology, Pavia, Italy
| | - S. Molinari
- Policlinic Foundation San Matteo IRCCS, AAT 118, Pavia, Italy
| | - M. Pagani
- Policlinic Foundation San Matteo IRCCS, Intensive care unit, Pavia, Italy
| | - B. Lusona
- Policlinic Foundation San Matteo IRCCS, Intensive care unit, Pavia, Italy
| | - F. Mojoli
- Policlinic Foundation San Matteo IRCCS, Intensive care unit, Pavia, Italy
| | - R. Bertona
- Ospedale Civile, Cardiology, Vigevano, Italy
| | - R. Osti
- Ospedale Civile, Cardiology, Voghera, Italy
| | - L. Oltrona Visconti
- Policlinic Foundation San Matteo IRCCS, Department of Cardiology, Pavia, Italy
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Spampinato RA, Kammerlander A, Ondrus T, Cho SW, Gillis K, Italia L, Zito C, Ancona F, Jahnke C, Paetsch I, Hilbert S, Schloma V, Dmitrieva Y, Strotdrees E, Hindricks G, Mohr FW, Wiesinger M, Duca F, Aschauer S, Zotter-Tufaro C, Schwaiger ML, Marzluf BA, Bartko PE, Bonderman D, Mascherbauer J, Mirica DC, Kotrc M, Kockova R, Van Camp G, Mo Y, Praveckova A, Penicka M, Park SJ, Kim SM, Hwang JW, Chang SA, Jeong DS, Lee SC, Park SW, Choe YH, Park PW, Bala G, Roosens B, Hernot S, Remory I, Droogmans S, Cosyns B, Geremia G, Stella S, Marini C, Rosa I, Ancona F, Latib A, Montorfano M, Colombo A, Margonato A, Agricola E, Bracco A, Baldi E, Di Bella G, Cusma Piccione M, Di Nunzio D, Donato R, Manganaro R, Terrizzi A, Pizzino F, Carerj ML, Rivetti L, Bitto R, Sergi M, Carerj S, Agricola E, Stella S, Rosa I, Marini C, Spartera M, Denti P, Margonato A, Hahn R, Alfieri O, Latib A, Colombo A. Rapid Fire Abstract: Multimodality imaging valvular heart disease742Quantification of aortic regurgitation by pulsed Doppler examination of the left subclavian artery velocity contour: a validation study with cardiac magnetic resonance imaging743Diastolic retrograde flow in the descending aorta by cardiovascular magnetic resonance imaging for the quantification of aortic regurgitation744Native T1 relaxation time can accurately identify limited left ventricular contractile reserve in patients with aortic stenosis745The validation and assessment of myocardial fibrosis by using cardiac magnetic resonance and speckle-tracking echocardiography in severe aortic stenosis746Clinical validation of a semi-automatic quantification score of aortic valve calcification with ultrasound747A comparison among conventional 3D-transesophageal echocardiography manual analysis, 3D automatic software analysis and computed tomography for the aortic annulus sizing in TAVI patients748New insights from a multimodality imaging evaluation of LV remodeling in patients with chronic ischemic mitral regurgitation: a combined magnetic resonance and speckle tracking analysis749Multimodality imaging monitoring during percutaneous tricuspid valve repair procedures. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew251] [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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Lotti F, Maseroli E, Fralassi N, Degl'Innocenti S, Boni L, Baldi E, Maggi M. Is thyroid hormones evaluation of clinical value in the work-up of males of infertile couples? Hum Reprod 2016; 31:518-29. [PMID: 26759137 DOI: 10.1093/humrep/dev338] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 12/14/2015] [Indexed: 01/23/2023] Open
Abstract
STUDY QUESTION Is thyroid hormones (TH) evaluation of clinical value in the work-up of males of infertile couples? STUDY ANSWER Our results suggest that TH evaluation is not mandatory in the work-up of male infertility. WHAT IS KNOWN ALREADY A few previous studies performed on a limited series of subjects reported a negative impact of hyper- and hypo-thyroidism on semen volume, sperm concentration, progressive motility and normal morphology. No previous study has systematically evaluated associations between TH variation, semen parameters and ultrasound characteristics of the male genital tract. STUDY