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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando JIL, Bosch X, Sinha A, Vidal P, Izquierdo M, Marin F, Esteve-Pastor MA, Tello-Montoliu A, Lopez-Garcia C, Rivera-Caravaca JM, Gil-Pérez P, Nicolas-Franco S, Keituqwa I, Farhan HA, Silva L, Blasco A, Escudier JM, Ortega J, Zamorano JL, Sanmartin M, Pereda DC, Rincon LM, Gonzalez P, Casado T, Sadeghipour P, Lopez-Sendon JL, Manjavacas AMI, Marin LAM, Sotelo LR, Rodriguez SOR, Bueno H, Martin R, Maruri R, Moreno G, Moris C, Gudmundsdottir I, Avanzas P, Ayesta A, Junco-Vicente A, Cubero-Gallego H, Pascual I, Sola NB, Rodriguez OA, Malagon L, Martinez-Basterra J, Arizcuren AM, Indolfi C, Romero J, Calleja AG, Fuertes DG, Crespín Crespín M, Bernal FJC, Ojeda FB, Padron AL, Cabeza MM, Vargas CM, Yanes G, Kitai T, Gonzalez MJG, Gonzalez Gonzalez J, Jorge P, De La Fuente B, Bermúdez MG, Perez-Lopez CMB, Basiero AB, Ruiz AC, Pamias RF, Chamero PS, Mirrakhimov E, Hidalgo-Urbano R, Garcia-Rubira JC, Seoane-Garcia T, Arroyo-Monino DF, Ruiz AB, Sanz-Girgas E, Bonet G, Rodríguez-López J, Scardino C, De Sousa D, Gustiene O, Elbasheer E, Humida A, Mahmoud H, Mohamed A, Hamid E, Hussein S, Abdelhameed M, Ali T, Ali Y, Eltayeb M, Philippe F, Ali M, Almubarak E, Badri M, Altaher S, Alla MD, Dellborg M, Dellborg H, Hultsberg-Olsson G, Marjeh YB, Abdin A, Erglis A, Alhussein F, Mgazeel F, Hammami R, Abid L, Bahloul A, Charfeddine S, Ellouze T, Canpolat U, Oksul M, Muderrisoglu H, Popovici M, Karacaglar E, Akgun A, Ari H, Ari S, Can V, Tuncay B, Kaya H, Dursun L, Kalenderoglu K, Tasar O, Kalpak O, Kilic S, Kucukosmanoglu M, Aytekin V, Baydar O, Demirci Y, Gürsoy E, Kilic A, Yildiz Ö, Arat-Ozkan A, Sinan UY, Dagva M, Gungor B, Sekerci SS, Zeren G, Erturk M, Demir AR, Yildirim C, Can C, Kayikcioglu M, Yagmur B, Oney S, Xuereb RG, Sabanoglu C, Inanc IH, Ziyrek M, Sen T, Astarcioglu MA, Kahraman F, Utku O, Celik A, Surmeli AO, Basaran O, Ahmad WAW, Demirbag R, Besli F, Gungoren F, Ingabire P, Mondo C, Ssemanda S, Semu T, Mulla AA, Atos JS, Wajid I, Appelman Y, Al Mahmeed WAR, Atallah B, Bakr K, Garrod R, Makia F, Eldeeb F, Abdekader R, Gomaa A, Kandasamy S, Maruthanayagam R, Nadar SK, Nakad G, Nair R, Mota P, Prior P, Mcdonald S, Rand J, Schumacher N, Abraheem A, Clark M, Coulding M, Qamar N, Turner V, Negahban AQ, Crew A, Hope S, Howson J, Jones S, Lancaster N, Nicholson A, Wray G, Donnelly P, Gierlotka M, Hammond L, Hammond S, Regan S, Watkin R, Papadopoulos C, Ludman P, Hutton K, Macdonald S, Nilsson A, Roberts S, Monteiro S, Garg S, Balachandran K, Mcdonald J, Singh R, Marsden K, Davies K, Desai H, Goddard W, Iqbal N, Chalil S, Dan GA, Galasko G, Assaf O, Benham L, Brown J, Collins S, Fleming C, Glen J, Mitchell M, Preston S, Uttley A, Radovanovic M, Lindsay S, Akhtar N, Atkinson C, Vinod M, Wilson A, Clifford P, Firoozan S, Yashoman M, Bowers N, Chaplin J, Reznik EV, Harvey S, Kononen M, Lopesdesousa G, Saraiva F, Sharma S, Cruddas E, Law J, Young E, Hoye A, Harper P, Balghith M, Rowe K, Been M, Cummins H, French E, Gibson C, Abraham JA, Hobson S, Kay A, Kent M, Wilkinson A, Mohamed A, Clark S, Duncan L, Ahmed IM, Khatiwada D, Mccarrick A, Wanda I, Read P, Afsar A, Rivers V, Theobald T, Cercek M, Bell S, Buckman C, Francis R, Peters G, Stables R, Morgan M, Noorzadeh M, Taylor B, Twiss S, Widdows P, Brozmannová D, Wilkinson V, Black M, Clark A, Clarkson N, Currie J, George L, Mcgee C, Izzat L, Lewis T, Omar Z, Aytekin V, Phillips S, Ahmed F, Mackie S, Oommen A, Phillips H, Sherwood M, Aleti S, Charles T, Jose M, Kolakaluri L, Ingabire P, Karoudi RA, Deery J, Hazelton T, Knight A, Price C, Turney S, Kardos A, Williams F, Wren L, Bega G, Alyavi B, Scaletta D, Kunadian V, Cullen K, Jones S, Kirkup E, Ripley DP, Matthews IG, Mcleod A, Runnett C, Thomas HE, Cartasegna L, Gunarathne A, Burton J, King R, Quinn J, Sobolewska J, Munt S, Porter J, Christenssen V, Leng K, Peachey T, Gomez VN, Temple N, Wells K, Viswanathan G, Taneja A, Cann E, Eglinton C, Hyams B, Jones E, Reed F, Smith J, Beltrano C, Affleck DC, Turner A, Ward T, Wilmshurst N, Stirrup J, Brunton M, Whyte A, Smith S, Murray V, Walker R, Novas V, Weston C, Brown C, Collier D, Curtis K, Dixon K, Wells T, Trim F, Ghosh J, Mavuri M, Barman L, Dumont C, Elliott K, Harrison R, Mallinson J, Neale T, Smith J, Toohie J, Turnbull A, Parker E, Hossain R, Cheeseman M, Balparda H, Hill J, Hood M, Hutchinson D, Mellows K, Pendlebury C, Storey RF, Barker J, Birchall K, Denney H, Housley K, Cardona M, Middle J, Kukreja N, Gati S, Kirk P, Lynch M, Srinivasan M, Szygula J, Baker P, Cruz C, Derigay J, Cigalini C, Lamb K, Nembhard S, Price A, Mamas M, Massey I, Wain J, Delaney J, Junejo S, Martin K, Obaid D, Hoyle V, Brinkworth E, Davies C, Evans D, Richards S, Thomas C, Williams M, Dayer M, Mills H, Roberts K, Goodchild F, Dámaso ES, Greig N, Kundu S, Donaldson D, Tonks L, Beekes M, Button H, Hurford F, Motherwell N, Summers-Wall J, Felmeden D, Tapia V, Keeling P, Sheikh U, Yonis A, Felmeden L, Hughes D, Micklewright L, Summerhayes A, Sutton J, Panoulas V, Prendergast C, Poghosyan K, Rogers P, Barker LN, Batin P, Conway D, Exley D, Fletcher A, Wright J, Nageh T, Hadebe B, Kunhunny S, Mkhitaryan S, Mshengu E, Karthikeyan VJ, Hamdan H, Cooper J, Dandy C, Parkinson V, Paterson P, Reddington S, Taylor T, Tierney C, Adamyan M, Jones KV, Broadley A, Beesley K, Buckley C, Hellyer C, Pippard L, Pitt-Kerby T, Azam J, Hayes C, Freshwater K, Boyadjian S, Johnson L, Mcgill Y, Redfearn H, Russell M, Alyavi A, Alyavi B, Uzokov J, Hayrapetyan H, Azaryan K, Tadevosyan M, Poghosyan H, Kzhdryan H, Vardanyan A, Huber K, Geppert A, Ahmed A, Weidinger F, Derntl M, Hasun M, Schuh-Eiring T, Riegler L, Haq MM, Cader FA, Dewan MAM, Fatema ME, Hasan AS, Islam MM, Khandoker F, Mayedah R, Nizam SU, Azam MG, Arefin MM, Jahan J, Schelfaut D, De Raedt H, Wouters S, Aerts S, Batjoens H, Beauloye C, Dechamps M, Pierard S, Van Caenegem O, Sinnaeve F, Claeys MJ, Snepvangers M, Somers V, Gevaert S, Schaubroek H, Vervaet P, Buysse M, Renders F, Dumoulein M, Hiltrop N, De Coninck M, Naessens S, Senesael I, Hoffer E, Pourbaix S, Beckers J, Dugauquier C, Jacquet S, Malmendier D, Massoz M, Evrard P, Collard L, Brunner P, Carlier S, Blockmans M, Mayne D, Timiras E, Guédès A, Demeure F, Hanet C, Domange J, Jourdan K, Begic E, Custovic F, Dozic A, Hrvat E, Kurbasic I, Mackic D, Subo A, Durak-Nalbantic A, Dzubur A, Rebic D, Hamzic-Mehmedbasic A, Redzepovic A, Djokic-Vejzovic A, Hodzic E, Hujdur M, Musija E, Gljiva-Gogic Z, Serdarevic N, Bajramovic NS, Brigic L, Halilcevic M, Cibo M, Hadžibegic N, Kukavica N, Begic A, Iglica A, Osmanagic A, Resic N, Grgurevic MV, Zvizdic F, Pojskic B, Mujaric E, Selimovic H, Ejubovic M, Pojskic L, Stimjanin E, Sut M, Zapata PS, Munoz CG, Andrade LAF, Upegui MPT, Perez LE, Chavarria J, Quesada D, Alvarado K, Zaputovic L, Tomulic V, Gobic D, Jakljevic T, Lulic D, Bacic G, Bastiancic L, Avraamides P, Eftychiou C, Eteocleous N, Ioannou A, Lambrianidi C, Drakomathioulakis M, Groch L, Hlinomaz O, Rezek M, Semenka J, Sitar J, Beranova M, Kramarikova P, Pesl L, Sindelarova S, Tousek F, Warda HM, Ghaly I, Habiba S, Habib A, Gergis MN, Bahaa H, Samir A, Taha HSE, Adel M, Algamal HM, Mamdouh M, Shaker AF, Shokry K, Konsoah A, Mostafa AM, Ibrahim A, Imam A, Hafez B, Zahran A, Abdelhamid M, Mahmoud K, Mostafa A, Samir A, Abdrabou M, Kamal A, Sallam S, Ali A, Maghraby K, Atta AR, Saad A, Ali M, Lotman EM, Lubi R, Kaljumäe H, Uuetoa T, Kiitam U, Durier C, Ressencourt O, El Din AA, Guiatni A, Bras ML, Mougenot E, Labeque JN, Banos JL, Capendeguy O, Mansourati J, Fofana A, Augagneur M, Bahon L, Pape AL, Batias-Moreau L, Fluttaz A, Good F, Prieur F, Boiffard E, Derien AS, Drapeau I, Roy N, Perret T, Dubreuil O, Ranc S, Rio S, Bonnet JL, Bonnet G, Cuisset T, Deharo P, Mouret JP, Spychaj JC, Blondelon A, Delarche N, Decalf V, Guillard N, Hakme A, Roger MP, Biron Y, Druelles P, Loubeyre C, Lucon A, Hery P, Nejjari M, Digne F, Huchet F, Neykova A, Tzvetkov B, Larrieu M, Quaino G, Armangau P, Sauguet A, Bonfils L, Dumonteil N, Fajadet J, Farah B, Honton B, Monteil B, Philippart R, Tchetche D, Cottin M, Petit F, Piquart A, Popovic B, Varlot J, Maisuradze D, Sagirashvili E, Kereselidze Z, Totladze L, Ginturi T, Lagvilava D, Hamm C, Liebetrau C, Haas M, Hamm C, Koerschgen T, Weferling M, Wolter JS, Maier K, Nickenig G, Sedaghat A, Zachoval C, Lampropoulos K, Mpatsouli A, Sakellaropoulou A, Tyrovolas K, Zibounoumi N, Argyropoulos K, Toulgaridis F, Kolyviras A, Tzanis G, Tzifos V, Milkas A, Papaioannou S, Kyriazopoulos K, Pylarinou V, Kontonassakis I, Kotakos C, Kourgiannidis G, Ntoliou P, Parzakonis N, Pipertzi A, Sakalidis A, Ververeli CL, Kafkala K, Sinanis T, Diakakis G, Grammatikopoulos K, Papoutsaki E, Patialiatos T, Mamaloukaki M, Papadaki ST, Kanellos IE, Antoniou A, Tsinopoulos G, Goudis C, Giannadaki M, Daios S, Petridou M, Skantzis P, Koukis P, Dimitriadis F, Savvidis M, Styliadis I, Sachpekidis V, Pilalidou A, Stamatiadis N, Fotoglidis A, Karakanas A, Ruzsa Z, Becker D, Nowotta F, Gudmundsdottir I, Libungan B, Skuladottir FB, Halldorsdottir H, Shetty R, Iyengar S, Bs C, G S, Lakshmana S, S R, Tripathy N, Sinha A, Choudhary B, Kumar A, Kumar A, Raj R, Roy RS, Dharma S, Siswanto BB, Farhan HA, Yaseen IF, Al-Zaidi M, Dakhil Z, Amen S, Rasool B, Rajeeb A, Amber K, Ali HH, Al-Kinani T, Almyahi MH, Al-Obaidi F, Masoumi G, Sadeghi M, Heshmat-Ghahdarijani K, Roohafza H, Sarrafzadegan N, Shafeie M, Teimouri-Jervekani Z, Noori F, Kyavar M, Sadeghipour P, Firouzi A, Alemzadeh-Ansari MJ, Ghadrdoost B, Golpira R, Ghorbani A, Ahangari F, Salarifar M, Jenab Y, Biria A, Haghighi S, Mansouri P, Yadangi S, Kornowski R, Orvin K, Eisen A, Oginetz N, Vizel R, Kfir H, Pasquale GD, Casella G, Cardelli LS, Filippini E, Zagnoni S, Donazzan L, Ermacora D, Indolfi C, Polimeni A, Curcio A, Mongiardo A, De Rosa S, Sorrentino S, Spaccarotella C, Landolina M, Marino M, Cacucci M, Vailati L, Bernabò P, Montisci R, Meloni L, Marchetti MF, Biddau M, Garau E, Barbato E, Morisco C, Strisciuglio T, Canciello G, Lorenzoni G, Casu G, Merella P, Novo G, D'Agostino A, Di Lisi D, Di Palermo A, Evola S, Immordino F, Rossetto L, Spica G, Pavan D, Mattia AD, Belfiore R, Grandis U, Vendrametto F, Spagnolo C, Carniel L, Sonego E, Gaudio C, Barillà F, Biccire FG, Bruno N, Ferrari I, Paravati V, Torromeo C, Galasso G, Peluso A, Prota C, Radano I, Benvenga RM, Ferraioli D, Anselmi M, Frigo GM, Sinagra G, Merlo M, Perkan A, Ramani F, Altinier A, Fabris E, Rinaldi M, Usmiani T, Checco L, Frea S, Mussida M, Matsukawa R, Sugi K, Kitai T, Furukawa Y, Masumoto A, Miyoshi Y, Nishino S, Assembekov B, Amirov B, Chernokurova Y, Ibragimova F, Mirrakhimov E, Ibraimova A, Murataliev T, Radzhapova Z, Uulu ES, Zhanyshbekova N, Zventsova V, Erglis A, Bondare L, Zaliunas R, Gustiene O, Dirsiene R, Marcinkeviciene J, Sakalyte G, Virbickiene A, Baksyte G, Bardauskiene L, Gelmaniene R, Salkauskaite A, Ziubryte G, Kupstyte-Kristapone N, Badariene J, Balciute S, Kapleriene L, Lizaitis M, Marinskiene J, Navickaite A, Pilkiene A, Ramanauskaite D, Serpytis R, Silinskiene D, Simbelyte T, Staigyte J, Philippe F, Degrell P, Camus E, Ahmad WAW, Kassim ZA, Xuereb RG, Buttigieg LL, Camilleri W, Pllaha E, Xuereb S, Popovici M, Ivanov V, Plugaru A, Moscalu V, Popovici I, Abras M, Ciobanu L, Litvinenco N, Fuior S, Dumanschi C, Ivanov M, Danila T, Grib L, Filimon S, Cardaniuc L, Batrinac A, Tasnic M, Cozma C, Revenco V, Sorici G, Dagva M, Choijiljav G, Dandar E, Khurelbaatar MU, Tsognemekh B, Appelman Y, Den Hartog A, Kolste HJT, Van Den Buijs D, Van'T Hof A, Pustjens T, Houben V, Kasperski I, Ten Berg J, Azzahhafi J, Bor W, Yin DCP, Mbakwem A, Amadi C, Kushimo O, Kilasho M, Oronsaye E, Bakracheski N, Bashuroska EK, Mojsovska V, Tupare S, Dejan M, Jovanoska J, Razmoski D, Marinoski T, Antovski A, Jovanovski Z, Kocho S, Markovski R, Ristovski V, Samir AB, Biserka S, Kalpak O, Peovska IM, Taleska BZ, Pejkov H, Busljetik O, Zimbakov Z, Grueva E, Bojovski I, Tutic M, Poposka L, Vavlukis M, Al-Riyami A, Nadar SK, Abdelmottaleb W, Ahmed S, Mujtaba MS, Al-Mashari S, Al-Riyami H, Laghari AH, Faheem O, Ahmed SW, Qamar N, Furnaz S, Kazmi K, Saghir T, Aneel A, Asim A, Madiha F, Sobkowicz B, Tycinska A, Kazimierczyk E, Szyszkowska A, Mizia-Stec K, Wybraniec M, Bednarek A, Glowacki K, Prokopczuk J, Babinski W, Blachut A, Kosiak M, Kusinska A, Samborski S, Stachura J, Szastok H, Wester A, Bartoszewska D, Sosnowska-Pasiarska B, Krzysiek M, Legutko J, Nawrotek B, Kasprzak JD, Klosinska M, Wiklo K, Kurpesa M, Rechcinski T, Cieslik-Guerra U, Gierlotka M, Bugajski J, Feusette P, Sacha J, Przybylo P, Krzesinski P, Ryczek R, Karasek A, Kazmierczak-Dziuk A, Mielniczuk M, Betkier-Lipinska K, Roik M, Labyk A, Krakowian M, Machowski M, Paczynska M, Potepa M, Pruszczyk P, Budaj A, Ambroziak M, Omelanczuk-Wiech E, Torun A, Opolski G, Glowczynska R, Fojt A, Kowalik R, Huczek Z, Jedrzejczyk S, Roleder T, Brust K, Gasior M, Desperak P, Hawranek M, Farto-Abreu P, Santos M, Baptista S, Brizida L, Faria D, Loureiro J, Magno P, Monteiro C, Nédio M, Tavares J, Sousa C, Almeida I, Almeida S, Miranda H, Santos H, Santos AP, Goncalves L, Monteiro S, Baptista R, Ferreira C, Ferreira J, Goncalves F, Lourenço C, Monteiro P, Picarra B, Santos AR, Guerreiro RA, Carias M, Carrington M, Pais J, de Figueiredo MP, Rocha AR, Mimoso J, De Jesus I, Fernandes R, Guedes J, Mota T, Mendes M, Ferreira J, Tralhão A, Aguiar CT, Strong C, Da Gama FF, Pais G, Timóteo AT, Rosa SAO, Mano T, Reis J, Selas M, Mendes DE, Satendra M, Pinto P, Queirós C, Oliveira I, Reis L, Cruz I, Fernandes R, Torres S, Luz A, Campinas A, Costa R, Frias A, Oliveira M, Martins V, Castilho B, Coelho C, Moura AR, Cotrim N, Dos Santos RC, Custodio P, Duarte R, Gomes R, Matias F, Mendonca C, Neiva J, Rabacal C, Almeida AR, Caeiro D, Queiroz P, Silva G, Pop-Moldovan AL, Darabantiu D, Mercea S, Dan GA, Dan AR, Dobranici M, Popescu RA, Adam C, Sinescu CJ, Andrei CL, Brezeanu R, Samoila N, Baluta MM, Pop D, Tomoaia R, Istratoaie O, Donoiu I, Cojocaru A, Oprita OC, Rocsoreanu A, Grecu M, Ailoaei S, Popescu MI, Cozma A, Babes EE, Rus M, Ardelean A, Larisa R, Moisi M, Ban E, Buzle A, Filimon G, Dobreanu D, Lupu S, Mitre A, Rudzik R, Sus I, Opris D, Somkereki C, Mornos C, Petrescu L, Betiu A, Volcescu A, Ioan O, Luca C, Maximov D, Mosteoru S, Pascalau L, Roman C, Brie D, Crisan S, Erimescu C, Falnita L, Gaita D, Gheorghiu M, Levashov S, Redkina M, Novitskii N, Dementiev E, Baglikov A, Zateyshchikov D, Zubova E, Rogozhina A, Salikov A, Nikitin I, Reznik EV, Komissarova MS, Shebzukhova M, Shitaya K, Stolbova S, Larina V, Akhmatova F, Chuvarayan G, Arefyev MN, Averkov OV, Volkova AL, Sepkhanyan MS, Vecherko VI, Meray I, Babaeva L, Goreva L, Pisaryuk A, Potapov P, Teterina M, Ageev F, Silvestrova G, Fedulaev Y, Pinchuk T, Staroverov I, Kalimullin D, Sukhinina T, Zhukova N, Ryabov V, Kruchinkina E, Vorobeva D, Shevchenko I, Budyak V, Elistratova O, Fetisova E, Islamov R, Ponomareva E, Khalaf H, Shaimaa AA, Kamal W, Alrahimi J, Elshiekh A, Balghith M, Ahmed A, Attia N, Jamiel AA, Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Amicone S, Bergamaschi L, Armillotta M, Sansonetti A, Stefanizzi A, Impellizzeri A, Suma N, Tattilo FP, Angeli F, Paolisso P, Rinaldi A, Foa' A, Casella G, Galie' N, Pizzi C. Predictors of late gadolinium enhancement development and extension in myocardial infarction with non-obstructive coronary arteries. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous clinical entity and in its complex diagnostic approach cardiovascular magnetic resonance (CMR) plays a pivotal role.
