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Zuin M, Bilato C, Rigatelli G, Quadretti L, Roncon L. Trends in age-specific and sex-specific pulmonary hypertension mortality in Italy between 2005 and 2017. J Cardiovasc Med (Hagerstown) 2023; 24:289-296. [PMID: 36938812 DOI: 10.2459/jcm.0000000000001457] [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: 03/21/2023]
Abstract
AIMS Data regarding the pulmonary hypertension (PH)-related mortality and relative trends in the Italian population remain scant. We sought to assess the PH mortality rates and relative trends among the Italian population between 2005 and 2017. METHODS Data regarding the cause-specific mortality and population size by sex in 5-year age groups were extracted from the WHO global mortality database. The age-standardized mortality rates, with relative 95% confidence intervals (CIs), also stratified by sex, were using the direct method. Joinpoint regression analyses were used to identify periods with statistically distinct log linear trends in PH-related death rates. To calculate nationwide annual trends in DCM-related mortality, we assessed the average annual percentage change (AAPC) and relative 95% CIs. RESULTS In Italy, the PH age-standardized annual mortality rate decreased from 2.34 (95% CI: 2.32-2.36) deaths per 100 000 to 1.51 (95% CI: 1.48-1.53) deaths per 100 000 population. Over the entire period, men had higher PH-related mortality rates than women. Moreover, the PH-related mortality trend rose with a seemingly exponential distribution with a similar trend among male and female individuals. Joinpoint regression analysis revealed a linear significant decrease in age-standardized PH-related mortality from 2005 to 2017 [AAPC: -3.1% (95% CI: -3.8 to -2.5), P < 0.001] in the entire Italian population. However, the decline was more pronounced among men [AAPC: -5.0 (95% CI: -6.1 to -3.9), P < 0.001] compared with women [AAPC: -1.5 (95% CI: -2.3 to -0.7), P = 0.001]. CONCLUSION In Italy, the PH-related mortality rates linearly declined from 2005 to 2017.
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Affiliation(s)
- Marco Zuin
- Department of Cardiology, West Vicenza Hospital, Arzignano, Vicenza.,Department of Translational Medicine, University of Ferrara, Ferrara
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Vicenza
| | | | - Laura Quadretti
- Department of Cardiology, Casa di Cura Madonna della Slaute, Porto Viro
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
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Zuin M, Rigatelli G, Bilato C, Quadretti L, Roncon L, Zuliani G. COVID-19 patients with acute pulmonary embolism have a higher mortality risk: systematic review and meta-analysis based on Italian cohorts. J Cardiovasc Med (Hagerstown) 2022; 23:773-778. [PMID: 36166326 PMCID: PMC9671546 DOI: 10.2459/jcm.0000000000001354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 06/03/2022] [Accepted: 07/17/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Acute pulmonary embolism has been recognized as a frequent complication of COVID-19 infection influencing the clinical course and outcomes of these patients. OBJECTIVES We performed a systematic review and meta-analysis to evaluate the mortality risk in COVID-19 Italian patients complicated by acute pulmonary embolism in the short-term period. METHODS The study was performed in accordance with the Preferred Report Items for Systematic Reviews and Meta-analyses guidelines. PubMed-MEDLINE and Scopus databases were systematically searched for articles, published in the English language and enrolling Italian cohorts with confirmed COVID-19 infection from inception through 20 October 2021. Mortality risk data were pooled using the Mantel-Haenszel random effects models with odds ratio as the effect measure with 95% confidence interval. Heterogeneity among studies was assessed using Higgins and Thomson I2 statistic. RESULTS Eight investigations enrolling 1.681 patients (mean age 64.9 years, 1125 males) met the inclusion criteria and were considered for the analysis. A random-effect model showed that acute pulmonary embolism was present in 19.0% of Italian patients with COVID-19 infection. Moreover, these patients were at higher mortality risk compared with those without (odds ratio: 1.76, 95% confidence interval: 1.26-2.47, P = 0.001, I2 = 0%). Sensitivity analysis confirmed yielded results. CONCLUSION In Italian patients with COVID-19 infection, acute pulmonary embolism was present in about one out of five and significantly associated with a higher mortality risk in the short-term period. The identification of acute pulmonary embolism in these patients remains critical to promptly identify vulnerable populations who would require prioritization in treatment and prevention and close monitoring.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara
- Department of Cardiology, West Vicenza Hospital, Arzignano
| | | | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano
| | | | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, Rovigo
| | - Giovanni Zuliani
- Department of Translational Medicine, University of Ferrara, Ferrara
- Department of Medicine, Porto Viro General Hospital, Rovigo, Italy
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Zuin M, Valerio L, Quadretti L, Zuliani G, Manfredini R, Rigatelli G, Barco S, Roncon L. Weekend effect and short-term mortality in patients with acute pulmonary embolism: systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2022; 23:744-747. [PMID: 35905006 DOI: 10.2459/jcm.0000000000001332] [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: 11/05/2022]
Abstract
