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Vitarelli A, Miraldi F, Capotosto L, Galea N, Francone M, Marchitelli L, Viceconte N, Smaldone C, Mangieri E, Nguyen BL, Tanzilli G, Mancone M, Al-Kindy S. Comprehensive echocardiographic assessment of right ventricular function, pulmonary arterial elastic properties and ventricular-vascular coupling in adult patients with repaired tetralogy of fallot: clinical significance of 3D derived indices. Int J Cardiovasc Imaging 2023; 39:1631-1641. [PMID: 37405609 DOI: 10.1007/s10554-023-02857-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/21/2023] [Indexed: 07/06/2023]
Abstract
We aimed to comprehensively analyze by three-dimensional speckle-tracking echocardiography (3DSTE) and Doppler echocardiography right ventricular (RV) performance, pulmonary arterial (PA) elastic properties and right ventricular-pulmonary artery coupling (RVPAC) in patients with repaired tetralogy of Fallot (rTOF) and assess the feasibility and clinical utility of related echocardiographic indices. Twenty-four adult patients with rTOF and twenty-four controls were studied. RV end-diastolic volume(3D-RVEDV), RV end-systolic volume(3D-RVESV), RV ejection fraction(3D-RVEF), RV longitudinal strain(3D-RVLS) and RV area strain(3D-RVAS) were calculated by 3DSTE. RV end-systolic area (RVESA) was obtained by planimetry. Pulmonary regurgitation (PR) was assessed as trivial/mild or significant by cardiac magnetic resonance (CMR) and color-Doppler. Pulmonary artery (PA) elastic properties were determined using two-dimensional/Doppler echocardiography. RV systolic pressure (RVSP) was measured using standard Doppler methods. RVPAC was assessed using various 3DSTE-derived parameters (3DRVAS/RVSP, 3DRVLS/RVESA, 3DRVAS/RVESV). Overall, 3DRVEF and 3DRVAS were impaired in rTOF patients compared with controls. PA pulsatility and capacitance were reduced (p = 0.003) and PA elastance was higher (p = 0.0007) compared to controls. PA elastance had a positive correlation with 3DRVEDV (r = 0.64, p = 0.002) and 3DRVAS (r = 0.51, p = 0.02). By ROC (receiver operating characteristics) analysis, 3DRVAS/RVESV, 3DRVAS/RVSP and 3DRVLS/RVESA cutoff values of 0.31%/mmHg, 0.57%/mmHg and 0.86%/mmHg, respectively, had 91%, 88% and 88% sensitivity and 81%, 81% and 79% specificity in identifying exercise capacity impairment. In rTOF patients increased 3DSTE-derived RV volumes and impaired RV ejection fraction and strain are associated with reduced PA pulsatility and capacitance and increased PA elastance. 3DSTE-derived RVPAC parameters using different afterload-markers are accurate indices of exercise capacity.
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Affiliation(s)
- Antonio Vitarelli
- Depts of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy.
- Cardiodiagnostica, via Lima 35, Rome, 00198, Italy.
| | - Fabio Miraldi
- Depts of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Lidia Capotosto
- Depts of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
- Cardiodiagnostica, via Lima 35, Rome, 00198, Italy
| | - Nicola Galea
- Depts of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Marco Francone
- Depts of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Livia Marchitelli
- Depts of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Nicola Viceconte
- Depts of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | | | - Enrico Mangieri
- Depts of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Bich Lien Nguyen
- Depts of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Gaetano Tanzilli
- Depts of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Massimo Mancone
- Depts of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Sulaiman Al-Kindy
- Depts of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
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Arrivi A, Pucci G, Sordi M, Dominici M, Barillà F, Carnevale R, Morgantini A, Rosati R, Mangieri E, Tanzilli G. Repeated Glutathione Sodium Salt Infusion May Counteract Contrast-Associated Acute Kidney Injury Occurrence in ST-Elevation Myocardial Infarction Patients Undergoing Primary PCI: A Randomized Subgroup Analysis of the GSH 2014 Trial. Life (Basel) 2023; 13:1391. [PMID: 37374173 DOI: 10.3390/life13061391] [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: 05/15/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Contrast-associated acute kidney injury (CA-AKI) is still a major concern for referring physicians, especially in the setting of ST-elevation myocardial infarction (STEMI) patients undergoing primary-PCI (pPCI). To evaluate whether glutathione sodium salt (GSS) infusion impacts favorably on CA-AKI, an unplanned exploratory data analysis of the GSH 2014 trial was performed. METHODS One hundred patients with STEMI were assigned at random to an experimental group (No. 50) or to a placebo group (No. 50). Treatment consisted of an intravenous infusion of GSS lasting over 10 min before p-PCI. The placebo group received the same quantity of normal saline solution. After the interventions, glutathione was administered in the same doses to both groups at 24, 48 and 72 h. RESULTS CA-AKI occurred in 5 out of 50 patients (10%) allocated to the experimental group (GSS infusion) and in 19 out of 50 patients (38%) allocated to the placebo group (p between groups < 0.001). No patients in either group required renal replacement therapy. After allowing for multiple confounders, GSS administration (OR 0.17, 95% CI 0.04-0.61) and door-to-balloon time (in hours) (OR 1.61, 95% CI 1.01-2.58) have been the only independent predictors of CA-AKI. CONCLUSIONS the results of this sub-study, which show a significant trend towards an improved nephroprotection in the experimental group, led to the hypothesis of a possible new prophylactic approach to counteract CA-AKI using repeated GSS infusion. Subsequent studies with specific clinical outcomes would be necessary to confirm these data.
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Affiliation(s)
- Alessio Arrivi
- Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy
| | - Giacomo Pucci
- Unit of Internal Medicine, "Santa Maria" University Hospital, 05100 Terni, Italy
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Martina Sordi
- Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy
| | - Marcello Dominici
- Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy
| | - Francesco Barillà
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, 04100 Latina, Italy
- IRCCS Neuromed, Località Camerelle, 86077 Pozzilli, Italy
| | - Amalia Morgantini
- Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Riccardo Rosati
- Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Enrico Mangieri
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Gaetano Tanzilli
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
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Arrivi A, Truscelli G, Pucci G, Barillà F, Carnevale R, Nocella C, Sordi M, Dominici M, Tanzilli G, Mangieri E. The Combined Treatment of Glutathione Sodium Salt and Ascorbic Acid for Preventing Contrast-Associated Acute Kidney Injury in ST-Elevation Myocardial Infarction Patients Undergoing Primary PCI: A Hypothesis to Be Validated. Antioxidants (Basel) 2023; 12:antiox12030773. [PMID: 36979021 PMCID: PMC10045886 DOI: 10.3390/antiox12030773] [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: 02/23/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
The occurrence of Contrast-Associated Acute Kidney Injury (CA-AKI) in patients with ST-Elevation Myocardial Infarction (STEMI) has a negative impact on the length of hospital stay and mortality. Reactive Oxygen Species (ROS) release, along with vasoconstriction and hypoperfusion, play a key role in its development. To date, there is still no validated prophylactic therapy for this disease. The use of antioxidants, based on experimental and clinical studies, looks promising. Taking into consideration previous literature, we speculate that an early, combined and prolonged intravenous administration of both Glutathione (GSH) and ascorbic acid in STEMI patients undergoing primary Percutaneous Coronary Intervention (pPCI) may be of value in counteracting the occurrence of CA-AKI. We aimed at evaluating this hypothesis by applying a multicenter research protocol, using a double-blind randomized, placebo-controlled trial design. The primary endpoint will be to test the efficacy of this combined antioxidant therapy in reducing the occurrence of renal damage, in patients with acute myocardial infarction treated with pPCI. Furthermore, we will investigate the effect of the study compounds on changes in oxidative stress markers and platelet activation levels through bio-humoral analyses.
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Affiliation(s)
- Alessio Arrivi
- Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy
| | | | - Giacomo Pucci
- Unit of Internal Medicine, S. Maria University Hospital, 05100 Terni, Italy
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Francesco Barillà
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies Sapienza University, 04100 Latina, Italy
- IRCCS Neuromed, Località Camerelle, 86077 Pozzilli, Italy
| | - Cristina Nocella
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Martina Sordi
- Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy
| | - Marcello Dominici
- Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy
| | - Gaetano Tanzilli
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Enrico Mangieri
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
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Vitarelli A, Capotosto L, Mangieri E, Tanzilli G, Viceconte N, Miraldi F. A Novel Index of Right Ventriculoarterial Coupling in Adult Patients With Repaired Tetralogy of Fallot Using Three-Dimensional Speckle-Tracking Echocardiography. J Am Soc Echocardiogr 2023; 36:341-343. [PMID: 36442766 DOI: 10.1016/j.echo.2022.11.008] [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] [Received: 06/08/2022] [Revised: 09/03/2022] [Accepted: 11/17/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Antonio Vitarelli
- Cardiodiagnostica CS and Department of Cardiology and Cardiac Surgery, Sapienza University, Rome, Italy.
| | - Lidia Capotosto
- Cardiodiagnostica CS and Department of Cardiology and Cardiac Surgery, Sapienza University, Rome, Italy
| | - Enrico Mangieri
- Cardiodiagnostica CS and Department of Cardiology and Cardiac Surgery, Sapienza University, Rome, Italy
| | - Gaetano Tanzilli
- Cardiodiagnostica CS and Department of Cardiology and Cardiac Surgery, Sapienza University, Rome, Italy
| | - Nicola Viceconte
- Cardiodiagnostica CS and Department of Cardiology and Cardiac Surgery, Sapienza University, Rome, Italy
| | - Fabio Miraldi
- Cardiodiagnostica CS and Department of Cardiology and Cardiac Surgery, Sapienza University, Rome, Italy
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Al-Kebsi M, Al-Motarreb A, Al-Kadasi H, Al-Muqayad MH, Mangieri E, Capotosto L, Miraldi F, Mastroianni C, Vitarelli A. Peculiar clinical and diagnostic features of infective endocarditis in Yemen: Comparative analysis with a Western University Hospital. J Investig Med 2023; 71:132-139. [PMID: 36647330 DOI: 10.1177/10815589221143327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The aim of this study was to describe the pattern, characteristics, and outcomes of infective endocarditis (IE) in Yemen and compare the results with the findings of a Western university hospital. Patients (pts) with a final diagnosis of IE observed in Al-Thawra Sanaa Cardiac Center were prospectively enrolled in 1-year time period. Clinical and diagnostic findings were compared to clinical and diagnostic data of 50 pts with IE observed at Sapienza University Hospital in Rome, Italy. The mean age was 38 ± 6. Predisposing factors for IE were rheumatic heart disease (RHD) in 34 pts (68%), congenital heart disease in 9 pts (18%), prosthetic valve IE in 4 pts (8%), and previous IE in 3 pts (6%). Transthoracic echocardiography (TTE) was done in 50 pts and transesophageal echocardiography (TEE) in 25. Blood cultures were taken in all pts and were positive in 3 pts (6%) and negative in 47 (94%). TTE was positive in 34/50 pts (68%) and TEE in 20/25 (80%). Compared to Sapienza University pts, Al-Thawra Cardiac Center pts had a younger age (p = 0.003), more predisposing RHD (p = 0.0004), less prosthetic heart valves IE (p = 0.002), and more negative blood cultures (p = 0.0001). IE is still a common disease in Yemen among RHD pts and affects the younger age group. It has severe complications which need early diagnosis and proper management. Echocardiography is of prime diagnostic value in the absence of positive blood cultures. An effort should be made to prevent rheumatic fever and RHD.