Purpose
To characterize the differences of MINOCA patients with and without late gadolinium enhancement (LGE) at CMR and to identify the predictors for ischemic LGE development and extension.
Methods
We assessed 461 MINOCA cases from January 2016 to June 2021. MINOCA were defined according to the current European guidelines criteria. We excluded acute myocarditis, Tako-tsubo syndromes, cardiomyopathies, or non-pathological CMR. According to CMR imaging findings, our cohort was divided into two CMR phenotypes based on regional myocardial necrosis detected throughout LGE (“LGE-positive MINOCA”) or regional ischemic injury without LGE (“LGE-negative MINOCA”). Extended LGE was considered as the presence of >2 segments with transmural LGE. Multivariate logistic regression analysis was used to determine the predictors of LGE and extended LGE.
Results
The final cohort included 175 MINOCA: 121 (69.1%) constituted the LGE-positive group. The mean time delay between acute clinical presentation and CMR was 6±2.9 days. At admission MINOCA LGE-patients more frequently presented angina and ST segment elevation (24% vs 7.4%, p=0.01), compared to LGE negative ones. Furthermore, the LGE positive group had a significantly greater infarct size, measured by peak hs-Troponin I values and left ventricular function (LVEF). The only predictor of LGE was the peak troponin value (OR 1.64, 95% CI 1.18–2.28, p=0.003), while predictors of extended LGE were ST-segment elevation at admission (OR 7.44, 95% CI 1.57–35.22, p=0.01), peak troponin values (OR 1.07, 95% CI 1.02–1.13, p=0.01) and the presence of non-obstructive coronary artery disease at coronary angiography (OR 5.49, 95% CI 1.20–25.09, p=0.028).
Conclusion
The presence and extension of LGE at early CMR evaluation is an important feature in the setting of MINOCA. In addition, simple baseline characteristics (such as ST elevation, peak troponin value and LVEF) may aid the identification of a greater ischemic necrosis burden at CMR and therefore these high-risk MINOCA subjects could be benefit from a stricter management effort.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Amicone
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - L Bergamaschi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - M Armillotta
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - A Sansonetti
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - A Stefanizzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - A Impellizzeri
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - N Suma
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - F P Tattilo
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - F Angeli
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - P Paolisso
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - A Rinaldi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - A Foa'
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - G Casella
- Maggiore Hospital, Cardiology Department , Bologna , Italy
| | - N Galie'
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - C Pizzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
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3
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Suma N, Sansonetti A, Armillotta M, Angeli F, Amicone S, Impellizzeri A, Bodega F, Canton L, Tattilo FP, Bergamaschi L, Iannopollo G, Casella G, Galie' N, Foa' A, Pizzi C. Prognostic role of acute myocardial infarction diagnostic criteria in patients presenting with non-ST segment elevation myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Fourth Universal Definition of Myocardial Infarction (UDMI) defines acute myocardial infarction (AMI) as an acute myocardial injury associated with clinical evidence of acute myocardial ischemia. However, the prognostic role of each single diagnostic criteria has never been explored.
Purpose
To evaluate the prognostic role of the different diagnostic criteria of AMI according to the Fourth UDMI in patients with non-ST-segment elevation myocardial infarction.
Methods
We enrolled all consecutive patients with NSTEMI undergoing coronary angiography at our Centre. The admission diagnosis was performed according to the current guidelines criteria, namely the detection of an increase and/or decrease of high-sensitivity cardiac troponin I, with at least one value above the 99th percentile of the upper reference limit and at least one of the following: symptoms of ischemia, ECG changes (new ST depression or negative T-waves), echocardiographic evidence of new regional wall motion abnormality. Patients with very high-risk NSTEMI were excluded. Patients were then divided into different subgroups according to the combination of diagnostic criteria presented at admission. A composite endpoint of all-cause mortality, re-hospitalization for myocardial reinfarction or heart failure was collected. The predictive value of AMI diagnostic criteria alone and their combination were evaluated using Kaplan-Meier survival curves and subsequent Cox-regression analysis to find independent predictors of major adverse events.
Results
Our study population consisted of 2791 patients. The mean age was 68.3±13.4 and 31.5% were female. The mean follow-up time was 23.3±14.5 months. Depending on the AMI diagnostic criteria and their combination, patients were divided into three subgroups: 196 patients fulfilling only clinical criteria (group A), 187 with clinical and ECG-graphic criteria (group B) and 829 patients with clinical, ECG-graphic and echo-graphic criteria (group C). Baseline characteristics of the three groups were similar. At two-year follow-up, patients with clinical criteria alone exhibited the best outcome, whereas those with all three criteria fulfilled showed the worse prognosis (14.8% for group A vs 23.6% for group B vs 28.0% for group C; p-value <0.001). In multivariable Cox-regression model, the presence of clinical criteria alone was the independent predictor of better prognosis compared to the other diagnostic criteria combination (HR=0.48; CI 95% 0.31–0.74; p<0.001).
Conclusions
In non-very high-risk NSTEMI, not all diagnostic criteria have the same prognostic value. In fact, prognosis is significantly more favorable in patients exhibiting only the clinical criteria at admission. We hypothesize that the absence of ECG-graphic and echocardiographic alterations may indirectly indicate smaller infarct sizes that contribute to patients' outcomes. These findings could enhance the current risk stratification in patients admitted with NSTEMI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Suma
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - A Sansonetti
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - M Armillotta
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - F Angeli
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - S Amicone
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - A Impellizzeri
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - F Bodega
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - L Canton
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - F P Tattilo
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - L Bergamaschi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - G Iannopollo
- Maggiore Hospital, Cardiology Department , Bologna , Italy
| | - G Casella
- Maggiore Hospital, Cardiology Department , Bologna , Italy
| | - N Galie'
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - A Foa'
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - C Pizzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
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Armillotta M, Bergamaschi L, Amicone S, Sansonetti A, Stefanizzi A, Impellizzeri A, Tattilo FP, Angeli F, Fabrizio M, Paolisso P, Rinaldi A, Foa' A, Casella G, Galie' N, Pizzi C. Prognostic role of early cardiac magnetic resonance in myocardial infarction with non-obstructive coronary arteries. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a significant proportion of acute myocardial infarction (AMI) population. MINOCA is a working diagnosis and an accurate investigation of the underlying causes should always be performed. In this setting, cardiac magnetic resonance (CMR) imaging plays a pivotal diagnostic role. However, a prognostic stratification based on the CMR findings in ischemic MINOCA is still unavailable.
Purpose
To evaluate the potential prognostic impact of specific CMR findings - especially ischemic late gadolinium enhancement (LGE) patterns - in order to look for measurable parameters that may guide the management of this still troubled clinical entity.
Methods
We assessed 461 MINOCA from January 2016 to June 2021. We excluded acute myocarditis, Tako-tsubo syndromes, cardiomyopathies, or non-pathological CMR. According to CMR findings, MINOCA were classified in two phenotypes: LGE-positive (an ischemic subendocardial or transmural LGE pattern) or LGE-negative (cases without LGE but exhibiting regional myocardial injury defined by myocardial edema in a coronary territory with a typically ischemic “wave-front” and/or regional wall motion abnormality consistent with coronary distribution).
All-cause mortality, re-infarction, stroke, heart failure (HF) and the composite endpoint (MACE) were evaluated. Extended LGE was considered as the presence of >2 segments with transmural LGE. The mean follow-up was 36.1±15.2 months and CMR was performed at a mean of 6±2.9 days from the acute presentation.
Results
The final cohort included 175 MINOCA with a likely-ischemic etiology: 121 (69.1%) constituted the LGE-positive group. The mean age of the study population was 62.3±12.9 years and more than 61% were females. During follow-up, HF (15.7% vs 1.9%, p=0.008) and MACE (20.7% vs 7.4%, p=0.029) occurred more frequently in MINOCA “LGE-positive” compared to the “LGE-negative” ones. Extended LGE was significantly more prevalent in patients with versus without subsequent HF. On multivariable Cox regression, extended LGE was an independent predictor of HF occurrence (HR 18.49, 95% CI 4.65–73.61, p<0.001) and MACE (HR 14.64, 95% CI 3.91–54.86, p<0.001).
Conclusions
Our data suggest that in MINOCA patients the detection of LGE is correlated with the incidence of major cardiovascular events and heart failure during long-term follow-up. In fact, LGE extension was identified as the strongest predictor of cardiac adverse events. The early execution of CMR is useful in the prognostic stratification of MINOCA and this could guide the subsequent clinical and therapeutic management.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Armillotta
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - L Bergamaschi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - S Amicone
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - A Sansonetti
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - A Stefanizzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - A Impellizzeri
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - F P Tattilo
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - F Angeli
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - M Fabrizio
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - P Paolisso
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - A Rinaldi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - A Foa'
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - G Casella
- Maggiore Hospital, Cardiology Department , Bologna , Italy
| | - N Galie'
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
| | - C Pizzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine , Bologna , Italy
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Cardelli LS, Barbato G, Carinci V, Pergolini F, Leci E, Verardi R, Casella G. Catheter ablation of well tolerated ventricular tachycardia in patients with structural heart disease: long term follow-up of 62 cases without automatic defibrillator implantation. Europace 2022. [DOI: 10.1093/europace/euac053.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The occurrence of a sustained monomorphic ventricular tachycardias (SMVT) in patients with underlying structural heart disease (SHD) is considered correlated to a poor prognosis, based on historical data in patients with heterogeneous heart disease and clinical presentation; therefore the recommendation for implantation of automatic implantable cardioverter defibrillator (AICD) is strong. Information about prognosis of patients with SMVT is still limited, but recent studies have established that these patients represent a low-risk subgroup for sudden death that could benefit from radiofrequency (RF) ablation of the arrhythmic substrate and the AICD implantation could be deferred during the follow up.
Purpose
Patients with well-tolerated SMVT, SHD and left ventricular ejection fraction (LVEF) over 30% can benefit from a primary VT ablation strategy without the immediate need for AICD implantation.
Methods
We reviewed consecutive SHD patients with LVEF over 30% admitted for the occurrence of SMVT and who were treated by RF ablation as a first-choice therapy in a single Italian center, between 2009 and 2020 and who were discharged without AICD implantation. The primary outcome of the study was a composite of all-cause death and recurrence of VT. The secondary outcome was death from all causes. Patients with similar characteristics but who underwent AICD implantation during the same period served as control group.
Results
Clinical and electrophysiological features of 62 patients were analyzed (Table 1). In the study group, 88% were male; the median age was 72 years (IQR 55-81) and the median LVEF was 50.0% (IQR 40.0-55.0). The estimated success rate of ablative procedures (defined as VT no longer inducible) was around 82%. After a median follow-up of 38.8 months (IQR 15.6-76.1), the primary outcome occurred in 24 patients and the secondary outcome in 11 patients. All-cause mortality was 17%, corresponding to an annual mortality rate of 4.3%. Ten patients died for non-cardiovascular causes and one for advanced heart failure. No patient in the study died from sudden death. During the follow-up, 10 patients (16.1%) underwent AICD implantation due to VT relapse. At 36 months, between study and control groups, there was no difference in either the primary composite outcome (HR 1.03, 95% CI 0.45-2.21, p = 0.98) or in the secondary outcome (HR 1.4, 95% CI 0.48-4.54, p = 0.49).
Conclusions
Patients with well-tolerated SMVT, SHD and LVEF over 30% represent a subgroup of patients at lower risk that can benefit of RF ablation as a first-choice therapy. Delay in AICD implantation, after a possible VT relapse or clinical worsening, appears to represent a safe therapeutic strategy. Therefore, it is ethical and desirable to start a prospective randomized clinical trial to evaluate the benefit and cost-effectiveness of this strategy, as an alternative to AICD implantation.
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Affiliation(s)
| | | | | | | | - E Leci
- Maggiore Hospital, Bologna, Italy
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Piscitelli L, Pedone C, Perugini E, Coutsoumbas G, Riva L, Dattolo G, Carinci V, Barbato G, Cardelli L, Casella G. P101 ARRHYTHMIC MITRAL VALVE PROLAPSE: COULD ELECTROANATOMICAL MAPPING AND CARDIAC MAGNETIC RESONANCE BE GOOD FRIENDS? Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
There is an increasing awareness of the association between mitral valve prolapse (MVP) and sudden cardiac death (SCD), but risk stratification is still challenging. Mitral annular disjunction (MAD) is a recognized risk factor for arrhythmic complications. A multimodality imaging strategy, including advanced echocardiography, magnetic resonance (CMR) and electromechanical mapping, could improve risk stratification and management by combining anatomical and functional information.
Case Review
We report a case of a 50–year–old woman without cardiovascular risk factors, complaining for worsening palpitations in the last months. Echocardiogram documented bileaflet MVP with moderate regurgitation, MAD (12 mm in inferolateral wall) and normal ventricular systolic function. 24–hour Holter monitoring revealed a high (13%) premature ventricular complexes burden with ventricular bigeminy and non–sustained ventricular tachycardia. Stress test showed a reduction of the arrhythmias during exercise. CMR confirmed MAD but no late gadolinium enhancement areas were detected. The patient underwent electrophysiological study with electroanatomic mapping (CARTO). The latter revealed multifocal fragmented and delayed low voltage potentials close to the posterior papillary muscle and the posterior anular mitral area, respectively. Both locations were the targets of endoventricular radiofrequency ablation. However, due to her high arrhythmic risk profile the patient implanted a cardioverter defibrillator.
Discussion
In arrhythmic risk stratification of MVP with MAD, CMR could have technical limitations due to diffuse fibrosis patterns or irregular cardiac rhythm that could undermine a detailed and complete evaluation. Thus, electroanatomical mapping during electrophysiological testing could offer additional and complementary information that could improve risk stratification and further management.
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Affiliation(s)
- L Piscitelli
- U.O.C. CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI; U.O.C. CARDIOLOGIA OSPEDALE MAGGIORE, BOLOGNA; UNITÀ DI CARDIOLOGIA– AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA
| | - C Pedone
- U.O.C. CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI; U.O.C. CARDIOLOGIA OSPEDALE MAGGIORE, BOLOGNA; UNITÀ DI CARDIOLOGIA– AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA
| | - E Perugini
- U.O.C. CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI; U.O.C. CARDIOLOGIA OSPEDALE MAGGIORE, BOLOGNA; UNITÀ DI CARDIOLOGIA– AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA
| | - G Coutsoumbas
- U.O.C. CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI; U.O.C. CARDIOLOGIA OSPEDALE MAGGIORE, BOLOGNA; UNITÀ DI CARDIOLOGIA– AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA
| | - L Riva
- U.O.C. CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI; U.O.C. CARDIOLOGIA OSPEDALE MAGGIORE, BOLOGNA; UNITÀ DI CARDIOLOGIA– AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA
| | - G Dattolo
- U.O.C. CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI; U.O.C. CARDIOLOGIA OSPEDALE MAGGIORE, BOLOGNA; UNITÀ DI CARDIOLOGIA– AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA
| | - V Carinci
- U.O.C. CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI; U.O.C. CARDIOLOGIA OSPEDALE MAGGIORE, BOLOGNA; UNITÀ DI CARDIOLOGIA– AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA
| | - G Barbato
- U.O.C. CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI; U.O.C. CARDIOLOGIA OSPEDALE MAGGIORE, BOLOGNA; UNITÀ DI CARDIOLOGIA– AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA
| | - L Cardelli
- U.O.C. CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI; U.O.C. CARDIOLOGIA OSPEDALE MAGGIORE, BOLOGNA; UNITÀ DI CARDIOLOGIA– AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA
| | - G Casella
- U.O.C. CARDIOLOGIA UNIVERSITARIA POLICLINICO DI BARI, BARI; U.O.C. CARDIOLOGIA OSPEDALE MAGGIORE, BOLOGNA; UNITÀ DI CARDIOLOGIA– AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA
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Dal Passo B, Cardelli L, Perugini E, Bugani G, Canovi L, Frascaro F, Zanarelli L, Piscitelli L, Colletta M, Casella G. P411 MINOCA OR NOT MINOCA? THE DECISIVE ROLE OF CARDIAC MAGNETIC RESONANCE IN THE DIFFERENTIAL DIAGNOSIS OF MYOCARDIAL DAMAGE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Cardiac MRI can facilitate the differential diagnosis of myocardial damage in patients without coronary artery disease. Our case report is about a 50–year–old man who was admitted to the Emergency Department of the Maggiore Hospital in Bologna in October 2021 for oppressive chest pain at rest; previously he had experienced a similar episode but of minor intensity. He had not previous medical records. When the patient arrived at the emergency department chest pain had regressed, blood pressure was elevated (170/110 mmHg). The ECG showed sinus tachycardia at 100 bpm without electrocardiographic abnormalities suggestive of acute ischemia. Cardiac biomarkers were elevated (hsTnI 312 ng / L –> 975 ng / L – n.v. <19.8 ng / L); blood gas analysis showed pH 7.42, pO2 47 mmHg and pCO2 33 mmHg. Chest CT scan excluded pulmonary embolism and acute aortic syndrome. The patient was transferred to Cardiology Ward in the suspicion of acute coronary syndrome, where echocardiogram showed normal biventricular volumes, mild wall hypertrophy and hypokinesia of the lower middle wall (EF 52%). Coronary angiography didn’t showed any obstructive stenosis in any epicardial vessels. In consideration of the clinical presentation and instrumental evidences, the patient was discharged with a diagnosis of myocardial infarction with non–obstructive coronary arteries (MINOCA), but a cardiac MRI was scheduled in the post–discharge to clarify its genesis. MRI didn’t showed any areas of signal hyperintensity, any perfusion deficits in the first pass study and any areas of late gadolinium enhancement (LGE). Those images permitted to exclude areas of necrosis or inflammation, orienting the diagnosis to myocardial damage during hypertensive crisis. Therefore, the antiplatelet therapy recommended at discharge was suspended. In this case report, cardiac magnetic resonance showed that it can improve the etiological diagnosis of MINOCA, allowing for better clinical and therapeutic management.
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Affiliation(s)
- B Dal Passo
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - L Cardelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - E Perugini
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - G Bugani
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - L Canovi
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - F Frascaro
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - L Zanarelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - L Piscitelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - M Colletta
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - G Casella
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
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Dal Passo B, Cardelli L, Capecchi A, Nobile G, Canovi L, Frascaro F, Zanarelli L, Piscitelli L, Casella G. P193 MECHANICAL COMPRESSION DEVICE (LUCAS®) IN THE CATHETERIZATION LABORATORY: RETROSPECTIVE ANALYSIS OF A SINGLE CENTER. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
The survival of IHCA and OHCA depends on the timeliness and the quality of cardiopulmonary resuscitation (CPR). During transport, in the Cath Lab or when resuscitation is extended, the availability of chest compression systems increases the quality of CPR and it is recommended in these specific situations by the AHA 2020 Guidelines.