We systematically reviewed the available literature and performed a meta-analysis of data from cohort studies to estimate the association between weekend admission and early mortality in patients diagnosed with acute pulmonary embolism (PE). Statistical heterogeneity between groups was measured using the Higgins I2 statistic. Data were pooled using a random-effects models with odds ratio (OR) and related 95% CI. Publication bias was evaluated both by the Egger's test and by visual examination of the corresponding funnel plot. Among the 12 studies reviewed, based on 1.782.385 patients with PE, the pooled analysis showed that patients admitted during the weekend had a higher risk of 30-day or in-hospital death than those admitted during weekdays (unadjusted OR: 1.17; 95% CI 1.13-1.20, P < 0.0001, I2 = 36.6%). A sub-analysis based on the adjusted OR derived from those studies performing a multivariate regression analysis confirmed yielded results (adjusted OR: 1.15, 95% CI 1.07-1.75, P < 0.0001, I2 = 0%). In conclusion, patients admitted during weekend for acute pulmonary embolism are characterized by an approximately 15% excess in the risk of early death, defined as either 30-day or in-hospital death.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, Section of Internal and CardioRespiratory Medicine., University of Ferrara, Ferrara, Italy
| | - Luca Valerio
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Laura Quadretti
- Department of Medicine and Cardiology, Porto Viro General Hospital, Rovigo
| | - Giovanni Zuliani
- Department of Translational Medicine, Section of Internal and CardioRespiratory Medicine., University of Ferrara, Ferrara, Italy
| | - Roberto Manfredini
- Department of Medical Sciences, Clinical Medicine Unit, University of Ferrara, Ferrara
| | - Gianluca Rigatelli
- Division of Cardiology, Department of Specialistic Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Stefano Barco
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Loris Roncon
- Division of Cardiology, Department of Specialistic Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy
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Zuin M, Bilato C, Quadretti L, Vatrano M, Navaro M, Rigatelli G, Zuliani G, Roncon L. [Incidence of acute pulmonary embolism in hospitalized COVID-19 Italian patients. A pooled meta-analysis]. G Ital Cardiol (Rome) 2022; 23:233-243. [PMID: 35343472 DOI: 10.1714/3766.37530] [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: 06/14/2023]
Abstract
BACKGROUND Acute pulmonary embolism (PE) represents a frequent and prognostically relevant complication of COVID-19. METHODS We performed a systematic review and meta-analysis, according to the PRISMA guidelines to determine the in-hospital incidence of acute PE, based on Italian studies published on this issue. We searched PubMed and Scopus to locate all articles published between February 2020 to October 15, 2021, reporting the incidence of acute PE in Italian COVID-19 patients. The pooled in-hospital incidence of acute PE was calculated using a random-effect model and presented with relative 95% confidence interval (CI). RESULTS We analysed data from 3287 Italian COVID-19 patients (mean age 65.7 years) included in 20 studies. The pooled in-hospital incidence of acute PE was 20% (95% CI 13.4-28.7%; I2 = 95.1%); the incidence was lower among patients hospitalized in intensive care unit (ICU) (32.3%; 95% CI 20.2-44.0%; I2 = 77.2%) compared to those admitted in general wards (47.6%; 95% CI 18.7-78.2%; I2 = 94.4%). Meta-regression showed a significant direct correlation of acute PE incidence using age, male gender and previous coronary artery disease as moderating variables. Conversely, an inverse correlation was observed in relation to the use of anticoagulation at therapeutic dose. Prophylactic and therapeutic anticoagulation was administered in 80.2% of patients (95% CI 72.5-86.2%; I2 = 91.0%); the former regimen was more frequently used compared to the latter (63.5% vs 14.3%; p<0.001). Computed tomography angiography (CTPA) was used only in 10.7% of infected patients across 7 studies. CONCLUSIONS One in five COVID-19 patients experienced acute PE as complication of the infection during hospitalization. The in-hospital incidence of acute PE was lower in ICU compared to general wards. CTPA was scantly used. Early prophylactic anticoagulation was associated with a lower incidence of acute PE.
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Affiliation(s)
- Marco Zuin
- Sezione di Medicina Interna e Cardio-Respiratoria, Dipartimento di Medicina Traslazionale, Università degli Studi, Ferrara
| | - Claudio Bilato
- U.O.C. Cardiologia, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Arzignano (VI)
| | - Laura Quadretti
- Dipartimento di Medicina e Cardiologia, Casa di Cura Madonna della Salute, Porto Viro (RO)
| | - Marco Vatrano
- U.O.C. Cardiologia-UTIC-Emodinamica e Cardiologia Interventistica, Azienda Ospedaliera "Pugliese-Ciaccio", Catanzaro
| | - Monica Navaro
- U.O.C. Igiene e Sanità Pubblica, Azienda AULSS 5 Polesana, Rovigo
| | | | - Giovanni Zuliani
- Sezione di Medicina Interna e Cardio-Respiratoria, Dipartimento di Medicina Traslazionale, Università degli Studi, Ferrara
| | - Loris Roncon
- U.O.C. Cardiologia, Ospedale Santa Maria della Misericordia, Rovigo
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Frison G, Zancanaro F, Frasson S, Quadretti L, Agnati M, Vlassich F, Gagliardi G, Salerno TMG, Donato P, Mondello L. Analytical Characterization of 3-MeO-PCP and 3-MMC in Seized Products and Biosamples: The Role of LC-HRAM-Orbitrap-MS and Solid Deposition GC-FTIR. Front Chem 2021; 8:618339. [PMID: 33628763 PMCID: PMC7897676 DOI: 10.3389/fchem.2020.618339] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/22/2020] [Indexed: 11/13/2022] Open
Abstract
Among the phencyclidine (PCP) and synthetic cathinone analogs present on the street market, 3-methoxyphencyclidine (3-MeO-PCP) is one of the most popular dissociative hallucinogen drugs, while 3-methylmethcathinone (3-MMC) is a commonly encountered psychostimulant. