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Bellino M, Antonini-Canterin F, Bossone E, Faggiano P, Chirillo F, La Carrubba S, Faganello G, Cecconi M, Zito C, Dasseni N, Nistri S, Moreo A, Fabiani I, Faden G, Agostini F, Manuppelli V, Cameli M, Cresti A, Dentamaro I, Monte IP, Barbieri A, Ciampi Q, Giorgi M, Galasso G, Carerj S, Pepi M, Benedetto F, Colonna P, Citro R. Aortopathy and aortic valve surgery in patients with bicuspid aortic valve with and without raphe. Int J Cardiol 2024:132000. [PMID: 38561108 DOI: 10.1016/j.ijcard.2024.132000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/04/2024]
Abstract
AIM To evaluate the association between raphe in bicuspid aortic valve (BAV) patients and valve dysfunction, aortopathy and aortic valve surgery in the REBECCA registry [REgistro della valvola aortica Bicuspide della Società Italiana di ECocardiografia e CArdiovascular Imaging (SIECVI)]. METHODS Prevalence of aortic valve dysfunction and aortopathy was investigated in BAV patients with and without raphe. Aortic valve dysfunction (regurgitation or stenosis) was categorized as mild, moderate and severe. Aortopathy was defined as annulus ≥14 mm/m2; root ≥20 mm/m2; sinotubular junction ≥16 mm/m2; ascending aorta ≥17 mm/m2, and classified in Type A, isolated ascending aorta dilatation; Type B, aortic root and ascending aorta dilatation; and Type C, isolated aortic root dilatation. RESULTS Overall, 695 patients with BAV were enrolled; 520 (74.8%) with raphe and 175 (25.2%) without raphe. BAV patients with raphe presented more frequently with moderate or severe aortic stenosis than BAV patients without raphe (183 [35.2%] vs 34 [19.4%], p < 0.001). A higher prevalence of aortopathy, particularly Type B, was observed in patients with vs without raphe. At multivariable analysis, raphe was a predictor of aortic valve surgery at three-year follow-up (odds ratio 2.19, 95% confidence interval 1.08-4.44, p < 0.001). CONCLUSIONS Patients with BAV and raphe have a higher prevalence of significant aortic stenosis, aortopathy, especially Type B, and a higher risk of undergoing aortic valve surgery at three-year follow-up.
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Affiliation(s)
- Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | | | - Eduardo Bossone
- Department of Public Health, "Federico II" University of Naples, Naples, Italy
| | - Pompilio Faggiano
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Fabio Chirillo
- Department of Cardiology, Ospedale San Bassiano, Bassano del Grappa (VI), Italy
| | | | - Giorgio Faganello
- Cardiovascular Department, University Hospital and Health Services of Trieste, Trieste, Italy
| | - Moreno Cecconi
- Department of Cardiology and Cardiac Surgery, Azienda Ospedaliero Universitaria, Ospedali Riuniti, Ancona, Italy
| | - Concetta Zito
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino", Messina, Italy
| | - Nicolò Dasseni
- Cardiology Division, ASST Franciacorta, Chiari (BS), Italy
| | - Stefano Nistri
- Department of Cardiology, CMSR, Altavilla Vicentina (VI), Italy
| | - Antonella Moreo
- Cardiology IV, "A. De Gasperis" Department, ASST Niguarda Metropolitan Hospital, Milan, Italy
| | - Iacopo Fabiani
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | | | | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alberto Cresti
- Cardiology, Cardio Neuro Vascular Department, Asl Sudest Toscana, Hospital of Grosseto, Grosseto, Italy
| | - Ilaria Dentamaro
- Cardiology Department and Cardiovascular Imaging Laboratory, Hospital Miulli, Bari, Italy
| | - Ines Paola Monte
- Department of General Surgery and Medical Surgery Specialties, University of Catania, AOU Policlinico G. Rodolico-San Marco, Catania, Italy
| | - Andrea Barbieri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Mauro Giorgi
- Department of Cardiology, University Hospital Città della Scienza e Salute, Molinette Hospital, Turin, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Scipione Carerj
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino", Messina, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Frank Benedetto
- Cardiology, G.O.M. "Bianchi Melacrino Morelli", Reggio Calabria, Italy
| | - Paolo Colonna
- Department of Cardiology, Hospital Policlinico of Bari, Bari, Italy
| | - Rodolfo Citro
- Cardio-Thoracic and Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy; Department of Vascular Physiopathology, IRCCS Neuromed, Pozzilli (IS), Italy.
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De Luca L, Calabrò P, Capranzano P, Di Mario C, Chirillo F, Rolfo C, Menozzi A, Menichelli M, Bolognese L, Musumeci G. Safety of cangrelor and transition to oral P2Y 12 inhibitors in patients undergoing percutaneous coronary intervention: the ARCANGELO study. Eur Heart J Open 2023; 3:oead076. [PMID: 37646045 PMCID: PMC10462400 DOI: 10.1093/ehjopen/oead076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/04/2023] [Accepted: 08/01/2023] [Indexed: 09/01/2023]
Abstract
Aims Cangrelor is the only intravenous P2Y12 inhibitor available. Safety, efficacy, and transitioning from cangrelor to oral P2Y12 inhibitors were recorded in patients with acute coronary syndrome (ACS). The ARCANGELO study aims to assess the safety of cangrelor on bleeding and the effects of the transition to oral P2Y12 inhibitors in a real-world setting according to the European Medical Agency's requirement. Methods and results Adult patients with ACS undergoing percutaneous coronary intervention (PCI) receiving cangrelor were included in the study. Patients were followed for 30 days. Incidence of bleeding events, major adverse cardiac events, and transition strategy to oral P2Y12 were recorded. Among 1004 ACS patients undergoing PCI, 995 (99.1%) were eligible for the analysis; 597 (60.0%) of them had ST-segment elevation myocardial infarction. A total of 925 (93.1%) patients underwent PCI by radial catheter access, and 972 (97.2%) received drug-eluting stents. All eligible patients received bolus and cangrelor infusion between 2 and 4 h in 95% of the cases. A total of 730 patients (73.4%) received ticagrelor, 127 (12.8%) prasugrel, and 138 (13.9%) clopidogrel as transition therapy. Bleeding, according to Bleeding Academic Research Consortium (BARC) criteria, within 30 days post-PCI occurred in 5.2% of patients (95% confidence interval: 3.9-6.8%); 0.5% experienced a moderate (BARC 3), and all others mild (BARC 1-2) bleeding events. Major adverse cardiac events occurred in 14 (1.4%) patients, principally all-cause mortality (n = 6 patients) and myocardial infarction (n = 7 patients). Conclusion The use of cangrelor in ACS patients undergoing PCI and the transition strategy to P2Y12 inhibitors are confirmed as safe and effective in daily practice.
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Affiliation(s)
- Leonardo De Luca
- Division of Cardiology, Department of Cardiosciences, Azienda Ospedaliera San Camillo-Forlanini, Circonvallazione Gianicolense, 87, 00152 Roma, Italy
| | - Paolo Calabrò
- UOC Cardiologia Clinica con UTIC. A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy
| | - Piera Capranzano
- Cardiology Division, Policlinico Hospital, University of Catania, Catania, Italy
| | - Carlo Di Mario
- Interventistica Cardiologica Strutturale A.O.U. Careggi, Firenze, Italy
| | - Fabio Chirillo
- UOC Cardiologia, Ospedale San Bassiano, Bassano del Grappa (VI), Italy
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Zuin M, Mugnai G, Zamboni A, Zakja E, Valle R, Turiano G, Themistoclakis S, Scarpa D, Saccà S, Roncon L, Rizzetto F, Purita P, Polo A, Pantano I, Mugnolo A, Molon G, Meneghin S, Mancuso D, Lia M, Grassi G, Cutolo A, Chirillo F, Bozzini P, Bonapace S, Anselmi M, Rigatelli G, Bilato C. Decline of Admission for Acute Coronary Syndromes and Acute Cardiovascular Conditions during COVID-19 Pandemic in Veneto Region. Viruses 2022; 14:v14091925. [PMID: 36146731 DOI: 10.3390/v1409192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 05/27/2023] Open
Abstract
Background: The present study aimed to examine longitudinal trends in hospitalizations for acute coronary syndrome (ACS) before and during the COVID-19 pandemic, by reviewing the data from 13 hospitals of the Veneto Region, in the north-east of Italy. Methods: We performed a multicenter, retrospective analysis including all the consecutive patients presenting with ACS and other acute cardiovascular (CV) conditions (defined as heart failure, arrhythmias, cardiac arrest and venous thromboembolism) hospitalized in 13 different hospitals of the Veneto Region covering a population of 2,554,818 inhabitants, during the first (between 15 March 2020 and 30 April 2020) and second (between 15 November 2020 and 30 December 2020) COVID-19 pandemic waves (the 2020 cohort). Data were compared with those obtained at the same time-windows of years 2018 and 2019 (the historical cohorts). Results: Compared to the historical cohorts, a significant decrease in the number of ACS cases was observed in 2020 (−27.3%, p = 0.01 and −32%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). The proportion of patients hospitalized for acute CV conditions decreased during the first and second wave COVID-19 pandemic when compared to the historical cohorts (−36.5%, p < 0.001 and −40.6%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). Pearson’s correlation evidenced a significant inverse relationship between the number of COVID-19 cases and both ACS hospital admissions (r = −0.881, p = 0.005) and hospitalizations for acute CV conditions (r = −0.738, p = 0.01), respectively. Conclusions: The decrease in hospitalizations for ACS and other acute CV conditions will strongly affect future patients’ management since undiagnosed nonfatal CV events represent a source of increased (and unknown) CV morbidity and mortality.