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Affiliation(s)
- Mohammed Al-Kebsi
- Faculty of Medicine & Health Sciences, Sanaa University, Sanaa, Yemen
| | - Ahmed Al-Motarreb
- Faculty of Medicine & Health Sciences, Sanaa University, Sanaa, Yemen
| | | | | | - Enrico Mangieri
- Departments of Cardiology and Infectious Diseases, Sapienza University, Rome, Italy
| | - Lidia Capotosto
- Departments of Cardiology and Infectious Diseases, Sapienza University, Rome, Italy
| | - Fabio Miraldi
- Departments of Cardiology and Infectious Diseases, Sapienza University, Rome, Italy
| | - Claudio Mastroianni
- Departments of Cardiology and Infectious Diseases, Sapienza University, Rome, Italy
| | - Antonio Vitarelli
- Departments of Cardiology and Infectious Diseases, Sapienza University, Rome, Italy
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Arrivi A, Pucci G, Placanica A, Bier N, Sordi M, Dominici M, Carnevale R, Tanzilli G, Mangieri E. Early and prolonged glutathione infusion favourably impacts length of hospital stay in ST-elevation myocardial infarction patients: a sub-analysis of the GSH2014 trial. Minerva Cardiol Angiol 2022; 71:147-152. [PMID: 36083043 DOI: 10.23736/s2724-5683.22.06134-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Developing strategies aimed to shorten the length of stay (LOS) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) is a healthcare goal to be pursued. We carried out a subanalysis of the GSH 2014 Trial to assess the potentiality of glutathione sodium salt infusion to impact on LOS. METHODS 100 consecutive patients with STEMI, aged more than 18 years and referred to the three enrolling centers for primary angioplasty (p-PCI), were asked to participate to the GSH 2014 Trial. Fifty patients were randomized to treatment group and fifty to placebo; treatment consisted into an intravenous infusion of glutathione sodium salt over 10 minutes before p-PCI; after interventions, glutathione was infused at the same doses at 24, 48 and 72 h elapsing time. A stepwise linear multivariate model was built in order to assess independent predictors of LOS. RESULTS Subjects receiving infusion of glutathione sodium salt had a significantly lower LOS than subjects receiving placebo (8.6±3 vs. 10.8±4 days, P=0.006). At multivariate analysis, the randomization to GSH group was negatively associated with length of stay (β±SEβ -1.64±0.74, cumulative R2 0.43, P=0.03) independently from age, sex, cardiovascular risk factors, number of treated vessels, infarct-related coronary artery (left anterior descending artery as reference) and enrolment hospital. CONCLUSIONS Results from this subanalysis support the hypothesis that an early and prolonged glutathione sodium salt administration, as antioxidant therapy to patients with STEMI, may favorably impact on LOS. Further studies with larger sample size are necessary to confirm these data.
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Affiliation(s)
- Alessio Arrivi
- Unit of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy -
| | - Giacomo Pucci
- Unit of Internal Medicine, Santa Maria University Hospital, Terni, Italy
- Department of Medicine and Surgery, University of Perugia, Terni, Italy
| | | | - Nicola Bier
- Unit of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy
- Department of Medicine and Surgery, University of Perugia, Terni, Italy
| | - Martina Sordi
- Unit of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy
| | - Marcello Dominici
- Unit of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Gaetano Tanzilli
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Enrico Mangieri
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
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Vitarelli A, Capotosto L, Nguyen BL, Tanzilli G, Viceconte N, Mancone M, Mangieri E, Ciardi M, Mastroianni C, Miraldi F. SIMPLE AND COMPLEX MITRAL VALVE PROLAPSE: ASSESSMENT BY THREE-DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAPHY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02272-0] [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: 11/30/2022]
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Capotosto L, Tanzilli G, Iannucci G, Viceconte N, Placanica G, Mancone M, Mangieri E, Miraldi F, Vitarelli A. Three-dimensional transesophageal echocardiographic assessment of valvar and ventricular aspects in simple and complex mitral valve prolapse. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.015] [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
Funding Acknowledgements
Type of funding sources: None.
Purpose. In mitral valve prolapse (MVP), preoperative assessment of repairability depends primarily on the complexity of the prolapse and is one of the most challenging roles of the echocardiologist. The aim of this study was to investigate whether three-dimensional transesophageal echocardiography helps in the evaluation of both valvar/annular and ventricular aspects in simple (single segment) and complex (multisegmental) MVP.
Methods. We studied 24 patients with mitral regurgitation due to MVP using three-dimensional transesophageal echocardiography. Mitral valve (MV), left atrium (LA) and left ventricle (LV) were analyzed. Leaflets surface area, mitral annulus antero-posterior and inter-commissural diameters, area and circumference were determined. Mitral annular disjunction (MAD) defined as a separation between LA-MV junction and LV attachment was evaluated. Papillary muscle to annulus plane distances and inter-papillary distance were obtained. LV global longitudinal and circumferential strain was assessed by speckle tracking echocardiography.
Results. Thirteen patients had complex MVP and 11 had simple MVP. Prolapse volume was 6.37 ± 4.68 mL in complex MVP and 1.59 ± 1.21 mL in simple MVP (p = 0.004). Prolapse height was 10.1 ± 2.9 mm in complex MVP and 5.8 ± 3.2 mm in simple MVP (p = 0.003). Volume/height ratio was 0.58 ± 0.29 in complex MVP and 0.21 ± 0.14 in simple MVP (p = 0.001). LV longitudinal strain had a negative correlation with change in prolapse height (r = 0.58, p < 0.001), whereas LV circumferential strain correlated with change in prolapse volume (r = 0.53, p < 0.005). Annular area was 1037 ± 191mm2 in simple MVP and 1842 ± 336mm2 in complex MVP (p < 0.01). MAD was evident in 8 complex MVP patients (61%) and 2 simple MVP patients (18%, p < 0.05). The 3D extension of MAD was significantly related to total (r = 0.54; p = 0.002) and anterior leaflet surface area (r = 0.52; p = 0.004), length from papillary muscles to coaptation (r = 0.61; p = 0.002) and regurgitant orifice (r = 0.66; p < 0.001).
Conclusions. In MVP patients 3DTEE helps to refine the characterization of simple and complex prolapse by a combined assessment of leaflets/annular details and ventricular attachment.
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Arrivi A, Pucci G, Dominici M, Mangieri E, Tanzilli G. Contrast-induced acute kidney injury and nitric oxide depletion in patients undergoing primary percutaneous coronary intervention: insights from GSH 2014 trial. J Cardiovasc Med (Hagerstown) 2021; 22:788-789. [PMID: 33399348 DOI: 10.2459/jcm.0000000000001154] [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] [Indexed: 11/05/2022]
Affiliation(s)
| | - Giacomo Pucci
- Unit of Internal Medicine, 'Santa Maria' University Hospital
- University of Perugia/Terni School of Medicine, Terni
| | - Marcello Dominici
- Interventional Cardiology Unit
- University of Perugia/Terni School of Medicine, Terni
| | - Enrico Mangieri
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Gaetano Tanzilli
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Tanzilli G, Arrivi A, Placanica A, Viceconte N, Cammisotto V, Nocella C, Barillà F, Torromeo C, Pucci G, Acconcia MC, Granatelli A, Basili S, Dominici M, Gaudio C, Carnevale R, Mangieri E. Glutathione Infusion Before and 3 Days After Primary Angioplasty Blunts Ongoing NOX2-Mediated Inflammatory Response. J Am Heart Assoc 2021; 10:e020560. [PMID: 34533039 PMCID: PMC8649545 DOI: 10.1161/jaha.120.020560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Glutathione is a water‐soluble tripeptide with a potent oxidant scavenging activity. We hypothesized that glutathione administration immediately before and after primary angioplasty (primary percutaneous coronary intervention) could be effective in modulating immune cell activation, thereby preventing infarct expansion. Methods and Results One hundred consecutive patients with ST‐segment–elevation myocardial infarction, scheduled to undergo primary percutaneous coronary intervention were randomly assigned before the intervention to receive an infusion of glutathione (2500 mg/25 mL over 10 minutes), followed by drug administration at the same doses at 24, 48, and 72 hours elapsing time or placebo. Total leukocytes, NOX2 (nicotinamide adenine dinucleotide phosphate oxidase 2) activation, NO bioavailability, cTpT (serum cardiac troponin T), hsCRP (high‐sensitivity C‐reactive protein), and TNF‐α (tumor necrosis factor α) levels were measured. Left ventricular size and function were assessed within 120 minutes, 5 days, and 6 months from percutaneous coronary intervention. Following reperfusion, a significant reduction of neutrophil to lymphocyte ratio (P<0.0001), hsCRP generation (P<0.0001), NOX2 activation (P<0.0001), TNF‐α levels (P<0.001), and cTpT release (P<0.0001) were found in the glutathione group compared with placebo. In treated patients, blunted inflammatory response was linked to better left ventricular size and function at follow‐up (r=0.78, P<0.005). Conclusions Early and prolonged glutathione infusion seems able to protect vital myocardial components and endothelial cell function against harmful pro‐oxidant and inflammatory environments, thus preventing maladaptive cardiac repair and left ventricular adverse remodeling. Registration URL: https://www.clinicaltrialsregister.eu; Unique identifier: 2014‐004486‐25.
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Affiliation(s)
- Gaetano Tanzilli
- Department of Clinical, Internal Medicine, Anesthesiology, and Cardiovascular Sciences Sapienza University of Rome Rome Italy
| | - Alessio Arrivi
- Department of Cardiology Interventional Cardiology Unit, "Santa Maria" Hospital Terni Italy
| | - Attilio Placanica
- Department of Cardiology "San Giovanni Evangelista" Hospital Tivoli Italy
| | - Nicola Viceconte
- Department of Clinical, Internal Medicine, Anesthesiology, and Cardiovascular Sciences Sapienza University of Rome Rome Italy
| | - Vittoria Cammisotto
- Department of General Surgery and Surgical Specialty Paride Stefanini Sapienza University of Rome Rome Italy
| | - Cristina Nocella
- Department of Clinical, Internal Medicine, Anesthesiology, and Cardiovascular Sciences Sapienza University of Rome Rome Italy
| | - Francesco Barillà
- Department of Clinical, Internal Medicine, Anesthesiology, and Cardiovascular Sciences Sapienza University of Rome Rome Italy
| | - Concetta Torromeo
- Department of Clinical, Internal Medicine, Anesthesiology, and Cardiovascular Sciences Sapienza University of Rome Rome Italy
| | - Giacomo Pucci
- Internal Medicine Unit, "Santa Maria" Hospital Terni Italy
| | - Maria Cristina Acconcia
- Department of Clinical, Internal Medicine, Anesthesiology, and Cardiovascular Sciences Sapienza University of Rome Rome Italy
| | | | - Stefania Basili
- Department of Translational and Precision Medicine SapienzaUniversity of Rome Rome Italy
| | - Marcello Dominici
- Department of Cardiology Interventional Cardiology Unit, "Santa Maria" Hospital Terni Italy
| | - Carlo Gaudio
- Department of Clinical, Internal Medicine, Anesthesiology, and Cardiovascular Sciences Sapienza University of Rome Rome Italy
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies Sapienza University Latina Italy.,Mediterranea Cardiocentro Napoli Italy
| | - Enrico Mangieri
- Department of Clinical, Internal Medicine, Anesthesiology, and Cardiovascular Sciences Sapienza University of Rome Rome Italy
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Carnevale R, Sciarretta S, Valenti V, di Nonno F, Calvieri C, Nocella C, Frati G, Forte M, d'Amati G, Pignataro MG, Severino A, Cangemi R, Arrivi A, Dominici M, Mangieri E, Gaudio C, Tanzilli G, Violi F. Low-grade endotoxaemia enhances artery thrombus growth via Toll-like receptor 4: implication for myocardial infarction. Eur Heart J 2021; 41:3156-3165. [PMID: 31898723 DOI: 10.1093/eurheartj/ehz893] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/04/2019] [Accepted: 12/10/2019] [Indexed: 12/15/2022] Open
Abstract
AIMS Low-grade endotoxaemia is detectable in human circulation but its role in thrombosis is still unclear. METHODS AND RESULTS We measured serum lipopolysaccharide (LPS) concentration, soluble P-selectin (sP-selectin), a marker of platelet activation, and zonulin, a marker of gut permeability, in peripheral circulation, coronary thrombi, and intracoronary blood of patients with ST-elevation myocardial infarction (STEMI, n = 50) and stable angina (SA) (n = 50), respectively, and in controls (n = 50). Experimental study was carried out in mice to assess if Escherichia coli-LPS (E. coli-LPS) possess thrombotic property. Coronary thrombi from STEMI showed higher concentrations of LPS, sP-selectin vs. intracoronary blood of SA and peripheral blood of controls (P < 0.001). Zonulin was higher in STEMI compared to the other two groups [4.57 (3.34-5.22); 2.56 (0.41-4.36); 1.95 (1.22-2.65) ng/mL; P < 0.001] and correlated with LPS (Rs = 0.585; P < 0.001). Escherichia coli DNA was positive in 34% of STEMI vs. 12% of SA and 4% of controls (P < 0.001). In a subgroup of 12 STEMI, immunohistochemical analysis of coronary thrombi showed positivity for leucocyte Toll-like receptor 4 (TLR4), cathepsin G, and LPS from E. coli in 100%, 80%, and 25% of samples, respectively. E. coli-LPS injected in mice to reach LPS concentrations like those detected in coronary thrombi was associated with enhanced artery thrombosis and platelet activation, an effect blunted by TLR4 inhibitor co-administration. In vitro study demonstrated that LPS from E. coli enhanced platelet aggregation via TLR4-mediated leucocyte cathepsin G activation. CONCLUSION ST-elevation myocardial infarction patients disclose an enhanced gut permeability that results in LPS translocation in human circulation and eventually thrombus growth at site of artery lesion via leucocyte-platelet interaction.
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Affiliation(s)
- Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina 04100, Italy.,Mediterranea Cardiocentro, via Orazio 2, Napoli 80122, Italy
| | - Sebastiano Sciarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina 04100, Italy.,IRCCS NeuroMed, via Atinense 18, Pozzilli 86077, Italy
| | - Valentina Valenti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina 04100, Italy
| | | | - Camilla Calvieri
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | - Cristina Nocella
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina 04100, Italy.,IRCCS NeuroMed, via Atinense 18, Pozzilli 86077, Italy
| | | | - Giulia d'Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | - Maria G Pignataro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | - Anna Severino
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo Francesco Vito 1, Rome 00168, Italy
| | - Roberto Cangemi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | - Alessio Arrivi
- Interventional Cardiology Unit, Santa Maria Hospital, Viale Tristano di Joannuccio, Terni 05100, Italy
| | - Marcello Dominici
- Interventional Cardiology Unit, Santa Maria Hospital, Viale Tristano di Joannuccio, Terni 05100, Italy
| | - Enrico Mangieri
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | - Carlo Gaudio
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | - Gaetano Tanzilli
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | - Francesco Violi
- Mediterranea Cardiocentro, via Orazio 2, Napoli 80122, Italy.,Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
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12
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Capotosto L, Galea N, Francone M, Marchitelli L, Tanzilli G, Viceconte N, Mangieri E, Gaudio C, Miraldi F, Vitarelli A. P670 RV function in adult patients with repaired tetralogy of Fallot: assessment by three-dimensional echocardiography, comparison to CMR findings and relationship to pulmonary artery distensibility. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.350] [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
Purpose
The purpose of this study was to examine right ventricular (RV) function by three-dimensional speckle-tracking echocardiography (3DSTE) in patients after correction of tetralogy of Fallot (TF), the accuracy of 3DSTE compared to cardiovascular magnetic resonance (CMR) findings and assess pulmonary arterial (PA) distensibility in order to achieve a more comprehensive understanding of the matching between RV performance and PA load.
Methods
Twenty-one patients (mean age 39 ± 16 years) with repaired TF and twenty-one age-matched healthy subjects selected as controls were studied. CMR findings were available in 14 patients. RV volumes, RV ejection fraction (RVEF) and RV longitudinal and circumferential strains were calculated by three-dimensional echocardiography and three-dimensional speckle tracking echocardiography. The main pulmonary artery was interrogated by color, pulsed, and continuous-wave Doppler. Pulmonary regurgitation (PR) was assessed by color-flow mapping and graded as none, mild, or greater than mild using the measurement of the regurgitant jet width in relation to the outflow tract diameter. Right pulmonary artery (PA) was visualized from suprasternal view by two-dimensional echocardiography. Tissue Doppler Imaging (TDI) mode was activated in B-mode imaging to examine arterial motion, then mode was changed to color-mode with the beam line aligned perpendicular to the superior and inferior walls of the right PA. PA distensibility and strain were determined. Data analysis was performed offline.
Results
Overall, 3D RVEF and RV longitudinal strain were reduced in TF patients compared to the control group. Nine patients had moderate or moderate-to-severe PR. PA strain and distensibility were decreased (p = 0.003) compared with controls, both in the presence and absence of PR. PA strain had a positive correlation with RVEF (r = 0.79, p < 0.005) and RV strain (r = 0.82, p < 0.001). RV end-diastolic and end-systolic volumes by 3DE correlated with the respective parameters by CMR (r = 0.88,p < 0.001 and r = 0.87,p < 0.005 respectively). Patients with moderate-to-severe PR had more prominent PA strain changes (p = 0.02).
Conclusions
Three-dimensional right ventricular ejection fraction and RV strain are impaired in patients with repaired TF, in agreement with CMR data. Reduced PA strain is associated with reduced RV 3DSTE parameters and is more pronounced in the presence of pulmonary regurgitation.
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Affiliation(s)
| | - N Galea
- Sapienza University, Rome, Italy
| | | | | | | | | | | | - C Gaudio
- Sapienza University, Rome, Italy
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13
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Capotosto L, Tanzilli G, Mangieri E, Ciardi MR, Gaudio C, Miraldi F, Vullo V, Vitarelli A. P202 Two-dimensional and three-dimensional transesophageal echocardiography in the diagnosis of infective endocarditis of native and prosthetic valves. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.070] [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
Purpose
The purpose of this study was to examine the incremental value of three-dimensional transesophageal echocardiography (3D-TEE) compared to two-dimensional transesophageal echocardiography (2D-TEE) in the diagnosis of infective endocarditis (IE) of native and prosthetic valves.
Methods
Forty-three patients with clinically suspected IE were studied. The patients had clinical, microbiological and echocardiographic assessment to establish a diagnosis of IE in accordance to current guidelines recommendations. Presence, location and size of vegetations, new or progressive valve regurgitation, possible chordae tendineae rupture, paravalvular extension, and new dehiscence of a valve prosthesis were assessed by echocardiography.
Results
In 25 (58%) patients the diagnosis of IE was established. Thirteen patients had native valves and 12 patients had prosthetic valves (9 mechanical, 3 biological). 2D-TEE and 3D-TEE showed a sensitivity, specificity, positive and negative predictive value for diagnosis of IE of 91% and 89%, 88% and 91%, 84% and 86%, and 93% and 90%, respectively, in native valves, and of 92 and 90% 91% and 97% (p = 0.002), 84% and 82% and 89% and 95% (p = 0.01), respectively, in patients with prosthetic valves. Major vegetation diameter was 18mm for 3D-TEE and 16mm for 2D-TEE in native valves and 19mm for 3D-TEE and 14mm for 2D-TEE in prosthetic valves (p = 0.04). Peri-annular extension was detected by any of the echocardiographic modalities in three patients with native valve IE and two patients with prosthetic valves, and by 3D-TEE only and not by 2D-TEE in one patient with prosthetic valve.
Conclusions
Patients with prosthetic valve infective endocarditis seem to have more additive benefit from 3D-TEE compared to patients with native valve IE.
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Affiliation(s)
| | | | | | | | - C Gaudio
- Sapienza University, Rome, Italy
| | | | - V Vullo
- Sapienza University, Rome, Italy
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14
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Capotosto L, D'Ettorre G, Ajassa C, Cavallari N, Ciardi MR, Placanica G, Ricci S, Lucchetti P, Tanzilli G, Mangieri E, Gaudio C, Vullo V, Vitarelli A. Assessment of Biventricular Function by Three-Dimensional Speckle Tracking Echocardiography in Adolescents and Young Adults with Human Immunodeficiency Virus Infection: A Pilot Study. Cardiology 2019; 144:101-111. [PMID: 31614346 DOI: 10.1159/000503140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of the study was to assess biventricular parameters of wall deformation with three-dimensional speckle tracking echocardiography (3DSTE) in adolescents and young adults with human immunodeficiency virus (HIV) infection on antiretroviral therapy in order to detect a possible subclinical myocardial dysfunction. METHODS Twenty-one patients aged 12-39 years with HIV, 21 normal controls of the same age and sex, and 21 patients with idiopathic nonischemic dilated cardiomyopathy (DCM) were studied with 3DSTE. All HIV patients were stable in terms of HIV infection, with no history of heart disease or other chronic systemic disease except HIV infection, and were on highly active antiretroviral therapy with good immunological control. Standard echocardiographic measures of left ventricular (LV)-right ventricular (RV) function were assessed. 3D LV global longitudinal strain (GLS), circumferential strain, radial strain, and LV twist were calculated. Global area strain (GAS) was calculated by 3DSTE as percentage variation in surface area defined by the longitudinal and circumferential strain vectors. 3D RV global and free-wall longitudinal strain (FWLS) were obtained. RESULTS LV GLS and GAS were lower in HIV patients compared to normal controls (p = 0.002, and p = 0.01, respectively). There were no significant differences in LV ejection fractions between the groups. There was a weak positive correlation between LV GLS and age (r = 0.215, p = 0.034) and a weak negative correlation between LV GLS and nadir-CD4 T-cells count (r = 0.198, p = 0.043). DCM patients had more marked and widespread reduction in LV GLS and GAS compared to controls (p < 0.001), whereas in HIV patients LV strain impairment (p < 0.05) was more localized in basal and apical regions. RV FWLS was significantly reduced in HIV patients when compared with the control group (p = 0.03). No patient had pulmonary systolic pressure higher than 35 mm Hg. CONCLUSIONS 3DSTE may help to identify HIV patients at high cardiovascular risk allowing early detection of biventricular dysfunction in the presence of normal LV ejection fraction and in the absence of pulmonary hypertension. LV strain impairment in HIV patients is less prominent and widespread compared to DCM patients.
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Affiliation(s)
| | | | - Camilla Ajassa
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | - Nelson Cavallari
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | | | | | - Serafino Ricci
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | - Pietro Lucchetti
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | | | | | - Carlo Gaudio
- Department of Cardiology, Sapienza University, Rome, Italy
| | - Vincenzo Vullo
- Department of Infectious Diseases, Sapienza University, Rome, Italy
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15
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Tanzilli G, Truscelli G, Arrivi A, Carnevale R, Placanica A, Viceconte N, Raparelli V, Mele R, Cammisotto V, Nocella C, Barillà F, Lucisano L, Pennacchi M, Granatelli A, Dominici M, Basili S, Gaudio C, Mangieri E. Glutathione infusion before primary percutaneous coronary intervention: a randomised controlled pilot study. BMJ Open 2019; 9:e025884. [PMID: 31399448 PMCID: PMC6701599 DOI: 10.1136/bmjopen-2018-025884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE In the setting of reperfused ST-elevation myocardial infarction (STEMI), increased production of reactive oxygen species (ROS) contributes to reperfusion injury. Among ROS, hydrogen peroxide (H2O2) showed toxic effects on human cardiomyocytes and may induce microcirculatory impairment. Glutathione (GSH) is a water-soluble tripeptide with a potent oxidant scavenging activity. We hypothesised that the infusion of GSH before acute reoxygenation might counteract the deleterious effects of increased H2O2 generation on myocardium. METHODS Fifty consecutive patients with STEMI, scheduled to undergo primary angioplasty, were randomly assigned, before intervention, to receive an infusion of GSH (2500 mg/25 mL over 10 min), followed by drug administration at the same doses at 24, 48 and 72 hours elapsing time or placebo. Peripheral blood samples were obtained before and at the end of the procedure, as well as after 5 days. H2O2 production, 8-iso-prostaglandin F2α (PGF2α) formation, H2O2 breakdown activity (HBA) and nitric oxide (NO) bioavailability were determined. Serum cardiactroponin T (cTpT) was measured at admission and up to 5 days. RESULTS Following acute reperfusion, a significant reduction of H2O2 production (p=0.0015) and 8-iso-PGF2α levels (p=0.0003), as well as a significant increase in HBA (p<0.0001)and NO bioavailability (p=0.035), was found in the GSH group as compared with placebo. In treated patients, attenuated production of H2O2 persisted up to 5 days from the index procedure (p=0.009) and these changes was linked to those of the cTpT levels (r=0.41, p=0.023). CONCLUSION The prophylactic and prolonged infusion of GSH seems to determine a rapid onset and persistent blunting of H2O2 generation improving myocardial cell survival. Nevertheless, a larger trial, adequately powered for evaluation of clinical endpoints, is ongoing to confirm the current finding. TRIAL REGISTRATION NUMBER EUDRACT 2014-00448625; Pre-results.