DESIGN, SIZE AND DURATION Cross-sectional analysis of a consecutive series of 172 subjects seeking medical care for couple infertility from September 2010 to November 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS Of the entire cohort, 163 men (age 38.9 ± 8.0 years) free of genetic abnormalities were studied. All subjects underwent a complete andrological and physical examination, biochemical and hormonal assessment, scrotal and transrectal colour-Doppler ultrasound (CDUS) and semen analysis (including seminal interleukin 8 levels, sIL-8) evaluation within the same day. MAIN RESULTS AND THE ROLE OF CHANCE Among the patients studied, 145 (88.9%) showed euthyroidism, 6 (3.7%) subclinical hyper- and 12 (7.4%) subclinical hypo-thyroidism. No subjects showed overt hyper- or hypo-thyroidism. At univariate analysis, no associations among thyroid-stimulating hormone (TSH) or TH levels and sperm parameters were observed. Conversely, we observed positive associations among free triiodothyronine (fT3) and free thyroxine (fT4) levels, ejaculate volume and seminal fructose levels. In a multivariate model, after adjusting for confounders such as age, body mass index, smoking habit, sexual abstinence, calculated free testosterone, prolactin and sIL-8 levels, only the associations found for fT3 levels were confirmed. When CDUS features were investigated, using the same multivariate model, we found positive associations between fT3 levels and seminal vesicles (SV) volume, both before and after ejaculation (adj. r = 0.354 and adj. r = 0.318, both P < 0.0001), as well as with SV emptying (ΔSV volume; adj. r = 0.346, P < 0.0001) and echo-texture inhomogeneity. In addition, after adjusting for confounders, negative associations between fT4 levels and epididymal body and tail diameters were found. No significant associations between TSH or TH levels and CDUS features of other organs of the male genital tract, including testis and prostate, were found. Finally, when the features of subjects with euthyroidism, subclinical hypo- and hyper-thyroidism were compared, no significant differences in seminal or hormonal parameters were found. Conversely, evaluating CDUS parameters, subjects with subclinical hyperthyroidism showed a higher difference between the SV longitudinal diameters measured before and after ejaculation when compared with that of subclinical hypothyroid men, even after adjusting for confounders (P < 0.007). All the other male genital tract CDUS characteristics did not differ among groups. LIMITATIONS, REASONS FOR CAUTION First, the number of patients investigated is relatively small and those with (subclinical) thyroid dysfunctions are an even smaller number; hence, it is therefore difficult to draw firm conclusions. Moreover, the present results are derived from patients consulting an Italian Andrology Clinic for couple infertility, and could have different characteristics from the male general population or from those males consulting general practitioners for reasons other than couple infertility. Finally, due to the cross-sectional nature of the study, neither a causality hypothesis nor mechanistic models can be inferred. WIDER IMPLICATIONS OF THE FINDINGS Although no associations between TH and sperm parameters were observed, present data support a positive effect of TH on SV size and a permissive role on the ejaculatory machinery, likely through an action on SV and epididymal contractility. This is the first study reporting such evidence. However, in contrast with the view that TH assessment is important for female fertility, our results do not support a systematic evaluation of thyroid function in males of infertile couples. How TH abnormalities impact male fertility needs to be addressed by further studies. STUDY FUNDING/COMPETING INTERESTS No funding was received for the study. None of the authors have any conflict of interest to declare.