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Affiliation(s)
- Marco Zuin
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
| | - Giacomo Mugnai
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
| | - Alberto Zamboni
- Division of Cardiology, Legnago General Hospital, 37045 Legnago, Verona, Italy
| | - Edlira Zakja
- Division of Cardiology, San Donà General Hospital, 30027 San Donà di Piave, Venezia, Italy
| | - Roberto Valle
- Division of Cardiology, Chioggia General Hospital, 30015 Chioggia, Venezia, Italy
| | - Giovanni Turiano
- Division of Cardiology, San Donà General Hospital, 30027 San Donà di Piave, Venezia, Italy
| | | | - Daniele Scarpa
- Division of Cardiology, Santi Giovanni & Paolo Hospital, 30122 Venezia, Venezia, Italy
| | - Salvatore Saccà
- Division of Cardiology, Mirano General Hospital, 30035 Mirano, Venezia, Italy
| | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, 45100 Rovigo, Rovigo, Italy
| | - Francesca Rizzetto
- Division of Cardiology, Verona University Hospital, 37100 Verona, Verona, Italy
| | - Paola Purita
- Division of Cardiology, Mirano General Hospital, 30035 Mirano, Venezia, Italy
| | - Angela Polo
- Division of Cardiology, San Bassiano Hospital, 36061 Bassano, Vicenza, Italy
| | - Ivan Pantano
- Division of Cardiology, Chioggia General Hospital, 30015 Chioggia, Venezia, Italy
| | - Antonio Mugnolo
- Division of Cardiology, Legnago General Hospital, 37045 Legnago, Verona, Italy
| | - Giulio Molon
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy
| | - Samuele Meneghin
- Division of Cardiology, Padua University Hospital, 35128 Padova, Padova, Italy
| | - Daniela Mancuso
- Division of Cardiology, Padua University Hospital, 35128 Padova, Padova, Italy
| | - Micaela Lia
- Division of Cardiology, Verona University Hospital, 37100 Verona, Verona, Italy
| | - Giuseppe Grassi
- Division of Cardiology, Santi Giovanni & Paolo Hospital, 30122 Venezia, Venezia, Italy
| | - Ada Cutolo
- Division of Cardiology, All'Angelo Hospital, 30174 Mestre, Venezia, Italy
| | - Fabio Chirillo
- Division of Cardiology, San Bassiano Hospital, 36061 Bassano, Vicenza, Italy
| | - Paolo Bozzini
- Division of Cardiology, Fracastoro Hospital, 37020 San Bonifacio, Verona, Italy
| | - Stefano Bonapace
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy
| | - Maurizio Anselmi
- Division of Cardiology, Fracastoro Hospital, 37020 San Bonifacio, Verona, Italy
| | - Gianluca Rigatelli
- Division of Cardiology, Madre Teresa Hospital, 35043 Padova, Schiavonia, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
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Zuin M, Mugnai G, Zamboni A, Zakja E, Valle R, Turiano G, Themistoclakis S, Scarpa D, Saccà S, Roncon L, Rizzetto F, Purita P, Polo A, Pantano I, Mugnolo A, Molon G, Meneghin S, Mancuso D, Lia M, Grassi G, Cutolo A, Chirillo F, Bozzini P, Bonapace S, Anselmi M, Rigatelli G, Bilato C. Decline of Admission for Acute Coronary Syndromes and Acute Cardiovascular Conditions during COVID-19 Pandemic in Veneto Region. Viruses 2022; 14:v14091925. [PMID: 36146731 PMCID: PMC9502380 DOI: 10.3390/v14091925] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The present study aimed to examine longitudinal trends in hospitalizations for acute coronary syndrome (ACS) before and during the COVID-19 pandemic, by reviewing the data from 13 hospitals of the Veneto Region, in the north-east of Italy. Methods: We performed a multicenter, retrospective analysis including all the consecutive patients presenting with ACS and other acute cardiovascular (CV) conditions (defined as heart failure, arrhythmias, cardiac arrest and venous thromboembolism) hospitalized in 13 different hospitals of the Veneto Region covering a population of 2,554,818 inhabitants, during the first (between 15 March 2020 and 30 April 2020) and second (between 15 November 2020 and 30 December 2020) COVID-19 pandemic waves (the 2020 cohort). Data were compared with those obtained at the same time-windows of years 2018 and 2019 (the historical cohorts). Results: Compared to the historical cohorts, a significant decrease in the number of ACS cases was observed in 2020 (−27.3%, p = 0.01 and −32%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). The proportion of patients hospitalized for acute CV conditions decreased during the first and second wave COVID-19 pandemic when compared to the historical cohorts (−36.5%, p < 0.001 and −40.6%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). Pearson’s correlation evidenced a significant inverse relationship between the number of COVID-19 cases and both ACS hospital admissions (r = −0.881, p = 0.005) and hospitalizations for acute CV conditions (r = −0.738, p = 0.01), respectively. Conclusions: The decrease in hospitalizations for ACS and other acute CV conditions will strongly affect future patients’ management since undiagnosed nonfatal CV events represent a source of increased (and unknown) CV morbidity and mortality.
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Affiliation(s)
- Marco Zuin
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
- Correspondence: (M.Z.); (C.B.); Tel.: +39-0444-479106 (C.B.); Fax: +39-0444-931163 (C.B.)
| | - Giacomo Mugnai
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
| | - Alberto Zamboni
- Division of Cardiology, Legnago General Hospital, 37045 Legnago, Verona, Italy
| | - Edlira Zakja
- Division of Cardiology, San Donà General Hospital, 30027 San Donà di Piave, Venezia, Italy
| | - Roberto Valle
- Division of Cardiology, Chioggia General Hospital, 30015 Chioggia, Venezia, Italy
| | - Giovanni Turiano
- Division of Cardiology, San Donà General Hospital, 30027 San Donà di Piave, Venezia, Italy
| | | | - Daniele Scarpa
- Division of Cardiology, Santi Giovanni & Paolo Hospital, 30122 Venezia, Venezia, Italy
| | - Salvatore Saccà
- Division of Cardiology, Mirano General Hospital, 30035 Mirano, Venezia, Italy
| | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, 45100 Rovigo, Rovigo, Italy
| | - Francesca Rizzetto
- Division of Cardiology, Verona University Hospital, 37100 Verona, Verona, Italy
| | - Paola Purita
- Division of Cardiology, Mirano General Hospital, 30035 Mirano, Venezia, Italy
| | - Angela Polo
- Division of Cardiology, San Bassiano Hospital, 36061 Bassano, Vicenza, Italy
| | - Ivan Pantano
- Division of Cardiology, Chioggia General Hospital, 30015 Chioggia, Venezia, Italy
| | - Antonio Mugnolo
- Division of Cardiology, Legnago General Hospital, 37045 Legnago, Verona, Italy
| | - Giulio Molon
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy
| | - Samuele Meneghin
- Division of Cardiology, Padua University Hospital, 35128 Padova, Padova, Italy
| | - Daniela Mancuso
- Division of Cardiology, Padua University Hospital, 35128 Padova, Padova, Italy
| | - Micaela Lia
- Division of Cardiology, Verona University Hospital, 37100 Verona, Verona, Italy
| | - Giuseppe Grassi
- Division of Cardiology, Santi Giovanni & Paolo Hospital, 30122 Venezia, Venezia, Italy
| | - Ada Cutolo
- Division of Cardiology, All’Angelo Hospital, 30174 Mestre, Venezia, Italy
| | - Fabio Chirillo
- Division of Cardiology, San Bassiano Hospital, 36061 Bassano, Vicenza, Italy
| | - Paolo Bozzini
- Division of Cardiology, Fracastoro Hospital, 37020 San Bonifacio, Verona, Italy
| | - Stefano Bonapace
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy
| | - Maurizio Anselmi
- Division of Cardiology, Fracastoro Hospital, 37020 San Bonifacio, Verona, Italy
| | - Gianluca Rigatelli
- Division of Cardiology, Madre Teresa Hospital, 35043 Padova, Schiavonia, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
- Correspondence: (M.Z.); (C.B.); Tel.: +39-0444-479106 (C.B.); Fax: +39-0444-931163 (C.B.)
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De Luca L, Calabrò P, Chirillo F, Rolfo C, Menozzi A, Capranzano P, Menichelli M, Nicolini E, Mauro C, Trani C, Versaci F, Tomai F, Musumeci G, Di Mario C, Pepe M, Berti S, Cernetti C, Cirillo P, Maffeo D, Talanas G, Ferlini M, Contarini M, Lanzilotti V, Scherillo M, Tarantini G, Muraglia S, Rossini R, Bolognese L. Use of cangrelor in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Study design and interim analysis of the ARCANGELO study. Clin Cardiol 2022; 45:913-920. [PMID: 35733352 PMCID: PMC9451664 DOI: 10.1002/clc.23878] [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] [Received: 02/15/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The itAlian pRospective Study on CANGrELOr (ARCANGELO) was aimed to assess the safety of using cangrelor during percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS) in the daily practice. HYPOTHESIS The safety of cangrelor after the transition to oral P2Y12 inhibitors was evaluated as the incidence of bleeding outcomes in the 30 days following PCI according to postauthorization safety study guidelines. METHODS Adults with ACS who were treated with cangrelor in one of the 28 centers involved in the study. Patients who consented to participate were followed in the 30 days following their PCI. Bleedings (Bleeding Academic Research Consortium [BARC] classification), major adverse cardiac events (MACEs), and adverse events were recorded. The interim results at two-thirds of the enrollment period are presented. RESULTS A total of 17 bleedings were observed in the 320 patients who completed the study at this stage. All bleedings were classified as BARC Type 1-2, except for one case of Type 3a (vessel puncture site hematoma). Four patients experienced MACEs (2 acute myocardial infarctions, 1 sudden cardiac death, 1 noncardiovascular death due to respiratory distress, and multiorgan failure). None of the bleedings was rated as related to cangrelor. CONCLUSIONS The interim results of the ARCANGELO study provide a preliminary confirmation that the use of cangrelor on patients with ACS undergoing PCI is not associated with severe bleedings.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, Division of Cardiology, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Paolo Calabrò
- U.O.C. Cardiologia Clinica con UTIC. A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy
| | - Fabio Chirillo
- U.O.C. Cardiologia Ospedale San Bassiano, Bassano del Grappa (VI), Italy
| | - Cristina Rolfo
- S.C. Cardiologia Ospedale degli Infermi di Rivoli ASLTO3, Rivoli, Italy
| | - Alberto Menozzi
- S.C. Cardiologia, Ospedale S. Andrea, ASL5 Liguria, La Spezia, Italy
| | | | | | - Elisa Nicolini
- U.O. Cardiologia Interventistica, strutturale e pediatrica, Ospedali Riuniti, Ancona, Italy
| | - Ciro Mauro
- Cardiologia UTIC con emodinamica AORN Cardarelli Napolii, Napoli, Italy
| | - Carlo Trani
- U.O.C. Interventistica Cardiologica e diagnostica invasiva Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Versaci
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | | | | | - Carlo Di Mario
- Interventistica Cardiologica Strutturale A.O.U. Careggi, Firenze, Italy
| | - Martino Pepe
- Cardiologia Universitaria A.O.U. Consorziale Policlinico, Bari, Italy
| | - Sergio Berti
- Fondazione C.N.R. Reg. Toscana G. Monasterio, Pisa, Italy
| | | | - Plinio Cirillo
- Dipartimento di Scienze Biomediche Avanzate, Cardiologia, A.O.U.P. "Federico II", Napoli, Italy
| | - Diego Maffeo
- Cardiologia Emodinamica Fondazione Poliambulanza, Brescia, Italy
| | - Giuseppe Talanas
- U.O.C. Cardiologia Clinica ed Interventistica, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Marco Ferlini
- U.O.C. Cardiologia Fondazione IRCCS Policlinico San Matteo, San Matteo, Italy
| | - Marco Contarini
- U.O.C. di Cardiologia con UTIC ed Emodinamica Ospedale Umberto I di Siracusa Azienda Sanitaria Provinciale di, Siracusa, Italy
| | | | - Marino Scherillo
- U.O.C. Cardiologia interventistica e UTIC Azienda Ospedaliera San Pio, Benevento, Italy
| | - Giuseppe Tarantini
- U.O.S.D. Emodinamica e Cardiologia Interventistica Azienda Ospedale Università, Padova, Italy
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6
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Lopez A, Dentamaro I, Galian L, Calvo F, Alegret JM, Sanchez V, Citro R, Moreo A, Chirillo F, Colonna P, Carrero MC, Bossone E, Moral S, Sao-Aviles A, Gutiérrez L, Teixido-Tura G, Rodríguez-Palomares J, Evangelista A. Predictors of Ascending Aorta Enlargement and Valvular Dysfunction Progression in Patients with Bicuspid Aortic Valve. J Clin Med 2021; 10:jcm10225264. [PMID: 34830546 PMCID: PMC8621265 DOI: 10.3390/jcm10225264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 12/01/2022] Open
Abstract
Bicuspid aortic valve (BAV) patients are at high risk of developing progressive aortic valve dysfunction and ascending aorta dilation. However, the progression of the disease is not well defined. We aimed to assess mid-long-term aorta dilation and valve dysfunction progression and their predictors. Patients were referred from cardiac outpatient clinics to the echocardiographic laboratories of 10 tertiary hospitals and followed clinically and by echocardiography for >5 years. Seven hundred and eighteen patients with BAV (median age 47.8 years [IQR 33–62], 69.2% male) were recruited. BAV without raphe was observed in 11.3%. After a median follow-up of 7.2 years [IQR5–8], mean aortic root growth rate was 0.23 ± 0.15 mm/year. On multivariate analysis, rapid aortic root dilation (>0.35 mm/year) was associated with male sex, hypertension, presence of raphe and aortic regurgitation. Annual ascending aorta growth rate was 0.43 ± 0.32 mm/year. Rapid ascending aorta dilation was related only to hypertension. Variables associated with aortic stenosis and regurgitation progression, adjusted by follow-up time, were presence of raphe, hypertension and dyslipidemia and basal valvular dysfunction, respectively. Intrinsic BAV characteristics and cardiovascular risk factors were associated with aorta dilation and valvular dysfunction progression, taking into account the inherent limitations of our study-design. Strict and early control of cardiovascular risk factors is mandatory in BAV patients.