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Affiliation(s)
- Gaetano Tanzilli
- Department of Heart and Great Vessels, Sapienza University of Rome, Rome, Italy
| | - Giovanni Truscelli
- Department of Heart and Great Vessels, Sapienza University of Rome, Rome, Italy
| | - Alessio Arrivi
- Department of Cardiology, "Santa Maria" Hospital, Terni, Italy
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Attilio Placanica
- Department of Cardiology, "San Giovanni Evangelista" Hospital, Tivoli, Italy
| | - Nicola Viceconte
- Department of Heart and Great Vessels, Sapienza University of Rome, Rome, Italy
| | - Valeria Raparelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Rita Mele
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Vittoria Cammisotto
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Cristina Nocella
- Internal Medicine and Medical Specialties, Sapienza University of Rome
| | - Francesco Barillà
- Department of Heart and Great Vessels, Sapienza University of Rome, Rome, Italy
| | - Luigi Lucisano
- Department of Cardiology, "San Giovanni Evangelista" Hospital, Tivoli, Italy
| | - Mauro Pennacchi
- Department of Cardiology, "San Giovanni Evangelista" Hospital, Tivoli, Italy
| | - Antonino Granatelli
- Department of Cardiology, "San Giovanni Evangelista" Hospital, Tivoli, Italy
| | | | - Stefania Basili
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Carlo Gaudio
- Department of Heart and Great Vessels, Sapienza University of Rome, Rome, Italy
| | - Enrico Mangieri
- Department of Heart and Great Vessels, Sapienza University of Rome, Rome, Italy
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16
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Pelliccia F, Barillà F, Tanzilli G, Viceconte N, Paravati V, Mangieri E, Gaudio C. [The importance of defining methodology for post-marketing observational studies on cardiovascular therapies]. G Ital Cardiol (Rome) 2019; 18:3-10. [PMID: 28956866 DOI: 10.1714/2781.28049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In recent years, a growing number of observational studies in cardiology have been carried out following the criticism that rigid design of randomized clinical trials produces information that is not applicable to the general patient. This approach is very common in several branches of medicine, first of all oncology, but has often been considered marginal in cardiology. The recent introduction of new oral anticoagulants (NOACs) on the market, however, has seen a proliferation of "real-life" studies, drawing the attention of cardiologists to the advantages and limitations of post-marketing studies. NOACs have been approved for use on the basis of large randomized clinical trials that have clearly documented their efficacy and safety. Since they have become available, the analysis of phase IV data has been considered crucial and therefore a great amount of information on the use of NOACs in daily practice has become available. It should be considered, however, that the possibility exists that results obtained from "real-world" studies, which do not apply rigid scientific criteria, may lead to incorrect conclusions. Accordingly, it is mandatory to fully define the operational standards of observational studies. All the protagonists of post-marketing analysis (physicians, epidemiologists, pharmacologists, statisticians) should handle the data strictly in order to ensure their reliability and comparability with other studies. To this end, it is crucial that researchers follow rigorous operational protocols for phase IV studies. Briefly, any "real-life" study should be prospective and adhere to what is prespecified by the research protocol - which must illustrate the background and rationale of the study, define its primary endpoint, and detail the methods, i.e. study design, population and variables.
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Affiliation(s)
| | | | | | | | | | - Enrico Mangieri
- Dipartimento "Attilio Reale", Sapienza Università di Roma, Roma
| | - Carlo Gaudio
- Dipartimento "Attilio Reale", Sapienza Università di Roma, Roma - Fondazione Eleonora Lorillard Spencer Cenci, Roma
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17
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Vitarelli A, Lai S, Petrucci MT, Gaudio C, Capotosto L, Mangieri E, Ricci S, Germanò G, De Sio S, Truscelli G, Vozella F, Pergolini MS, Giordano M. Biventricular assessment of light-chain amyloidosis using 3D speckle tracking echocardiography: Differentiation from other forms of myocardial hypertrophy. Int J Cardiol 2018; 271:371-377. [DOI: 10.1016/j.ijcard.2018.03.088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/24/2018] [Accepted: 03/19/2018] [Indexed: 01/08/2023]
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Vitarelli A, Mangieri E, Gaudio C, Tanzilli G, Miraldi F, Capotosto L. Right atrial function by speckle tracking echocardiography in atrial septal defect: Prediction of atrial fibrillation. Clin Cardiol 2018; 41:1341-1347. [PMID: 30117180 DOI: 10.1002/clc.23051] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 07/10/2018] [Accepted: 08/13/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Most antiarrhythmic interventional therapies for atrial fibrillation (AF) have been provided with special focus on the treatment of left-sided valvular disease and enlarged left atrium but few studies have assessed AF associated with congenital heart disease and dilated right atrium. HYPOTHESIS We hypothesized that right atrial (RA) function assessed by two-dimensional (2DSTE) and three-dimensional (3DSTE) speckle-tracking echocardiography in patients with atrial septal defect (ASD) before and after percutaneous trancatheter closure could predict paroxysmal atrial fibrillation (PAF) development. METHODS Seventy-three patients with hemodynamically significant secundum ASD were prospectively studied and followed up for 6 months after occluder insertion and compared with a normal age-matched group (n = 73). A subgroup of 17 patients who developed PAF after device implantation was also studied. RA peak global longitudinal strain (PS) was determined using 2DSTE. Standard deviations (SDs) of times to peak strain (TPS) were calculated as indices of dyssynchrony. RA volumes, emptying fraction (EF), and expansion index (EI) were determined using 3DSTE. RESULTS RA-PS, EF, and EI (pre-closure values) were reduced in patients with atrial devices compared with controls, and further reductions were observed in patients with PAF. Pre-closure 3D-RA-EI (P = 0.009) and RA-TPS (P = 0.023) were independent predictors of PAF by multivariate analysis after adjustment for age and left atrial dysfunction. The areas under the ROC-curve (AUC) for 3D-RA-EI, RA-PS, RA-TPS (pre-closure values) showed high discriminative values(from 0.76 to 0.85) in predicting PAF. By combining 3D-RA-EI and RA-TPS, the AUC increased to 0.90. CONCLUSIONS Two-dimensional and three-dimensional speckle tracking echocardiography was clinically helpful in ASD patients in revealing right atrial dilatation and dysfunction pre-existent to device closure and associated with PAF development. RA parameters had a higher association with PAF compared to both the size of the implanted device and left atrial indices.
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Affiliation(s)
| | | | - Carlo Gaudio
- Cardiac Department, Sapienza University, Rome, Italy
| | | | - Fabio Miraldi
- Cardiac Department, Sapienza University, Rome, Italy
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Vitarelli A, Gaudio C, Mangieri E, Capotosto L, Tanzilli G, Ricci S, Viceconte N, Placanica A, Placanica G, Ashurov R. Bi-Atrial Function before and after Percutaneous Closure of Atrial Septum in Patients with and without Paroxysmal Atrial Fibrillation: A 2-D and 3-D Speckle Tracking Echocardiographic Study. Ultrasound Med Biol 2018; 44:1198-1211. [PMID: 29609808 DOI: 10.1016/j.ultrasmedbio.2018.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/12/2018] [Accepted: 02/26/2018] [Indexed: 06/08/2023]
Abstract
Our aim was to analyze atrial function with 2-D (2-D-STE) and 3-D (3-D-STE) speckle tracking echocardiography in patients with atrial septal devices and paroxysmal atrial fibrillation (PAF). One hundred sixteen patients and a subgroup of 22 patients who developed PAF after device insertion were studied. Left atrial and right atrial peak longitudinal strain and standard deviations of time to peak strain (TPS) were calculated using 2-D-STE. The left atrial/right atrial emptying fraction and expansion index were determined using 3-D-STE. By multivariate analysis, pre-closure 3-D right atrial expansion index, left atrial time to peak strain, and 3-D left atrial expansion index were independently associated with PAF. Compared with the other indices, receiver operating characteristic analysis revealed better diagnostic accuracy for the combination of pre-closure time to peak strain and 3-D expansion index in detecting PAF. Patients with atrial septal devices have pre-existing left and right atrial dilation and dysfunction as assessed by 2-D-STE and 3-D-STE that appear sensitive for the stratification of PAF risk in this population.
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Affiliation(s)
- Antonio Vitarelli
- Deptartments of Cardiology and Medicine, Sapienza University, Rome, Italy.
| | - Carlo Gaudio
- Deptartments of Cardiology and Medicine, Sapienza University, Rome, Italy
| | - Enrico Mangieri
- Deptartments of Cardiology and Medicine, Sapienza University, Rome, Italy
| | - Lidia Capotosto
- Deptartments of Cardiology and Medicine, Sapienza University, Rome, Italy
| | - Gaetano Tanzilli
- Deptartments of Cardiology and Medicine, Sapienza University, Rome, Italy
| | - Serafino Ricci
- Deptartments of Cardiology and Medicine, Sapienza University, Rome, Italy
| | - Nicola Viceconte
- Deptartments of Cardiology and Medicine, Sapienza University, Rome, Italy
| | - Attilio Placanica
- Deptartments of Cardiology and Medicine, Sapienza University, Rome, Italy
| | - Giuseppe Placanica
- Deptartments of Cardiology and Medicine, Sapienza University, Rome, Italy
| | - Rasul Ashurov
- Deptartments of Cardiology and Medicine, Sapienza University, Rome, Italy
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20
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Vitarelli A, Petrucci MT, Lai S, Gaudio C, Capotosto L, Mangieri E, Ricci S, De Sio S, Truscelli G, Vozella F, Pergolini MS. Dataset on the use of 3D speckle tracking echocardiography in light-chain amyloidosis. Data Brief 2018; 18:1239-1246. [PMID: 29900299 PMCID: PMC5996947 DOI: 10.1016/j.dib.2018.04.013] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/04/2018] [Indexed: 11/28/2022] Open
Abstract
The dataset presented in this article is related to the research article entitled "Biventricular assessment of light-chain amyloidosis using 3D speckle tracking echocardiography: Differentiation from other forms of myocardial hypertrophy" (Vitarelli et al., 2018) [1], which examined the potential utility of left ventricular (LV) and right ventricular (RV) deformation and rotational parameters derived from three-dimensional speckle-tracking echocardiography (3DSTE) to diagnose cardiac amyloidosis(CA) and differentiate this disease from other forms of myocardial hypertrophy. The combined assessment of LV basal longitudinal strain, LV basal rotation and RV basal longitudinal strain had a high discriminative power for detecting CA. The data of this study provides more understanding on the value of LV 3DSTE deformation parameters as well as RV parameters in this particular cardiomyopathy.
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Affiliation(s)
- Antonio Vitarelli
- Depts of Cardiology, Hematology and Medicine, Sapienza University, Rome, Italy
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Gaudio C, Petriello G, Pelliccia F, Tanzilli A, Bandiera A, Tanzilli G, Barillà F, Paravati V, Pellegrini M, Mangieri E, Barillari P. A novel ultrafast-low-dose computed tomography protocol allows concomitant coronary artery evaluation and lung cancer screening. BMC Cardiovasc Disord 2018; 18:90. [PMID: 29739328 PMCID: PMC5941681 DOI: 10.1186/s12872-018-0830-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 02/14/2018] [Accepted: 05/03/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiac computed tomography (CT) is often performed in patients who are at high risk for lung cancer in whom screening is currently recommended. We tested diagnostic ability and radiation exposure of a novel ultra-low-dose CT protocol that allows concomitant coronary artery evaluation and lung screening. METHODS We studied 30 current or former heavy smoker subjects with suspected or known coronary artery disease who underwent CT assessment of both coronary arteries and thoracic area (Revolution CT, General Electric). A new ultrafast-low-dose single protocol was used for ECG-gated helical acquisition of the heart and the whole chest. A single IV iodine bolus (70-90 ml) was used. All patients with CT evidence of coronary stenosis underwent also invasive coronary angiography. RESULTS All the coronary segments were assessable in 28/30 (93%) patients. Only 8 coronary segments were not assessable in 2 patients due to motion artefacts (assessability: 98%; 477/485 segments). In the assessable segments, 20/21 significant stenoses (> 70% reduction of vessel diameter) were correctly diagnosed. Pulmonary nodules were detected in 5 patients, thus requiring to schedule follow-up surveillance CT thorax. Effective dose was 1.3 ± 0.9 mSv (range: 0.8-3.2 mSv). Noteworthy, no contrast or radiation dose increment was required with the new protocol as compared to conventional coronary CT protocol. CONCLUSIONS The novel ultrafast-low-dose CT protocol allows lung cancer screening at time of coronary artery evaluation. The new approach might enhance the cost-effectiveness of coronary CT in heavy smokers with suspected or known coronary artery disease.
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Affiliation(s)
- Carlo Gaudio
- Department of Cardiovascular Sciences, Sapienza University, Via del Policlinico 155, 00161 Rome, Italy
| | - Gennaro Petriello
- Department of Cardiovascular Sciences, Sapienza University, Via del Policlinico 155, 00161 Rome, Italy
| | - Francesco Pelliccia
- Department of Cardiovascular Sciences, Sapienza University, Via del Policlinico 155, 00161 Rome, Italy
| | - Alessandra Tanzilli
- Department of Cardiovascular Sciences, Sapienza University, Via del Policlinico 155, 00161 Rome, Italy
| | | | - Gaetano Tanzilli
- Department of Cardiovascular Sciences, Sapienza University, Via del Policlinico 155, 00161 Rome, Italy
| | - Francesco Barillà
- Department of Cardiovascular Sciences, Sapienza University, Via del Policlinico 155, 00161 Rome, Italy
| | - Vincenzo Paravati
- Department of Cardiovascular Sciences, Sapienza University, Via del Policlinico 155, 00161 Rome, Italy
| | | | - Enrico Mangieri
- Department of Cardiovascular Sciences, Sapienza University, Via del Policlinico 155, 00161 Rome, Italy
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Di Marino S, Viceconte N, Lembo A, Summa V, Tanzilli G, Raparelli V, Truscelli G, Mangieri E, Gaudio C, Cicero DO. Early metabolic response to acute myocardial ischaemia in patients undergoing elective coronary angioplasty. Open Heart 2018; 5:e000709. [PMID: 29632675 PMCID: PMC5888439 DOI: 10.1136/openhrt-2017-000709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 02/09/2018] [Accepted: 02/14/2018] [Indexed: 01/10/2023] Open
Abstract
Objective Balloon-induced transient coronary ischaemia represents a model of myocardial ischaemia and reperfusion. We are interested in the very early systemic metabolic response to this event. Methods Blood samples of patients with stable angina (SA) were collected before and after coronary angioplasty. Serum metabolic profiles were obtained using nuclear magnetic resonance spectroscopy. Univariate and multivariate analyses were used to investigate changes in metabolite concentrations. Results Thirty-four consecutive patients with SA, undergoing elective coronary angioplasty at Policlinico Umberto I of Rome, were included in this study. Changes in metabolites concentration induced by balloon occlusion in venous and arterial sera were detected. In both serum types, a significant increase in ketone bodies, 2-hydroxybutyrate, glutamine and O-acetylcarnitine concentration is observed, while alanine, lactate, phenylalanine and tyrosine decreased after intervention. Most significant metabolic changes were detected in arterial serum. Conclusions Our study points out two main global metabolic changes in peripheral blood after balloon-induced coronary ischaemia: ketone bodies increase and lactate decrease. Both could be related to compensation mechanisms finalised to fulfil heart's needs after short period of myocardial ischaemia and probably after reperfusion.