Methods
Retrospective analysis of patients who encountered cardiocirculatory arrest (CCA) in the Cath Lab or in ICU of the Maggiore Hospital managed with CPR and application of a chest compression device (LUCAS® 3) from 2020 to 2021.
Results
The study population consisted of 21 patients, all undergoing invasive procedure (coronary angiography, angioplasty or aortic valvuloplasty) in peri–arrest: 17 patients (81%) with CCA during STEMI, 3 (14%) during NSTEMI and one patient during acute pulmonary edema caused by severe aortic stenosis. In 6 cases (29%) the onset rhythm of CCA was shockable, the others were pulseless electrical activities. Considering patients admitted with STEMI, 4 (24%) have OHCA and LUCAS® had been applied by 118 operators before entering the Cath Lab. In the other cases LUCAS® was placed in the Cath Lab, before or during the procedure; in all but two cases, the procedure was concluded. The resuscitation maneuvers involved, in addition to LUCAS®, the use of an external defibrillator, orotracheal intubation, administration of inotropes and, in 2 cases (10%) the intra–aortic balloon pump (IABP). The average time between CCA and application of LUCAS® was 14 minutes – the device was always positioned after at least 2 manual ECM cycles without restoring the circulation – and the average CPR duration was 73 minutes. Any complications related to the implantation of the device were observed. The survival at the end of the procedure in the Cath Lab was 24% and on discharge 14%.
Conclusion
The use of chest compression devices during CCA allows a better management by medical personnel during long–term CPR and a completion of invasive procedure. Unfortunately, it doesn’t substantially changes the survival of patients as reported by the literature.
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Affiliation(s)
- B Dal Passo
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - L Cardelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - A Capecchi
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - G Nobile
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - L Canovi
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - F Frascaro
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - L Zanarelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - L Piscitelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - G Casella
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
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Armillotta M, Sansonetti A, Amicone S, Stefanizzi A, Impellizzeri A, Bergamaschi L, Paolisso P, Foà A, Rinaldi A, Casella G, Galiè N, Pizzi C. P322 A MISLEADING SAM. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A 66–year–old woman with a history of anxious–depressive syndrome and osteoporosis, without significant cardiological history, reported onset of cardiopalmus and dyspnoea for a few days due to moderate efforts, in conjunction with a period of strong emotional stress. Due to the persistence of these symptoms and the onset of epigastric pain, she underwent a cardiological examination which found low blood pressure values associated with the presence of a systolic murmur. The ECG showed diffuse changes in repolarization compatible with ischemia. Access to the emergency room (ER) was recommended. In ER, the first high–sensitivity troponin value was significantly high (1542 ng/L). Therefore, in the suspect of ACS, the patient was transferred to the cardiological intensive care unit. Echocardiogram showed akinesia of the mid–apical segments, hypercontractility of the bases (EF 35%) and a SAM (systolic anterior motion) with a dynamic outflow tract pressure gradient of 80 mmHg which resulted in severe mitral regurgitation. During the first days of hospitalization, persistent hypotension was observed requiring intravenous infusion of fluids to maintain systolic blood pressure values between 90–100 mmHg. Coronary angiography showed only severe ostial stenosis of a branch of the first diagonal branch. At the same time, ventriculography was performed which showed basal hypercontractility with muscle salience at the base and systolic obliteration of the outflow tract with a small apical aneurysm. 5 days after admission, another echocardiogram showed the almost complete normalization of the global systolic function (EF 68%) with apical hypokinesia and hypercontractility of the basal segments. However, the SAM persisted with a dynamic outflow tract pressure gradient of 140 mmHg with the presence of multiple and dislocated papillaries, accessory tendon cords and insertion of muscle tendon at the level of the septum. To complete the diagnosis, cardiac MRI was performed which documented a diffuse increase in T2 relaxation times more evident in the apical area, absence of LGE areas and normalization of contractility of the left ventricle with disappearance of the SAM. These findings, together with the absence of significant hypertrophy and the complete regression of the ECGgraphic changes, allowed us to exclude the presence of an unrecognized hypertrophic cardiomyopathy and to diagnose Takotsubo syndrome.
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Affiliation(s)
- M Armillotta
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA
| | - A Sansonetti
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA
| | - S Amicone
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA
| | - A Stefanizzi
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA
| | - A Impellizzeri
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA
| | - L Bergamaschi
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA
| | - P Paolisso
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA
| | - A Foà
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA
| | - A Rinaldi
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA
| | - G Casella
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA
| | - N Galiè
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA
| | - C Pizzi
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA
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Canovi L, Zanarelli L, Cardelli L, Dal Passo B, Frascaro F, Piscitelli L, De Carolis B, Gibiino F, Vitagliano A, Sciarra F, Zagnoni S, Pallotti M, Colletta M, Casella G. C52 THE BIG FOUR: RESPIRATORY FAILURE, RENAL INSUFFICIENCY, HAEMORRHAGE AND SEPSIS, HOW DO THEY IMPACT ON CICU PATIENT? Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The current rise in life expectancy in the general population leads to changes in baseline characteristics of Cardiac Intensive Care Unit (CICU) patients, increasing the risk of non–cardiac complications during the hospitalization.
Objectives
Evaluate epidemiology and prognostic impact of major non–cardiac complications (respiratory failure, renal insufficiency, haemorrhage and sepsis) during CICU stay. Methods: Retrospective analysis of CICU patients at Ospedale Maggiore of Bologna between March and November 2021.
Results
Baseline characteristics, cardiovascular risk factors and comorbidities of the patients are reported in Table 1. During the CICU stay, 19.7% of patients suffered from acute respiratory failure, needing for ventilation; 15.0% had renal insufficiency (considered as need for haemodialysis, glomerular filtration rate according to Cockcroft–Gault < 60 ml/min, serum creatinine rise > 25% from baseline); 1.8% reported major haemorrhages (defined as serum haemoglobin < 8 g/dl or need for blood transfusion); 1.7% developed sepsis (positive blood cultures). Mean CICU stay for complicated patients was 6 days, intra–CICU mortality was 1.7% (8 deaths) and 30–days mortality was 7.0% (32 deaths). At univariate logistic regression analysis, acute respiratory failure was the only complication associated with a statistically relevant increase in 30–days mortality (OR 2.37, CI 95%, 1.05–5.34; p = 0.038), although, also the other complications had a negative prognostic effect: haemorrhage (OR 1.58, CI 95%, 1.77–14.16; p = 0.681), renal insufficiency (OR 1.47, CI 95%, 0.56–3.87; p = 0.432) and sepsis (OR 1.25, CI 95%, 0.33–5.87, p = 0.850).
Conclusions
Epidemiology and baseline characteristics of CICU patients are changing. Older age and frailty make non–cardiac complications more likely to happen. Acute respiratory failure has the worst prognostic effect on mortality. This fact suggests that CICU Cardiologists should improve their management of these major non–cardiac complications.
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Affiliation(s)
- L Canovi
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - L Zanarelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - L Cardelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - B Dal Passo
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - F Frascaro
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - L Piscitelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - B De Carolis
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - F Gibiino
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - A Vitagliano
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - F Sciarra
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - S Zagnoni
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - M Pallotti
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - M Colletta
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - G Casella
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
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11
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Armillotta M, Sansonetti A, Amicone S, Stefanizzi A, Fabrizio M, Angeli F, Bergamaschi L, Paolisso P, Impellizzeri A, Foà A, Rinaldi A, Casella G, Galiè N, Pizzi C. P215 PROGNOSTIC IMPACT OF EARLY VERSUS DEFERRED CORONARY ANGIOGRAPHY IN MINOCA PATIENTS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Although an early invasive strategy (coronary angiography performed < 24 hours) is associated with a lower risk of recurrent/refractory ischaemia among patients with acute myocardial infarction (AMI) and obstructive coronary arteries, the optimal timing of invasive examination in patients with non–obstructive coronary arteries and non–ST–segment elevation presentation (NSTE–MINOCA) has not been explored.
Purpose
This study tested the hypothesis that, compared to early (< 24 h) invasive strategy, deferred (≥ 24 h) coronary angiography has an equivalent prognostic impact in patients with NSTE–MINOCA.
Methods
From 2016 to 2020, all consecutive MINOCA patients diagnosed according to the current ESC diagnostic criteria (angiographic conventional cut–off of < 50% coronary stenosis without a clinically apparent alternative diagnosis) and admitted to our Centre with non–ST–segment elevation myocardial infarction (NSTEMI) presentation were enrolled. Very high–risk NSTEMI patients had been excluded from the study. The prognostic value of an early (< 24 h) vs. deferred (≥ 24 h) coronary angiography was assessed. All–cause mortality and a composite endpoint (MACE) of all–cause mortality, stroke, re–hospitalization for heart failure and myocardial re–infarction were evaluated.
Results
198 NSTE–MINOCA patients were enrolled, of which 79 underwent coronary angiography < 24 hours and 119 ≥ 24 hours. MINOCA patients were more frequently females (64%) and the mean age was 66.8±13.2 years. After a median follow–up of 26 [14–40] months, the overall all–cause mortality was 13,6% and the composite endpoint (MACE) was achieved in 27.3% of the entire population. Kaplan–Meier curves showed that there was no statistically significant difference (p = 0.88) between the two study groups depending on the time of invasive strategy adopted. Specifically, rates of death (11.4% vs. 15.1%) and MACE (25.3% vs. 28.6%) were similar in MINOCA patients undergoing early versus deferred coronary angiography.
Conclusions
We demonstrated for the first time that in the MINOCA population the prognosis is not influenced by an early versus deferred coronary angiography, as opposed to AMI patients with obstructive coronary arteries. These results add another piece to the puzzle and pave the way for the initial use of a non–invasive imaging strategy (eg. Coronary–CT), mostly in patients with NSTEMI and high clinical suspicion of non–obstructive coronary arteries.
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Affiliation(s)
- M Armillotta
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA–MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA, ITALY, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA, ITALY, BOLOGNA
| | - A Sansonetti
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA–MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA, ITALY, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA, ITALY, BOLOGNA
| | - S Amicone
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA–MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA, ITALY, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA, ITALY, BOLOGNA
| | - A Stefanizzi
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA–MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA, ITALY, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA, ITALY, BOLOGNA
| | - M Fabrizio
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA–MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA, ITALY, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA, ITALY, BOLOGNA
| | - F Angeli
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA–MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA, ITALY, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA, ITALY, BOLOGNA
| | - L Bergamaschi
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA–MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA, ITALY, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA, ITALY, BOLOGNA
| | - P Paolisso
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA–MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA, ITALY, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA, ITALY, BOLOGNA
| | - A Impellizzeri
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA–MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA, ITALY, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA, ITALY, BOLOGNA
| | - A Foà
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA–MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA, ITALY, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA, ITALY, BOLOGNA
| | - A Rinaldi
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA–MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA, ITALY, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA, ITALY, BOLOGNA
| | - G Casella
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA–MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA, ITALY, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA, ITALY, BOLOGNA
| | - N Galiè
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA–MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA, ITALY, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA, ITALY, BOLOGNA
| | - C Pizzi
- UNIVERSITY HOSPITAL POLICLINIC S. ORSOLA–MALPIGHI, CARDIOLOGY, DEPARTMENT OF EXPERIMENTAL DIAGNOSTIC AND SPECIALTY MEDICINE, BOLOGNA, ITALY, BOLOGNA; MAGGIORE HOSPITAL, CARDIOLOGY DEPARTMENT, BOLOGNA, ITALY, BOLOGNA
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12
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Leci E, Carinci V, Bugani G, Greco C, D‘Angelo C, Pecoraro A, Casella G. P23 TIMING OF EJECTION FRACTION REASSESSMENT AFTER SACUBITRIL–VALSARTAN INITIATION FOR INDICATION TO DEFIBRILLATOR IMPLANTATION. A SINGLE CENTER EXPERIENCE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Sacubitril/Valsartan (SV) has been validated for heart failure (HF) with reduced ejection fraction (EF) treatment. SV is effective on hard end–points as well as symptoms and heart remodeling. Present guidelines reccomend at least 3 month of optimized medical therapy (OMT). However, the best timing of EF assessment after SV initiation in order to proceed with defibrillator (ICD) implantation, is still unknown.
Purpose
Evaluate timing of improvement of EF after SV initiation in patients (pts) with systolic HF, candidates to primary prevention ICD implantation.
Methods
From 1 of february 2018, we evaluated retrospectively clinical and echocardiographic data of all consecutive pts with EF < 35% treated with SV and candidates to primary prevention ICD implantation. We evaluated clinical and echo follow up (Fup). Results have been analyzed with paired T–test.
Results
The study involved 95 pts (mean age 67±10 years, 70% male, ischaemic etiology 48%). Mean EF at enrollment was 30 ± 5% (ED vol 90 ±23 ml/m2; ES vol 62 ± 19 ml/m2, severe MR 23%) and NYHA III–IV 50%. In 58% pts reached the target dose of SV (97/103 mg bid). After a mean Fup of 6 months, mean EF of the study population increased to 37±7% (ED vol 80±19 ml/m2, ES vol 51±17 ml/m2, severe MR 5%, p < 0.001), and NYHA III–IV decreased to 8% (p = 0.01). Interestingly, thirty–one pts (32%) had their first Fup within 3 months and showed already an improvement [meanEF 28±5% to 35±6%; ΔEF 7±6%; NYHA III–IV 10 %]. Moreover, 49 pts (51%) had last Fup echo after 1 year (mean 13±6 months) and showed a further EF improvement (meanEF 41±8%; ΔEF 12±9%; p < 0.001).Sixteen pt (16%) underwent ICD (62%) or CRT–D (38%) implantation after 3±2 months of treatment and excluded from further FUP analysis. More favorable effects of treatment with SV were more evident in patient with non–ischaemic etiology of heart failure.
Conclusions
After SV initiation in systolic HF, favourable heart remodeling is clearly evident at 6 months FUP, but could be already observed after 3 months . These findings need to be validated from larger trials but suggest that the best timing of EF reassessment to decide for primary prevention ICD is likely between 3 and 6 months after SV initiation. However decision must be taken following close and individualized FUP for every patient, based on clinical characteristics and response to OMT.
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Affiliation(s)
- E Leci
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - V Carinci
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - G Bugani
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - C Greco
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - C D‘Angelo
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - A Pecoraro
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - G Casella
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
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13
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Zanarelli L, Canovi L, Cardelli L, Dal Passo B, Frascaro F, Piscitelli L, Pallotti M, Colletta M, Casella G. P413 ISCHEMIC ECG CHANGES, NOT ALWAYS CORONARY ISSUES. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Many abdominal deseases can mimic cardiac symthoms at their presentation and they can lead to electrocardiographic (ECG) changes, acting as a confounding factor for the physichan during the diagnostic process.
Case presentation
A 77–year–old man, former smoker, with high blood pressure not being treated, came to the emergency room with mesogastric pain and vomiting, since three hours before. The ECG showed a sinus rhythm, at 55 beats per minute and a slight elevation of the ST segment in the leads DII, DIII and aVF, evolving as T waves negativization in the same leads and flattening in V5– V6. Laboratory tests showed increasing Troponin I values from 23 to 277 ng / L. Because of this pathological context, the patient was taken to our Unit to perform a coronary angiography study in the hypothesis of acute myocardial infarction. The examination showed diffuse atheromatous lesions in the coronaries without haemodynamically significant stenosis. The patient developed fever during the hospitalization, abdominal CT study with contrast was performed, with a definitive diagnosis of acute cholecystitis and the patient was finally moved to the Internal Medicine ward.
Conclusions
ECG alterations in acute cholecystitis are not specific, but some of them are recurrent: among these there are ischemic modifications affecting the ST segment or the T waves, widely described in the scientific literature. All these ECG modifications solve with the treatment of cholecystitis, whether conservative or surgical, without acting on the cardiological side in any way; on the other hand, they can lead to unnecessary diagnostic–therapeutic investigations, to a diagnosis’delay and to complications’ onset. It is important for the clinician being able to consider abdominal pathology in case of diagnostic investigations’ inconsistency. However, ST segment’s changes during cholecystitis may deserve a cardiological study, as they are specific for acute myocardial infarction, especially in patients with high cardiovascular risk. This reminds to us, once again, the importance of anamnesis, physical examination and appropriate tests, to reach the correct diagnosis.
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Affiliation(s)
- L Zanarelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - L Canovi
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - L Cardelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - B Dal Passo
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - F Frascaro
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - L Piscitelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - M Pallotti
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - M Colletta
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - G Casella
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
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14
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Frascaro F, Cardelli SL, Bugani G, Sciarra F, Zagnoni S, Canovi L, Dal Passo B, De Carolis B, Zanarelli L, Piscitelli L, Colletta M, Casella G. P354 GENDER DIFFERENCES IN EPIDEMIOLOGY OF A CORONARY CARE UNIT HUB IN COVID ERA. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
The attention about sex disparities in Cardiology has grown in the last few years. Women are still often under–represented in cardiovascular randomised clinical trials (RCTs) and several studies have shown later diagnosis, less aggressive treatments and poor prognosis among women, even though hospitalized in the coronary care unit (CCU).
Objective
To analyze gender–related differences and their relationships with prognosis among patients admitted to a contemporary CCU Hub.
Methods
Between 1st March 2021 and 30th November 2021, we prospectively collected the data of patients admitted to the II level CCU of Maggiore Hospital in Bologna.
Results
The clinical characteristics of 458 enrolled patients are shown in Table 1. Women represent 32% of the population, are older (p < 0.001) and have been admitted to the CCU mainly for acute coronary syndrome (ACS) (43%) or bradyarrhythmias (23%); men for ACS (57.5%) or heart failure (11.3%). Among patients with ACS, 82% of women underwent coronary angioplasty – both primary and non–primary– versus 88.1% of men (p = 0.276). Females have fewer cardiovascular risk factors and comorbidities than their male counterparts. In CCU, women received similar treatments to men (except for increased use of parenteral nutrition). Similarly, the prevalence of ischemic, haemorrhagic and septic complications was the same between the sexes. The rate of women‘s mortality in CCU was 1.4%, which increases to 4.8% at 30 days, similar to men’s mortality (1.9% versus 3%, respectively).
Conclusions
The study demonstrates that one third of the population of a CCU Hub is represented by women, older and more often hospitalized for ACS. These women receive the same treatments as men, including coronary revascularization. There were no differences about gender prognosis, despite a higher trend towards mortality in females after discharge from the CCU. Therefore, studies where women are more represented are needed, in order to obtain precise indications on how to modulate clinical management according to gender.
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Affiliation(s)
- F Frascaro
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - SL Cardelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - G Bugani
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - F Sciarra
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - S Zagnoni
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - L Canovi
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - B Dal Passo
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - B De Carolis
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - L Zanarelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - L Piscitelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - M Colletta
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - G Casella
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
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15
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Guarnieri M, Andreoni P, Gay H, Giudici R, Bottiroli M, Mondino M, Casella G, Chiara O, Morelli O, Conforti S, Langer T, Fumagalli R. Tracheostomy in Mechanically Ventilated Patients With SARS-CoV-2-ARDS: Focus on Tracheomalacia. Respir Care 2021; 66:1797-1804. [PMID: 34548406 PMCID: PMC9993780 DOI: 10.4187/respcare.09063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The SARS-CoV-2 pandemic increased the number of patients needing invasive mechanical ventilation, either through an endotracheal tube or through a tracheostomy. Tracheomalacia is a rare but potentially severe complication of mechanical ventilation, which can significantly complicate the weaning process. The aim of this study was to describe the strategies of airway management in mechanically ventilated patients with respiratory failure due to SARS-CoV-2, the incidence of severe tracheomalacia, and investigate the factors associated with its occurrence. METHODS This retrospective, single-center study was performed in an Italian teaching hospital. All adult subjects admitted to the ICU between February 24, 2020, and June 30, 2020, treated with invasive mechanical ventilation for respiratory failure caused by SARS-CoV-2 were included. Clinical data were collected on the day of ICU admission, whereas information regarding airway management was collected daily. RESULTS A total of 151 subjects were included in the study. On admission, ARDS severity was mild in 21%, moderate in 62%, and severe in 17% of the cases, with an overall mortality of 40%. A tracheostomy was performed in 73 (48%), open surgical technique in 54 (74%), and percutaneous Ciaglia technique in 19 (26%). Subjects who had a tracheostomy performed had, compared to the other subjects, a longer duration of mechanical ventilation and longer ICU and hospital stay. Tracheomalacia was diagnosed in 8 (5%). The factors associated with tracheomalacia were female sex, obesity, and tracheostomy. CONCLUSIONS In our population, approximately 50% of subjects with ARDS due to SARS-CoV-2 were tracheostomized. Tracheostomized subjects had a longer ICU and hospital stay. In our population, 5% were diagnosed with tracheomalacia. This percentage is 10 times higher than what is reported in available literature, and the underlying mechanisms are not fully understood.
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Affiliation(s)
- Marcello Guarnieri
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy
| | - Patrizia Andreoni
- Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy
| | - Hedwige Gay
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Riccardo Giudici
- Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy
| | - Maurizio Bottiroli
- Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy
| | - Michele Mondino
- Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy
| | - Gianpaolo Casella
- Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy
| | - Osvaldo Chiara
- Department of Emergency and Trauma Surgery, Niguarda Hospital, University of Milan, Milan, Italy
| | - Oscar Morelli
- Department of Otolaryngology, Niguarda Hospital, Milan, Italy
| | - Serena Conforti
- Department of Thoracic Surgery, Niguarda Hospital, Milan, Italy
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
- Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy
| | - Roberto Fumagalli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy
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16
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Carinci V, Leci E, Bugani G, Greco C, D'Angelo C, Pecoraro A, Casella G. Timing of ejection fraction reassessment after sacubitril-valsartan initiation for indication to defibrillator implantation. A single center experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Sacubitril/Valsartan (SV) has recently been validated in the therapy of heart failure (HF) with reduced ejection fraction (EF). SV is effective on symptoms and heart remodeling. At the moment the best timing to EF assessment after SV initiation in order to proceed with defibrillator (ICD) implantation, it's unknown.
Purpose
Evaluate the timing of improvement of EF after SV initiation in patients (pts) with systolic HF, candidates to primary prevention ICD implantation.
Methods
We enrolled all consecutive pts candidates to primary prevention ICD implantation that underwent SV initiation from February 2018. We evaluated clinical and echo follow up (Fup). Results have been analyzed with paired T-test).
Results
The study involved 61 pts (mean age 67±10 years, 71% male, ischemic cardiopathy 44%, mean time from diagnosis 31 months) with mean EF at enrollment 30±5% (ED vol 94 ml/m2, ES vol 64 ml/m2, severe MR 21%) and mean NYHA 3±0.6. After a mean Fup of 6 months mean EF increased to 37±7% (ED vol 80 ml/m2, ES vol 51 ml/m2, severe MR 8%, p<0.004), NYHA decreased to 2±0.6 (p<0.04). In 69% pts SV dosage reached 97/103 mg bid. 28 pts (45%) had first Fup at 3 months and showed already mean EF 34±6% and mean NYHA 1.6±0.6 (p<0.04). 26 pts (43%) had last Fup echo after 1 year (mean 17±10 months) and showed further EF little improvement (38.3±8%, p 0.05).
Conclusions
After SV initiation in systolic HF, heart remodeling is already evident at 3 months Fup and better appreciable at 6 months Fup. Little non significant further EF improvement could be seen later. In our study best timing to decide for primary prevention ICD is likely between 3 and 6 months after SV initiation.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- V Carinci
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - E Leci
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - G Bugani
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - C Greco
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - C D'Angelo
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - A Pecoraro
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - G Casella
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
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17
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Armillotta M, Sansonetti A, Angeli F, Fabrizio M, Stefanizzi A, Bergamaschi L, Magnani I, Donati F, Toniolo S, Paolisso P, Foa' A, Rinaldi A, Casella G, Galie' N, Pizzi C. Prognostic role of diagnostic criteria of acute myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The term acute myocardial infarction (AMI) reflects cell death of cardiac myocytes caused by ischaemia. The Fourth Universal Definition of Myocardial Infarction (UDMI) defined AMI by a typical rise and fall in the level of biochemical markers of myocardial necrosis together with criteria of myocardial ischaemia. However, the prognostic role of each single diagnostic criteria has never been explored.
Purpose
To evaluate the prognostic role of the different diagnostic criteria of AMI according to the Fourth UDMI.
Methods
We enrolled all consecutive patients with AMI admitted from 2016 to 2019. We used a combination of criteria, according to the current ESC guidelines, to meet the diagnosis, namely the detection of an increase and/or decrease of high-sensitivity cardiac troponin I, with at least one value above the 99th percentile of the upper reference limit and at least one of the following: symptoms of ischaemia; ECG changes (new ST-T changes or new LBBB); development of pathological Q waves in the ECG; imaging evidence of new loss of viable myocardium or new regional wall motion abnormality, in our study evaluated by transthoracic echocardiogram. All-cause mortality and a composite endpoint of all-cause mortality, re-hospitalization for heart failure and myocardial re-infarction were collected. The predictive value of diagnostic criteria alone and its association were evaluated using Kaplan-Meier survival curves and subsequent Cox-regression analysis to find independent predictors of adverse events.
Results
2386 patients were evaluated. The median follow-up time was 23.3±14.5 months. The total number of events was 703 (29.3%). Kaplan-Meier curves showed that major adverse cardiac events (MACE) were statistically different depending on the diagnostic criteria of AMI at admission. Particularly, clinical criteria alone showed a better predictive value (p<0.001) than other diagnostic AMI criteria. Multivariable Cox-regression model demonstrated that clinical criteria was the independent predictor of good prognosis in patients with AMI (HR=0.43; CI 95% 0.28–0.67; p<0.001). Conversely, the others diagnostic criteria (electrocardiographic and echocardiographic) and the combination of all diagnostic criteria were not independent prognostic factors of MACE (HR=1.1 CI 95% 0.6–2.4, p=0.6; HR=1.1 CI 95% 0.7–1.2, p=0.6; HR=0.9 CI 95% 0.7–1.0, p=0.8 respectively).
Conclusions
Our data suggest that the prognosis is considerably better among patients with a diagnosis of AMI if clinical criteria alone are present at admission. We also demonstrated that clinical criteria are a strong prognostic predictor of good outcomes in patients with AMI. We hypothesize that the absence of electrocardiographic and echocardiographic alterations could indirectly indicate a smaller infarct sizes that contribute to patients' outcome.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): None
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Affiliation(s)
- M Armillotta
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Sansonetti
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - F Angeli
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - M Fabrizio
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Stefanizzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - L Bergamaschi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - I Magnani
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - F Donati
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - S Toniolo
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - P Paolisso
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Foa'
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Rinaldi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - G Casella
- Maggiore Hospital, Cardiology Department, Bologna, Italy
| | - N Galie'
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - C Pizzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
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18
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De Felice F, D'Ambrosio G, Iafrate F, Gelibter A, Magliocca FM, Musio D, Caponetto S, Casella G, Clementi I, Picchetto A, Sirgiovani G, Parisi M, Orciuoli C, Torrese G, De Toma G, Tombolini V, Cortesi E. Intensified Total Neoadjuvant Therapy in Patients With Locally Advanced Rectal Cancer: A Phase II Trial. Clin Oncol (R Coll Radiol) 2021; 33:788-794. [PMID: 34176711 DOI: 10.1016/j.clon.2021.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/05/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
AIMS We assessed the efficacy and safety of total neoadjuvant therapy, including targeted agent plus FOLFOXIRI (5-fluorouracil, leucovorin, oxaliplatin and irinotecan) induction chemotherapy followed by intensified chemoradiotherapy (CRT) and surgical resection, in patients with locally advanced rectal cancer. MATERIALS AND METHODS This was a single-arm, single-centre phase II trial. Eligible patients had non-metastatic locally advanced rectal adenocarcinoma. Based on Ras-BRAF status, patients were treated with bevacizumab (mutated Ras-BRAF) or panitumumab/cetuximab (wild-type Ras-BRAF) plus FOLFOXIRI regimen followed by oxaliplatin-5-fluorouracil-based CRT and surgery. The primary end point was pathological complete response rate. Secondary end points were toxicity, compliance, tumour downstaging, complete resection, surgical complications, local and distant failures and overall survival. The sample size was planned to expect an absolute 20% improvement in pathological complete response rate over historical literature data with an α error of 0.05 and a power of 80%. RESULTS Between October 2015 and September 2019, 28 patients (median age 66 years) were enrolled. All patients had regional lymph node involvement at diagnosis. FOLFOXIRI plus bevacizumab was administered in 11 mutated Ras-BRAF patients, whereas the 17 wild-type Ras-BRAF patients received FOLFOXIRI plus panitumumab/cetuximab. Overall, total neoadjuvant therapy was well tolerated and 26 patients (92.9%) completed the programmed strategy. A complete response was achieved in nine cases (32.1%) and a nearly pathological complete response (ypT1 ypN0) in two patients (7.2%). There was no evidence of febrile neutropenia and no grade 4 adverse events were recorded. Radical resection was achieved in all cases. CONCLUSION FOLFOXIRI plus targeted agent-based induction chemotherapy and intensified CRT before surgery showed promising clinical activity and was well tolerated in locally advanced rectal cancer patients. This phase II trial provides a strong rationale for phase III studies.
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Affiliation(s)
- F De Felice
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy.
| | - G D'Ambrosio
- Department of General Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - F Iafrate
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - A Gelibter
- Medical Oncology Department, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - F M Magliocca
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - D Musio
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - S Caponetto
- Medical Oncology Department, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - G Casella
- Department of General Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - I Clementi
- Department of General Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - A Picchetto
- Department of General Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - G Sirgiovani
- Medical Oncology Department, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - M Parisi
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - C Orciuoli
- Medical Oncology Department, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - G Torrese
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - G De Toma
- Department of General Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - V Tombolini
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - E Cortesi
- Medical Oncology Department, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
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19
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De Bastiani R, Sanna G, Bertolusso L, Casella G, De Polo M, Zamparella M, Cottone C, Tosetti C, Mancuso M, Pirrotta E, Lanzarotto L, Napoli L, De Bastiani M, Disclafani G, Gambaro P, Scoglio R, Belvedere A, Fasulo S, D'Urso M, Benedetto E, Baldi E, Marchesan F, Abagnale G, Turnava L, Salomè E, Ingravalle F, Tursi A. General practitioners' management of symptomatic uncomplicated diverticular disease of the colon by using rifaximin, a non-adsorbable antibiotic. Eur Rev Med Pharmacol Sci 2021; 25:423-430. [PMID: 33506932 DOI: 10.26355/eurrev_202101_24410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Symptomatic uncomplicated diverticular disease of the colon (SUDD) is generally managed by gastroenterologists rather than General Practitioners (GPs). The aim of this study was to assess the efficacy of the treatment of SUDD with rifaximin, a non-absorbable antibiotic, in a primary care setting by GPs. PATIENTS AND METHODS This retrospective, observational study investigated the use of rifaximin at a dose of 400 mg b.i.d. for 5, 7 or 10 days monthly, up to 3 months. The symptoms were reported by the patients using a visual analogic scale (VAS) of 0-10. RESULTS 286 SUDD patients were enrolled (44.4% of men, average age 70.92±10.98). Respectively, 15 (5.2%) patients received the treatment for 5 days, 205 (71.7%) for 7 days and 66 (23.1%) for 10 days. After three months, a significant reduction of VAS score was observed in almost all symptoms assessed: 135 (47.2%) patients reported no abdominal pain (p<0.001) and 23 (8.1%) reported no symptom. Adverse events related to the treatment were recorded in 3 (1.04%) patients, all of them mild and not requiring interruption of the treatment. Acute diverticulitis occurred in 9 (3.1%) patients, but only 2 of them [0.7% (n=2)] underwent surgery due to complicated diverticulitis. Analysis within the different treatment groups (5, 7 and 10 days) shows that rifaximin treatment is effective in reducing the severity of symptoms in almost all groups except for the constipation in the 5-day group. CONCLUSIONS Rifaximin can be effectively used by GPs in real-life for the management of SUDD.
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Affiliation(s)
- R De Bastiani
- General Practitioner, Italian Association for Gastroenterology in Primary Care (GIGA-CP), Feltre (BL), Italy.
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20
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Claeys MJ, Roubille F, Casella G, Zukermann R, Nikolaou N, De Luca L, Gierlotka M, Iakobishvili Z, Thiele H, Koutouzis M, Sionis A, Monteiro S, Beauloye C, Held C, Tint D, Zakke I, Serpytis P, Babic Z, Belohlavev J, Magdy A, Sivagowry Rasalingam M, Daly K, Arroyo D, Vavlukis M, Radovanovic N, Trendafilova E, Marandi T, Hassenger C, Lettino M, Price S, Bonnefoy E. Organization of intensive cardiac care units in Europe: Results of a multinational survey. European Heart Journal. Acute Cardiovascular Care 2020; 9:993-1001. [DOI: 10.1177/2048872619883997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background:
The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe.
Methods:
A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries (n=13) from middle-income countries (n=14).
Results:
A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries.
Conclusion:
More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.
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Affiliation(s)
- MJ Claeys
- Department of Cardiology, Antwerp University Hospital, Belgium
| | - F Roubille
- Department of Cardiology, University Hospital of Montpellier, France
| | - G Casella
- Department of Cardiology, Ospedale Maggiore, Italy
| | | | - N Nikolaou
- Department of Cardiology, Konstantopouleio General Hospital, Greece
| | - L De Luca
- Department of Cardiology, S. Giovanni Evangelista Hospital, Italy
| | - M Gierlotka
- Department of Cardiology, University of Opole, Poland
| | | | - H Thiele
- Heart Center Leipzig, University Hospital, Germany
| | | | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | | | - C Beauloye
- Cliniques Universitaires Saint Luc, UCLouvain, Belgium
| | - C Held
- Department of Medical Sciences, Uppsala Clinical Research Center, Sweden
| | - D Tint
- ICCO Clinics, Transilvania University, Romania
| | - I Zakke
- Pauls Stradins Clinical University Hospital, Latvia
| | - P Serpytis
- Faculty of Medicine, Vilnius University, Lithuania
| | - Z Babic
- University Hospital Centre, Sisters of Mercy, Croatia
| | - J Belohlavev
- 2nd Department of Medicine, Charles University, Czech Republic
| | - A Magdy
- National Heart Institution, Egypt
| | | | - K Daly
- University College Hospital, Ireland
| | - D Arroyo
- Hôpital Cantonal Fribourg, Switzerland
| | - M Vavlukis
- PHO University Clinic of Cardiology, Macedonia
| | | | | | - T Marandi
- North Estonia Medical Centre, Estonia
- Department of Cardiology, University of Tartu, Estonia
| | - C Hassenger
- Department of Cardiology, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - M Lettino
- Division of Cardiology, San Gerardo Hospital, Italy
| | - S Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London
| | - E Bonnefoy
- Intensive Cardiac Care Unit, Hospices Civils de Lyon, France
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21
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Claeys MJ, Roubille F, Casella G, Zukermann R, Nikolaou N, De Luca L, Gierlotka M, Iakobishvili Z, Thiele H, Koutouzis M, Sionis A, Monteiro S, Beauloye C, Held C, Tint D, Zakke I, Serpytis P, Babic Z, Belohlavev J, Magdy A, Sivagowry Rasalingam M, Daly K, Arroyo D, Vavlukis M, Radovanovic N, Trendafilova E, Marandi T, Hassenger C, Lettino M, Price S, Bonnefoy E. Organization of intensive cardiac care units in Europe: Results of a multinational survey. European Heart Journal. Acute Cardiovascular Care 2020; 9:993-1001. [DOI: mj claeys, f roubille, g casella, r zukermann, n nikolaou, l de luca, m gierlotka, z iakobishvili, h thiele, m koutouzis, a sionis, s monteiro, c beauloye, c held, d tint, i zakke, p serpytis, z babic, j belohlavev, a magdy, m sivagowry rasalingam, k daly, d arroyo, m vavlukis, n radovanovic, e trendafilova, t marandi, c hassenger, m lettino, s price, e bonnefoy, organization of intensive cardiac care units in europe: results of a multinational survey, european heart journal.acute cardiovascular care, volume 9, issue 8, 1 december 2020, pages 993–1001, https:/doi.org/10.1177/2048872619883997] [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] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background:
The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe.
Methods:
A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries (n=13) from middle-income countries (n=14).
Results:
A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries.
Conclusion:
More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.
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Affiliation(s)
- MJ Claeys
- Department of Cardiology, Antwerp University Hospital, Belgium
| | - F Roubille
- Department of Cardiology, University Hospital of Montpellier, France
| | - G Casella
- Department of Cardiology, Ospedale Maggiore, Italy
| | | | - N Nikolaou
- Department of Cardiology, Konstantopouleio General Hospital, Greece
| | - L De Luca
- Department of Cardiology, S. Giovanni Evangelista Hospital, Italy
| | - M Gierlotka
- Department of Cardiology, University of Opole, Poland
| | | | - H Thiele
- Heart Center Leipzig, University Hospital, Germany
| | | | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | | | - C Beauloye
- Cliniques Universitaires Saint Luc, UCLouvain, Belgium
| | - C Held
- Department of Medical Sciences, Uppsala Clinical Research Center, Sweden
| | - D Tint
- ICCO Clinics, Transilvania University, Romania
| | - I Zakke
- Pauls Stradins Clinical University Hospital, Latvia
| | - P Serpytis
- Faculty of Medicine, Vilnius University, Lithuania
| | - Z Babic
- University Hospital Centre, Sisters of Mercy, Croatia
| | - J Belohlavev
- 2nd Department of Medicine, Charles University, Czech Republic
| | - A Magdy
- National Heart Institution, Egypt
| | | | - K Daly
- University College Hospital, Ireland
| | - D Arroyo
- Hôpital Cantonal Fribourg, Switzerland
| | - M Vavlukis
- PHO University Clinic of Cardiology, Macedonia
| | | | | | - T Marandi
- North Estonia Medical Centre, Estonia
- Department of Cardiology, University of Tartu, Estonia
| | - C Hassenger
- Department of Cardiology, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - M Lettino
- Division of Cardiology, San Gerardo Hospital, Italy
| | - S Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London
| | - E Bonnefoy
- Intensive Cardiac Care Unit, Hospices Civils de Lyon, France
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22
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Donati F, Toniolo S, Bergamaschi L, Paolisso P, D'Angelo E, Magnani I, Angeli F, Bartoli L, Stefanizzi A, Foa' A, Rinaldi A, Casella G, Pizzi C, Galie' N. Myocardial infarction with non-obstructive coronary artery disease: the prognostic role of infarct size predictors. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In patients with Acute Myocardial Infarction (AMI) the levels of cardiac troponin T and absolute neutrophil count have been shown to correlate with infarct scar size and left ventricular ejection fraction (LVEF) as well as conferring a risk for major cardiovascular adverse events (MACE). In the context of myocardial infarction with non-obstructive coronary arteries (MINOCA) the prognostic role of such indicators has never been explored.
Purpose
To evaluate the prognostic role of known myocardial infarct size indicators in a MINOCA population compared to patients with obstructive AMI (Ob – AMI).
Methods
Among 1990 patients admitted to our coronary care unit from 2016 to 2019 with AMI, we enrolled 186 consecutive MINOCA patients according to the current ESC diagnostic criteria. We compared troponin peak levels, absolute neutrophil count at the time of hospital admission and LVEF in MINOCA patients versus Ob–AMI. Furthermore we assessed the prognostic value of these indicators. All-cause mortality and a composite end - point of all-cause mortality and myocardial re-infarction were evaluated. The median follow-up time was 19.6±12.9 months.
Results
MINOCA patients were more frequently females (64,9% vs 35,1%; p<0.001), non-smokers (42,3% vs 61,8%; p<0.001) with a lower prevalence of diabetes (9.9% vs 23.7%; p<0.001) compared to the Ob-AMI population. Conversely, no differences were found in hypertension and dyslipidemia. As far as infarct size predictors are concerned, MINOCA patients showed lower levels of troponin value and absolute neutrophil count measured at the time of hospital admission (1838.27±601.0 ng/L vs 13543±3350.6 ng/L; p<0.001, 6.7±1.36x109/L vs 7.1±1.29x109/L; p=0.001, respectively). Moreover, these patients exhibited a higher LVEF (56.1±10% vs 49.3±11%; p<0.001) as compared to Ob-AMI.