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Affiliation(s)
- Angela Lopez
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Ilaria Dentamaro
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Laura Galian
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Francisco Calvo
- Cardiology Department, Hospital Alvaro Cunqueiro, 36213 Vigo, Spain;
| | - Josep M. Alegret
- Cardiology Department, Hospital Universitari Sant Joan de Reus, IISPV, Universitat Rovira i Virgili, 43204 Reus, Spain;
| | - Violeta Sanchez
- Cardiology Department, University Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Rodolfo Citro
- Cardiology Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84125 Salerno, Italy;
| | - Antonella Moreo
- Cardiology Department, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy;
| | - Fabio Chirillo
- Cardiology Department, Bassano del Grappa General Hospital, 36061 Bassano Del Grappa, Italy;
| | - Paolo Colonna
- Cardiology Department, Polyclinic Hospital of Bari, 70124 Bari, Italy;
| | - María Celeste Carrero
- Instituto Cardiovascular San Isidro, Sanatorio Las Lomas, Buenos Aires 3031, Argentina;
| | - Eduardo Bossone
- Cardiology Department, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, 80131 Napoli, Italy;
| | - Sergio Moral
- Servei de Cardiologia, Hospital Josep Trueta, 17007 Girona, Spain;
| | - Augusto Sao-Aviles
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Laura Gutiérrez
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Gisela Teixido-Tura
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Jose Rodríguez-Palomares
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Arturo Evangelista
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
- Heart Institute, Teknon Medical Center-Quirón Salud, 08022 Barcelona, Spain
- Correspondence:
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7
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Onorato EM, Cucchini U, Carasi M, Zadro M, Iavernaro A, Chirillo F. Transcatheter Closure of Secundum Atrial Septal Defect with Large Multifenestrated Septum Primum Aneurysm and Double Atrial Septum: A Challenging Transesophageal Echocardiography–Guided Procedure. CASE 2021; 5:177-182. [PMID: 34195518 PMCID: PMC8236381 DOI: 10.1016/j.case.2021.01.005] [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] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Secundum ASD with large multifenestrated ASA and double atrial septum is rare. Innovative device technology is key to successful closure in such septal defect variants.
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8
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Chirillo F, Baritussio A, Cucchini U, Toniolli E, Polo A, Iavernaro A. Challenges in the diagnosis of peripartum cardiomyopathy: a case series. Eur Heart J Case Rep 2021; 5:ytab001. [PMID: 33738415 PMCID: PMC7954255 DOI: 10.1093/ehjcr/ytab001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/03/2020] [Accepted: 01/06/2021] [Indexed: 11/13/2022]
Abstract
Background Peripartum cardiomyopathy (PPCM) is usually characterized by overt heart failure, but other clinical scenarios are possible, sometimes making the diagnosis challenging. Case summary We report a case series of four patients with PPCM. The first patient presented with acute heart failure due to left ventricular (LV) systolic dysfunction. Following medical treatment, LV function recovered completely at 1 month. The second patient had systemic and pulmonary thromboembolism, secondary to severe biventricular dysfunction with biventricular thrombi. The third patient presented with myocardial infarction with non-obstructed coronary arteries and evidence of an aneurysm of the mid-anterolateral LV wall. The fourth patient, diagnosed with PPCM 11 years earlier, presented with sustained ventricular tachycardia. A repeat cardiac magnetic resonance, compared to the previous one performed 11 years earlier, showed an enlarged LV aneurysm in the mid-LV anterolateral wall with worsened global LV function. Discussion Peripartum cardiomyopathy may have different clinical presentations. Attentive clinical evaluation and multimodality imaging can provide precise diagnostic and prognostic information.
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Affiliation(s)
- Fabio Chirillo
- Department of Cardiology and Radiology, San Bassiano Hospital, Via dei Lotti 40, 36061 Bassano del Grappa, VI, Italy
| | - Anna Baritussio
- Department of Cardiology, Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35100 Padova, Italy
| | - Umberto Cucchini
- Department of Cardiology and Radiology, San Bassiano Hospital, Via dei Lotti 40, 36061 Bassano del Grappa, VI, Italy
| | - Ermanno Toniolli
- Department of Cardiology and Radiology, San Bassiano Hospital, Via dei Lotti 40, 36061 Bassano del Grappa, VI, Italy
| | - Angela Polo
- Department of Cardiology and Radiology, San Bassiano Hospital, Via dei Lotti 40, 36061 Bassano del Grappa, VI, Italy
| | - Antonio Iavernaro
- Department of Cardiology and Radiology, San Bassiano Hospital, Via dei Lotti 40, 36061 Bassano del Grappa, VI, Italy
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Abstract
Despite significant diagnostic and therapeutic improvements, infective endocarditis (IE) still carries high morbidity and mortality. In the last three decades, significant variations in epidemiological and clinical profile of IE have been observed. The diagnosis of IE requires an adequate clinical suspicion, given its pleomorphic presentation. Microbiological and imaging techniques, which are pivotal in confirming the diagnosis, need constant refinement because of suboptimal accuracy. A clinically integrated multidisciplinary approach is recommended. Guidelines provide useful support despite being based mainly on the opinion of experts rather than on randomized trials, with some inconsistencies among different recommendations. This review encounters the current state of knowledge, gaps in evidence, and future research direction in the field of IE.
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Affiliation(s)
- Fabio Chirillo
- Department of Cardiology, Ospedale San Bassiano, Via dei Lotti 40, 36061 Bassano del Grappa (VI), Italy.
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10
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Cecchi E, Chirillo F, Moreo A, Graziosi M, De Michele L, Faggiano P, Mattioli R, Polizzi V, Labanti G, Benedetto FA, Colonna P. Practical implementation of the Endocarditis Team in 'functional' reference centres: the Italian hospital network experience and recommendations of the Italian Society of Echocardiography and Cardiovascular Imaging. J Cardiovasc Med (Hagerstown) 2019; 20:414-418. [PMID: 31593558 DOI: 10.2459/jcm.0000000000000810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: The 2015 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis recommend the use of a multidisciplinary team in the care of patients with infective endocarditis. A standardized collaborative approach should be implemented in centres with immediate access to different imaging techniques, cardiac surgery and health professionals from several specialties. This position paper has been produced by the Task Force for Management of Infective Endocarditis of Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) with the aim of providing recommendations for the implementation of the Endocarditis Team within the Italian hospital network. On the basis of the Italian hospital network with many cardiology facilities encompassing a total of 405 intensive cardiac care units (ICCUs) across the country, 224 (3.68 per million inhabitants) of which have on-site 24-h PCI capability, but with relatively few centres equipped with cardiac surgery and nuclear medicine, in the present article, the SIECVI Task Force for Management of Infective Endocarditis develops the idea of a network where 'functional' reference centres act as a link with the periphery and with 'structural' reference centres. A number of minimum characteristics are provided for these 'functional' reference centres. Outcome and cost analysis of implementing an Endocarditis Team with functional referral is expected to be derived from ongoing Italian and European registries.
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Affiliation(s)
- Enrico Cecchi
- Cardiology Department, Hospital Maria Vittoria, Turin
| | - Fabio Chirillo
- Cardiology Department, Hospital 'San Bassiano' Bassano del Grappa (Vicenza)
| | | | | | | | | | | | | | | | - Frank A Benedetto
- Cardiology Department, Hospital 'Bianchi Melacrino Morelli' Reggio Calabria, Italy
| | - Paolo Colonna
- Cardiology Department, University Hospital Policlinico Consorziale, Bari
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11
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Dentamaro I, Sao-Aviles A, Teixido G, Galian L, Gutierrez L, Gonzalez-Alujas MT, Calvo F, Sanchez V, Alegret J, Colonna P, Moreo A, Citro R, Chirillo F, Rodriguez-Palomares JF, Evangelista A. P3373Predictors of dilatation of ascending aorta in patients with bicuspid aortic valve, a longitudinal multicenter study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The bicuspid aortic valve (BAV) is frequently associated to dilation of the ascending aorta. Some cross-sectional studies have related the aortic dilation with morphotype and valvular dysfunction. The aim of this longitudinal multicenter study was to analyze the progression of the aortic dilation and to identify its predictors.
Methods
We included 459 patients (mean age 52±17; 325 men 70.8%) with BAV, without aortic coarctation. The BAV morphotype, significant valvular dysfunction and dilation of the aortic root and ascending aorta were established by echocardiography. The patients were followed annually, with an average of 7.5±3.2 years.
Results
77% of the patients had BAV with a fusion between left and right cusps, 21% between right and non coronary cusps and 2% between left and non coronary cusps, with a raphe in 77% of these patients. Risk factors included: 35% hypertension, 20% smoking, 5% diabetes and 18% dyslipidemia. The baseline study showed a maximum root diameter of 36±6.2 mm and ascending aorta of 39±8.1 mm. In 7% the aortic root was>45 mm, while in 32% the ascending aorta>45 mm. There was no valvular dysfunction in 17% of patients, while the 8% had significant aortic stenosis and 35% significant aortic regurgitation. The annual growth of the aortic root was 0.33±0.2 mm and for the ascending aorta was 0.38±0.3 mm. At the end of follow-up, 16% of the patients had a root>45 mm and 41% an ascending aorta>45 mm. The annual progression of aortic diameters was not related to valvular morphotype, valvular dysfunction or cardiovascular risk factors. The univariate analysis showed a significant relationship between the annual growth of the aortic root and arterial hypertension (p=0.028) and the annual growth of the ascending aorta with the male sex (p=0.019), smoking (p=0.046) and significant (moderate or severe) aortic stenosis (p=0.013). Diabetes mellitus and the presence of raphe were found to be slightly protective (p=0.049 and p=0.031, respectively). In the multivariate analysis, only the male sex and significant aortic stenosis were independent predictors of dilation of the ascending aorta.
Conclusions
In patients with bicuspid aortic valve, the progression of the dilation of the aortic root is related to hypertension and the growth of the ascending aorta with the male sex and the presence of significant aortic stenosis. Both bicuspid valve morphotype, basal aortic diameter or age were not related to the progression of aortic dilation.
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Affiliation(s)
- I Dentamaro
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - A Sao-Aviles
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - G Teixido
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - L Galian
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - L Gutierrez
- University Hospital Vall d'Hebron, Barcelona, Spain
| | | | - F Calvo
- Hospital of Meixoeiro, Cardiology Department, Vigo, Spain
| | - V Sanchez
- University Hospital 12 de Octubre, Cardiology Department, Madrid, Spain
| | - J Alegret
- Hospital Universitario Joan XXIII, Cardiology Department, Tarragona, Spain
| | - P Colonna
- Polyclinic Hospital of Bari, Cardiology Department, Bari, Italy
| | - A Moreo
- Niguarda Ca' Granda Hospital, Milan, Italy
| | - R Citro
- AOU S. Giovanni e Ruggi, Cardiology Department, Salerno, Italy
| | - F Chirillo
- Bassano del Grappa General Hospital, Cardiology Department, Bassano Del Grappa, Italy
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12
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Cecchi E, Ciccone G, Chirillo F, Imazio M, Cecconi M, Del Ponte S, Moreo A, Faggiano P, Cialfi A, Squeri A, Enia F, Forno D, De Rosa FG, Rinaldi M, Castiglione A. Mortality and timing of surgery in the left-sided infective endocarditis: an Italian multicentre study. Interact Cardiovasc Thorac Surg 2019; 26:602-609. [PMID: 29272391 DOI: 10.1093/icvts/ivx394] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 11/18/2017] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Observational studies on early surgery in infective endocarditis have conflicting results. This study aims to compare the treatment strategies for early surgery (within 2 weeks of diagnosis) and late surgery/medical therapy in terms of survival among patients with the left-sided infective endocarditis. METHODS This study included patients with the left-sided infective endocarditis registered between 2006 and 2010 in the Italian Registry of Infective Endocarditis (RIEI). A Cox proportional hazards model was used to estimate the effect of these treatment strategies on overall survival and included sociodemographic and clinical characteristics associated with treatment, risk factors for mortality and early surgery as a time-dependent covariate to avoid indication and immortal time biases. RESULTS Among the 502 patients included, 184 (36.7%) underwent early surgery. Of the remaining 318 patients, 138 underwent late surgery. The early surgery group had fewer patients with comorbidities and with enterococcus as the causative microorganism, but this group had more complicated cardiac conditions. No difference in mortality risk was estimated between the treatment groups including early surgery as time-dependent variables (adjusted hazard ratio = 0.95, 95% confidence interval 0.55-1.63), while a distorted and overestimated beneficial effect of surgery was estimated considering surgery as a non-time-dependent variable (adjusted hazard ratio 0.41, 95% confidence interval 0.25-0.70). CONCLUSIONS Our study did not confirm a better overall survival in patients undergoing early surgery. However, even with the use of statistical techniques to control biases, we could not draw definitive conclusions that early surgery is not beneficial. Our results need to be assessed by randomized trials before any changes in clinical practice can be recommended.
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Affiliation(s)
- Enrico Cecchi
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - Fabio Chirillo
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Massimo Imazio
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Moreno Cecconi
- Dipartimento di Scienze Cardiologiche Mediche e Chirurgiche Azienda, Ospedaliera Universitaria, Ospedali Riuniti, Ancona, Italy
| | | | - Antonella Moreo
- Department of Cardiology, Niguarda Ca' Granda Hospital, Milano, Italy
| | | | | | - Angelo Squeri
- Dipartimento Cardio, Nefro-Polmonare, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | - Francesco Enia
- Department of Cardiology, Cervello Hospital, Palermo, Italy
| | - Davide Forno
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, University of Turin; Infectious Diseases at Amedeo di Savoia Hospital, Turin, Italy
| | - Mauro Rinaldi
- Department of Cardiac Surgery, Molinette Hospital, University of Torino, Torino, Italy
| | - Anna Castiglione
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
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13
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Chirillo F, Cucchini U, Covolo E, Carasi M, Zadro M, Iavernaro A, Zasso A, Baritussio A, Bontorin M, Libardoni M, Galzignan E, Molon E, Cognolato D. P4465Coronary angiography and revascularization in patients with peripheral artery disease undergoing percutaneous transluminal angioplasty. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- F Chirillo
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - U Cucchini
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - E Covolo
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - M Carasi
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - M Zadro
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - A Iavernaro
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - A Zasso
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - A Baritussio
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - M Bontorin
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - M Libardoni
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - E Galzignan
- General Hospital, Vascular Surgery, Bassano del Grappa, Italy
| | - E Molon
- General Hospital, Vascular Surgery, Bassano del Grappa, Italy
| | - D Cognolato
- General Hospital, Vascular Surgery, Bassano del Grappa, Italy
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14
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Dentamaro I, Galian L, Calvo F, Moral S, Robledo-Carmona J, Sanchez V, Saura D, Arnold R, Citro R, Moreo A, Chirillo F, Colonna P, Teixido G, Rdriguez-Palomares J, Evangelista A. P674Evaluation of sex differences in aortic valve dysfunction and aorta dilation in patients with bicuspid aortic valve. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- I Dentamaro
- University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain
| | - L Galian
- University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain
| | - F Calvo
- University Hospital Gregorio Maranon, Madrid, Spain
| | - S Moral
- University Hospital de Girona Dr. Josep Trueta, Girona, Spain
| | | | - V Sanchez
- University Hospital 12 de Octubre, Madrid, Spain
| | - D Saura
- Hospital Clínico Univeristario Virgen de la Arrixaca, Murcia, Spain
| | - R Arnold
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - R Citro
- AOU S. Giovanni e Ruggi, Salerno, Italy
| | - A Moreo
- Niguarda Ca' Granda Hospital, Milan, Italy
| | - F Chirillo
- Bassano del Grappa General Hospital, Bassano Del Grappa, Italy
| | - P Colonna
- Polyclinic Hospital of Bari, Bari, Italy
| | - G Teixido
- University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain
| | | | - A Evangelista
- University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain
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Zuin G, Frigo G, Roncon L, Bonso A, Carbonieri E, Chirillo F, De Conti F, Delise P, Desideri A, D'Este D, Milani L, Valle R, Bilato C. [Appropriateness in Cardiology: a statement of the ANMCO Veneto Region]. G Ital Cardiol (Rome) 2018; 19:24-31. [PMID: 29451507 DOI: 10.1714/2852.28776] [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
Inappropriate tests are responsible for longer waiting lists, higher economical costs for the National Health System and major clinical risks due to radiation exposure from prescription abuse of diagnostic testing. Clinical inappropriateness frequently derives from poor knowledge of guidelines, "defensive medicine" approach and/or repeat requests of patients and family members. About one third of non-invasive imaging tests are considered inappropriate.In order to define the most appropriate instruments for the follow-up of the most common cardiovascular diseases with the highest risk of inappropriateness, all the cardiologists of the Veneto Region (Italy), along with the local chapters of the main national cardiology societies and general practitioners have been involved by the Regional Section of the Italian Association of Hospital Cardiologists (ANMCO) in several scientific meetings on the following topics: hypertension, chronic ischemic heart disease, valvular heart disease, heart failure, and atrial fibrillation. This has led to the present document where: (i) the most appropriate clinical and diagnostic strategies are taken into account, and (ii) the most robust scientific evidence is provided for the regulatory commission of the Veneto Region Health Service to identify inappropriateness, prescription unsuitability, and economical sustainability.
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Affiliation(s)
| | | | - Loris Roncon
- U.O. Cardiologia, Ospedale Santa Maria della Misericordia (RO)
| | - Aldo Bonso
- U.O. Cardiologia, Ospedale di Feltre (BL)
| | | | | | | | - Pietro Delise
- Cardiologia, Ospedale P. Pederzoli, Peschiera del Garda (VR)
| | | | | | | | | | - Claudio Bilato
- U.O. Cardiologia, Ospedali dell'Ovest Vicentino, Arzignano (VI)
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16
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Citro R, Cecconi M, La Carrubba S, Bossone E, Antonini-Canterin F, Nistri S, Chirillo F, Dentamaro I, Bellino M, Posteraro A, Giorgi M, Petrella L, Monte I, Manuppelli V, Mantero A, Carerj S, Benedetto F, Colonna P. Bicuspid Aortic Valve Registry of the Italian Society of Echocardiography and Cardiovascular Imaging (REgistro della valvola aortica bicuspide della società italiana di ECocardiografia e CArdiovascular imaging): Rationale and Study Design. J Cardiovasc Echogr 2018; 28:78-89. [PMID: 29911003 PMCID: PMC5989554 DOI: 10.4103/jcecho.jcecho_5_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: Bicuspid aortic valve (BAV) is the most common congenital heart disease, affecting 0.5%–2% of the general population. It is associated not only with notable valvular risk (aortic stenosis and/or regurgitation, endocarditis) but also with aortopathy with a wide spectrum of unpredictable clinical presentations, including aneurysmal dilation of the aortic root and/or ascending thoracic aorta, isthmic coarctation, aortic dissection, or wall rupture. Methods: The REgistro della Valvola Aortica Bicuspide della Società Italiana di ECocardiografia e CArdiovascular Imaging is a retrospective (from January 1, 2010)/prospective, multicenter, observational registry, expected to enroll 3000 patients with definitive diagnosis of BAV made by transthoracic and/or transesophageal echocardiography, computed tomography, cardiovascular magnetic resonance, or at surgery. Inclusion criteria were definitive diagnosis of BAV. Patients will be enrolled regardless of the presence and severity of aortic valve dysfunction or aortic vessel disease and the coexistence of other congenital cardiovascular malformations. Exclusion criteria were uncertain BAV diagnosis, impossibility of obtaining informed consent, inability to carry out the follow-up. Anamnestic, demographic, clinical, and instrumental data collected both at first evaluation and during follow-up will be integrated into dedicated software. The aim is to derive a data set of unselected BAV patients with the main purpose of assessing the current clinical presentation, management, and outcomes of BAV. Conclusions: A multicenter registry covering a large population of BAV patients could have a profound impact on the understanding of the natural history of this disease and could influence its management.
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Affiliation(s)
- Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | - Moreno Cecconi
- Department of Cardiovascular Science, University Hospital "Ospedali Riuniti Ancona," Ancona, Italy
| | | | - Eduardo Bossone
- Cardiology Department Hospital of Cava de' Tirreni and Costa d'Amalfi, Cava de' Tirreni, Italy
| | - Francesco Antonini-Canterin
- Division of Rehabilitation Cardiology, Rehabilitation Hospital of High Specialization ORAS, Motta di Livenza, Italy
| | - Stefano Nistri
- Cardiology Department, CMSR Veneto Medica, Altavilla Vicentina, Italy
| | - Fabio Chirillo
- Cardiology Department, Ca' Foncello Hospital, Treviso, Italy
| | - Ilaria Dentamaro
- Department of Cardiology, Hospital Policlinico of Bari, Bari, Italy
| | - Michele Bellino
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | | | - Mauro Giorgi
- Cardiology Department, University Hospital Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Licia Petrella
- Cardiology Department, G. Mazzini Hospital, Teramo, Italy
| | - Ines Monte
- Cardiology Department Echocardiography Laboratory, Department of Cardiothoracic and Vascular, Policlinico Vittorio Emanuele, Catania University, Catania, Italy
| | - Vincenzo Manuppelli
- Department of Cardiology, University Hospital "Ospedali Riuniti di Foggia," Foggia, Italy
| | - Antonio Mantero
- Department of Cardiology, San Paolo University Hospital, Milan, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Messina, Italy
| | - Frank Benedetto
- Division of Cardiology, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Paolo Colonna
- Cardiology Department, Ca' Foncello Hospital, Treviso, Italy
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Chirillo F, Calabro' F, Boccaletto F, Mondin F, Calzolari V, Pantano P, Martire P, Benettin A, Scotton P, Polesel E, Olivari Z. P4539Assessment of the diagnostic accuracy of 18fluorodesoxyglucose positron emission tomography/computed tomography in prosthetic heart valve and cardiac implantable electronic device infection. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4539] [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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Chirillo F. It is not how old you are, it is how you are old: need for changes in the management of infective endocarditis in the elderly. Heart 2017; 103:1562-1564. [DOI: 10.1136/heartjnl-2017-311411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chirillo F, Calabro' F, De Leo A, Pedrocco A, Tona F, Mondin F, Minniti G, Scotton P, Olivari Z. CHANGING SPECTRUM OF INFECTIVE ENDOCARDITIS: REVIEW OF 707 PATIENTS OVER 26 YEARS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35344-5] [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: 11/26/2022]
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Chirillo F, Faggiano P, Cecconi M, Moreo A, Squeri A, Gaddi O, Cecchi E. Predisposing cardiac conditions, interventional procedures, and antibiotic prophylaxis among patients with infective endocarditis. Am Heart J 2016; 179:42-50. [PMID: 27595678 DOI: 10.1016/j.ahj.2016.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/30/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED Efficacy and safety of antibiotic prophylaxis (AP) for prevention of infective endocarditis (IE) in patients with predisposing cardiac condition (PCC) undergoing invasive procedures is still debated. We sought to assess the prevalence of PCC, the type of interventional procedures preceding the onset of symptoms, and the usefulness of AP in a large cohort of consecutive patients with definite IE. METHODS We examined 677 (median age 65.34 years; male 492 [73%]) consecutive patients with IE enrolled from July 2007 through 2010 into the Italian Registry of Infective Endocarditis. RESULTS Predisposing cardiac condition was present in 341 patients (50%).Thirty-two patients (4.7%) underwent dental procedures. Of 20 patients with PCC undergoing dental procedure, 13 had assumed AP. Viridans group streptococci were isolated from blood cultures in 8 of 20 patients with PCC and prior dental procedure. Nondental procedures preceded IE in 139 patients (21%). They were significantly older and had more comordibities compared with patients undergoing dental procedures. Predisposing cardiac condition was identified in 91 patients. Perioperative antimicrobial prophylaxis was administered to 67 patients. Staphylococcus aureus was the most frequent causative agent. Cardiac surgery was necessary in 85 patients (20 with prior dental and 65 with nondental procedure). Surgical mortality (12% vs 0%, P = .03) and hospital mortality (23% vs 3%, P = .001) were significantly larger among patients with nondental procedures. CONCLUSIONS In a large unselected cohort of patients with IE, the incidence of preceding dental procedures was minimal. The number of cases potentially preventable by means of AP was negligible. Nondental procedures were more frequent than dental procedures and were correlated with poorer prognosis.