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Affiliation(s)
| | - Nicola Viceconte
- Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | | | | | - Gaetano Tanzilli
- Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Valeria Raparelli
- Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Giovanni Truscelli
- Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Enrico Mangieri
- Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Carlo Gaudio
- Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Daniel Oscar Cicero
- IRBM Science Park S.p.A., Pomezia, Italy.,Department of Chemical Science and Technology, Università di Roma "Tor Vergata", Rome, Italy
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Truscelli G, Tanzilli G, Viceconte N, Dominici M, Arrivi A, Sommariva L, Granatelli A, Gaudio C, Mangieri E. Glutathione sodium salt as a novel adjunctive treatment for acute myocardial infarction. Med Hypotheses 2017; 102:48-50. [PMID: 28478830 DOI: 10.1016/j.mehy.2017.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 03/05/2017] [Indexed: 10/20/2022]
Abstract
Timely recanalization of infarct related artery along with effective myocardial cell reperfusion represents a major challenge in the management of STEMI. The reperfusion of coronary arteries can induce further cardiomyocyte death by generating oxidative stress, which itself can mediate myocardial damage through a number of different mechanisms. Based on experimental and clinical studies, interventions to treat reperfusion injury by antioxidants were considered to be an appropriate therapeutic option. We emphasize the hypothesis that glutathione sodium salt, a physiologic antioxidant, may be of value when administered to STEMI patients both at an early stage of myocardial reperfusion by primary angioplasty and for up to three days after the procedure, in addition to standard treatment.
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Affiliation(s)
- G Truscelli
- Department of Heart and Great Vessels "Attilio Reale", "Sapienza" University of Rome, Italy
| | - G Tanzilli
- Department of Heart and Great Vessels "Attilio Reale", "Sapienza" University of Rome, Italy
| | - N Viceconte
- Department of Heart and Great Vessels "Attilio Reale", "Sapienza" University of Rome, Italy
| | | | - A Arrivi
- Ospedale "Santa Maria" Terni, Italy
| | | | - A Granatelli
- Ospedale " San Giovanni Evangelista" Tivoli, Italy
| | - C Gaudio
- Department of Heart and Great Vessels "Attilio Reale", "Sapienza" University of Rome, Italy
| | - E Mangieri
- Department of Heart and Great Vessels "Attilio Reale", "Sapienza" University of Rome, Italy.
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Tanzilli G, Viceconte N, Truscelli G, Scappaticci M, Mangieri E. A Case of Very Late Bare-Metal Coronary Stent Thrombosis Two Weeks after Aspirin Discontinuation, Histopathologic Thrombus Findings and Clinical Considerations. Exp Clin Cardiol 2017. [DOI: 10.4172/2155-9880.1000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hubert A, De Zuttere D, Slieker MG, Szymczyk E, Sokalskis V, Danilowicz-Szymanowicz L, Nguyen TM, Lashkul D, Unlu S, Dandu RR, Gouda MGM, Kazakov AI, Zito C, Cambronero Cortinas E, Capotosto L, Galli E, Bouzille G, Samset E, Donal E, Lardoux H, Rocha R, Kone A, Meimoun P, Fackoury C, Slorach C, Hui W, Liu P, Kantor PF, Mital S, Nathan PC, Mertens L, Lipiec P, Michalski BW, Szymczyk K, Kasprzak JD, Aruta P, Cherata D, Muraru D, Badano LP, Fijalkowski M, Rozwadowska K, Kaufmann D, Sikorska K, Galaska R, Gruchala M, Raczak G, Melichova D, Grenne B, Sjoli B, Smiseth OA, Haugaa KH, Edvardsen T, Brunvand H, Sahinarslan A, Gokalp G, Seckin O, Cengel A, Raja D, Kumar S, Garg N, Tewari S, Kapoor A, Goel PK, D'angelo M, Daffina MG, Zucco M, Costantino R, Manganaro R, Longobardo L, Albiero F, Cusma Piccione M, Nucifora G, Caprino A, Carerj ML, Antonini Canterin F, Vriz O, Carerj S, Grapsa J, Valle-Munoz A, Corbi-Pascual MJ, Gin-Sing W, Dawson D, Howard L, Ridocci-Soriano F, Gibbs S, Nihoyannopoulos P, Ashurov R, Mangieri E, Gaudio C, Vitarelli A. P697New indices for a best quantification of left ventricular function in heart valve diseasesP698Intrapatient comparison of three echocardiographic techniques of determination of left ventricular (LV) longitudinal strain, and evaluation of their respective relationship to ejection fractionP699Myocardial strain as an early marker of cardiac dysfunction in a large cohort of anthracycline-treated pediatric cancer survivors?P700Resting 2D speckle tracking echocardiography for the prediction of death 5 years after ST- elevation myocardial infarctionP701Use of fully automated software to quantify left ventricular ejection fraction and left ventricular global longitudinal strainP702Can two-dimensional speckle tracking echocardiography be useful for the left ventricular assessment in the early stages of hereditary hemochromatosis?P703Assessment of left ventricular ejection fraction, global longitudinal strain and mechanical dispersion in acute myocardial infarction after revascularization with percutaneous coronary interventionP704Echocardiographic predictors of worse outcome in patients with ischemic chronic heart failure and renal disfunctionP705Impact of volume overload on right ventricular systolic and diastolic functions evaluated by speckle tracking echocardiographyP706Detection and localisation of obstructive coronary artery disease in chronic stable angina by myocardial deformation parmaters using tissue doppler imagingP707The determinants of deleterious effects of diabetes on the myocardiumP708Echocardiographic evaluation of the left atrium function after catheter ablation of long-standing persistent atrial fibrillationP709Early assessment of chemotherapy-related cardiovascular toxicity: an integrated evaluation through global longitudinal strain and arterial stiffness studyP710Prognostic value of right atrial 3-dimensional speckle tracking in different types of pulmonary arterial hypertensionP711Assessment of biventricular strain by 3-dimensional speckle-tracking echocardiography in chronic aortic regurgitation. Eur Heart J Cardiovasc Imaging 2016; 17:ii143-ii147. [DOI: 10.1093/ehjci/jew250.003] [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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Vitarelli A, Gaudio C, Mangieri E, Tanzilli G, Capotosto L. VALUE OF CONVENTIONAL AND SPECKLE TRACKING ECHOCARDIOGRAPHY IN THE ASSESSMENT OF BIVENTRICULAR FUNCTION IN SECONDARY MITRAL REGURGITATION AFTER REPAIR WITH THE MITRACLIP SYSTEM. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31781-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tanzilli G, Truscelli G, Barillà F, Cocco N, Pannitteri G, Tanzilli A, Al Kindy S, Mangieri E, Gaudio C. Evaluation of hand circulation with CardioWaves photoplethysmograph device during Allen test in healthy volunteers. Eur Rev Med Pharmacol Sci 2015; 19:3006-3011. [PMID: 26367720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Radial artery occlusion is a potential complication of transradial procedures and its occurrence ranges from 0.8 to 30%. It is virtually always asymptomatic but the functional and sensorial consequences of a long acting hand hypoperfusion could go underestimated. CardioWaves is a novel photoplethysmograh device that allows us to detect the pulse wave amplitude of the blood flowing to the hand. Our objective was to assess in normal subjects the hand blood flow supplied by radial arteries and ulnopalmar arches, respectively, by using CardioWaves device during modified Allen's test (MAT). PATIENTS AND METHODS MAT was performed on both hands of 60 normal subjects, age ranging 21 to 66 years, without any cardiovascular factor risk. RESULTS Photoplethysmograh and MAT showed a high positive linear correlation (r=0.93). Despite that, MAT tends to give a higher reading by between 1.05 and 1.6 sec. 11 of 120 readings (9%) by CardioWaves showed values of radial/ulnar pulse amplitude ratio more than mean + 1 SD, suggesting a significant decrease in ulnopalmar arterial circulation when radial blood flow supply would ceased. CONCLUSIONS The CardioWaves device allows us an accurate reading of the flow because of its independency from respiratory changes. Furthemore, the evaluation of radial and ulnar pulse wave amplitude and the ratio between them would reveal an insufficient blood flow supply by the ulnar artery irrespective of the MAT results. We suggest that their assessment before performing coronary angiography and interventions may reduce potential complication of transradial access.
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Affiliation(s)
- G Tanzilli
- Department of Heart and Great Vessel "A. Reale", Sapienza University of Rome, Rome, Italy.
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Illuminati G, Schneider F, Greco C, Mangieri E, Schiariti M, Tanzilli G, Barillà F, Paravati V, Pizzardi G, Calio' F, Miraldi F, Macrina F, Totaro M, Greco E, Mazzesi G, Tritapepe L, Toscano M, Vietri F, Meyer N, Ricco JB. Long-term Results of a Randomized Controlled Trial Analyzing the Role of Systematic Pre-operative Coronary Angiography before Elective Carotid Endarterectomy in Patients with Asymptomatic Coronary Artery Disease. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Illuminati G, Schneider F, Greco C, Mangieri E, Schiariti M, Tanzilli G, Barillà F, Paravati V, Pizzardi G, Calio’ F, Miraldi F, Macrina F, Totaro M, Greco E, Mazzesi G, Tritapepe L, Toscano M, Vietri F, Meyer N, Ricco JB. Long-term Results of a Randomized Controlled Trial Analyzing the Role of Systematic Pre-operative Coronary Angiography before Elective Carotid Endarterectomy in Patients with Asymptomatic Coronary Artery Disease. Eur J Vasc Endovasc Surg 2015; 49:366-74. [DOI: 10.1016/j.ejvs.2014.12.030] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 12/22/2014] [Indexed: 11/28/2022]
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Vitarelli A, Mangieri E, Terzano C, Gaudio C, Salsano F, Rosato E, Capotosto L, D'Orazio S, Azzano A, Truscelli G, Cocco N, Ashurov R. Three-dimensional echocardiography and 2D-3D speckle-tracking imaging in chronic pulmonary hypertension: diagnostic accuracy in detecting hemodynamic signs of right ventricular (RV) failure. J Am Heart Assoc 2015; 4:e001584. [PMID: 25792128 PMCID: PMC4392438 DOI: 10.1161/jaha.114.001584] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Our aim was to compare three-dimensional (3D) and 2D and 3D speckle-tracking (2D-STE, 3D-STE) echocardiographic parameters with conventional right ventricular (RV) indexes in patients with chronic pulmonary hypertension (PH), and investigate whether these techniques could result in better correlation with hemodynamic variables indicative of heart failure. METHODS AND RESULTS Seventy-three adult patients (mean age, 53±13 years; 44% male) with chronic PH of different etiologies were studied by echocardiography and cardiac catheterization (25 precapillary PH from pulmonary arterial hypertension, 23 obstructive pulmonary heart disease, and 23 postcapillary PH from mitral regurgitation). Thirty healthy subjects (mean age, 54±15 years; 43% male) served as controls. Standard 2D measurements (RV-fractional area change-tricuspid annular plane systolic excursion) and mitral and tricuspid tissue Doppler annular velocities were obtained. RV 3D volumes and global and regional ejection fraction (3D-RVEF) were determined. RV strains were calculated by 2D-STE and 3D-STE. RV 3D global-free-wall longitudinal strain (3DGFW-RVLS), 2D global-free-wall longitudinal strain (GFW-RVLS), apical-free-wall longitudinal strain, basal-free-wall longitudinal strain, and 3D-RVEF were lower in patients with precapillary PH (P<0.0001) and postcapillary PH (P<0.01) compared to controls. 3DGFW-RVLS (hazard ratio 4.6, 95% CI 2.79 to 8.38, P=0.004) and 3D-RVEF (hazard ratio 5.3, 95% CI 2.85 to 9.89, P=0.002) were independent predictors of mortality. Receiver operating characteristic curves showed that the thresholds offering an adequate compromise between sensitivity and specificity for detecting hemodynamic signs of RV failure were 39% for 3D-RVEF (AUC 0.89), -17% for 3DGFW-RVLS (AUC 0.88), -18% for GFW-RVLS (AUC 0.88), -16% for apical-free-wall longitudinal strain (AUC 0.85), 16 mm for tricuspid annular plane systolic excursion (AUC 0.67), and 38% for RV-FAC (AUC 0.62). CONCLUSIONS In chronic PH, 3D, 2D-STE and 3D-STE parameters indicate global and regional RV dysfunction that is associated with RV failure hemodynamics better than conventional echo indices.
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Affiliation(s)
- Antonio Vitarelli
- Sapienza University, Department of Cardiology, Italy (A.V., E.M., C.G., L.C., S.O., A.A., G.T., N.C., R.A.)
| | - Enrico Mangieri
- Sapienza University, Department of Cardiology, Italy (A.V., E.M., C.G., L.C., S.O., A.A., G.T., N.C., R.A.)
| | | | - Carlo Gaudio
- Sapienza University, Department of Cardiology, Italy (A.V., E.M., C.G., L.C., S.O., A.A., G.T., N.C., R.A.)
| | | | | | - Lidia Capotosto
- Sapienza University, Department of Cardiology, Italy (A.V., E.M., C.G., L.C., S.O., A.A., G.T., N.C., R.A.)
| | - Simona D'Orazio
- Sapienza University, Department of Cardiology, Italy (A.V., E.M., C.G., L.C., S.O., A.A., G.T., N.C., R.A.)
| | - Alessia Azzano
- Sapienza University, Department of Cardiology, Italy (A.V., E.M., C.G., L.C., S.O., A.A., G.T., N.C., R.A.)
| | - Giovanni Truscelli
- Sapienza University, Department of Cardiology, Italy (A.V., E.M., C.G., L.C., S.O., A.A., G.T., N.C., R.A.)
| | - Nino Cocco
- Sapienza University, Department of Cardiology, Italy (A.V., E.M., C.G., L.C., S.O., A.A., G.T., N.C., R.A.)
| | - Rasul Ashurov
- Sapienza University, Department of Cardiology, Italy (A.V., E.M., C.G., L.C., S.O., A.A., G.T., N.C., R.A.)
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Vitarelli A, Terzano C, Saponara M, Gaudio C, Mangieri E, Capotosto L, Pergolini M, D'Orazio S, Continanza G, Cimino E. Assessment of Right Ventricular Function in Obstructive Sleep Apnea Syndrome and Effects of Continuous Positive Airway Pressure Therapy: A Pilot Study. Can J Cardiol 2015; 31:823-31. [PMID: 25980631 DOI: 10.1016/j.cjca.2015.01.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/25/2015] [Accepted: 01/25/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND It is known that obstructive sleep apnea syndrome (OSAS) can affect right ventricular (RV) performance even in the absence of systemic hypertension and other known cardiac or obstructive pulmonary disease. The purpose of the present study was to assess RV function in OSAS using 3-D echocardiography and speckle tracking echocardiography (STE) and evaluate changes after continuous positive airway pressure (CPAP) treatment. METHODS Thirty-seven patients with OSAS without comorbidities and thirty control subjects were studied using 3-D echocardiography and STE. Fifteen patients underwent CPAP therapy and were studied before and after treatment. RV 3-D ejection fraction was calculated. Peak systolic strain was determined. RV dyssynchrony was defined as SD of the 6 time to peak systolic strain values. RESULTS 3-D RV ejection fraction was lower and RV dyssynchrony was greater in patients with moderate-severe OSAS compared with control subjects in the presence and absence of pulmonary hypertension. 3-D RV ejection fraction and RV dyssynchrony were independently associated with apnea-hypopnea index. Patients treated with CPAP had significant changes in RV parameters. CONCLUSIONS 3-D RV ejection fraction and RV dyssynchrony were abnormal in OSAS patients compared with control subjects and associated with OSAS severity. RV 3-D STE abnormalities improved after chronic application of CPAP.
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Affiliation(s)
| | - Claudio Terzano
- Cardio-Respiratory Department, Sapienza University, Rome, Italy
| | | | - Carlo Gaudio
- Cardio-Respiratory Department, Sapienza University, Rome, Italy
| | - Enrico Mangieri
- Cardio-Respiratory Department, Sapienza University, Rome, Italy
| | - Lidia Capotosto
- Cardio-Respiratory Department, Sapienza University, Rome, Italy
| | | | - Simona D'Orazio
- Cardio-Respiratory Department, Sapienza University, Rome, Italy
| | | | - Ester Cimino
- Cardio-Respiratory Department, Sapienza University, Rome, Italy
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Wang Y, Gong X, Su Y, Cui J, Shu X, Perge P, Kovacs A, Liptai C, Apor A, Nagy K, Geller L, Szeplaki G, Merkely B, Goebel B, Hamadanchi A, Schmidt-Winter C, Otto S, Jung C, Figulla H, Poerner T, Rotzak R, Aharonovich A, Geva Y, Rozenman Y, Capotosto L, D'angeli I, Azzano A, Placanica A, Mukred K, Rinaldi E, Ashurov R, Tanzilli G, Mangieri E, Vitarelli A, Lesevic H, Karl M, Rosner S, Ott I, Sonne C, Borges IP, Peixoto E, Peixoto R, Peixoto R, Marcolla V, Citro R, Baldi C, Provenza G, Di Maio M, Silverio A, Prota C, Di Muro MR, Bossone E, Giudice P, Piscione F, Muratori M, Fusini L, Gripari P, Tamborini G, Ghulam Ali S, Salvi L, Bartorelli A, Agrifoglio M, Alamanni F, Pepi M, Fusini L, Tamborini G, Muratori M, Cefalu' C, Bottari V, Gripari P, Ghulam Ali S, Andreini D, Pontone G, Pepi M. MODERATED POSTER SESSION: Imaging in interventional cardiology: Wednesday 3 December 2014, 09:00-16:00 * Location: Moderated Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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West C, Garcia-Aranda Dominguez B, Alonso-Gonzalez R, Li W, Uebing A, Cruz C, Lebreiro A, Pinho T, Dias C, Silva Cardoso J, Julia Maciel M, Pirat B, Varan B, Erdogan I, Sade L, Muderrisoglu H, Cruz C, Lebreiro A, Pinho T, Dias C, Silva Cardoso J, Julia Maciel M, Mateescu A, Enache R, Nastase O, Botezatu D, Popescu B, Ginghina C, Di Salvo G, D'aiello A, Del Gaizo F, Rea A, Capogrosso C, Russo M, Capotosto L, D'angeli I, Placanica A, Ashurov R, Placanica G, Tanzilli G, Mangieri E, Vitarelli A, Grosse-Wortmann L, Compton G, Dragulescu A, Nield L, Ierano P, Esposito R, Santoro C, De Stefano F, Muscariello R, Buonauro A, Tufano A, Galderisi M, Cantinotti M, Assanta N, Crocetti M, Marotta M, Scalese M, Molinaro S, Murzi B, De Lucia V, Spadoni I, Iervasi G. MODERATED POSTER SESSION: Deformation and multimodality imaging in congenital heart: Thursday 4 December 2014, 08:30-18:00 * Location: Moderated Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tong L, Huang C, Ramalli A, Tortoli P, Luo J, D'hooge J, Tzemos N, Mordi I, Bishay T, Bishay T, Negishi T, Hristova K, Kurosawa K, Bansal M, Thavendiranathan P, Yuda S, Popescu B, Vinereanu D, Penicka M, Marwick T, Hamed W, Kamel M, Yaseen R, El-Barbary H, Nemes A, Kis O, Gavaller H, Kanyo E, Forster T, Angelis A, Vlachopoulos C, Ioakimidis N, Felekos I, Chrysohoou C, Aznaouridis K, Abdelrasoul M, Terentes D, Ageli K, Stefanadis C, Kurnicka K, Domienik-Karlowicz J, Lichodziejewska B, Goliszek S, Grudzka K, Krupa M, Dzikowska-Diduch O, Ciurzynski M, Pruszczyk P, Gual Capllonch F, Lopez Ayerbe J, Teis A, Ferrer E, Vallejo N, Junca G, Pla R, Bayes-Genis A, Schwaiger J, Knight D, Gallimore A, Schreiber B, Handler C, Coghlan J, Bruno RM, Giardini G, Malacrida S, Catuzzo B, Armenia S, Brustia R, Ghiadoni L, Cauchy E, Pratali L, Kim K, Lee K, Cho J, Yoon H, Ahn Y, Jeong M, Cho J, Park J, Cho S, Nastase O, Enache R, Mateescu A, Botezatu D, Popescu B, Ginghina C, Gu H, Sinha M, Simpson J, Chowienczyk P, Fazlinezhad A, Tashakori Behesthi A, Homaei F, Mostafavi H, Hosseini G, Bakaeiyan M, Boutsikou M, Petrou E, Dimopoulos A, Dritsas A, Leontiadis E, Karatasakis G, Sahin ST, Yurdakul S, Yilmaz N, Cengiz B, Cagatay Y, Aytekin S, Yavuz S, Karlsen S, Dahlslett T, Grenne B, Sjoli B, Smiseth O, Edvardsen T, Brunvand H, Nasr G, Nasr A, Eleraki A, Elrefai S, Mordi I, Sonecki P, Tzemos N, Gustafsson U, Naar J, Stahlberg M, Cerne A, Capotosto L, Rosato E, D'angeli I, Azzano A, Truscelli G, De Maio M, Salsano F, Terzano C, Mangieri E, Vitarelli A, Renard S, Najih H, Mancini J, Jacquier A, Haentjens J, Gaubert J, Habib G, Caminiti G, D'antoni V, D'antoni V, Cardaci V, Cardaci V, Conti V, Conti V, Volterrani M, Volterrani M, Ahn J, Kim D, Lee H, Iliuta L, Lo Iudice F, Esposito R, Lembo M, Santoro C, Ballo P, Mondillo S, De Simone G, Galderisi M, Hwang Y, Kim J, Kim J, Moon K, Yoo K, Kim C, Tagliamonte E, Rigo F, Cirillo T, Caruso A, Astarita C, Cice G, Quaranta G, Romano C, Capuano N, Calabro' R, Zagatina A, Zhuravskaya N, Guseva O, Huttin O, Benichou M, Voilliot D, Venner C, Micard E, Girerd N, Sadoul N, Moulin F, Juilliere Y, Selton-Suty C, Baron T, Christersson C, Johansson K, Flachskampf F, Lee S, Lee J, Hur S, Park J, Yun J, Song S, Kim W, Ko J, Nyktari E, Bilal S, Ali S, Izgi C, Prasad S, Aly M, Kleijn S, Kandil H, Kamp O, Beladan C, Calin A, Rosca M, Craciun A, Gurzun M, Calin C, Enache R, Mateescu A, Ginghina C, Popescu B, Mornos C, Mornos A, Ionac A, Cozma D, Crisan S, Popescu I, Ionescu G, Petrescu L, Camacho S, Gamaza Chulian S, Carmona R, Diaz E, Giraldez A, Gutierrez A, Toro R, Benezet J, Antonini-Canterin F, Vriz O, La Carrubba S, Poli S, Leiballi E, Zito C, Careri S, Caruso R, Pellegrinet M, Nicolosi G, Kong W, Kyu K, Wong R, Tay E, Yip J, Yeo T, Poh K, Correia M, Delgado A, Marmelo B, Correia E, Abreu L, Cabral C, Gama P, Santos O, Rahman M, Borges IP, Peixoto E, Peixoto R, Peixoto R, Marcolla V, Okura H, Kanai M, Murata E, Kataoka T, Stoebe S, Tarr A, Pfeiffer D, Hagendorff A, Generati G, Bandera F, Pellegrino M, Alfonzetti E, Labate V, Guazzi M, Kuznetsov V, Yaroslavskaya E, Pushkarev G, Krinochkin D, Zyrianov I, Carigi S, Baldazzi F, Bologna F, Amati S, Venturi P, Grosseto D, Biagetti C, Fabbri E, Arlotti M, Piovaccari G, Rahbi H, Bin Abdulhaq A, Tleyjeh I, Santoro C, Galderisi M, Costantino M, Tarsia G, Innelli P, Dores E, Esposito G, Matera A, De Simone G, Trimarco B, Capotosto L, Azzano A, Mukred K, Ashurov R, Tanzilli G, Mangieri E, Vitarelli A, Merlo M, Gigli M, Stolfo D, Pinamonti B, Antonini Canterin F, Muca M, D'angelo G, Scapol S, Di Nucci M, Sinagra G, Behaghel A, Feneon D, Fournet M, Thebault C, Martins R, Mabo P, Leclercq C, Daubert C, Donal E, Davinder Pal S, Prakash Chand N, Sanjeev A, Rajeev M, Ankur D, Ram Gopal S, Mzoughi K, Zairi I, Jabeur M, Ben Moussa F, Ben Chaabene A, Kamoun S, Mrabet K, Fennira S, Zargouni A, Kraiem S, Demkina A, Hashieva F, Krylova N, Kovalevskaya E, Potehkina N, Zaroui A, Ben Said R, Smaali S, Rekik B, Ben Hlima M, Mizouni H, Mechmeche R, Mourali M, Malhotra A, Sheikh N, Dhutia H, Siva A, Narain R, Merghani A, Millar L, Walker M, Sharma S, Papadakis M, Siam-Tsieu V, Mansencal N, Arslan M, Deblaise J, Dubourg O, Zaroui A, Rekik B, Ben Said R, Boudiche S, Larbi N, Tababi N, Hannachi S, Mechmeche R, Mourali M, Mechmeche R, Zaroui A, Chalbia T, Ben Halima M, Rekik B, Boussada R, Mourali M, Lipari P, Bonapace S, Valbusa F, Rossi A, Zenari L, Lanzoni L, Targher G, Canali G, Molon G, Barbieri E, Novo G, Giambanco S, Sutera M, Bonomo V, Giambanco F, Rotolo A, Evola S, Assennato P, Novo S, Budnik M, Piatkowski R, Kochanowski J, Opolski G, Chatzistamatiou E, Mpampatseva Vagena I, Manakos K, Moustakas G, Konstantinidis D, Memo G, Mitsakis O, Kasakogias A, Syros P, Kallikazaros I, Marketou M, Parthenakis F, Kalyva N, Pontikoglou C, Maragkoudakis S, Zacharis E, Patrianakos A, Maragoudakis