Among our MINOCA patients, 13 (10.6%) all-cause deaths and 3 (4.3%) myocardial re-infarction were observed during follow-up. Multivariable Cox-regression model demonstrated that mean troponin level, absolute neutrophil count and LVEF were not independent predictors of MACE (HR = 1.0, 95% CI: 0.9–1.1, p=0.6; HR = 0.96, 95% CI: 0.9–1.1, p=0.187; HR = 0.9, 95% CI: 0.79–1.02, p=0. 12 respectively).
Conclusion
MINOCA patients show a similar prognosis compared to the worldwide AMI population.
However, in this study the outcome in the MINOCA population was not influenced by commonly used infarct size predictors, in contrast to what is observed in Ob-AMI patients. These results once again emphasize both the complexity of MINOCA patients and the importance of a better understanding of the different underlying pathophysiological mechanisms.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- F Donati
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - S Toniolo
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - L Bergamaschi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - P Paolisso
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - E.C D'Angelo
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - I Magnani
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - F Angeli
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - L Bartoli
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Stefanizzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Foa'
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Rinaldi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - G Casella
- Maggiore Hospital, Cardiology Department, Bologna, Italy
| | - C Pizzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - N Galie'
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
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23
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Paolisso P, Donati F, Bergamaschi L, Toniolo S, D'Angelo E, Magnani I, Angeli F, Bartoli L, Stefanizzi A, Foa' A, Rinaldi A, Casella G, Taglieri N, Pizzi C, Galie' N. Impact of type 2 diabetes mellitus and blood glucose admission levels in patients with myocardial infarction with non obstructive coronary artery disease (MINOCA). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous clinically entity and represents 5% to 10% of all patients with myocardial infarction (MI). Besides type 2 diabetes mellitus (DM), which is a common comorbidity in patients hospitalized for an acute coronary syndrome, high glucose levels (HGL) at admission are frequently observed in this context. The risk of major adverse cardiovascular events following acute coronary syndrome is increased in people with DM and HGL. However, evidence regarding diabetes and high glucose level among MINOCA patients is lacking.
Purpose
To examine the incidence of major adverse cardiovascular events (MACEs) in diabetic and non-diabetic MINOCA patients as well as according to HGL at presentation.
Methods
Among 1995 patients with acute MI admitted to our coronary care unit from 2016 to 2018, we enrolled 186 consecutive MINOCA patients according to the current ESC diagnostic criteria. HGL at admission was defined as serum glucose level above 180 mg/dl. All-cause mortality and a composite end-point of all-cause mortality and myocardial re-infarction were compared. The median follow-up time was 19.6±12.9 months.
Results
Diabetic MINOCA patients were older (mean age 75.5±9.6 vs 66.5±14.7; p=0.002) and with higher prevalence of hypertension (p=0.016). Conversely, there were no significant differences in gender, BMI, dyslipidemia and atrial fibrillation. Similarly, no significant differences were observed regarding clinical and ECG presentation, echocardiographic features and laboratory tests. The rates of death (30.8% vs 8.3%; p=0.013) and MACEs (22.2% vs 6.8%; p=0.025) were significantly higher in MINOCA-DM patients; conversely, no significant differences were observed for re-MI (p=0.58). At multivariate regression model adjusted for age and sex, type 2 DM was not an independent predictor of all cause deaths (p=0.36) and MACE (p=0.24).
Patients with admission HGL had similar baseline characteristics, cardiovascular risk factors, clinical presentations, echocardiographic features and troponin values as compared to patients with no-HGL. HGL at admission was associated with higher incidence of all-cause-death (p<0.001) and MACE (p=0.003) during follow-up compared to patients with no HGL; conversely, no significant differences were observed in the incidence of re-MI (p=0.7). Multivariate analysis adjusted for age and sex demonstrated that HGL was an independent predictor of death (HR 6.25; CI 1.64–23.85; p=0.007) and MACEs (HR 6.17; CI 1.79–21.23, p=0.004).
Conclusion
In MINOCA patients, HGL was an independent risk factor for both MACEs and death while type 2 DM was not correlated with these hard endpoints. As a consequence, HGL could have a still unexplored pathophysiological role in MINOCA. Properly powered randomized trials are warranted.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Paolisso
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - F Donati
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - L Bergamaschi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - S Toniolo
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - E.C D'Angelo
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - I Magnani
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - F Angeli
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - L Bartoli
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Stefanizzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Foa'
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Rinaldi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - G Casella
- Maggiore Hospital, Cardiology Department, Bologna, Italy
| | - N Taglieri
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - C Pizzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - N Galie'
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
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24
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Castagneto-Gissey L, Casella G, Russo MF, Del Corpo G, Iodice A, Lattina I, Ferrari P, Iannone I, Mingoli A, La Torre F. Impact of COVID-19 outbreak on emergency surgery and emergency department admissions: an Italian level 2 emergency department experience. Br J Surg 2020; 107:e374-e375. [PMID: 32687596 PMCID: PMC7405032 DOI: 10.1002/bjs.11813] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 12/25/2022]
Affiliation(s)
| | - G Casella
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - M F Russo
- Fondazione Policlinico A. Gemelli IRCCS, Catholic University of Rome, Rome, Italy
| | - G Del Corpo
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - A Iodice
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - I Lattina
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - P Ferrari
- Emergency Surgery Department, Sapienza University of Rome, Rome, Italy
| | - I Iannone
- Emergency Surgery Department, Sapienza University of Rome, Rome, Italy
| | - A Mingoli
- Emergency Surgery Department, Sapienza University of Rome, Rome, Italy
| | - F La Torre
- Emergency Surgery Department, Sapienza University of Rome, Rome, Italy
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25
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Falcone F, Scambia G, Benedetti Panici P, Signorelli M, Cormio G, Giorda G, Bogliolo S, Marinaccio M, Ghezzi F, Rabaiotti E, Breda E, Casella G, Fanfani F, Di Donato V, Leone Roberti Maggiore U, Greggi S. Tertiary cytoreductive surgery in recurrent epithelial ovarian cancer: A multicentre MITO retrospective study. Gynecol Oncol 2017; 147:66-72. [PMID: 28716306 DOI: 10.1016/j.ygyno.2017.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/01/2017] [Accepted: 07/06/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To evaluate the impact of tertiary cytoreductive surgery (TCS) on survival in recurrent epithelial ovarian cancer (EOC), and to determine predictors of complete cytoreduction. METHODS A multi-institutional retrospective study was conducted within the MITO Group on a 5-year observation period. RESULTS A total of 103 EOC patients with a ≥6month treatment-free interval (TFI) undergoing TCS were included. Complete cytoreduction was achieved in 71 patients (68.9%), with severe post-operative complications in 9.7%, and no cases of mortality within 60days from surgery. Multivariate analysis identified the complete tertiary cytoreduction as the most potent predictor of survival followed by FIGO stage I-II at initial diagnosis, exclusive retroperitoneal recurrence, and TCS performed ≥3years after primary diagnosis. Patients with complete tertiary cytoreduction had a significantly longer overall survival (median OS: 43months, 95% CI 31-58) compared to those with residual tumor (median OS: 33months, 95% CI 28-46; p<0.001). After multivariate adjustment the presence of a single lesion and good (ECOG 0) performance status were the only significant predictors of complete surgical cytoreduction. CONCLUSIONS This is the only large multicentre study published so far on TCS in EOC with ≥6month TFI. The achievement of postoperative no residual disease is confirmed as the primary objective also in a TCS setting, with significant survival benefit and acceptable morbidity. Accurate patient selection is of utmost importance to have the best chance of complete cytoreduction.
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Affiliation(s)
- F Falcone
- Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy; Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - G Scambia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - P Benedetti Panici
- Department of Gynecology, Obstetrics and Urology, Sapienza University of Rome, Rome, Italy
| | - M Signorelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - G Cormio
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy; Gynecologic Oncology Unit, National Cancer Institute, Bari, Italy
| | - G Giorda
- Department of Gynecological Oncology, CRO National Cancer Institute, Aviano, Italy
| | - S Bogliolo
- Department of Obstetrics and Gynaecology, IRCCS Fondazione Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - M Marinaccio
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - F Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - E Rabaiotti
- Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy
| | - E Breda
- Medical Oncology Unit Ospedale S Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - G Casella
- Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - F Fanfani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - V Di Donato
- Department of Gynecology, Obstetrics and Urology, Sapienza University of Rome, Rome, Italy
| | | | - S Greggi
- Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy.
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26
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Bertani R, Mozzon M, Sgarbossa P, Tamburini S, Casarin M, Mangione G, Casella G, Venzo A, Rizzato S, Albinati A. Pt(II) nitrile complexes: New insights on old complexes from a combined experimental and theoretical study. Inorganica Chim Acta 2017. [DOI: 10.1016/j.ica.2016.07.015] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Casella G, Di Bella C, Salemme M, Villanacci V, Antonelli E, Baldini V, Bassotti G. Celiac disease, non-celiac gluten sensitivity and inflammatory bowel disease. MINERVA GASTROENTERO 2015; 61:267-271. [PMID: 26006779] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Celiac disease (CD) and inflammatory bowel disease (IBD), such as Crohn's disease (CrD) and ulcerative colitis (UC), are chronic inflammatory condition of the gastro-intestinal tract. The prevalence of IBD in celiac patients has been reported as 5-10 times higher than in the general population. The possibility of the presence of CD in IBD should be considered in IBD patients with long-term iron deficiency anemia (IDA) not responsive to iron supplementation. Non-celiac gluten sensitivity (NCGS) is characterized by intestinal and extra intestinal symptoms due to the ingestion of gluten-containing food in subject without CD and/or wheat allergy. Patients with Crohn's disease and SR-NCGS were more significantly affected by joint pains compared to UC patients (50% versus 11.1%). In Crohn's patients, a higher percentage of fatigue (50% versus 38.9%) and headache (27.3% versus 22.2%) was evident. For the association between NCGS and IBD new studies are warranted and, at this moment, a gluten free diet (GFD) may be useful more in CrD than in UC.
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Affiliation(s)
- G Casella
- Gastroenterology and Hepatology Unit, Medical Department, Desio Hospital, Desio, Monza e Brianza, Italy -
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28
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Casella G, Soricelli E, Castagneto-Gissey L, Redler A, Basso N, Mingrone G. Changes in insulin sensitivity and secretion after sleeve gastrectomy. Br J Surg 2015; 103:242-8. [DOI: 10.1002/bjs.10039] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/27/2015] [Accepted: 09/23/2015] [Indexed: 01/07/2023]
Abstract
Abstract
Background
Sleeve gastrectomy is indicated for the treatment of obesity and related co-morbidity including diabetes. The dynamic changes in insulin secretion and sensitivity after sleeve gastrectomy are unknown.
Methods
Whole-body insulin sensitivity was measured by the euglycaemic hyperinsulinaemic clamp technique, and insulin secretion by C-peptide deconvolution after an oral glucose tolerance test (OGTT), before and 3, 6 and 12 months after sleeve gastrectomy in morbidly obese subjects. The time course of glucagon-like peptide (GLP) 1, as a marker of insulin secretion following OGTT, was also assessed.
Results
Ten patients were included in the study. Median (range) baseline insulin sensitivity (M-value) increased from 84·0 (20·2–131·4) mmol per kg per min at baseline to 122·8 (99·0–179·3) mmol per kg per min at 12 months after surgery (P = 0·015). Fasting insulin sensitivity, measured by homeostatic model assessment of insulin resistance, which represents a surrogate index of hepatic insulin resistance, decreased from 3·3 (1·9–5·5) to 0·7 (0·5–1·1) mg/dl·µunits/ml (P < 0·001). Total insulin secretion, measured as incremental area under the curve (AUC), after OGTT decreased from 360·4 (347·9–548·0) to 190·1 (10·1–252·0) mmol/l·180 min at 12 months (P = 0·011). The AUC for GLP-1 increased from 258·5 (97·5–552·6) to 5531·8 (4143·0–7540·9) pmol/l·180 min at 12 months after sleeve gastrectomy (P < 0·001). In multiple regression analysis, 51 per cent of the M-value variability was explained by GLP-1 secretion.
Conclusion
Sleeve gastrectomy improved insulin sensitivity and reduced insulin secretion within 6 months after surgery. Although there was a correlation between insulin sensitivity and bodyweight, the major driver of the improvement in insulin sensitivity was GLP-1 secretion.
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Affiliation(s)
- G Casella
- Surgical Sciences Department, Medical School ‘Sapienza’ University, Rome, Italy
| | - E Soricelli
- Surgical Sciences Department, Medical School ‘Sapienza’ University, Rome, Italy
| | - L Castagneto-Gissey
- Surgical Sciences Department, Medical School ‘Sapienza’ University, Rome, Italy
| | - A Redler
- Surgical Sciences Department, Medical School ‘Sapienza’ University, Rome, Italy
| | - N Basso
- Surgical Sciences Department, Medical School ‘Sapienza’ University, Rome, Italy
| | - G Mingrone
- Department of Internal Medicine, Catholic University of Rome, Rome, Italy
- Department of Diabetes and Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College, London, UK
- Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität, Dresden, Germany
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29
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Monti G, Terzi V, Calini A, Di Marco F, Cruz D, Pulici M, Brioschi P, Vesconi S, Fumagalli R, Casella G. Rescue therapy with polymyxin B hemoperfusion in high-dose vasopressor therapy refractory septic shock. Minerva Anestesiol 2015; 81:516-525. [PMID: 25319136] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Refractory septic shock (RSS) requiring major vasopressor support is associated with high mortality, especially in Gram-negative infections. The study aim was to describe hemodynamics, organ failure, and clinical outcomes in high-dose vasopressor therapy (HDVT) RSS patients treated with Polymyxin B hemoperfusion (PMX-HP) as rescue therapy. METHODS We retrospectively analyzed 52 patients, unresponsive to conventional therapy, treated with two sessions of PMX-HP requiring HDVT (norepinephrine and/or epinephrine requirement (NEP+EP) ≥ 0.5 µg/kg/min), ≥ 2 organ failures, and suspected/confirmed Gram-negative infection from any source. RESULTS At baseline, mean arterial pressure (MAP) was 80 ± 13 mmHg and NEP + EP requirement was 1.11 ± 0.56 µg/kg/min. After two PMX-HP sessions, at 72 h, MAP significantly increased and NEP + EP requirement decreased respectively by 12% and 76%. Pulmonary and renal function also improved significantly. Thirty patients (58%) showed a ≥ 50% reduction in NEP + EP dose within only 24 h after the first PMX-HP session (early responders), and 22 did not or died from irreversible shock in the same time frame (early non-responders). The 30-day hospital mortality was 29%; it was 16% in early responders and 45% in early non-responders. On multivariate analysis, SAPS II score, vasopressin, and central venous pressure significantly affected 30-day hospital mortality. CONCLUSION This is the first study describing the use of PMX-HP as a rescue therapy in RSS patients with HDVT and MOF. Our results suggest a possible role for PMX-HP in improving hemodynamics, organ function, and mortality in RSS, with a 30-day survival of up to 70%.
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Affiliation(s)
- G Monti
- Unità di Terapia Intensiva "Bozza", I Servizio di Anestesia e Rianimazione, Azienda Ospedaliera Niguarda Ca' Granda, Milano, Italia -
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30
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Bottiroli M, Pinciroli R, Monti G, Mininni M, Casella G, Fumagalli R. Prevalence and clinical significance of early endotoxin activity in septic shock patients. Crit Care 2015. [PMCID: PMC4472797 DOI: 10.1186/cc14128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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De Luca L, Bolognese L, Valgimigli M, Ceravolo R, Danzi GB, Piccaluga E, Rakar S, Cremonesi A, Bovenzi FM, Abbate R, Andreotti F, Bolognese L, Biondi-Zoccai G, Bovenzi FM, Capodanno D, Caporale R, Capranzano P, Carrabba N, Casella G, Cavallini C, Ceravolo R, Colombo P, Conte MR, Cordone S, Cremonesi A, Danzi GB, Del Pinto M, De Luca G, De Luca L, De Servi S, Di Lorenzo E, Di Pasquale G, Esposito G, Farina R, Fiscella A, Formigli D, Galli S, Giudice P, Gonzi G, Greco C, Grieco NB, La Vecchia L, Lazzari M, Lettieri C, Lettino M, Limbruno U, Lupi A, Macchi A, Marini M, Marzilli M, Montinaro A, Musumeci G, Navazio A, Olivari Z, Oltrona Visconti L, Oreglia JA, Ottani F, Parodi G, Pasquetto G, Patti G, Perkan A, Perna GP, Piccaluga E, Piscione F, Prati F, Rakar S, Ravasio R, Ronco F, Rossini R, Rubboli A, Saia F, Sardella G, Satullo G, Savonitto S, Sbarzaglia P, Scorcu G, Signore N, Tarantini G, Terrosu P, Testa L, Tubaro M, Valente S, Valgimigli M, Varbella F, Vatrano M. ANMCO/SICI-GISE paper on antiplatelet therapy in acute coronary syndrome. Eur Heart J Suppl 2014. [DOI: 10.1093/eurheartj/suu030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Casella G, Carinci V, Pavesi PC, Cavallo P, Sangiorgio P, Coniglio C, Pallotti MG, Barbato G, Gordini G, Di Pasquale G. Emergency coronary angiography and interventions in comatose patients resuscitated after out-of-hospital cardiac arrest treated with mild therapeutic hypothermia. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht311.5910] [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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Chew DP, Kinnaird T, Casella G, Radke PW, Schiele F, Kaul U, Eijgelshoven I, Medic G, Bergman G. Relative efficacy of bivalirudin vs. heparin monotherapy in STEMI patients treated with primary percutaneous coronary intervention - a network meta-analysis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5570] [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: 11/14/2022] Open
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Aranzulla TC, Conte MR, Gonzini L, Casella G, Cassin M, Chinaglia A, Fradella G, Pirelli S, Scorcu G, Oltrona Visconti L. Invasive strategy and outcomes: gender differences in patients with non st-elevation acute coronary syndrome during coronary care unit hospitalisation. an Italian national survey (BLITZ-3). Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.3513] [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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Carinci V, Casella G, Pavesi PC, Cavallo P, Gordini G, Di Pasquale G. The ECG after out-of-hospital cardiac arrest is a reliable tool to guide immediate triage? Analysis of 88 patients matched with acute coronary angiography. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4058] [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: 11/12/2022] Open
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Patrizi G, Di Rocco G, Giannotti D, Casella G, Casella Mariolo JR, Bernieri MG, Redler A. Double ileo-ceco-colic invagination due to right colon carcinoma: clinical presentation and management. Eur Rev Med Pharmacol Sci 2013; 17:2267-2269. [PMID: 23893196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Intestinal intussusceptions represent a rare cause of intestinal obstruction in adults (about 1% of intestinal obstructions). The principle causes are benign or malignant tumors. In adults, the most frequent localizations of intestinal invaginations are the ileo-cecal segment, ileum and colon as exclusive localization. We report the case of a 56 year-old Caucasian male admitted in our Department complaining with diffuse abdominal pain and severe anemia. The colonoscopy revealed a vegetant, stenosing and ulcerated mass in the hepatic flexure. The computed tomography suggested the additional diagnosis of intestinal intussusception with no evidence of intestinal obstruction. In our experience, surgery is always indicated for the treatment of intussusceptions in adults, especially for the almost constant underlying neoplasm.
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Affiliation(s)
- G Patrizi
- Department of Surgical Sciences and Department of Radiology, Oncology and Pathology; University of Rome "Sapienza", Rome, Italy.
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Di Rocco G, Casella G, Giannotti D, Bernieri MG, Marchetti M, Iavarone C, Trapè S, Patrizi G, Redler A. Transmesenteric hernia after right nephrectomy: diagnostic and therapeutic management. Eur Rev Med Pharmacol Sci 2013; 17:842-844. [PMID: 23609370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Internal abdominal hernias are a rare cause of intestinal obstruction (0.2-0.9%). Transmesenteric hernia is a rare type of internal hernia and usually in adult people is acquired. We report the case of a 44 year-old caucasian female with a small bowel occlusion after right nephrectomy for clear cell renal carcinoma caused by an acquired transmesenteric hernia. We emphasize the role of CT scanning for a prompt diagnosis and a quick surgical treatment in order to avoid intestinal gangrene.
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Affiliation(s)
- G Di Rocco
- Department of Surgical Sciences, and Department of Radiology; "Sapienza" University of Rome, Rome, Italy.