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Chirillo F, Fusaro M, Morana G, Olivari Z. An intriguing intracardiac mass in a woman with atrial fibrillation. Left atrial appendage (LAA) thrombus. Heart 2016; 102:693, 727. [PMID: 26719358 DOI: 10.1136/heartjnl-2015-308704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/27/2015] [Indexed: 11/04/2022] Open
Abstract
CLINICAL INTRODUCTION A 74-year-old hypertensive woman presented with shortness of breath. There was no associated coughing, chest pain or fever. ECG identified atrial fibrillation with rapid ventricular response. A transoesophageal echocardiogram was scheduled to exclude thrombus before cardioversion (Figure 1A); however, an echogenic structure was seen (Figure 1B arrow, see online supplementary video 1) between the left atrium, the pulmonary artery and the aortic root. QUESTION Which of the following is the most likely diagnosis? A. Aortic valve endocarditis with annular abscess. B. Left atrial appendage thrombus. C. Left atrial myxoma. D. Pulmonary embolism.
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Affiliation(s)
- Fabio Chirillo
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Michele Fusaro
- Department of Radiology, Ca' Foncello Hospital, Treviso, Italy
| | - Giovanni Morana
- Department of Radiology, Ca' Foncello Hospital, Treviso, Italy
| | - Zoran Olivari
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
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Cecchi E, Chirillo F, Castiglione A, Faggiano P, Cecconi M, Moreo A, Cialfi A, Rinaldi M, Del Ponte S, Squeri A, Corcione S, Canta F, Gaddi O, Enia F, Forno D, Costanzo P, Zuppiroli A, Ronzani G, Bologna F, Patrignani A, Belli R, Ciccone G, De Rosa FG. Clinical epidemiology in Italian Registry of Infective Endocarditis (RIEI): Focus on age, intravascular devices and enterococci. Int J Cardiol 2015; 190:151-6. [PMID: 25918069 DOI: 10.1016/j.ijcard.2015.04.123] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 08/02/2014] [Revised: 04/07/2015] [Accepted: 04/15/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The epidemiology of infective endocarditis (IE) is changing due to a number of factors, including aging and health related comorbidities and medical procedures. The aim of this study is to describe the main clinical, epidemiologic and etiologic changes of IE from a large database in Italy. METHODS We prospectively collected episodes of IE in 17 Italian centers from July 2007 to December 2010. RESULTS We enrolled 677 patients with definite IE, of which 24% health-care associated. Patients were male (73%) with a median age of 62 years (IQR: 49-74) and 61% had several comorbidities. One hundred and twenty-eight (19%) patients had prosthetic left side IE, 391 (58%) native left side IE, 94 (14%) device-related IE and 54 (8%) right side IE. A predisposing cardiopathy was present in 50%, while odontoiatric and non odontoiatric procedures were reported in 5% and 21% of patients respectively. Symptoms were usually atypical and precocious. The prevalent etiology was represented by Staphylococcus aureus (27%) followed by coagulase-negative staphylococci (CNS, 21%), Streptococcus viridans (15%) and enterococci (14%). CNS and enterococci were relatively more frequent in patients with intravascular devices and prosthesis and S. viridans in left native valve. Diagnosis was made by transthoracic and transesophageal echocardiography in 62% and 94% of cases, respectively. The in-hospital mortality was 14% and 1-year mortality was 21%. CONCLUSION The epidemiology is changing in Italy, where IE more often affects older patients with comorbidities and intravascular devices, with an acute onset and including a high frequency of enterococci. There were few preceding odontoiatric procedures.
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Affiliation(s)
- Enrico Cecchi
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Fabio Chirillo
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Anna Castiglione
- SSCVD Epidemiologia Clinica e Valutativa, Città della Salute e della Scienza di Torino, Italy
| | | | - Moreno Cecconi
- Dipartimento di Scienze Cardiologiche Mediche e Chirurgiche Azienda Ospedaliera Universitaria, Ospedali Riuniti, Ancona, Italy
| | - Antonella Moreo
- Department of Cardiology, Niguarda Ca' Granda Hospital, Milano, Italy
| | | | - Mauro Rinaldi
- Department of Cardiac Surgery, Molinette Hospital, University of Torino, Torino, Italy
| | | | - Angelo Squeri
- Dipartimento Cardio-Nefro-Polmonare, Azienda Ospedaliera - Universitaria di Parma, Parma, Italy
| | - Silvia Corcione
- Department of Medical Sciences, University of Turin; Infectious Diseases at Amedeo di Savoia Hospital, Turin, Italy
| | | | - Oscar Gaddi
- Department of Cardiology, Reggio Emilia Hospital, Reggio Emilia, Italy
| | - Francesco Enia
- Department of Cardiology, Cervello Hospital, Palermo, Italy
| | - Davide Forno
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Piera Costanzo
- Department of Cardiology, Giovanni Bosco Hospital, Torino, Italy
| | | | | | - Flavio Bologna
- Department of Cardiology, Rimini Hospital, Rimini, Italy
| | - Anna Patrignani
- Department of Cardiology, Senigallia Hospital, Senigallia, Italy
| | - Riccardo Belli
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Giovannino Ciccone
- SSCVD Epidemiologia Clinica e Valutativa, Città della Salute e della Scienza di Torino, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, University of Turin; Infectious Diseases at Amedeo di Savoia Hospital, Turin, Italy
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Imazio M, Brucato A, Ferrazzi P, Pullara A, Adler Y, Barosi A, Caforio AL, Cemin R, Chirillo F, Comoglio C, Cugola D, Cumetti D, Dyrda O, Ferrua S, Finkelstein Y, Flocco R, Gandino A, Hoit B, Innocente F, Maestroni S, Musumeci F, Oh J, Pergolini A, Polizzi V, Ristic A, Simon C, Spodick DH, Tarzia V, Trimboli S, Valenti A, Belli R, Gaita F. Colchicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation: the COPPS-2 randomized clinical trial. JAMA 2014; 312:1016-23. [PMID: 25172965 DOI: 10.1001/jama.2014.11026] [Citation(s) in RCA: 222] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Postpericardiotomy syndrome, postoperative atrial fibrillation (AF), and postoperative effusions may be responsible for increased morbidity and health care costs after cardiac surgery. Postoperative use of colchicine prevented these complications in a single trial. OBJECTIVE To determine the efficacy and safety of perioperative use of oral colchicine in reducing postpericardiotomy syndrome, postoperative AF, and postoperative pericardial or pleural effusions. DESIGN, SETTING, AND PARTICIPANTS Investigator-initiated, double-blind, placebo-controlled, randomized clinical trial among 360 consecutive candidates for cardiac surgery enrolled in 11 Italian centers between March 2012 and March 2014. At enrollment, mean age of the trial participants was 67.5 years (SD, 10.6 years), 69% were men, and 36% had planned valvular surgery. Main exclusion criteria were absence of sinus rhythm at enrollment, cardiac transplantation, and contraindications to colchicine. INTERVENTIONS Patients were randomized to receive placebo (n=180) or colchicine (0.5 mg twice daily in patients ≥70 kg or 0.5 mg once daily in patients <70 kg; n=180) starting between 48 and 72 hours before surgery and continued for 1 month after surgery. MAIN OUTCOMES AND MEASURES Occurrence of postpericardiotomy syndrome within 3 months; main secondary study end points were postoperative AF and pericardial or pleural effusion. RESULTS The primary end point of postpericardiotomy syndrome occurred in 35 patients (19.4%) assigned to colchicine and in 53 (29.4%) assigned to placebo (absolute difference, 10.0%; 95% CI, 1.1%-18.7%; number needed to treat = 10). There were no significant differences between the colchicine and placebo groups for the secondary end points of postoperative AF (colchicine, 61 patients [33.9%]; placebo, 75 patients [41.7%]; absolute difference, 7.8%; 95% CI, -2.2% to 17.6%) or postoperative pericardial/pleural effusion (colchicine, 103 patients [57.2%]; placebo, 106 patients [58.9%]; absolute difference, 1.7%; 95% CI, -8.5% to 11.7%), although there was a reduction in postoperative AF in the prespecified on-treatment analysis (placebo, 61/148 patients [41.2%]; colchicine, 38/141 patients [27.0%]; absolute difference, 14.2%; 95% CI, 3.3%-24.7%). Adverse events occurred in 21 patients (11.7%) in the placebo group vs 36 (20.0%) in the colchicine group (absolute difference, 8.3%; 95% CI; 0.76%-15.9%; number needed to harm = 12), but discontinuation rates were similar. No serious adverse events were observed. CONCLUSIONS AND RELEVANCE Among patients undergoing cardiac surgery, perioperative use of colchicine compared with placebo reduced the incidence of postpericardiotomy syndrome but not of postoperative AF or postoperative pericardial/pleural effusion. The increased risk of gastrointestinal adverse effects reduced the potential benefits of colchicine in this setting. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01552187.