F, Papadaki H, Vardas P, Rodrigues A, Perandini L, Souza T, Sa-Pinto A, Borba E, Arruda A, Furtado M, Carvalho F, Bonfa E, Andrade J, Hlubocka Z, Malinova V, Palecek T, Danzig V, Kuchynka P, Dostalova G, Zeman J, Linhart A, Chatzistamatiou E, Konstantinidis D, Memo G, Mpampatzeva Vagena I, Moustakas G, Manakos K, Trachanas K, Vergi N, Feretou A, Kallikazaros I, Corut H, Sade L, Ozin B, Atar I, Turgay O, Muderrisoglu H, Ledakowicz-Polak A, Polak L, Krauza G, Zielinska M, Szulik M, Streb W, Wozniak A, Lenarczyk R, Sliwinska A, Kalarus Z, Kukulski T, Nogueira M, Branco L, Agapito A, Galrinho A, Borba A, Teixeira P, Monteiro A, Ramos R, Cacela D, Cruz Ferreira R, Guala A, Camporeale C, Tosello F, Canuto C, Ridolfi L, Chatzistamatiou E, Moustakas G, Memo G, Konstantinidis D, Mpampatzeva Vagena I, Manakos K, Traxanas K, Vergi N, Feretou A, Kallikazaros I, Hristova K, Marinov R, Stamenov G, Mihova M, Persenska S, Racheva A, Plaskota K, Trojnarska O, Bartczak A, Grajek S, Ramush Bejiqi R, Retkoceri R, Bejiqi H, Beha A, Surdulli S, Dreyfus J, Durand-Viel G, Cimadevilla C, Brochet E, Vahanian A, Messika-Zeitoun D, Jin C, Fang F, Meng F, Kam K, Sun J, Tsui G, Wong K, Wan S, Yu C, Lee A, Cho IJ, Chung H, Heo R, Ha S, Hong G, Shim C, Chang H, Ha J, Chung N, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Alexopoulos A, Dawson D, Nihoyannopoulos P, Zainal Abidin HA, Ismail J, Arshad K, Ibrahim Z, Lim C, Abd Rahman E, Kasim S, Peteiro J, Barrio A, Escudero A, Bouzas-Mosquera A, Yanez J, Martinez D, Castro-Beiras A, Scali M, Simioniuc A, Mandoli G, Lombardo A, Massaro F, Di Bello V, Marzilli M, Dini F, Adachi H, Tomono J, Oshima S, Merchan Ortega G, Bravo Bustos D, Lazaro Garcia R, Sanchez Espino A, Macancela Quinones J, Ikuta I, Ruiz Lopez M, Valencia Serrano F, Bonaque Gonzalez J, Gomez Recio M, Romano G, D'ancona G, Pilato G, Di Gesaro G, Clemenza F, Raffa G, Scardulla C, Sciacca S, Lancellotti P, Pilato M, Addetia K, Takeuchi M, Maffessanti F, Weinert L, Hamilton J, Mor-Avi V, Lang R, Sugano A, Seo Y, Watabe H, Kakefuda Y, Aihara H, Nishina H, Ishizu T, Fumikura Y, Noguchi Y, Aonuma K, Luo X, Fang F, Lee A, Shang Q, Yu C, Sammut EC, Chabinok R, Jackson T, Siarkos M, Lee L, Carr-White G, Rajani R, Kapetanakis S, Byrne D, Walsh J, Ellis L, Mckiernan S, Norris S, King G, Murphy R, Hristova K, Katova T, Simova I, Kostova V, Shuie I, Ferferieva V, Bogdanova V, Castelon X, Nemes A, Sasi V, Domsik P, Kalapos A, Lengyel C, Orosz A, Forster T, Grapsa J, Demir O, Dawson D, Sharma R, Senior R, Nihoyannopoulos P, Pilichowska E, Zaborska B, Baran J, Stec S, Kulakowski P, Budaj A, Kosmala W, Kaye G, Saito M, Negishi K, Marwick T, Maceira Gonzalez AM, Ripoll C, Cosin-Sales J, Igual B, Salazar J, Belloch V, Dulai RS, Taylor A, Gupta S. Poster session 1: Wednesday 3 December 2014, 09:00-16:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014; 15:ii25-ii51. [DOI: 10.1093/ehjci/jeu248] [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: 09/02/2023] Open
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Vitarelli A, Mangieri E, Capotosto L, Tanzilli G, D'Angeli I, Toni D, Azzano A, Ricci S, Placanica A, Rinaldi E, Mukred K, Placanica G, Ashurov R. Echocardiographic findings in simple and complex patent foramen ovale before and after transcatheter closure. Eur Heart J Cardiovasc Imaging 2014; 15:1377-85. [PMID: 25139906 DOI: 10.1093/ehjci/jeu143] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Percutaneous closure of patent foramen ovale (PFO) in cryptogenic cerebrovascular events is an alternative to medical therapy. The interpretation of residual shunts after implantation of different devices for PFO with different morphologies is controversial. METHODS AND RESULTS Transcatheter PFO closure was performed in 123 patients with a history of ≥1 paradoxical embolism using three different devices: Amplatzer (n = 46), Figulla Occlutech (n = 41), and Atriasept Cardia (n = 36). Fifty-six patients presented with simple PFO and 67 patients had complex morphologies. All patients were studied with contrast enhanced transesophageal echocardiography (TEE) before interventional procedure and thereafter at 1 and 6 months and every 6-12 months in case of incomplete closure. Definite closure was confirmed in at least two consecutive TEE studies. Various PFO morphologies were identified by TEE before device implantation. The device size to PFO diameter ratio was significantly increased in patients with complex PFO compared with those patients with a simple PFO morphology (P < 0.05). The difference between the closure rate of S-PFO and C-PFO concerning each device type was significant (Amplatzer P = 0.0027, Figulla P = 0.0043, and Atriasept P < 0.01). The mean follow-up period was 3.4 years (median 2.7 years) with a cerebrovascular re-event rate of 2.4% per year. In three patients, thrombi were detected in the 6-month TEE controls and resolved after medical therapy. In three other patients, the implantation of an adjunctive device was necessary for residual shunt. CONCLUSION In our series of patients, the closure rate was dependent on PFO morphology more than occluder size and type. An adjunctive device was implanted in selected cases.
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Affiliation(s)
| | | | | | | | | | - Danilo Toni
- Sapienza University, Via Lima 35, Rome 00198, Italy
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Basili S, Tanzilli G, Raparelli V, Calvieri C, Pignatelli P, Carnevale R, Dominici M, Placanica A, Arrivi A, Farcomeni A, Barillà F, Mangieri E, Violi F. Aspirin reload before elective percutaneous coronary intervention: impact on serum thromboxane b2 and myocardial reperfusion indexes. Circ Cardiovasc Interv 2014; 7:577-84. [PMID: 25074252 DOI: 10.1161/circinterventions.113.001197] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Microvascular obstruction seems to predict poor outcome in patients undergoing elective percutaneous coronary intervention (PCI), but the underlying mechanism is still unclear. We analyzed whether serum thromboxane B2, a stable metabolite of thromboxane A2, may be implicated in post-PCI microvascular obstruction. METHODS AND RESULTS We enrolled 91 patients (74 males, 66±10 years) on chronic low-dose aspirin therapy (aspirin, 100 mg daily) scheduled for elective PCI and randomly assigned to receive aspirin reload (325 mg orally, n=46) or no reload (control group, n=45) ≥1 hour before elective PCI. Serum levels of thromboxane B2, reperfusion indexes (corrected Thrombolysis In Myocardial Infarction frame count and myocardial blush grade), and serum cardiac troponin I were assessed before and after PCI. Serum thromboxane B2 significantly increased after 120 minutes (P=0.0447) from PCI in control but not in aspirin reload group. After PCI, both groups showed a statistically significant reduction in corrected Thrombolysis In Myocardial Infarction frame count more evident in aspirin reload group (P=0.0023). Moreover, after PCI, 61% of patients allocated to aspirin reload and only 32% of patients allocated to control group reached normal microcirculatory reperfusion (myocardial blush grade=3); patients with myocardial blush grade=3 exhibited lower values of serum thromboxane B2 compared with those with myocardial blush grade <3 (P=0.05). Periprocedural cardiac troponin I significantly increased (F=3.64; P=0.01334) and correlated with serum thromboxane B2 (ρ=0.31; P=0.0413) in control but not in aspirin reload group. In addition, left ventricular ejection fraction significantly increased after PCI only in the aspirin reload group (P=0.0005). CONCLUSIONS Aspirin loading dose before elective PCI improves myocardial reperfusion and injury indexes, suggesting a possible role of platelet thromboxane A2 in microvascular occlusion. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01374698.
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Affiliation(s)
- Stefania Basili
- From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.).
| | - Gaetano Tanzilli
- From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.)
| | - Valeria Raparelli
- From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.)
| | - Camilla Calvieri
- From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.)
| | - Pasquale Pignatelli
- From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.)
| | - Roberto Carnevale
- From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.)
| | - Marcello Dominici
- From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.)
| | - Attilio Placanica
- From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.)
| | - Alessio Arrivi
- From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.)
| | - Alessio Farcomeni
- From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.)
| | - Francesco Barillà
- From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.)
| | - Enrico Mangieri
- From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.)
| | - Francesco Violi
- From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.)
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Pellicori P, Torromeo C, Barillà F, Mangieri E, Evangelista A, Truscelli G, Costanzo P, Hoye A, Wong K. Intravenous versus intracoronary bolus of glycoprotein IIb/IIIa inhibitor administration during primary percutaneous coronary intervention on long-term left ventricular systolic and diastolic function. Cardiol J 2013; 20:310-7. [PMID: 23788306 DOI: 10.5603/cj.2013.0077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 06/10/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In primary percutaneous coronary intervention (PCI), glycoprotein (GP) IIb/IIIa inhibitors are often given in order to attain and maintain better myocardial perfusion. We tested the hypothesis that intracoronary (IC) bolus of GP IIb/IIIa inhibitors might produce a greater improvement in left ventricular (LV) systolic and diastolic function than an intravenous(IV) bolus. METHODS AND RESULTS Seventy seven patients undergoing primary PCI for their first ST elevation myocardial infarction (STEMI) were randomly assigned to either an IC or IV bolus of GP IIb/IIIa inhibitor, followed by IV infusion. Compared with the echocardiographic findings within 3 days after PCI, LV ejection fraction was higher at 1 year, with no significant differences between the IV and IC groups (IV: 44% vs. 49%, p = 0.001; IC: 43% vs. 48%,p < 0.001). LV diastolic function (E/E') did not significantly change at 1 year by either approach. CONCLUSIONS LV systolic function improved by a similar magnitude following primary PCI, with either IC or IV bolus administration of GP IIb/IIIa inhibitor therapy. However, no significant changes were observed in LV diastolic function.