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Totzeck M, Hendgen-Cotta U, Rammos C, Petrescu A, Stock P, Goedecke A, Shiva S, Kelm M, Rassaf T, Duerr GD, Heuft T, Klaas T, Suchan G, Roell W, Zimmer A, Welz A, Fleischmann BK, Dewald O, Luedde M, Carter N, Lutz M, Sosna J, Jacoby C, Floegel U, Hippe HJ, Adam D, Heikenwaelder M, Frey N, Sobierajski J, Luedicke P, Hendgen-Cotta U, Lue H, Totzeck M, Dewor M, Kelm M, Bernhagen J, Rassaf T, Cortez-Dias N, Costa M, Carrilho-Ferreira P, Silva D, Jorge C, Robalo Martins S, Fiuza M, Pinto FJ, Nunes Diogo A, Enguita FJ, Tsiachris D, Tsioufis C, Kasiakogias A, Flessas D, Antonakis V, Kintis K, Giakoumis M, Hatzigiannis P, Katsimichas T, Stefanadis C, Andrikou E, Tsioufis C, Thomopoulos C, Kasiakogias A, Tzamou V, Andrikou I, Bafakis I, Lioni L, Kintis K, Stefanadis C, Lazaros G, Tsiachris D, Tsioufis C, Vlachopoulos C, Brili S, Chrysohoou C, Tousoulis D, Stefanadis C, Santos De Sousa CI, Pires S, Nunes A, Cortez Dias N, Belo A, Cabrita I, Pinto FJ, Benova T, Radosinska J, Viczenczova C, Bacova B, Knezl V, Dosenko V, Navarova J, Zeman M, Tribulova N, Maceira Gonzalez AM, Cosin Sales J, Igual B, Ruvira J, Diago JL, Aguilar J, Lopez Lereu MP, Monmeneu JV, Estornell J, Choi JC, Cha KS, Lee HW, Yun EY, Ahn JH, Oh JH, Choi JH, Lee HC, Hong TJ, Manzano Fernandez S, Lopez-Cuenca A, Januzzi JL, Mateo-Martinez A, Sanchez-Martinez M, Parra-Pallares S, Orenes-Pinero E, Romero-Aniorte AI, Valdes-Chavarri M, Marin F, Bouzas Mosquera A, Peteiro J, Broullon FJ, Alvarez Garcia N, Couto Mallon D, Bouzas Zubeldia B, Martinez Ruiz D, Yanez Wonenburger JC, Fabregas Casal R, Castro Beiras A, Backus BE, Six AJ, Cullen L, Greenslade J, Than M, Kameyama T, Sato T, Noto T, Nakadate T, Ueno H, Yamada K, Inoue H, Albrecht-Kuepper B, Kretschmer A, Kast R, Baerfacker L, Schaefer S, Kolkhof P, Andersson C, Kober L, Christensen SB, Nguyen CD, Nielsen MB, Olsen AMS, Gislason GH, Torp-Pedersen C, Shigekiyo M, Harada K, Lieu H, Neutel J, Maddock S, Goldsmith S, Koren M, Antwerp BV, Burnett J, Christensen SB, Charlot MG, Madsen M, Andersson C, Kober L, Gustafsson F, Torp-Pedersen C, Gislason GH, Cavusoglu Y, Mert KU, Nadir A, Mutlu F, Gencer E, Ulus T, Birdane A, Lim HS, Tahk SJ, Yang HM, Kim JW, Seo KW, Choi BJ, Choi SY, Yoon MH, Hwang GS, Shin JH, Russ MA, Wackerl C, Hochadel M, Brachmann J, Mudra H, Zeymer U, Weber MA, Menozzi A, Saia F, Valgimigli M, Belotti LM, Casella G, Manari A, Cremonesi A, Piovaccari G, Guastaroba P, Marzocchi A, Kuramitsu S, Iwabuchi M, Haraguchi T, Domei T, Nagae A, Hyodo M, Takabatake Y, Yokoi H, Toyota F, Nobuyoshi M, Kaitani K, Hanazawa K, Izumi C, Nakagawa Y, Ando K, Arita T, Nobuyoshi M, Shizuta S, Kimura T, Isshiuki T, Trucco ME, Tolosana JM, Castel MA, Borras R, Sitges M, Khatib M, Arbelo E, Berruezo A, Brugada J, Mont L, Romanov A, Pokushalov E, Prokhorova D, Chernyavskiy A, Shabanov V, Goscinska-Bis K, Bis J, Bochenek A, Gersak B, Karaskov A, Linde C, Daubert C, Bergemann TL, Abraham WT, Gold MR, Van Boven N, Bogaard K, Ruiter JH, Kimman GP, Kardys I, Umans VA, Cipriani M, Lunati M, Landolina M, Vittori C, Vargiu S, Ghio S, Petracci B, Campo C, Bisetti S, Frigerio M, Bongiorni MG, Soldati E, Segreti L, Zucchelli G, Di Cori A, De Lucia R, Viani S, Paperini L, Boem A, Levorato D, Kutarski A, Malecka B, Zabek A, Czajkowski M, Chudzik M, Kutarski A, Mitkowski P, Maciag A, Kempa M, Golzio PG, Fanelli A, Vinci M, Pelissero E, Morello M, Grosso Marra W, Gaita F, Kutarski A, Czajkowski M, Pietura R, Golzio PG, Vinci M, Pelissero E, Fanelli A, Ferraris F, Gaita F, Cuypers JAAE, Menting ME, Opic P, Utens EMWJ, Van Domburg RT, Helbing WA, Witsenburg M, Van Den Bosch AE, Bogers AJJC, Roos-Hesselink JW, Van Der Linde D, Takkenberg JJM, Rizopoulos D, Heuvelman HJ, Witsenburg M, Budts W, Van Dijk APJ, Bogers AJJC, Oechslin EN, Roos-Hesselink JW, Diller GP, Kempny A, Liodakis E, Alonso-Gonzalez R, Orwat S, Dimopoulos K, Swan L, Li W, Gatzoulis MA, Baumgartner H, Andrade AC, Voges I, Jerosch-Herold M, Pham M, Hart C, Hansen T, Kramer HH, Rickers C, Kempny A, Wustmann K, Borgia F, Dimopoulos K, Uebing A, Piorkowski A, Yacoub MH, Gatzoulis MA, Swan L, Diller GP, Mueller J, Weber R, Pringsheim M, Hoerer J, Hess J, Hager A, Hu K, Liu D, Niemann M, Herrmann S, Cikes M, Stoerk S, Knob S, Ertl G, Bijnens B, Weidemann F, Mornos C, Cozma D, Dragulescu D, Ionac A, Mornos A, Petrescu L, Mingo S, Ruiz Bautista L, Monivas Palomero V, Prados C, Maiz L, Giron R, Martinez M, Cavero Gibanel MA, Segovia J, Pulpon L, Kato H, Kubota S, Takasawa Y, Kumamoto T, Iacoviello M, Puzzovivo A, Forleo C, Lattarulo MS, Monitillo F, Antoncecchi V, Malerba G, Marangelli V, Favale S, Ruiz Bautista L, Mingo S, Monivas V, Segovia J, Prados C, Maiz L, Giron R, Martinez MT, Gonzalez Estecha M, Alonso Pulpon LA, Ren B, De Groot-De Laat L, Mcghie J, Vletter W, Ten Cate F, Geleijnse M, Looi JL, Lam YY, Yu CM, Lee PW, Apor A, Sax B, Huttl T, Nagy A, Kovacs A, Merkely B, Vecera J, Bartunek J, Vanderheyden M, Mertens P, Bodea O, Penicka M, Biaggi P, Gaemperli O, Corti R, Gruenenfelder J, Felix C, Bettex D, Datta S, Jenni R, Tanner F, Herzog B, Fattouch K, Murana G, Castrovinci S, Sampognaro R, Bertolino EC, Caccamo G, Ruvolo G, Speziale G, Lancellotti P. Saturday, 25 August 2012. Eur Heart J 2012. [DOI: 10.1093/eurheartj/ehs280] [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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O'Malley K, Butler K, Hong M, Novelo LGL, Restrepo C, Berceli S, Casella G, Moldawer L, Nelson P. Cytokine Prediction Modeling of Vein Bypass Failure. J Surg Res 2012. [DOI: 10.1016/j.jss.2011.11.265] [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]
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Graze RM, Novelo LL, Amin V, Fear JM, Casella G, Nuzhdin SV, McIntyre LM. Allelic imbalance in Drosophila hybrid heads: exons, isoforms, and evolution. Mol Biol Evol 2012; 29:1521-32. [PMID: 22319150 DOI: 10.1093/molbev/msr318] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Unraveling how regulatory divergence contributes to species differences and adaptation requires identifying functional variants from among millions of genetic differences. Analysis of allelic imbalance (AI) reveals functional genetic differences in cis regulation and has demonstrated differences in cis regulation within and between species. Regulatory mechanisms are often highly conserved, yet differences between species in gene expression are extensive. What evolutionary forces explain widespread divergence in cis regulation? AI was assessed in Drosophila melanogaster-Drosophila simulans hybrid female heads using RNA-seq technology. Mapping bias was virtually eliminated by using genotype-specific references. Allele representation in DNA sequencing was used as a prior in a novel Bayesian model for the estimation of AI in RNA. Cis regulatory divergence was common in the organs and tissues of the head with 41% of genes analyzed showing significant AI. Using existing population genomic data, the relationship between AI and patterns of sequence evolution was examined. Evidence of positive selection was found in 30% of cis regulatory divergent genes. Genes involved in defense, RNAi/RISC complex genes, and those that are sex regulated are enriched among adaptively evolving cis regulatory divergent genes. For genes in these groups, adaptive evolution may play a role in regulatory divergence between species. However, there is no evidence that adaptive evolution drives most of the cis regulatory divergence that is observed. The majority of genes showed patterns consistent with stabilizing selection and neutral evolutionary processes.
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Affiliation(s)
- R M Graze
- Department of Molecular Genetics and Microbiology, University of Florida, USA
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Capoccia D, Coccia F, Paradiso F, Abbatini F, Casella G, Basso N, Leonetti F. Laparoscopic gastric sleeve and micronutrients supplementation: our experience. J Obes 2012; 2012:672162. [PMID: 22545207 PMCID: PMC3321468 DOI: 10.1155/2012/672162] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 01/04/2012] [Indexed: 12/19/2022] Open
Abstract
Background. Laparoscopic gastric sleeve (LGS) has been recently introduced as a stand-alone, restrictive bariatric surgery. Theoretically, LGS attenuates micronutrients deficiencies and associated complications that were typically observed following malabsorptive procedures. The aim of this study was to assess some micronutrients and mineral deficiencies in patients undergoing LGS. Methods. In the period between July 2008 and April 2010, 138 obese patients (110 females and 28 males) with mean BMI 44.4 kg/m(2) ± 6.5, mean age 43.9 ± 10.9 years were enrolled and underwent LGS. Patients were followed up with routine laboratory tests and anthropometric measurements and assessed for nutritional status, as regards vitamin B12, folic acid, iron, hemoglobin, calcium, and vitamin D, every three months throughout 12 months. Results. 12 months after sleeve, patients did not show iron deficiency and/or anemia; plasma calcium levels were in the normal range without supplementation from the sixth month after the operation. Vitamin B12 and folic acid were adequately supplemented for all the follow-up period. Vitamin D was in suboptimal levels, despite daily multivitamin supplementation. Conclusion. In this study, we showed that LGS is an effective surgery for the management of morbid obesity. An adequate supplementation is important to avoid micronutrients deficiencies and greater weight loss does not require higher dosage of multivitamins.
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Affiliation(s)
- D. Capoccia
- Department of Clinical Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
- *D. Capoccia:
| | - F. Coccia
- Department of Clinical Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - F. Paradiso
- Department of Clinical Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - F. Abbatini
- Surgical-Medical Department for Digestive Diseases, Sapienza University of Rome, Rome, Italy
| | - G. Casella
- Surgical-Medical Department for Digestive Diseases, Sapienza University of Rome, Rome, Italy
| | - N. Basso
- Surgical-Medical Department for Digestive Diseases, Sapienza University of Rome, Rome, Italy
| | - F. Leonetti
- Department of Clinical Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
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Basso N, Capoccia D, Rizzello M, Abbatini F, Mariani P, Maglio C, Coccia F, Borgonuovo G, De Luca ML, Asprino R, Alessandri G, Casella G, Leonetti F. First-phase insulin secretion, insulin sensitivity, ghrelin, GLP-1, and PYY changes 72 h after sleeve gastrectomy in obese diabetic patients: the gastric hypothesis. Surg Endosc 2011; 25:3540-50. [PMID: 21638183 DOI: 10.1007/s00464-011-1755-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 04/21/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the possible role of sleeve gastrectomy (SG) per se in the reversibility of diabetes. METHODS Insulin secretion and peripheral insulin sensitivity using the intravenous glucose tolerance test (IVGTT) were assessed in 18 obese type 2 diabetic patients and in 10 nondiabetic obese patients before and 3 days after SG, before any food intake and any weight change occurrence. At the same time, ghrelin, GLP-1, and PYY levels were determined. RESULTS In diabetic patients who had the disease less than 10.5 years, the first phase of insulin secretion promptly improved after SG. The early insulin area under the curve (AUC) significantly increased at the postoperative IVGTT, indicating an increased glucose-induced insulin secretion. The second phase of insulin secretion (late AUC) significantly decreased after SG in all groups, indicating an improved insulin peripheral sensitivity. In all groups, pre- and postoperatively, intravenous glucose stimulation determined a decrease in ghrelin values and an increase in GLP-1 and PYY values. However, in the group of patients with disease duration >10.5 years, the differences were not significant except for the late insulin AUC. Postoperative basal and intravenous glucose-stimulated ghrelin levels were lower than preoperative levels in all groups of patients. Basal and intravenous stimulated GLP-1 and PYY postoperative values were higher than preoperative levels in all groups. CONCLUSIONS Restoration of the first phase of insulin secretion and improved insulin sensitivity in diabetic obese patients immediately after SG, before any food passage through the gastrointestinal tract and before any weight loss, seem to be related to ghrelin, GLP-1, and PYY hormonal changes of possible gastric origin and was neither meal- nor weight-change-related. Duration of the disease up to 10.5 years seems to be a major cut off in the pathophysiological changes induced by SG. A "gastric" hypothesis may be put forward to explain the antidiabetes effect of SG.
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Affiliation(s)
- N Basso
- Surgical-Medical Center for Digestive Diseases, Policlinico Umberto I, University of Rome Sapienza, Viale del Policlinico, 00161 Rome, Italy.
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Casella G, Villanacci V, Di-Bella C, de-Marco E, Pagni F, Drera E, Ortenzi R, Baldini V, Bassotti G. Colonoscopic findings in coeliac disease on a gluten-free diet. Rev Esp Enferm Dig 2011; 102:538-41. [PMID: 20883070 DOI: 10.4321/s1130-01082010000900005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND to date, there are few data on colonoscopic findings in patients with celiac disease, and most of these obtained in patients with iron deficiency anaemia. AIMS we assessed colonoscopic findings in unselected patients with coeliac disease, since there are no studies available also considering morphological aspects, and there is literature suggestion of increased prevalence of colorectal tumours. MATERIAL AND METHODS colonoscopies with multiple biopsies were retrospectively analyzed in 42 coeliac disease patients on gluten-free diet above age 40; 16 had clinical or laboratory features of iron deficiency anaemia. Mucosal biopsies were evaluated for the presence of intraepithelial lymphocytes and of mucosal eosinophils, in addition to conventional histologic assessment, and compared with those obtained in 15 controls. RESULTS macroscopic abnormalities (polyps, diverticula, inflammatory changes) were found in 26% of patients. Microscopic abnormalities (lymphocytic colitis, melanosis coli, rectal histiocytosis) were found in 36% of patients. None of these findings was found in controls. Coeliac disease patients had significantly higher eosinophil score than controls in the right colon, whereas this was not significantly different between groups in the left colon. CONCLUSIONS colonoscopic findings in coeliac disease on gluten-free diet may reveal significant findings, even in patients without iron deficiency anaemia. There is the need of further studies in larger cohorts of patients to establish whether colonoscopy in these patients may be clinically useful.