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Affiliation(s)
- F Lotti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - E Maseroli
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - N Fralassi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - S Degl'Innocenti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - L Boni
- Department of Oncology, Istituto Toscano Tumori/AOU Careggi, Florence, Italy
| | - E Baldi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - M Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
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Fainardi E, Bortolotti D, Bolzani S, Castellazzi M, Tamborino C, Roversi G, Baldi E, Caniatti ML, Casetta I, Gentili V, Granieri E, Rizzo R, Granieri E, Castellazzi M, Casetta I, Tola MR, Fainardi E, Dallocchio F, Bellini T, Rizzo R, Rotola A, Di Luca D, Seraceni S, Contini C, Sabbioni S, Negrini M, Tognon M, Antonelli T, Groppo E, Gentile M, Baldi E, Caniatti ML, Ceruti S, Manfrinato MR, Trentini A, Bortolotti D, Miotto E, Ferracin M, Mazzoni E, Pietrobon S, Masini I, Rotondo JC, Martini F, Baruzzi A, Roberto D’Alessandro R, Michelucci R, Salvi F, Stecchi S, Scandellari C, Terzano G, Granella F, Nichelli P, Sola P, Ferraro D, Vitetta F, Simone AM, Bedin R, Marcello N, Motti L, Montepietra S, Guidetti D, Immovilli P, Montanari E, Pesci I, Guareschi A, Greco G, Santangelo M, Mauro AM, Malagù S, Rasi F, Spadoni M, Galeotti M, Fiorani L, Neri W, Ravasio A, Pasquinelli M, Gutman S, Monaldini C. Cerebrospinal fluid amounts of HLA-G in dimeric form are strongly associated to patients with MRI inactive multiple sclerosis. Mult Scler 2015; 22:245-9. [DOI: 10.1177/1352458515590647] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/13/2015] [Indexed: 11/15/2022]
Abstract
Background: The relevance of human leukocyte antigen (HLA)-G in dimeric form in multiple sclerosis (MS) is still unknown. Objective: To investigate the contribution of cerebrospinal fluid (CSF) HLA-G dimers in MS pathogenesis. Methods: CSF amounts of 78-kDa HLA-G dimers were measured by western blot analysis in 80 MS relapsing–remitting MS (RRMS) patients and in 81 inflammatory and 70 non-inflammatory controls. Results: CSF amounts of 78kDa HLA-G dimers were more frequent in RRMS than in inflammatory ( p<0.01) and non-inflammatory controls ( p<0.001) and in magnetic resonance imaging (MRI) inactive than in MRI active RRMS ( p<0.00001). Conclusion: Our findings suggest that HLA-G dimers may be implicated in termination of inflammatory response occurring in MS.
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Affiliation(s)
- Enrico Fainardi
- Department of Neurosciences and Rehabilitation, Neuroradilogy Unit, Azienda Ospedaliero-Universitaria, Arcispedale S. Anna, Ferrara, Italy
| | - Daria Bortolotti
- Department of Medical Sciences, Section of Microbiology and Medical Genetics, University of Ferrara, Ferrara, Italy
| | - Silvia Bolzani
- Department of Medical Sciences, Section of Microbiology and Medical Genetics, University of Ferrara, Ferrara, Italy
| | - Massimiliano Castellazzi
- Department of Biomedical and Specialist Surgical Sciences, Section of Neurology, University of Ferrara, Ferrara, Italy
| | - Carmine Tamborino
- Department of Biomedical and Specialist Surgical Sciences, Section of Neurology, University of Ferrara, Ferrara, Italy
| | - Gloria Roversi
- Department of Biomedical and Specialist Surgical Sciences, Section of Neurology, University of Ferrara, Ferrara, Italy
| | - Eleonora Baldi
- Department of Neurosciences and Rehabilitation, Neurology Unit, Azienda Ospedaliero-Universitaria, Arcispedale S. Anna, Ferrara, Italy
| | - Maria Luisa Caniatti
- Department of Neurosciences and Rehabilitation, Neurology Unit, Azienda Ospedaliero-Universitaria, Arcispedale S. Anna, Ferrara, Italy
| | - Ilaria Casetta
- Department of Biomedical and Specialist Surgical Sciences, Section of Neurology, University of Ferrara, Ferrara, Italy
| | - Valentina Gentili
- Department of Medical Sciences, Section of Microbiology and Medical Genetics, University of Ferrara, Ferrara, Italy
| | - Enrico Granieri
- Department of Biomedical and Specialist Surgical Sciences, Section of Neurology, University of Ferrara, Ferrara, Italy
| | - Roberta Rizzo
- Department of Medical Sciences, Section of Microbiology and Medical Genetics, University of Ferrara, Ferrara, Italy
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