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Affiliation(s)
- Massimo Imazio
- Cardiology Department, Maria Vittoria Hospital, Torino, Italy2University of Torino, Torino, Italy
| | | | | | - Alberto Pullara
- University of Torino, Torino, Italy4AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Yehuda Adler
- Chaim Sheba Medical Center, Tel Hashomer and Sacker University, Tel Aviv, Israel
| | - Alberto Barosi
- Department of Internal Medicine and Cardiac Surgery, Ospedale Niguarda, Milano, Italy
| | - Alida L Caforio
- Department of Cardiological Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Roberto Cemin
- Cardiology Department, Ospedale Regionale San Maurizio, Bolzano, Italy
| | - Fabio Chirillo
- Department of Cardiology and Cardiac Surgery, Ca Foncello Hospital, Treviso, Italy
| | - Chiara Comoglio
- Department of Cardiac Surgery and Rehabilitation, Villa Maria Pia Hospital, Torino, Italy
| | | | | | - Oleksandr Dyrda
- Department of Cardiac Surgery and Rehabilitation, Villa Maria Pia Hospital, Torino, Italy
| | - Stefania Ferrua
- Department of Cardiology, Ospedale degli Infermi, Rivoli, Italy
| | - Yaron Finkelstein
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Anna Gandino
- Department of Internal Medicine and Cardiac Surgery, Ospedale Niguarda, Milano, Italy
| | - Brian Hoit
- Case Western Reserve University, Cleveland, Ohio15University Hospitals Case Medical Center, Cleveland, Ohio
| | | | | | | | - Jae Oh
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Amedeo Pergolini
- Department of Cardiac Surgery, Ospedale San Camillo, Roma, Italy
| | - Vincenzo Polizzi
- Department of Cardiac Surgery, Ospedale San Camillo, Roma, Italy
| | - Arsen Ristic
- Department of Cardiology, Belgrade University School of Medicine and Clinical Centre of Serbia, Belgrade, Serbia
| | | | | | - Vincenzo Tarzia
- Department of Cardiological Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Stefania Trimboli
- Department of Cardiac Surgery and Rehabilitation, Villa Maria Pia Hospital, Torino, Italy
| | | | - Riccardo Belli
- Cardiology Department, Maria Vittoria Hospital, Torino, Italy
| | - Fiorenzo Gaita
- University of Torino, Torino, Italy4AOU Città della Salute e della Scienza di Torino, Torino, Italy
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Chirillo F, Boccaletto F, Scotton P, Possamai M, Olivari Z. Complete and partly unexpected diagnostic findings at 18F-FDG-PET/CT scanning in patients with suspected prosthetic valve endocarditis. Eur Heart J Cardiovasc Imaging 2014; 15:1057. [PMID: 24686259 DOI: 10.1093/ehjci/jeu052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fabio Chirillo
- Departement of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Franco Boccaletto
- Department of Nuclear Medicine, Ca' Foncello Hospital, Treviso, Italy
| | | | - Marta Possamai
- Departement of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Zoran Olivari
- Departement of Cardiology, Ca' Foncello Hospital, Treviso, Italy
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Chirillo F, Scotton P, Rocco F, Rigoli R, Polesel E, Olivari Z. Management of patients with infective endocarditis by a multidisciplinary team approach: an operative protocol. J Cardiovasc Med (Hagerstown) 2013; 14:659-68. [PMID: 23907154 DOI: 10.2459/jcm.0b013e32835ec585] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Even in the modern era of advanced diagnostic imaging, improved antibiotic therapy and potentially curative surgery, infective endocarditis remains a serious disease with high rates of morbidity and mortality. Reasons for such a persistently poor outcome may be represented by the changing epidemiology and microbiology, with new groups of patients at risk and new and more aggressive microorganisms. However, the inadequate use of both diagnostic (blood cultures and echocardiography) and therapeutic (antibiotics and surgery) means can influence the generally delayed diagnosis and poor prognosis seen in patients with infective endocarditis. We tried to identify the critical points in the management of patients with infective endocarditis and to elaborate a formal multidisciplinary approach based on the strict collaboration of specialists in infectious diseases, microbiology, cardiology and cardiac surgery. We hypothesized that this approach could increase the adherence to the published guidelines, and could represent a means to improve the outcome of patients with infective endocarditis.
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Affiliation(s)
- Fabio Chirillo
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy.
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Chirillo F, Scotton P, Rocco F, Rigoli R, Pedrocco A, Martire P, Daniotti A, Minniti G, Polesel E, Olivari Z. Management strategies and outcome for prosthetic valve endocarditis. Am J Cardiol 2013; 112:1177-81. [PMID: 23831161 DOI: 10.1016/j.amjcard.2013.05.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 05/29/2013] [Accepted: 05/29/2013] [Indexed: 11/24/2022]
Abstract
The aim of this study was to assess the impact of an operative protocol with a multidisciplinary approach on the outcome of patients with prosthetic valve endocarditis (PVE). A formal policy for the care of PVE was introduced at our hospital in 2003 in which patients were referred to and managed by a preexisting team involving a cardiologist, a specialist in infectious diseases, and a cardiac surgeon. All patients underwent transesophageal echocardiography as soon as clinical suspicion of PVE arose. If high-risk conditions such as heart failure, ring abscess, conditions associated with impending malfunctioning of the prosthesis, or vegetations at high risk for systemic embolization were found during the initial multidisciplinary evaluation (performed within 12 hours of admission), patients were operated on within 48 hours. Stable patients were evaluated weekly by the multidisciplinary team, and on-treatment surgery was performed whenever high-risk conditions developed or when there was persistent fever/bacteremia after 1 week of adequate antibiotic therapy. Comparing the period 2003 through 2009 with 1996 through 2002 (when a multidisciplinary policy was not followed), patients with PVE were more numerous (61 vs 38), older (mean age 68.3 vs 63.1, p = 0.01), and had more co-morbidities (mean Charlson index 3.15 vs 2.42, p = 0.03). The most frequent causative organisms were Staphylococci in both periods. In the second period, fewer patients had delayed diagnosis (39% vs 71%, p = 0.03), heart failure (20% vs 45%, p = 0.01), abscess (20% vs 39%, p = 0.04), culture-negative infective endocarditis (11% vs 29%, p = 0.03), and worsened renal function (21% vs 42%, p = 0.04). A significant reduction in in-hospital mortality (53% to 23%, p = 0.04) and 3-year mortality (60% to 28%, p = 0.001) was observed, driven by the increased number of patients successfully treated with medical therapy alone (44% vs 16%, p = 0.04). In conclusion, formalized, collaborative management led to significant improvement in PVE-related mortality.
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Chirillo F, Scotton P, Rocco F, Rigoli R, Borsatto F, Pedrocco A, De Leo A, Minniti G, Polesel E, Olivari Z. Impact of a multidisciplinary management strategy on the outcome of patients with native valve infective endocarditis. Am J Cardiol 2013; 112:1171-6. [PMID: 23831163 DOI: 10.1016/j.amjcard.2013.05.060] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 11/27/2022]
Abstract
Strategies to improve management of patients with native valve endocarditis (NVE) are needed because of persistently high morbidity and mortality. We sought to assess the impact of an operative protocol of multidisciplinary approach on the outcome of patients with NVE. A formal policy for the care of infective endocarditis was introduced at our hospital in 2003 in which patients were referred to and managed by a preexisting team involving a cardiologist, a specialist in infectious diseases, and a cardiac surgeon. The initial multidisciplinary evaluation was performed within 12 hours of admission. Whenever conditions associated with impending hemodynamic impairment, high-risk for systemic embolization, or unsuccessful medical therapy were found, patients were operated on within 48 hours. Stable patients were evaluated weekly by the multidisciplinary team, and on-treatment surgery was performed whenever the above high-risk conditions had developed. Comparing the period 2003 through 2009 with 1996 through 2002 (when a multidisciplinary policy was not followed), patients were more numerous (190 vs 102), older (mean age 59.1 vs 54.2, p = 0.01), and had more co-morbidities (mean Charlson index 3.01 vs 2.31, p = 0.02). The pattern of infection did not change in terms of valve infected or paravalvular complications. In the second period, fewer patients had culture-negative NVE (8% vs 21%, p = 0.01) and worsened renal function (37% vs 58%, p = 0.001). A significant reduction in overall in-hospital mortality (28% to 13%, p = 0.02), mortality for surgery during the active phase (47% to 13%, p ≤0.001), and 3-year mortality (34% vs 16%, p = 0.0007) was observed. In conclusion, formalized, collaborative management led to significant improvement in NVE-related mortality, notwithstanding the less favorable patients' baseline characteristics.
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Cecchi E, Chirillo F, Faggiano P, Imazio M, Cecconi M, Moreo A, Cialfi A, Rinaldi M, Ponte SD, Squeri A, Gaddi O, Enia F, Ferro S, Costanzo P, Zuppiroli A, Bergandi G, Bologna F, Ciampani N, De Rosa F, Belli R. The Diagnostic Utility of Transthoracic Echocardiography for the Diagnosis of Infective Endocarditis in the Real World of the Italian Registry on Infective Endocarditis. Echocardiography 2013; 30:871-9. [DOI: 10.1111/echo.12173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Enrico Cecchi
- Department of Cardiology; Maria Vittoria Hospital; Torino; Italy
| | - Fabio Chirillo
- Department of Cardiology; Ca’ Foncello Hospital; Treviso; Italy
| | | | - Massimo Imazio
- Department of Cardiology; Maria Vittoria Hospital; Torino; Italy
| | - Moreno Cecconi
- Department of Cardiology and Cardiac Surgery, Hospitals Joint, University of Ancona; Ancona; Italy
| | - Antonella Moreo
- Department of Cardiology; Niguarda Ca’ Granda Hospital; Milano; Italy
| | | | - Mauro Rinaldi
- Department of Cardiac Surgery; Molinette Hospital; University of Torino; Torino; Italy
| | | | - Angelo Squeri
- Department of Cardio-Renal-Pulmonary, Hospital, University of Parma; Parma; Italy
| | - Oscar Gaddi
- Department of Cardiology; Reggio Emilia Hospital; Reggio Emilia; Italy
| | - Francesco Enia
- Department of Cardiology; Cervello Hospital; Palermo; Italy
| | - Silvia Ferro
- Department of Cardiology; Maria Vittoria Hospital; Torino; Italy
| | - Piera Costanzo
- Department of Cardiology; Giovanni Bosco Hospital; Torino; Italy
| | | | | | - Flavio Bologna
- Department of Cardiology; Rimini Hospital; Rimini; Italy
| | - Nino Ciampani
- Department of Cardiology; Senigallia Hospital; Senigallia; Italy
| | | | - Riccardo Belli
- Department of Cardiology; Maria Vittoria Hospital; Torino; Italy
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Cecconi M, Chirillo F, Costantini C, Iacobone G, Lopez E, Zanoli R, Gili A, Moretti S, Manfrin M, Münch C, Torracca L, Perna GP. The role of transthoracic echocardiography in the diagnosis and management of acute type A aortic syndrome. Am Heart J 2012; 163:112-8. [PMID: 22172444 DOI: 10.1016/j.ahj.2011.09.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 09/25/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Transthoracic echocardiography (TTE) has been traditionally considered inadequate for the diagnosis of acute type A aortic syndrome (AAAS). In the last decade, high-resolution probes and harmonic imaging have been implemented in new echocardiographic systems. However, studies assessing the diagnostic accuracy of TTE for the identification of AAAS in large populations using modern ultrasound technology are lacking. METHODS The diagnostic value of harmonic imaging TTE was assessed in 270 consecutive patients with suspected AAAS in whom TTE was the initial diagnostic test. RESULTS Acute type A aortic syndrome was diagnosed in 67 patients and excluded in 203 patients (disease prevalence 25%). Sixty-two patients had a classic acute type A aortic dissection, and 5, an acute type A intramural hematoma. Image quality achieved was considered optimal in 244 patients (90%). In the whole study population, TTE had sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of AAAS of 87%, 91%, 75%, and 95%, respectively. When evaluating only patients with optimal image quality, these values increased to 97%, 100%, 100%, and 99%, respectively. Forty-seven patients with clear-cut evidence of AAAS were transferred immediately to the operative room, where transesophageal echocardiography confirmed the diagnosis obtained by TTE in all patients. CONCLUSIONS Transthoracic echocardiography is a useful imaging modality for the diagnosis of classic acute type A aortic dissection. It cannot be used as the sole screening technique for detecting AAAS, but in the light of the predictive values observed, patients with optimal image quality and clear-cut diagnosis of AAAS should proceed to the operative room, whereas in patients with negative or indeterminate studies, other imaging techniques are needed to refine the diagnosis.