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Affiliation(s)
- G Casella
- Division of Internal Medicine, Desio General Hospital, Italy
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Barthelemy O, Silvain J, Brieger D, Bellemain-Appaix A, Cayla G, Beygui F, Lancar R, Collet JP, Mercadier A, Montalescot G, Cha KS, Nam YH, Kim JH, Park SY, Park TH, Kim MH, Kim YD, Lee HC, Ahn MS, Hong TJ, Blanco R, Blanco F, Szarfer J, Garcia Escudero A, Gigena G, Gagliardi J, Rodriguez A, Sarmiento R, Affatatto S, Riccitelli M, Petris A, Datcu MD, Pop C, Radoi M, Arsenescu-Georgescu C, Petrescu I, Petrescu L, Serban L, Nechita E, Tatu-Chitoiu G, Tatu-Chitoiu G, Dorobantu M, Benedek I, Craiu E, Sinescu C, Ionescu DD, Radoi M, Pop C, Ginghina C, Minescu B, Izzo A, Mantovani P, Tomasi L, Dall'oglio L, Bonatti S, Rosiello R, Romano M, Agostini F, Zanini R, Zhao ZY, Wu YJ, Li JJ, Yany YJ, Qian HY, Tang YD, Timoteo AT, Toste A, Lousinha A, Ramos R, Oliveira JA, Ferreira ML, Ferreira RC, Cabades C, Diez Gil JL, Aguar P, Sanmiguel D, Lopez-March A, Marmol R, Guerra L, Girbes V, Ferrando J, Rincon De Arellano A, Timoteo AT, Ramos R, Toste A, Oliveira JA, Patricio L, Ferreira ML, Ferreira RC, Blondal M, Ainla T, Marandi T, Eha J, Timoteo AT, Oliveira MM, Silva MN, Cunha PS, Feliciano J, Silva S, Ferreira RC, Silva B, Oliveira R, Caires G, Drumond A, Araujo J, Suarez-Barrientos A, Vivas D, Castro-Ferreira F, Nunez-Gil I, Franco E, Kanovsky J, Garcia-Rubira JC, Fernandez-Ortiz A, Fuster V, Macaya C, Ibanez Cabeza B, Salinger S, Perisic Z, Milic D, Stanojlovic T, Apostolovic S, Kala P, Obradovic S, Djordjevic-Radojkovic D, Damjanovic M, Koracevic G, Kostic T, Khan MA, Vrapi F, Naeem K, Davar J, Hristova K, Parenica J, Hristova K, Pencheva G, Radeva R, Milanov S, Trambaiolo P, Poli M, De Luca M, Lukic V, Mustilli M, Corsi F, Poloczek M, Simonetti M, Ferraiuolo G, Fareed A, Oraby M, Nasr GM, Maklady F, Dupouy P, Sorensen JT, Terkelsen CJ, Lassen JF, Prymusova K, Trautner S, Christensen EF, Nielsen TT, Botker HE, Andersen HR, Thygesen KA, Checco L, Usmiani T, Sbarra PL, Boffini M, Kubkova L, Saviolo R, Grasso C, Conrotto F, Marchetti M, Rinaldi M, Marra S, Moscoso Costa F, Ferreira J, Raposo L, Aguiar C, Spinar J, Trabulo M, Silva JA, Faria R, Mimoso J, Marques N, Trigo J, Marques V, Gomes V, Swiatkowski A, Kowalczyk J, Olinic D, Lenarczyk R, Chodor P, Honisz G, Was T, Swierad M, Sredniawa B, Polonski L, Kalarus Z, Postadzhiyan AS, Velinov H, Homorodean C, Velchev V, Hazarbasanov D, Apostolova M, Finkov B, Petrovic M, Panic G, Jovelic A, Canji T, Srdanovic I, Popov T, Ober M, Golubovic M, Pavlovic K, Cemerlic-Adjic N, Bro-Jeppesen J, Kjaergaard J, Wanscher MC, Nielsen SL, Rasmussen LS, Hassager C, Bro-Jeppesen J, Olinic M, Kjaergaard J, Wanscher MC, Rasmussen LS, Hassager C, Khan M, Crolla E, Morley H, Akeroyd L, Beaini Y, Morley C, Andrioaia C, Dores H, Leal S, Rosario I, Abecasis J, Monge J, Correia MJ, Arroja I, Fonseca C, Aleixo A, Silva A, Condac A, Bekeredjian RH, Krumsdorf U, Rottbauer W, Katus HA, Pleger S, Providencia RA, Silva J, Barra S, Gomes PL, Seca L, Masmoudi M, Botelho A, Quintal N, Mota P, Leitao-Marques AM, Silva B, Santos N, Cafe H, Faria P, Serrao M, Gomes S, Berdaoui B, Oliveira R, Caires G, Drumond A, Araujo J, Roussel JC, Senage T, Perigaud C, Habash O, Michel M, Treilhaud M, Labidi S, Despins P, Trochu JN, Baron O, Duveau D, Kitsiou AN, Giannakopoulos K, Papadimitriou G, Karas S, Babic Z, Nikolic Heitzler V, Tapia Ballesteros C, Milicic D, Bergovec M, Raguz M, Mirat J, Strozzi M, Plazonic Z, Giunio L, Steiner R, Freynhofer M, Brozovic I, Hernandez Luis C, Bruno V, Leherbauer L, Djurkovic M, Jarai R, Willheim M, Huebl W, Wojta J, Huber K, Vogel B, Hahne S, Sandin MG, Kozanli I, Kalla K, Jarai R, Freynhofer M, Smetana P, Geppert A, Unger G, Huber K, Simoes Marques Assuncao Caetano AF, Barra S, Vegas JM, Silva J, Providencia R, Faustino C, Botelho A, Mota P, Leitao Marques A, Ariza Sole A, Sanchez Salado JC, Lorente Tordera V, Martinez Garcia V, Andion R, Salazar Mendiguchia Y Garcia J, Gomez Hospital JA, Maristany Daunert J, Berdejo Gago FJ, Esplugas Oliveras E, Brzozowska-Czarnek A, Urbanik A, Kakouros N, Kakouros S, Lekakis J, Martinez N, Rizos J, Kokkinos D, Venevtseva J, Melnikov A, Valiahmetov M, Gomova T, Perelomova I, Ferrer Hita JJ, Bosa-Ojeda F, Sanchez-Grande-Flecha A, Gonzalez IA, Yanes-Bowden G, Vargas-Torres MJ, Rodriguez-Gonzalez A, Rubio-Iglesias-Garcia C, Dominguez-Rodriguez A, Enjuanes-Grau C, Marrero-Rodriguez F, Parepa I, Suceveanu AI, Suceveanu A, Alvarado M, Mazilu L, Alexandrescu L, Dumitru E, Miu V, Jitari V, Craiu E, Voinea FL, Balachandran KP, Schofield R, Sankaranarayanan R, Amat IJ, Helm K, Crowe C, Singh R, Mcdonald J, Chuen MJ, Kobusiak-Prokopowicz M, Preglowska M, Mysiak A, Doi T, Sakoda T, San Roman JA, Akagami T, Naka T, Tsujino T, Masuyama T, Ohyanagi M, Kume N, Mitsuoka H, Hayashida K, Tanaka M, Biasucci LM, Garcia Gonzalez MJ, Della Bona R, Biasillo G, Leo M, Zaninotto M, Plebani M, Crea F, Biasucci LM, Dellabona R, Leo M, Biasillo G, Arroyo Ucar E, Zaninotto M, Plebani M, Crea F, Cavusoglu Y, Gok B, Birdane A, Demirustu C, Gorenek B, Unalir A, Ata N, Hernandez Garcia C, Timuralp B, Nikulina N, Yakushin SS, Nikulina N, Yakushin SS, Furmenko GI, Akinina SA, Dores H, Ingrid R, Leal S, Dorta Martin M, Correia MJ, Bronze L, Monge J, Arroja I, Fonseca C, Aleixo A, Silva A, Djambazov S, Zhivkov A, Maznev I, Marrero Rodriguez F, Ingeliev M, Slavov R, Cvetkova N, Patarinski V, Groch L, Horak J, Dimitrov N, Hayrapetyan HG, Raposeiras Roubin S, Abu-Assi E, Dragu R, Cabanas-Grandio P, Agra-Bermejo R, Garcia-Acuna JM, Pena-Gil C, Gonzalez-Juanatey JR, Barra SNC, Silva J, Providencia R, Seca L, Gomes P, Kapeliovich M, Leitao Marques A, Daly MJ, Mc Keag NA, Mc Cann CJ, Cardwell C, Young IS, Adgey AAJ, Mikhalchikova N, Burova N, Zaccaria M, Hammerman H, Palmisano P, Palumbo V, Ciccone MM, Favale S, Chen KC, Yin WH, Liu JH, Goncalves S, Santos JF, Amador P, Silva D, Soares LN, Zahidova K, Guliyev F, Zahidov N, Carrilho-Ferreira P, Cortez-Dias N, Marques JS, Silva D, Jorge C, Robalo Martins S, Cortez-Dias N, Almeida Ribeiro M, Calisto C, Carvalho De Sousa J, Lopes MG, Cortez-Dias N, Calisto C, Silva D, Jorge C, Carrilho-Ferreira P, Silva Marques J, Jorge C, Robalo Martins S, Correia MJ, Carvalho De Sousa J, Lopes MG, Uthoff H, Thalhammer C, Potocki M, Reichlin T, Noveanu M, Aschwanden M, Silva Marques J, Staub D, Arenja N, Socrates T, Mueller C, Zhao Y, Wu X, Xue Q, Gao L, Lin H, Wang S, Carilho Ferreira P, Watanabe K, Kawamura A, Seko T, Omura A, Sakabe S, Kasai A, Starodubova AV, Storozhakov G, Kisliak O, Hautieva F, Robalo Martins S, Tursheva M, Fedotova N, Di Maio RC, Mclaughlin J, Allen JD, Anderson JMC, Adgey AAJ, Khaled Nagi H, Abed N, Tayeh O, Almeida Ribeiro M, Farok W, Mousa A, Neuzil P, Skoda J, Petru J, Sediva L, Kralovec S, Holy F, Holdova K, Jehlicka P, Calisto C, Plasil P, Reddy VY, Alabakovska S, Labudovic D, Jovanova S, Tosheska K, Alabakovski M, Jeevaratnam K, Tee SP, Zhang Y, Fiuza M, Guzadhur L, Gurung IS, Duehmke R, Grace AA, Lei M, Huang CL, Ishibashi Y, Yamauchi M, Akashi Y, Musha H, Lopes MG, Miyake F, Hnatek T, Kamenik L, Sedlon P, Luxova J, Steuerova B, Skvaril J, Cernohous M, Zavoral M, Ratkovic N, Milicevic P, Nemanja Djenic NR, Aleksandra Jovelic AJ, Slobodan Obradovic SO, Branko Gligic BG, Kletsiou E, Giannakopoulou M, Bozas E, Iliodromitis EK, Anastasiou-Nana M, Papathanassoglou EDE, Panic M, Anton M, Anton G, Muraru M, Stanojlovic T, Salinger Martinovic S, Radosavljevic M, Glasnovic J, Stanojevic D, Zivkovic M, Cortez-Dias N, Stankovic I, Jorge C, Calisto C, Silva D, Carrilho-Ferreira P, Silva Marques J, Robalo Martins S, Pessoa T, Fiuza M, Lopes MG, Aspromonte N, Milicevic D, Ronco C, Tubaro M, Santini M, Colivicchi F, Aiello A, Cruz D, Anzoletti Boscolo A, Vianello G, Valle R, Cavusoglu Y, Kalezic T, Parspour A, Birdane A, Tek M, Gorenek B, Unalir A, Ata N, Lee WP, Ong BB, Watkins S, Datta D, Kafedzic S, Halcox JPJ, Providencia RA, Barra S, Gomes PL, Seca L, Silva J, Botelho A, Quintal N, Pais JR, Mota P, Ilic I, Leitao-Marques AM, Nikishin AG, Pirnazarov MM, Nurbaev TA, Motovska Z, Fischerova M, Osmancik P, Maly M, Widimsky P, Pavli E, Cerovic M, Dibra A, Mehilli J, Dibra L, Schoemig A, Kastrati A, Carmo P, Ferreira J, Aguiar C, Almeida M, Raposo L, Putnikovic B, Teles R, Goncalves P, Brito J, Silva A, D'ascenzo F, Gonella A, Longo G, Pullara A, Moretti C, Sciuto F, Neskovic A, Omede' P, Biondi Zoccai G, Trevi GP, Sheiban I, Santos N, Serrao M, Cafe H, Silva B, Oliveira R, Caires G, Rott D, Drumond A, Araujo J, Cafe HM, Silva B, Santos N, Faria P, Oliveira R, Pereira A, Caires G, Pereira D, Leibowitz D, Freitas D, Araujo J, Pittl U, Schratter A, Klemm T, Lehmann D, Demmin K, Mende M, Schuler G, Thiele H, Monhart Z, Salazar Mendiguchia Y Garcia J, Ariza Sole A, Martinez Garcia V, Sanchez Salado JC, Lorente Tordera V, Ortiz Berbel D, Rabasa Baraibar JM, Esplugas Oliveras E, Monge J, Leal S, Reissigova J, Dores H, Bronze Carvalho L, Rosario I, Abecasis J, Correia MJ, Leitao A, Aleixo A, Silva A, Leone AM, De Caterina A, Grunfeldova H, Aurelio A, Sciahbasi A, Lioy E, Trani C, Burzotta F, Porto I, Rebuzzi AG, Crea F, Trusinskis K, Juhnevica D, Jansky P, Strenge K, Sondore D, Kumsars I, Jegere S, Narbute I, Grave A, Zakke I, Erglis A, Mihaylov G, Marenzi G, Timoteo AT, Assanelli E, Ferrari C, Marana I, Lauri G, De Metrio M, Grazi M, Campodonico J, Moltrasio M, Bartorelli AL, Martins H, Valente B, Saraiva F, Baptista R, Jorge E, Mendes PL, Monteiro P, Costa S, Franco F, Providencia LA, Saeed M, Gaber R, Oliveira JA, Mornos C, Cozma D, Pescariu S, Dragulescu SI, Kamal HS, Abdelfattah A, Abdelbary AM, Elassar H, Naggar A, Khaled M, Ferreira ML, Fareed AM, Pernes JM, Gaux JC, Oraby M, Nasr GM, Maklady F, Dupouy P, Prull MW, Sasko B, Wirdemann H, Ferreira RC, Bittlinsky A, Butz T, Trappe HJ, Perazzolo Marra M, Cacciavillani L, Marzari A, De Lazzari M, Turri R, China P, Corbetti F, Villanueva Benito I, Iliceto S, Stazhadze LL, Spiridonova EA, Bulanova NA, Ermolaev AA, Savic L, Mrdovic I, Krljanac G, Perunicic J, Asanin M, Solla I, Lasica R, Matic M, Vasiljevic Z, Ostojic M, Pudil R, Tichy M, Blaha V, Andrys C, Vojacek J, Conti A, Paredes E, Poggioni C, Viviani G, Bulletti F, Boni V, Luzzi M, Vicidomini S, Donati M, Del Taglia B, Pini R, Sousa O, Diaz Castro O, Fontes-Carvalho R, Caeiro D, Dias Ferreira N, Silva G, Pereira E, Ribeiro J, Albuquerque A, Gama Ribeiro V, Murai M, Takeda Y, Calvo F, Shinmyo T, Tanigawa J, Hazui H, Nakakohji T, Ohishi Y, Hoshiga M, Ishihara T, Hanafusa T, Belohlavek J, Rohn V, Baz JA, Kunstyr J, Lips M, Semrad M, Horak J, Mlejnsky F, Tosovsky J, Linhart A, Lindner J, Sablik Z, Samborska-Sablik A, Iniguez A, Drozdz J, Gaszynski W, Ferrer Hita JJ, Rodriguez-Gonzalez A, Izquierdo-Gomez MM, Enjuanes-Grau C, Rubio-Iglesias-Garcia C, Sanchez-Grande-Flecha A, Juarez-Prera R, Blanco-Palacios G, Aleksova A, Bosa-Ojeda F, Marrero-Rodriguez F, Lakhdar R, Drissa M, Drissa M, Jedaida B, Drissa H, Sousa O, Dias Ferreira N, Sampaio F, Gerloni R, Caeiro D, Fontes-Carvalho R, Silva G, Pereira E, Ribeiro J, Albuquerque A, Gama Ribeiro V, Hsin HT, Huang JH, Chiu KM, Belfiore R, Chen ZS, Lin PC, Chen LY, Chu SH, Efthimiadis I, Skendros P, Sarantopoulos A, Boura P, Delewi R, Nijveldt R, Carriere C, Van Der Laan AM, Hirsch A, Van Der Vleuten PA, Klees M, Tijssen JGP, Zijlstra F, Van Rossum AC, Piek JJ, Backus BE, Six AJ, Barbati G, Kelder JH, Mosterd A, Mast EG, Mast TP, Braam R, Tio R, Veldkamp R, Doevendans PA, Delewi R, Nijveldt R, Fabris E, Van Der Laan AM, Hirsch A, Van Der Vleuten PA, Klees M, Tijssen JGP, Zijlstra F, Van Rossum AC, Piek JJ, Paarup Dridi N, Holmvang L, Possa F, Engstroem T, Rekik S, Brunet J, Hager FX, Bayet G, Meille L, Quatre JM, Sainsous J, Chu PH, Tang CH, Nait D, Ibatov A, Pogosova N, Koltunov IE, Sapunova ID, Vigodin VA, Uhliar R, Gilis-Januszewski T, Mellwig KP, Wiemer M, Gilis-Januszewski J, Milo M, Peterschroeder A, Schmidt A, Brockmeyer B, Horstkotte D, Suzuki A, Eki Y, Higuchi H, Yukawa A, Yamauchi R, Sato Y, Sinagra G, Endo Y, Martinez Garcia V, Salazar Mendigucha Garcia J, Ariza Sole A, Sanchez Salado JC, Lorente Tordera V, Homs Vila S, Gomez Hospital JA, Cequier Fillat A, Esplugas Oliveras E, Marques N, Andion Ogando R, Hernandez Luis C, Sandin Fuentes M, Tapia Ballesteros C, Vegas Valle JM, Gonzalez Garcia IA, Duro Aguado IA, Palomino Doza AJ, Gomez Salvador I, San Roman Calvar JA, Mimoso J, Nikishin AG, Mamarasulov TM, Pirnazarov MM, Koracevic G, Pavlovic M, Glasnovic J, Damjanovic M, Stojkovic A, Kostic T, Todorovic L, Gomes V, Petrovic S, Zivkovic M, Djordjevic-Radojkovic D, Cherneva ZCH, Denchev SD, Heltai K, Becker D, Merkely B, Nikulina N, Yakushin SS, Agra Bermejo RM, Akinina SA, Furmenko GI, Boytsov A, Yakushin SS, Nikulina NN, Furmenko GI, Akinina SA, Dores H, Leal S, Rosario I, Emad Abu Assi EAA, Bronze L, Abecasis J, Correia MJ, Arroja I, Fonseca C, Aleixo A, Silva A, Dores H, Leal S, Rosario I, Sergio Raposeiras Roubin SRR, Monge J, Abecasis J, Correia MJ, Bronze L, Arroja I, Aleixo A, Silva A, Rosario I, Leal S, Dores H, Pilar Cabanas Grandio PCG, Correia MJ, Monge JC, Abecasis J, Arroja I, Aleixo A, Silva A, Palmisano P, Zaccaria M, Zanna D, Marangelli V, Carlos Pena Gil CPG, Caiati C, Ciccone MM, Favale S, Picon Heras R, Loureiro MJ, Nunez-Gil I, Garcia Rubira JC, Acebal C, Ruiz-Mateos B, Ibanez B, Jose Maria Garcia Acuna JMGA, Fernandez-Ortiz A, Macaya C, Rosario I, Dores H, Leal S, Monge JC, Correia MJ, Bronze Carvalho L, Arroja I, Fonseca C, Jose Ramon Gonzalez Juanatey JRGJ, Aleixo A, Silva A, Urazovskaya I, Vinogradova D, Vasilieva E, Shpektor A, Faustino A, Seca L, Barra S, Providencia R, Daly MJ, Silva J, Gomes P, Costa G, Caetano F, Costa M, Leitao-Marques A, Conti E, Musumeci MB, Lauri FM, Dito E, Scott P, De Giusti M, Lallo A, Fusco D, Davoli M, Volpe M, Autore C, Gamra H, Dridi Z, Hassine M, Addad F, Owens CG, Gherissi I, Reda A, Mahjoub M, Bouraoui S, Abdennadher M, Betbout F, Mota PMFP, Silva JD, Providencia RA, Leitao-Marques A, Tomlin A, Nikolic Heitzler V, Babic Z, Milicic D, Bergovec M, Raguz M, Mirat J, Strozzi M, Plazonic Z, Giunio L, Steiner R, Smith B, Stanojevic D, Apostolovic S, Jankovic Tomasevic R, Pavlovic M, Djordjevic V, Djordjevic Radojkovic D, Salinger Martinovic S, Koracevic G, Damjanovic M, Ilic I, Adgey AAJ, Scafa Udriste A, Fruntelata A, Gainoiu E, Bogdan S, Calmac L, Zamfir D, Teodorescu C, Guran M, Constantinescu D, Dorobantu M, Alvarez-Contreras LR, Rosario I, Dores H, Leal S, Abecasis J, Monge JC, Bronze L, Arroja I, Fonseca C, Aleixo A, Silva A, Juarez U, Konopka A, Banaszewski M, Wojtkowska I, Stepinska J, Vidergold JV, Osipova IV, Tavrovskaya TV, Galkina JV, Timofeev AV, Vorobyov RI, Altamirano A, Vorobyova EN, Matos L, Carvalho ACC, Oliveira W, Cintra F, Poyares D, Andersen M, Martins R, Tufik S, Neuzil P, Arias A, Ostadal P, Skoda J, Holy F, Holdova K, Brada J, Horakova S, Mlcek M, Hrachovina V, Kittnar O, Gorudko IV, Alvarez-San Gabriel A, Buko IV, Cherenkevich SN, Polonetsky LZ, Plotkin VY, Timoshina MA, Azanchevskaya SV, Chromov-Borisov NN, Vorlat A, Snoep L, Claeys MJ, Gonzalez-Pacheco H, Vrints CJ, Palazzuoli A, Caputo M, Quatrini I, Calabro A, Antonelli G, Campagna MS, Franci B, Nuti R, Maisel A, Martinez-Sanchez C, Paulo C, Mascarenhas J, Patacho M, Pimenta J, Bettencourt P, Negrini M, Minora T, Marino P, Seregni R, Tavlueva E, Rahnavardi M, Barbarash O, Barbarash L, Janota T, Kudlicka J, Malik K, Wichterle D, Hradec J, Faria R, Mimoso J, Marques N, Keshtkar-Jahromi M, Trigo J, Marques V, Gomes V, Body R, Carley SD, Mcdowell G, Nuttall M, Wibberley C, France M, Cruickshank JK, Vakili H, Mackway-Jones K, Cavusoglu Y, Cavusoglu A, Unluoglu I, Tek M, Demirustu C, Unalacak M, Gorenek B, Birdane A, Yuksel F, Gholamin S, Ata N, Leon M, Cozma C, Mitu F, Matos L, Carvalho ACC, Almeida DR, Oliveira W, Dias CB, Barra SNC, Razavi SM, Gomes P, Silva J, Providencia R, Seca L, Leitao Marques A, Burazor I, Burazor M, Krstic M, Lazovic M, Stojkovic A, Gilis-Januszewski T, Vukmanovic M, Djordjevic J, Radovanovic Z, Ilic D, Bosnjakovic P, Margato R, Ferreira AC, Mateus PS, Ribeiro H, Fontes P, Mellwig KP, Moreira JI, Teixeira T, Silva JD, Costa M, Leitao-Marques A, Conte G, Menozzi A, Solinas E, Bolognesi MG, Tadonio I, Wiemer M, Mantovani F, Cattabiani A, Vignali L, Ardissino D, Scafa Udriste A, Fruntelata A, Tautu O, Calmac L, Alexandrescu A, Niculescu R, Gilis-Januszewski J, Tatu-Chitoiu G, Dorobantu M, Djordjevic Radojkovic D, Apostolovic S, Perisic Z, Damjanovic M, Jankovic R, Salinger