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Affiliation(s)
- Pierpaolo Pellicori
- Department of Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, MRTDS (Daisy) Building, Castle Hill Hospital, Cottingham, UK; Heart and Great Vessel Department, Policlinico Umberto I, Sapienza University, Rome, Italy.
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Arrivi A, Tanzilli G, Puddu PE, Iannucci L, Mangieri E. Rosuvastatin was Effective in Acute Heart Failure and Slow Coronary Flow: A Hypothesis-generating Case Report. Open Cardiovasc Med J 2013; 7:12-5. [PMID: 23459636 PMCID: PMC3584290 DOI: 10.2174/1874192401307010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/01/2012] [Indexed: 11/22/2022] Open
Abstract
Slow coronary flow phenomenon (SCFP) is characterized by angiographically normal coronary arteries with delayed run-off of contrast medium across the vasculature. Its etiology and clinical significance are still not completely known; however, acute congestive heart failure (CHF) is rare in this context. A 71 year-old woman with SCFP presented with acute CHF complicated by ventricular tachycardia. Treated with rosuvastatin (20 mg/day for 6 days) and inotropic drug infusion she had a complete recovery of left ventricular function and normalization of serum levels of the high-sensitivity C-reactive protein (hs-CRP), which were increased (3.6 mg/L) during the acute phase. This case illustrates that the anti-inflammatory properties of rosuvastatin may deserve specific clinical tests not only during the chronic phase but also in the acute phase of CHF patients.
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Iriart X, Selly J, Thambo J, Van De Bruaene A, De Meester P, Delcroix M, Voigt J, Budts W, Sordi M, Aubry P, Juliard J, Messika-Zeitoun D, Mangieri E, Vahanian A, Brochet E, Elahi B, Sadeghpour A, Kyavar M, Madadi S, Iriart X, Horovitz A, Van Geldorp I, Thambo J. Congenital Heart Diseases. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Barillà F, Pulcinelli FM, Mangieri E, Torromeo C, Tanzilli G, Dominici T, Pellicano M, Paravati V, Acconcia MC, Gaudio C. Clopidogrel plus indobufen in acute coronary syndrome patients with hypersensitivity to aspirin undergoing percutaneous coronary intervention. Platelets 2012; 24:183-8. [DOI: 10.3109/09537104.2012.686072] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Basili S, Pignatelli P, Tanzilli G, Mangieri E, Carnevale R, Nocella C, Di Santo S, Pastori D, Ferroni P, Violi F. Anoxia-reoxygenation enhances platelet thromboxane A2 production via reactive oxygen species-generated NOX2: effect in patients undergoing elective percutaneous coronary intervention. Arterioscler Thromb Vasc Biol 2011; 31:1766-71. [PMID: 21636808 DOI: 10.1161/atvbaha.111.227959] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Platelets undergoing anoxia-reoxygenation (AR) simultaneously increase reactive oxygen species (ROS) and thromboxane (Tx) B(2). Our aim was to assess whether there is an interplay between activation of NOX2, the catalytic subunit of NADPH oxidase, and platelet TxB(2) in vitro and in vivo. METHODS AND RESULTS Platelets that underwent AR had enhanced ROS. This was associated with NOX2 activation and was inhibited by incubation with NOX2-blocking peptide. AR was associated with TxB(2) and isoprostane production, which were inhibited by NOX2-blocking peptide, vitamin C, and the inhibitor of phospholipase A(2). Platelet incubation with 100 μmol/L aspirin fully prevented AR-induced TxA(2) but did not affect isoprostane production. We included 56 aspirin-treated patients undergoing elective percutaneous coronary intervention (PCI) who were randomly allocated to receive either placebo or intravenous infusion of 1 g of vitamin C. Blood TxB(2), isoprostanes, and soluble NOX2-derived peptide, a marker of systemic NADPH oxidase activation, significantly increased at 60 and 120 minutes after PCI in placebo-treated but not in vitamin C-treated patients. CONCLUSIONS AR is associated with overproduction of platelet TxB(2) and isoprostanes, which is dependent on NOX2-dependent ROS generation. Low doses of aspirin are unable to prevent TxB(2) formation in patients who undergo PCI.
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Affiliation(s)
- Stefania Basili
- Divisione I Clinica Medica, Sapienza University of Rome, Italy
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Arrivi A, Tanzilli G, Tritapepe L, Mazzesi G, Mangieri E. Undetected acute aortic dissection in a patient referred for primary coronary angioplasty: a successful treatment of perioperative bleeding after abciximab administration. BMJ Case Rep 2010; 2010:2010/dec13_1/bcr1020103382. [PMID: 22802278 DOI: 10.1136/bcr.10.2010.3382] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors describe a case of an acute aortic dissection in a Japanese woman with long-lasting hypertension, who was referred to our cath lab for primary percutaneous coronary intervention because of an ECG feature of acute inferior myocardial infarction and systemic hypotension. A successful treatment of perioperative bleeding followed a missed diagnosis in the early stages and abciximab administration.
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Affiliation(s)
- A Arrivi
- Heart and Great Vessels A. Reale Second Division of Cardiology, Policlinico Umberto I, Sapienza University, Rome, Italy.
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Tanzilli G, Greco C, Pasceri V, Pelliccia F, Arrivi A, Placanica A, Mangieri E. Dipyridamole versus verapamil for treatment of no-reflow during primary angioplasty. Catheter Cardiovasc Interv 2010; 76:787-93. [DOI: 10.1002/ccd.22724] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 06/28/2010] [Indexed: 11/11/2022]
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Illuminati G, Ricco JB, Greco C, Mangieri E, Calio' F, Ceccanei G, Pacilè M, Schiariti M, Tanzilli G, Barillà F, Paravati V, Mazzesi G, Miraldi F, Tritapepe L. Systematic Preoperative Coronary Angiography and Stenting Improves Postoperative Results of Carotid Endarterectomy in Patients with Asymptomatic Coronary Artery Disease: A Randomised Controlled Trial. Eur J Vasc Endovasc Surg 2010; 39:139-45. [DOI: 10.1016/j.ejvs.2009.11.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 11/15/2009] [Indexed: 10/20/2022]
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Illuminati G, Ricco JB, Greco C, Mangieri E, Calio' F, Ceccanei G, Pacilè M, Schiariti M, Tanzilli G, Barillà F, Paravati V, Mazzesi G, Miraldi F, Tritapepe L. Systematic Preoperative Coronary Angiography and Stenting Improves Postoperative Results of Carotid Endarterectomy in Patients with Asymptomatic Coronary Artery Disease: A Randomised Controlled Trial. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2009.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tanzilli G, Greco C, Pelliccia F, Pasceri V, Barillà F, Paravati V, Pannitteri G, Gaudio C, Mangieri E. Effectiveness of two-year clopidogrel + aspirin in abolishing the risk of very late thrombosis after drug-eluting stent implantation (from the TYCOON [two-year ClOpidOgrel need] study). Am J Cardiol 2009; 104:1357-61. [PMID: 19892050 DOI: 10.1016/j.amjcard.2009.07.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 07/02/2009] [Accepted: 07/02/2009] [Indexed: 12/16/2022]
Abstract
It remains unclear whether dual antiplatelet therapy >12 months might carry a better prognosis after percutaneous coronary intervention (PCI) with drug-eluting stents (DESs). To address the hypothesis that in the real world the risk of very late thrombosis after PCI with DESs can be decreased by an extended use of clopidogrel, we set up the Two-Year ClOpidOgrel Need (TYCOON) registry and prospectively investigated the impact on very late thrombosis of 12- versus 24-month dual antiplatelet regimens in an unselected population. The registry enrolled 897 consecutive patients who underwent PCI with stenting from January 1, 2003, to December 31, 2004, and had dual antiplatelet therapy. All patients had a 4-year clinical follow-up. In the 447 patients with DES implantation, the dual antiplatelet regimen after PCI was given for 12 months in the 173 patients treated in 2003 (12-month group) and for 24 months in the 274 patients treated in 2004 (24-month group). Comparison between groups did not reveal any significant difference in baseline clinical characteristics, angiographic and procedural features, and major adverse cardiac events. During follow-up, there were 5 cases of stent thrombosis after PCI in the 12-month DES group and 1 case in the 24-month DES group (p = 0.02). Specifically, there were 2 cases of subacute thrombosis (1 in each group), no case of late thrombosis, and 4 cases of very late thrombosis occurring at 13, 15, 17, and 23 months after DES implantation in the 12-month group only. In conclusion, a 2-year dual antiplatelet regimen with aspirin and clopidogrel can prevent the occurrence of very late stent thrombosis after PCI with DESs.
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Affiliation(s)
- Gaetano Tanzilli
- Department of Heart and Great Vessels Attilio Reale, La Sapienza University, Rome, Italy
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Abstract
BACKGROUND Chest pain is frequently reported in Fabry disease (FD). However, its mechanism and clinical relevance are unclear. METHODS AND RESULTS Basal troponin I level, exercise stress test, single-photon emission computed tomography imaging with (99m)Tc sestamibi, coronary angiography with thrombolysis in myocardial infarction (TIMI) frame count and left ventricular angiography and endomyocardial biopsy were obtained in 13 patients with FD with angina. Ratio of external to lumen diameter of intramural arteries (E/L ratio), myocyte diameter, and extent of fibrosis were morphometrically evaluated by using tissue sections. Controls for coronary angiography and histology were 25 patients with FD without angina and 20 mitral stenosis patients with normal left ventricular function. Troponin I level was elevated in 6 of the 13 patients. Exercise stress test showed evidence of myocardial ischemia, and single-photon emission computed tomography was positive for stress-induced perfusion defects in all patients with FD with angina. Epicardial coronaries were structurally normal but showed slow flow in all and were associated with aneurisms of posterior left ventricular wall in 3 cases. Histology showed remarkable lumen narrowing of most intramural arteries (mean E/L ratio=3.5+/-1.2; P<0.001 versus both control groups), because of hypertrophy and proliferation of smooth muscle and endothelial cells, both engulfed by glycosphingolipids. Replacement fibrosis exceeded that of both controls (P<0.001). Small vessel disease correlated with coronary slow flow and extent of fibrosis, but did not with patients' age, sex, and degree of left ventricular hypertrophy. CONCLUSIONS patients with FD with angina have perfusion defects, slow coronary flow, and luminal narrowing of intramural arteries. Small vessel disease may contribute to symptomatic limitation and progressive myocardial dysfunction.
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Affiliation(s)
- Cristina Chimenti
- Heart and Great Vessels Attilio Reale Department, La Sapienza University, Rome, Italy
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Tanzilli G, Sordi M, Arrivi A, Mangieri E, Scappaticci M. Acute profound abciximab induced thrombocytopenia: a correct management of a methodological error. BMJ Case Rep 2009; 2009:bcr12.2008.1381. [PMID: 21977060 PMCID: PMC3030165 DOI: 10.1136/bcr.12.2008.1381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thrombocytopenia is a rare complication of glycoprotein IIb/IIIa treatment. We report a case of an acute profound abciximab induced thrombocytopenia and its successful management. The patient, presenting with unstable angina, underwent percutaneous coronary intervention with implantation of three drug eluting stents without receiving a clopidogrel loading dose according to guidelines. The rapid drop in the platelet count after abciximab elastomeric pump infusion was treated with drug discontinuation and platelet transfusion. The high risk of stent thrombosis was avoided by a timely readministration of the dual antiplatelet treatment.
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Affiliation(s)
- Gaetano Tanzilli
- Policlinico Umberto I, Viale del Policlinico 155, Roma, 00161, Italy
| | - Martina Sordi
- Policlinico Umberto I, “Attilio Reale”, Viale del Policlinico 155, Rome, 00161, Italy
| | - Alessio Arrivi
- Policlinico Umberto I, “Attilio Reale”, Viale del Policlinico 155, Rome, 00161, Italy
| | - Enrico Mangieri
- Policlinico Umberto I, “Attilio Reale”, Viale del Policlinico 155, Rome, 00161, Italy
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Tanzilli G, Arrivi A, Sordi M, Pavaci H, Placanica A, Mangieri E. Very late bare metal stent thrombosis with concomitant patent drug eluting stent in the same vessel: a case for a suggestive hypothesis. Case Reports 2009; 2009:bcr06.2009.2014. [DOI: 10.1136/bcr.06.2009.2014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Gaudio C, Mirabelli F, Pelliccia F, Francone M, Tanzilli G, Di Michele S, Leonetti S, De Vincentis G, Carbone I, Mangieri E, Catalano C, Passariello R. Early detection of coronary artery disease by 64-slice multidetector computed tomography in asymptomatic hypertensive high-risk patients. Int J Cardiol 2009; 135:280-6. [DOI: 10.1016/j.ijcard.2008.03.091] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 02/28/2008] [Accepted: 03/06/2008] [Indexed: 11/28/2022]
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