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Affiliation(s)
- Moreno Cecconi
- Department of Cardiology and Cardiac Surgery, Azienda Ospedaliero Universitaria, Ospedali Riuniti, Ancona, Italy
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Rubartelli P, Petronio AS, Guiducci V, Sganzerla P, Bolognese L, Galli M, Sheiban I, Chirillo F, Ramondo A, Bellotti S. Comparison of sirolimus-eluting and bare metal stent for treatment of patients with total coronary occlusions: results of the GISSOC II-GISE multicentre randomized trial. Eur Heart J 2010; 31:2014-20. [DOI: 10.1093/eurheartj/ehq199] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [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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Chirillo F, Bacchion F, Pedrocco A, Scotton P, De Leo A, Rocco F, Valfrè C, Olivari Z. Infective endocarditis in patients with diabetes mellitus. J Heart Valve Dis 2010; 19:312-320. [PMID: 20583393] [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: 05/29/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Numerous studies have been conducted to investigate the conditions associated with poor outcome among patients with infective endocarditis (IE). Yet, diabetes mellitus alone has rarely been analyzed as participating in the prognosis, and few data are available relating to the clinical characteristics of IE in diabetics. The study aim was to assess the influence of diabetes mellitus on the characteristics and prognosis of IE, and to identify predictors of poor outcome among diabetic patients with this condition. METHODS The study included consecutive patients with IE who had presented to a tertiary center between 1990 and 2006. All patients underwent transthoracic and transesophageal echocardiography. Three or more blood cultures were collected from each patient. Records of all patients were collected prospectively into a computerized database. RESULTS Among 309 patients with definitive IE (according to modified Duke criteria), 38 (12%) had diabetes mellitus. Typically, diabetic patients were older than non-diabetics (67.1 +/- 10.4 versus 60.7 +/- 15.8 years; p < 0.001), had more serious comorbidities (Charlson index 2.8 +/- 0.7 versus 1.2 +/- 0.5; p = 0.005), and a higher frequency of enterococcal endocarditis. No differences were noted between patients with or without diabetes mellitus for the valve involved, nor for the subvalvular involvement. In a multivariate analysis, diabetes mellitus was identified as an independent predictor of mortality (OR 2.49; 95% CI 1.15-5.62). Surgery was performed in the active phase in 139 patients: surgical mortality was higher for diabetic patients (29% versus 10% p = 0.049). In-hospital mortality was significantly higher among diabetic patients (34%) than in non-diabetics (20%) (p = 0.002). Enterococcal endocarditis, left ventricular ejection fraction < 0.45, multi-organ failure, heart failure, persistent fever after one week of antibiotic therapy, and a Charlson index > 3 were associated with an increased mortality among diabetic patients. CONCLUSION Diabetes mellitus represents a relevant risk factor for a worse clinical course and outcome of IE.
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Affiliation(s)
- Fabio Chirillo
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy.
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Cecchi E, De Rosa FG, Chirillo F, Petrelli E, Oreto G, Suter F, Lagioia R, Viale P, Enia F, Bassetti M, Venditti M, Petrosillo N, Utili R, Imazio M. [Prophylaxis of infective endocarditis. Joint position paper of the Italian Federation of Cardiology and the Italian Society of Infectious and Tropical Diseases]. G Ital Cardiol (Rome) 2009; 10:395C-400C. [PMID: 19603610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Enrico Cecchi
- Divisione di Cardiologia, Ospedale Maria Vittoria, Torino
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Chirillo F, Salvador L, Bacchion F. Acute discrete dissection of the ascending aorta. Case Reports 2009; 2009:brc2007115840. [DOI: 10.1136/brc.2007.115840] [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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Chirillo F, Salvador L, Bacchion F. Acute discrete dissection of the ascending aorta. Heart 2008; 94:924. [DOI: 10.1136/hrt.2007.115840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cecchi E, Imazio M, De Rosa FG, Chirillo F, Enia F, Pavan D, Cecconi M, Squeri A, Trinchero R. Infective endocarditis in the real world: the Italian Registry of Infective Endocarditis (Registro Italiano Endocardite Infettiva – RIEI). J Cardiovasc Med (Hagerstown) 2008; 9:508-14. [DOI: 10.2459/jcm.0b013e3282f20ae6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Chirillo F, Salvador L, Bacchion F, Franceschini Grisolia E, Valfrè C, Olivari Z. Clinical and anatomical characteristics of subtle-discrete dissection of the ascending aorta. Am J Cardiol 2007; 100:1314-9. [PMID: 17920378 DOI: 10.1016/j.amjcard.2007.05.063] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 05/31/2007] [Accepted: 05/31/2007] [Indexed: 10/22/2022]
Abstract
Subtle or discrete (class 3 in the classification of the European Society of Cardiology) dissection is the most neglected variant of aortic dissection. This study was conducted to define the clinical manifestations, diagnostic findings, and outcomes of subtle or discrete dissection involving the ascending aorta. The clinical and surgical records, preoperative studies, and outcomes of 109 consecutive patients with ascending aortic dissection observed from 1995 to 2005 were reviewed. Eight patients (7.3%) had discrete dissection. Five patients presented with acute anterior chest pain, 2 with abdominal pain, and 4 with syncope. The mean diameter of the ascending aorta was 44 +/- 8.8 mm. The intimal tears were located in all patients on the posterior aspect of the ascending aorta 1 to 40 mm above the left coronary ostium; its length varied from 2.8 to 12.3 mm. Preoperative aortography, magnetic resonance imaging, and computed tomography could not identify the discrete intimal tears. Transesophageal echocardiography provided unique diagnostic information on (1) subtle intimal discontinuity, (2) circumscribed intramural hematoma, and (3) discrete pericardial fluid around the dissected aorta. Six patients underwent emergency surgery on the basis of echocardiographic findings, and they were all alive at follow-up. Compared with patients with classic aortic dissection, those with discrete dissection had lower operative mortality (0% vs 26%, p = 0.11), shorter hospital stay (7.2 +/- 2.8 vs 21 +/- 19 days, p = 0.01), and less frequent need for blood transfusions (0% vs 39%, p = 0.02). In conclusion, elevated clinical suspicion and detailed transesophageal echocardiographic examination are important for the early identification of discrete aortic dissection, leading to prompt surgery, shorter hospital stays, and better outcomes.
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Mantovan R, Calzolari V, Cavallini C, Franceschini E, Marton F, Chirillo F, Olivari Z, Stritoni P. Anatomical and electrophysiological approach to atrial fibrillation ablation: technical limitations. J Cardiovasc Med (Hagerstown) 2006; 7:586-91. [PMID: 16858236 DOI: 10.2459/01.jcm.0000237905.03506.dc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/05/2022]
Abstract
OBJECTIVE Pulmonary vein (PV) disconnection by radiofrequency (RF) catheter ablation has been reported to cure atrial fibrillation (AF). Different techniques have been proposed. The aim of this study was to evaluate the technical limitations of both anatomical and electrophysiological approaches. METHODS A total of 110 PVs were ablated in 26 consecutive patients (23 male, 3 female, mean age 51 +/- 9.5 years) with paroxysmal (n = 19, 73%), persistent (n = 3, 12%) or permanent (n = 4, 15%) AF. Accurate reconstructions of the PV ostia were obtained using fluoroscopy, electrophysiology, and the CARTO mapping system. Electrophysiological mapping was attempted in all PVs by means of a decapolar circular catheter. RF ablation was performed in a single-blind fashion in order to anatomically create circumferential lines around each PV. Completeness of anatomically-guided, circumferential RF lesions around the PVs was established by the physician using the CARTO system, who was unaware of the decapolar circular catheter electrophysiological recordings of the PVs. If PV potentials persisted, RF delivery was targeted to the electrophysiological breakthroughs. RESULTS All PV ostia were anatomically ablated by performing circumferential RF lesions. Among 110 PVs, 73 (66%) were fully mapped by use of circular catheters. After anatomical ablation, electrical disconnection was achieved in 44/73 PVs (60%). In the remaining 29 PVs (40%), a median of one RF pulse (mean 1.8 +/- 1.4) was necessary to achieve complete PV disconnection. Total procedure duration, fluoroscopy time, and RF delivery time were 232 +/- 29, 50 +/- 16 and 39 +/- 11 min, respectively. Pericardial effusion occurred in one patient after the procedure. After 10.5 +/- 6.4 months, 21 patients (81%) were in stable sinus rhythm and 13 of them (62%) discontinued all drugs after 6 months. Only 4 patients (15%) required two procedures. CONCLUSIONS Electrical PV disconnection cannot be achieved in many PVs by means of a pure anatomical approach. On the other hand, electrophysiological mapping cannot be performed in many PVs owing to anatomical variations. An integrated approach might overcome these limitations.
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Affiliation(s)
- Roberto Mantovan
- Cardiovascular Department, S. Maria dei Battuti Regional Hospital, Treviso, Italy.
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Abstract
Chronic severe mitral regurgitation is a progressive disease that can lead to left ventricular dysfunction. New information on the natural history of the disease, along with advances in surgical techniques, has changed the roles of medical and surgical therapies. There is no well-defined role for medical therapy in chronic mitral regurgitation. The goal of the treating physician is therefore to identify the optimal timing for surgical intervention. The timing of surgical intervention depends primarily on two factors: (i) clinical symptoms and (ii) the left ventricular response to volume overload. However, the aetiology of mitral regurgitation, the likelihood of surgical repair, the occurrence of atrial fibrillation and the presence of pulmonary hypertension, together with the haemodynamic response to exercise, are important factors in the optimal surgical timing. New concepts in the understanding of the natural history of the disease coupled with success of mitral repair have recently resulted in a widespread evolution towards earlier surgery.
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Affiliation(s)
- Fabio Chirillo
- Cardiology Unit, Cardiovascular Department, Ca' Foncello Hospital, Treviso, Italy.
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Cavallini C, Chirillo F. Non-ST-elevation acute coronary syndromes management: a fresh look at glycoprotein IIb/IIIa inhibitors. Eur Heart J Suppl 2005. [DOI: 10.1093/eurheartj/sui073] [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: 11/14/2022]
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Chirillo F, Pedrocco A, De Leo A, Bruni A, Totis O, Meneghetti P, Stritoni P. Impact of harmonic imaging on transthoracic echocardiographic identification of infective endocarditis and its complications. Heart 2005; 91:329-33. [PMID: 15710712 PMCID: PMC1768775 DOI: 10.1136/hrt.2003.031583] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [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] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the comparative diagnostic value of harmonic imaging (HI) in the assessment of patients with suspected infective endocarditis (IE). SETTING Tertiary referral centre. DESIGN 139 consecutive patients were evaluated with three imaging modalities: transthoracic echocardiography with fundamental imaging (FI); HI; and transoesophageal echocardiography (TOE). Image quality was assessed for each modality by semiquantitative scoring (0, poor, to 3, excellent). Presence, dimension, and characteristics of vegetations were assessed separately for each imaging modality, as well as presence of abscesses. RESULTS 35 patients had definite IE. TOE was positive in 33 patients, HI in 28, and FI in 12 (p < 0.001 for FI v HI and v TOE). Mean image quality was 1.4 (0.7) for FI, 2.1 (0.6) for HI (p < 0.01 v FI), and 2.6 (0.4) for TOE (p < 0.001 v HI). The association between FI and TOE findings was Phi = 0.35 (chi2 = 17.57, p = 0.0014) and between HI and TOE it was Phi = 0.95 (chi2 = 125.72, p < 0.0001; p < 0.0001 v FI). The global echo score of vegetations was 7.1 (3.3) with FI, 8.5 (3.4) with HI, and 11.3 (3.9) with TOE (p < 0.001 v HI). Compared with TOE, FI identified only one of seven abscesses (sensitivity 14%) and HI identified two of seven abscesses (sensitivity 28%). CONCLUSIONS HI provides an accurate assessment of suspected IE. TOE achieves superior definition of IE related abnormalities.
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Affiliation(s)
- F Chirillo
- Department of Cardiology, Ca' Foncello Hospital, Piazzale Ospedale 1, 31100 Treviso, Italy.
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Chirillo F, Bruni A, De Leo A, Olivari Z, Franceschini-Grisolia E, Totis O, Stritoni P. Usefulness of dipyridamole stress echocardiography for predicting graft patency after coronary artery bypass grafting. Am J Cardiol 2004; 93:24-30. [PMID: 14697461 DOI: 10.1016/j.amjcard.2003.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [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] [Indexed: 11/19/2022]
Abstract
Noninvasive techniques often provide controversial results in patients who have coronary artery bypass grafts (CABGs). Vasodilator stress echocardiography allows semi-simultaneous imaging of CABG flow and segmental left ventricular wall motion. To assess the comparative and additive value of regional flow and function for noninvasive evaluation of graft patency status, we evaluated 110 consecutive patients who underwent CABG and who were scheduled for coronary angiography. All patients underwent stress echocardiography with dipyridamole (0.84 mg/kg) and atropine (1 mg), including wall motion analysis by 2-dimensional echocardiography and Doppler evaluation of flow reserve of each CABG. Echocardiographic findings were compared with angiographic data. Four patients had inadequate acoustic windows. The remaining 106 patients had 226 grafts performed. Stress echocardiography showed 67% sensitivity, 91% specificity, and 71% accuracy for identification of 50% to 100% stenosis in the graft or in the recipient coronary vessel. There was a fair agreement with angiography (kappa coefficient 0.60). Identification of impaired coronary bypass flow reserve (i.e., <1.9 for internal mammary grafts and <1.6 for saphenous vein grafts) by Doppler had 91% sensitivity, 88% specificity, and 89% accuracy for graft stenosis. There was good agreement with angiographic findings (kappa 0.77). The combination of the 2 techniques achieved 93% sensitivity, 93% specificity, and 93% accuracy, showing a very good agreement with the patency status of the grafts as evaluated at angiography (kappa 0.85). The combined assessment of wall motion and flow reserve in patients who underwent CABG is feasible and provides an accurate estimate of graft patency status by increasing sensitivity of stress echocardiography and specificity of Doppler flow reserve.
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Affiliation(s)
- Fabio Chirillo
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy.
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Mantovan R, Pitscheider W, Fischetto G, Perissinotto F, Chirillo F, Calzolari V, Striton P. 6.5 A new integrated approach for pulmonary veins ablation. Europace 2003. [DOI: 10.1016/eupace/4.supplement_1.a10-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | | | | | | | | | - P. Striton
- Cardiovascular Department, Treviso, Italy
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Chirillo F, Pedrocco A, Bruni A, Totis O, De Leo A, Zecchel R, Stritoni P. Transthoracic echocardiography using native tissue harmonic imaging: diagnostic alternative to transesophageal echocardiography in patients with suspected infective endocarditis. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)81911-8] [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: 11/24/2022]
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Chirillo F, Bruni A, Balestra G, Cavallini C, Olivari Z, Thomas JD, Stritoni P. Assessment of internal mammary artery and saphenous vein graft patency and flow reserve using transthoracic Doppler echocardiography. Heart 2001; 86:424-31. [PMID: 11559684 PMCID: PMC1729941 DOI: 10.1136/heart.86.4.424] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To investigate transthoracic Doppler echocardiography in the identification of coronary artery bypass graft (CABG) flow for assessing graft patency. DESIGN The initial study group comprised 45 consecutive patients with previous CABG undergoing elective cardiac catheterisation for recurrent ischaemia. The Doppler variables best correlated with angiographic graft patency were then tested prospectively in a further 84 patients (test group). SETTING Three tertiary referral centres. INTERVENTIONS Flow velocities in grafts were recorded at rest and during hyperaemia induced by dipyridamole (0.56 mg/kg/4 min), under the guidance of transthoracic colour Doppler flow mapping. Findings on transthoracic Doppler were compared with angiography. MAIN OUTCOME MEASURES Feasibility of identifying open grafts by Doppler and diagnostic accuracy for Doppler detection of significant (>/= 70%) graft stenosis. RESULTS In the test group the identification rate for mammary artery grafts was 100%, for saphenous vein grafts to left anterior descending coronary artery 91%, for vein grafts to right coronary artery 96%, and for vein grafts to circumflex artery 90%. Coronary flow reserve (the ratio between peak diastolic velocity under hyperaemia and at baseline) of < 1.9 (95% confidence interval 1.83 to 2.08) had 100% sensitivity, 98% specificity, 87.5% positive predictive value, and 100% negative predictive value for mammary artery graft stenosis. Coronary flow reserve of < 1.6 (95% CI 1.51 to 1.73) had 91% sensitivity, 87% specificity, 85.4% positive predictive value, and 92.3% negative predictive value for significant vein graft stenosis. CONCLUSIONS Transthoracic Doppler can provide non-invasive assessment of CABG patency.
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Affiliation(s)
- F Chirillo
- Department of Cardiology, Regional Hospital Ca' Foncello, 31100 Treviso, Italy.
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Mantovan R, Zecchel R, Viani S, De Leo A, Giujusa T, Marton F, Chirillo F, Cavallini C, Giommi L, Stritoni P. Size and determinants of myocardial lesion during radiofrequency catheter ablation. Europace 2001. [DOI: 10.1016/eupace/2.supplement_1.a27-b] [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: 10/14/2022] Open
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Ge J, Chirillo F, Schwedtmann J, Görge G, Haude M, Baumgart D, Shah V, von Birgelen C, Sack S, Boudoulas H, Erbel R. Screening of ruptured plaques in patients with coronary artery disease by intravascular ultrasound. Heart 1999; 81:621-7. [PMID: 10336922 PMCID: PMC1729066 DOI: 10.1136/hrt.81.6.621] [Citation(s) in RCA: 133] [Impact Index Per Article: 5.3] [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] [Indexed: 11/04/2022] Open
Abstract
AIM To visualise the characteristics of ruptured plaques by intravascular ultrasound (IVUS) and to correlate plaque characteristics with clinical symptoms to establish a quantitative index of plaque vulnerability. METHODS 144 consecutive patients with angina were examined using IVUS. Ruptured plaques, characterised by a plaque cavity and a tear on the thin fibrous cap, were identified in 31 patients (group A), of whom 23 (74%) presented with unstable angina. Plaque rupture was confirmed by injecting contrast medium filling the plaque cavity during IVUS examination. Of the patients without plaque rupture (group B, n = 108), only 19 (18%) had unstable angina. RESULTS No significant differences were found between groups A and B in relation to plaque and vessel area (p > 0.05). Mean (SD) per cent stenosis in group A was less than in group B, at 56.2 (16.5)% v 67.9 (13.4)%; p < 0.001. Area of the emptied plaque cavity in group A (4.1 (3.2) mm2) was larger than the echolucent zone in group B (1.32 (0.79) mm2) (p < 0.001). The plaque cavity to plaque ratio in group A (38.5 (17.1)%) was larger than the echolucent area to plaque ratio in group B (11.2 (8.9)%) (p < 0.001). The thickness of the fibrous cap in group A was less than in group B, at 0.47 (0.20) mm v 0.96 (0.94) mm; p < 0.001. CONCLUSIONS Plaques seem to be prone to rupture when the echolucent area is larger than 4.1 (3.2) mm2, when the echolucent area to plaque ratio is greater than 38.5 (17.1)%, and when the fibrous cap is thinner than 0.7 mm. IVUS can identify plaque rupture and vulnerable plaques. This may influence patient management and treatment.
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Affiliation(s)
- J Ge
- Department of Cardiology, University Essen, Hufelandstr 55, 45122 Essen, Germany
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Chirillo F, Totis O, De Leo A. Cardiogenic refractory hypoxaemia secondary to blunt chest trauma: diagnosis by transoesophageal echocardiography. Heart 1998; 79:527-8. [PMID: 9659210 PMCID: PMC1728692 DOI: 10.1136/hrt.79.5.527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- F Chirillo
- Department of Cardiology, Regional Hospital, Treviso, Italy
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Chirillo F, Brunazzi MC, Barbiero M, Giavarina D, Pasqualini M, Franceschini-Grisolia E, Cotogni A, Cavarzerani A, Rigatelli G, Stritoni P, Longhini C. Estimating mean pulmonary wedge pressure in patients with chronic atrial fibrillation from transthoracic Doppler indexes of mitral and pulmonary venous flow velocity. J Am Coll Cardiol 1997; 30:19-26. [PMID: 9207616 DOI: 10.1016/s0735-1097(97)00130-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.1] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVES We sought to obtain a noninvasive estimation of mean pulmonary wedge pressure (MPWP) in patients with chronic atrial fibrillation (AF). BACKGROUND It has previously been demonstrated that MPWP can be reliably estimated from Doppler indexes of mitral and pulmonary venous flow (PVF) in patients with sinus rhythm. Doppler estimation of MPWP has not been validated in patients with AF. METHODS MPWP was correlated with variables of mitral and pulmonary venous flow velocity as assessed by Doppler transthoracic echocardiography in 35 consecutive patients. The derived algorithm was prospectively tested in 23 additional patients. RESULTS In all patients the mitral flow pattern showed only a diastolic forward component. A significant but relatively weak correlation (r = -0.50) was observed between MPWP and mitral deceleration time. In 12 (34%) of 35 patients, the pulmonary vein flow tracing demonstrated only a diastolic forward component; a diastolic and late systolic forward flow was noted in the remaining 23 patients (66%). A strong negative correlation was observed between MPWP and the normalized duration of the diastolic flow (r = -0.80) and its initial deceleration slope time (r = -0.91). Deceleration time > 220 ms predicted MPWP < or = 12 mm Hg with 100% sensitivity and 100% specificity. When estimating MPWP by using the equation MPWP = -94.261 PVF deceleration time -9.831 Interval QRS to onset of diastolic PVF -16.337 Duration of PVF + 44.261, the measured and predicted MPWP closely agreed with a mean difference of -0.85 mm Hg. The 95% confidence limits were 4.8 and -6.1 mm Hg. CONCLUSIONS In patients with chronic AF, MPWP can be estimated from transthoracic Doppler study of PVF velocity signals.
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Affiliation(s)
- F Chirillo
- Department of Cardiology, Regional Hospital, Treviso, Italy
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Scorzoni D, Bazzanini F, Brunazzi MC, Chirillo F, Biondi P, Hölzi A, Musacci G, Longhini C. Age-related differences of blood pressure profile in essential hypertension. Chronobiol Int 1997; 14:397-407. [PMID: 9262875 DOI: 10.3109/07420529709001460] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 02/05/2023]
Abstract
The purpose was to assess age-related circadian changes of blood pressure profile (BPP) employing a truncated Fourier series with four harmonics (tFs) in patients with essential hypertension. The study was performed on 32 patients with essential hypertension divided in two groups: (A) 15 patients younger than 55 years and (B) 17 patients older than 60 years. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were monitored every 20 minutes for 24 h with a noninvasive portable device (SpaceLabs 90202). To evaluate the existence of SBP and DBP circadian rhythms a one-sample runs-test was performed and the mesor, amplitude, and acrophase from the overall curve of each patient were obtained by tFs. In both groups, SBP and DBP profiles showed a first peak in the late morning and a second peak in the early evening around the same hours. The two peaks in the SBP profile were higher and the two peaks in the DBP profile were lower in older patients than in younger ones (p < .01, p < .05, p < .3, p < .05). The truncated Fourier series with four harmonics evidences different age-related BP profiles characterized by two peaks with higher SBP and lower DBP in elderly patients. These changes of BPP are in accordance with the reported higher risk of cardiovascular events observed around the same hours.
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Affiliation(s)
- D Scorzoni
- Istituti di Medicina Interna I e II, Università di Ferrara, Italy
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