Martinovic S, Koracevic G, Todorovic L, Peterschroeder A, Bozinovic N, Matos L, Carvalho ACC, Almeida DR, Oliveira W, Dias CB, Santos C, Ferreira J, Carmo P, Costa F, Koerfer J, Brito J, Sousa P, Cardoso G, Correia I, Aguiar C, Silva A, Fountoulaki K, Kastellanos S, Voltirakis E, Kokotos A, Horstkotte D, Michalakeas C, Kontsas K, Hasioti K, Iliodromitis ET, Anastasiou-Nana M, Andion Ogando R, Hernandez Luis C, Sandin Fuentes MG, Tapia Ballesteros C, Vegas Valle JM, Vrsalovic M, Zatarain Nicolas E, Amat Santos IJ, Martinez Uruena N, Alvarado Montes De Oca M, San Roman Calvar JA, Belohlavek J, Dytrych V, Kovarnik T, Smid O, Kral A, Getaldic B, Linhart A, Aroutunov AG, Intwala S, Sondore D, Juhnevica D, Trusinskis K, Strenge K, Jegere I, Narbute I, Grave A, Vrkic N, Erglis A, Shaalan HSH, Pagava Z, Agladze R, Shakarishvili R, Sharashidze N, Gujejiani L, Saatashvili G, Martins H, Saraiva F, Pintaric H, Baptista R, Jorge E, Mendes PL, Monteiro P, Costa S, Franco F, Providencia LA, Gaber R, Gaber R, Hristova K, Khan S, Katova TZ, Kostova V, Simova Y, Parepa I, Suceveanu AI, Suceveanu A, Mazilu L, Voinea FL, Craiu E, Obradovic S, Wasan B, Salinger S, Vukotic S, Rafajlovski S, Romanovic R, Koracevic G, Antonijevic N, Gligic B, Hutyra M, Skala T, Horak D, Moretti L, Vindis D, Taborsky M, Contine A, Del Pinto M, Angeli F, Verdecchia P, Borgognoni F, Grikstaite E, Pantano P, Ambrosio G, Grossi P, Cavallini C, Bonanad C, Sanchis J, Bodi V, Nunez J, Bosch X, Heras M, Pellicer M, Llacer A, Seca LF, Silenzi S, Fontes-Carvalho R, Caeiro D, Adao L, Oliveira M, Goncalves H, Primo J, Gama V, Fresco C, De Biasio M, Sappa R, Testa M, Muser D, Morocutti G, Bernardi G, Proclemer A, Lombardi C, Metra M, Bugatti S, Pasotti E, Quinzani F, Adamo M, Candelori L, Villa C, Rovetta R, Manerba A, Dei Cas L, Mariani M, Dushpanova A, Baroni M, Cerone E, Nardelli A, Gianetti J, Clementi LN, Berti S, Timoteo AT, Oliveira MM, Silva MN, Toste A, Ramos R, Cunha PS, Feliciano F, Soares R, Santos S, Forlini M, Ferreira RC, Ostadal P, Kruger A, Vondrakova D, Herget J, Di Maio RC, Navarro C, Cromie NA, Anderson JMC, Adgey JAA, Lando L, Tadel-Kocjancic S, Radsel P, Knafelj R, Gorjup V, Noc M, Caeiro Pereira D, Braga P, Fontes Carvalho R, Sousa O, Rodrigues A, Pezzuoli ML, Goncalves H, Ribeiro J, Goncalves M, Simoes L, Gama V, Borisov KV, Corradetti P, Leurent G, Pennec PY, Filippi E, Moquet B, Hacot JP, Druelles P, Rialan A, Rouault G, Coudert I, Le Breton H, Gevaert S, Tromp F, Vandecasteele E, De Somer F, Van Belleghem Y, Bouchez S, Martens F, Herck I, De Pauw M, Spinar J, Ludka O, Sepsi M, Miklik R, Dusek L, Tomcikova D, Marques N, Mimoso J, Gomes V, Garcia-Acuna JM, Aguiar-Souto P, Raposeiras Roubin S, Agra-Bermejo R, Jacquet M, Abu-Assi E, Gonzalez-Juanatey JR, Ibatov A, Labrova R, Spinar J, Karlik R, Kanovsky J, Lokaj P, She Q, Deng SB, Huang SH, Gu LJ, Rong JIAN, Wu ZK, Li Y, Zhang J, Parascan L, Campanile A, Spinelli L, Santulli G, Ciccarelli M, De Gennaro S, Assante Di Panzillo E, Trimarco B, Iaccarino G, Bobescu E, Radoi M, Datcu G, Dobreanu D, Doka B, Charniot JC, Cosson C, Albertini JP, Bittar R, Giral P, Cherfils C, Guillerm E, Bonnefont-Rousselot D, Craiu E, Rusali A, Cojocaru L, Parepa I, Koizumi T, Iida S, Sato J, Kikutani T, Muramatsu T, Nishimura S, Komiyama N, Lee WP, Ong BB, Haralambos K, Townsend D, Rees JAE, Williams EJ, Halcox JP, Mcdowell I, Damjanovic M, Koracevic G, Djordjevic-Radojkovic D, Pavlovic M, Krstic N, Ciric-Zdravkovic S, Stojkovic A, Perisic Z, Apostolovic S, Faustino A, Seca L, Barra S, Caetano F, Providencia R, Silva J, Gomes P, Costa G, Costa M, Leitao-Marques A, Volkova AL, Arutyunov GP, Bylova NA, Dayter II, Jao YTFN, Fang CC, Chen Y, Yu CL, Wang SP, Valencia J, Perez-Berbel P, Ruiz-Nodar JM, Pineda J, Bordes P, Quintanilla M, Mainar V, Sogorb F, Santos N, Serrao M, Cafe H, Silva B, Oliveira R, Caires G, Drumond A, Araujo J, Providencia RA, Gomes PL, Seca L, Barra S, Silva J, Faustino A, Caetano F, Pais JR, Mota P, Leitao-Marques AM, Farhan S, Jarai R, Tentzeris I, Vogel B, Freynhofer MK, Wojta J, Huber K, Poli M, Trambaiolo P, Corsi F, De Luca M, Mustilli M, Lukic V, Simonetti M, Ferraiuolo G, Lettino M, Casella G, Conte MR, De Luca L, Geraci G, Ceravolo R, Milo M, Pani A, Trambaiolo P, Fradella G, Schratter A, Thiele H, Klemm T, Demmin K, Lehmann D, Mende M, Schuler G, Pittl U, Chernova A, Nikulina SU, Naruke T, Inomata T, Yanagisawa T, Maekawa E, Mizutani T, Shinagawa H, Nishii M, Takeuchi I, Takehana H, Izumi T, Paulo C, Mascarenhas J, Patacho M, Pimenta J, Bettencourt P, Nardai S, Szabo GY, Berta B, Edes I, Merkely B, Delgado Silva J, Seca L, Baptista R, Providencia R, Mota P, Costa M, Leitao-Marques A, Faria R, Trigo J, Gago P, Mimoso J, Marques N, Gomes V, Gheorghe G, Nanea IT, Cristea A, Almarichi S, Martins H, Saraiva F, Baptista R, Jorge E, Mendes PL, Monteiro P, Costa S, Franco F, Providencia LA, Nanea T, Gheorghe GS, Visan S, Paun N, Gaber R, Gaber R, Delewi R, Nijveldt R, De Bruin HA, Hirsch A, Van Der Laan A, Bouma BJ, Tijssen JPG, Van Rossum AC, Zijlstra F, Piek JJ, Rus H, Radoi M, Donea M, Ciurea C, Ifteni G, Casolo G, Chioccioli M, Magnacca M, Del Meglio J, Comella A, Baratto M, Lera J, Salvadori L, Tessa C, Vignali C, Keca Z, Momcilov Popin T, Panic G, White R, Mateen F, Weaver A, Dragu R, Agmon Y, Kapeliovich M, Hammerman H, Timoteo AT, Lousinha A, Santos N, Oliveira JA, Ferreira ML, Ferreira RC, Okisheva E, Tsaregorodtsev D, Sulimov V, Amat Santos IJ, Gonzalez IA, Hernandez C, Sandin MG, Tapia C, Andion R, Alvarado M, Campo A, San Roman JA, Fredman D, Svensson L, Rosenqvist M, Tadel-Kocjancic S, Radsel P, Knafelj R, Gorjup V, Noc M, Zima E, Jenei ZS, Kovacs E, Osztheimer I, Szabo GY, Molnar L, Horvath A, Becker D, Geller L, Merkely B, Maggi R, Furukawa T, Viscardi V, Brignole M, Leal SRN, Dores H, Rosario I, Monge J, Carvalho MJ, Arroja I, Leitao A, Fonseca C, Aleixo A, Silva A, Keuleers S, Herijgers P, Herregods MC, Budts W, Dubois C, Meuris B, Verhamme P, Flameng W, Van De Werf F, Adriaenssens T, Badran H, Elnoamany M, Lolah T, Tatu-Chitoiu G, Dorobantu M, Benedek I, Craiu E, Sinescu C, Ionescu DD, Olariu C, Radoi M, Pop C, Macarie C, Mollik MAH, Hassan AI, Paul TK, Haque MZ, Jahan R, Rahmatullah M, Khatun MA, Rahman MT, Chowdhury MH, Bustamante Munguira J, Tamayo E, Garcia-Cuenca I, Bustamante E, Gualis J, Gomez-Martinez ML, Florez S, Gomez-Herreras JI, Ramirez Rodriguez R, Ramirez Rodriguez AM, Garcia-Bello MA, Hernadez Ortega E, Caballero Dorta E, Garcia Quintana A, Piro Mastraccio V, Medina Fernandez Aceytuno A, Assanelli E, De Metrio M, Rubino M, Lauri G, Cabiati A, Campodonico J, Grazi M, Moltrasio M, Marana I, Marenzi G, Lovlien M, Schei B, Picon-Heras R, Acebal C, Garcia Rubira JC, Vivas Balcones D, Nunez-Gil I, Ruiz-Mateos B, Ibanez B, Fernandez-Ortiz A, Vintila VD, Enescu OA, Stoicescu CI, Udroiu C, Cinteza M, Tatu - Chitoiu G, Vinereanu D, Fresco C, De Biasio M, Muser D, Sappa R, Morocutti G, Bernardi G, Proclemer A, Fontanella B, Affatato A, Ciccarese C, Sacchini M, Volpini M, Bianchetti F, Verzura G, Dei Cas L, Pudil R, Blaha V, Vojacek J, Paraskevaidis I, Ikonomidis I, Parissis J, Papadopoulos C, Stasinos V, Bistola V, Anastasiou-Nana M, Shochat M, Shotan A, Kazatsker M, Gurovich V, Asif A, Noiman E, Levy Y, Blondhaim D, Rabinovich P, Meisel S, Koracevic G, Stojkovic A, Petrovic S, Pavlovic M, Glasnovic J, Tomasevic M, Krstic N, Djordjevic-Radojkovic D, Sakac D, Obradovic S, Londono Sanchez O, Pacreu S, Torres L, Mihaylov G, Shaban GM, Trendafilova E, Krasteva V, Mudrov TS, Didon JP, Panageas V, Vlachos N, Pernat A, Radan I, Mozina H, Izzo A, Tomasi L, Mantovani P, Dall'oglio L, Pepi P, Romano M, Cionini F, Baccaglioni N, Zanini R, Viertel A, Havers J, Ballard G, Groenefeld G, Santos N, Branco LM, Oliveira JA, Ferreira L, Timoteo AT, Fiarresga A, Feliciano J, Ramos R, Ferreira RC, Izzo A, Tomasi L, Mantovani P, Pepi P, Lettieri L, Dall'oglio L, Reggiani A, Zanini R, Garcia Gonzalez MJ, Arroyo Ucar E, Hernandez Garcia C, Juarez Prera R, Blanco Palacios G, Dorta Martin M, Marrero Rodriguez F, Martin AC, Manzo Silberman S, Chaib A, Varenne O, Allouch P, Salengro E, Jegou A, Margot O, Spaulding C, Diego A, De Miguel A, Cuellas C, Fraile E, Martin J, Vega B, Bangueses R, Fernandez-Vazquez F, Perez De Prado A, Rosario I, Dores H, Leal S, Correia MJ, Monge JC, Arroja I, Abecasis J, Aleixo A, Silva A, Dragu R, Agmon Y, Kapeliovich M, Hammerman H, Garcia-Garcia C, Subirana I, Sala J, Bruguera J, Valle V, Sanz G, Fiol M, Aros F, Marrugat J, Elosua R, Barra SNC, Silva J, Gomes P, Providencia R, Seca L, Leitao Marques A, Zhao ZY, Wu YJ, Li JJ, Yang YJ, Xu B, Tang YD, Song GY, G RL, Panic M, Milicevic P, Stankovic I, Ilic I, Kafedzic S, Kalezic T, Milicevic D, Aleksic A, Putnikovic B, Neskovic A, Serpytis P, Rucinskas K, Kalinauskas A, Karvelyte N, Santos De Sousa CI, Ferreira S, Calaca J, Lousada N, Palma Reis R, Gualandro DM, Seguro LFBC, Braga FGM, Silvestre OM, Lage RL, Fabri J, Oliveira MT, Urbano Moral JA, Torres Llergo J, Solanilla Rodriguez R, Sanchez Gonzalez A, Martinez Martinez A, Den Uil CA, Lagrand WK, Van Der Ent M, Jewbali LSD, Cheng JM, Spronk PE, Simoons ML, Mornos C, Petrescu L, Dragulescu D, Ionac A, Guardado J, Azevedo O, Fernandes M, Canario-Almeida F, Sanfins V, Pereira A, Almeida J, Kaplunova VU, Belenkov YN, Privalova EV, Fomin AA, Suvorov AY, Goodkova A, Rubakova MG, Kuznetsova IA, Semernin EN, Keshavarzi F, Kojuri J, Mikhailov VM, Vezhenkova IV, Goodkova AYA, Jarai R, Pavlovic I, Farhan S, Schwarz M, Jakl G, Huber K, Jarai R, Schwarz M, Smetana P, Jakl G, Perkmann T, Farhan S, Huber K, Mayr A, Mair J, Klug G, Schocke M, Trieb T, Jaschke W, Pachinger O, Metzler B, Bronze Carvalho L, Azevedo J, Andrade ML, Arroja I, Relvas MJ, Coucello J, Monge J, Morais G, Seabra M, Aleixo A, Afamefule F, Luaces Mendez M, Teijeiro-Mestre R, Nunez-Gil IJ, Leco-Gil N, Madronal-Cerezo E, Zannin I, Ruiz J, Orynchak MA, Vakalyuk II, Vakalyuk IP, Berezin A, Panasenko T, Cavusoglu Y, Cavusoglu A, Unluoglu I, Tek M, Demirustu C, Gorenek B, Unalacak M, Birdane A, Yuksel F, Ata N, Lee WP, Halcox JPJ, Cavusoglu Y, Beyaztas A, Entok E, Demirustu C, Uslu I, Birdane A, Gorenek B, Ata N, Schaefer A, Flierl U, Seydelmann N, Bauersachs J, Calmac L, Craiu E, Ionescu DD, Nanea T, Pop C, Marinescu S, Macarie C, Tatu Chitoiu G, Fruntelata AG, Dorobantu M, Hamdi S, Maazoun Y, Neji A, Farhat O, Majdoub M, Ben Hamda K, Maatouk F, Balanescu SM, Benedek I, Nedelciuc I, Deleanu D, Dobreanu D, Olinic D, Petrescu L, Ortan F, Mot S, Tatu Chitoiu G, Sinnaeve PR, Moreels S, Adriaenssens T, Dubois C, Coosemans M, Vydt T, Desmet W, Sinnaeve PR, Moreels S, Vydt T, Dubois C, Adriaenssens T, Coosemans M, Desmet W, Poli M, Trambaiolo P, Corsi F, De Luca M, Mustilli M, Lukic V, Simonetti M, Ferraiuolo G, Tobing D, Rifnaldi R, Juzar D, Firdaus I, Dharma S, Irmalita I, Kalim H, Bejiqi R, Retkoceri R, Bejiqi H, Kryeziu L, Kelmendi M, Borovci SH, Victor SM, Gnanaraj A, Deshmukh R, Mullasari AS, Yahalom M, Kaiyal RS, Roguin N, Bornstein J, Atar S, Farah R, Seca LF, Faustino A, Silva J, Providencia R, Gomes P, Barra S, Caetano F, Costa M, Leitao Marques AM, Margato R, Sousa P, Ribeiro H, Rocha L, Correia A, Moreira JI, Carvalho HC, Afifi M, Abed N, Santos N, Serrao M, Cafe H. Abstracts. Eur Heart J Suppl 2010. [DOI: 10.1093/eurheartj/suq023] [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: 11/15/2022]
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Basso N, Casella G, Rizzello M, Abbatini F, Soricelli E, Alessandri G, Maglio C, Fantini A. Laparoscopic sleeve gastrectomy as first stage or definitive intent in 300 consecutive cases. Surg Endosc 2010; 25:444-9. [PMID: 20607564 DOI: 10.1007/s00464-010-1187-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 06/04/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (SG) was originally used as a bridge to definitive surgery in high-risk patients. Recently it has been considered as a stand-alone procedure due to its effectiveness on weight loss and comorbidities resolution. This study was designed to evaluate the results of SG on complications, body mass index (BMI), and comorbidities resolution in 300 consecutive obese patients and to analyze the lesson learned from this experience. METHODS From October 2002 to November 2009, 300 patients underwent SG. In the first 100 cases (group 1: mean BMI, 54.4±9.3), SG was intended as a first stage of biliopancreatic diversion with duodenal switch in high risk super-obese patients. In the last 200 cases (group 2: mean BMI, 45.5±7.3), SG was intended as a definitive procedure. No routine reinforcement was performed in group 1. In group 2, oversewn reinforcement was performed routinely. SG was redo surgery in 21 patients (7%). RESULTS Mean operative time was 119±48.6 min in group 1 and 72±33.8 in group 2. Conversion rate was 0.6% (massive hepatomegaly). Mortality was 0.6%. Major postoperative complications were registered in 15 patients in group 1 and 11 in group 2. In 3 cases, a reoperation was needed. The mean BMI in group 1 was 46, 43, 39, and 31 at 6, 12, 24, and 36 months, respectively. In group 2, the mean BMI was 32.9, 30.6, and 31.7 at 6, 12, and 18 months. At 12 months, the diabetes, hypertension, and OSAS were cured on 69%, 62%, and 50% in group 1 and 88%, 57%, and 58% in group 2. In group 2, no patient required second stage. CONCLUSIONS SG is a safe and effective treatment for morbid obesity at mid-term follow-up. SG is effective for comorbidities resolution, especially for the treatment of diabetes. Suture line reinforcement allows a significant reduction of bleeding.
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Affiliation(s)
- N Basso
- Surgical-Medical Department for Digestive Diseases, Policlinico Umberto I, University of Rome Sapienza,, Viale del Policlinico, 00161, Rome, Italy.
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Martin EL, Cruz DN, Monti G, Casella G, Vesconi S, Ranieri VM, Ronco C, Antonelli M. Endotoxin removal: how far from the evidence? The EUPHAS 2 Project. Contrib Nephrol 2010; 167:119-125. [PMID: 20519906 DOI: 10.1159/000315926] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Since 1994, a polystyrene fiber cartridge used for extracorporeal hemoperfusion, to which polymyxin B is bound and immobilized, has been used in septic patients in order to absorb and remove circulating lipopolysaccharide, thereby neutralizing the effects of this endotoxin. This therapy gradually gained acceptance as the amount of evidence increased from initial small clinical studies to a carefully conducted systematic review, and ultimately to the multicentered randomized clinical trial conducted in Italy, entitled the EUPHAS Study (Early Use of Polymyxin B Hemoperfusion in Abdominal Septic Shock). While the conclusions of this initial randomized controlled trial were in agreement with previous studies, it possessed some important limitations, including a slow accrual rate, enrolling only 64 patients between 2004 and 2007, inability to blind treating physicians, and a premature study termination based on the results of the scheduled interim analysis. These limitations resulted in a modest patient sample size, which may have overestimated the true magnitude of the clinical effect. Apart from Japan, Italy is the current primary user of polymyxin B-hemoperfusion in the treatment of sepsis, with about 600 cartridges being used per year. However, no structured collection of data has been attempted, resulting in the an opportunity to understand the effects of polymyxin B-hemoperfusion on a large, diverse sample size. In response, Italian investigators and users of this treatment have designed a new prospective multicentered, collaborative data collection study, entitled EUPHAS 2. The aim of the EUPHAS 2 project is to collect a large database regarding polymyxin B-hemoperfusion treatments in order to better evaluate the efficacy and biological significance of endotoxin removal in clinical practice. Additionally, this study aims to verify the reproducibility of the data currently available in the literature, evaluate the patient population chosen for treatment and identify subpopulations of patients who may benefit from this treatment more than others.
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Monti G, Pizzilli G, Cecconi M, Rhodes A, Vesconi S, Brioschi P, Pulici M, Casella G. Bioreactance versus PICCOTD/PC in critically ill septic shock patients. Crit Care 2010. [PMCID: PMC2934106 DOI: 10.1186/cc8331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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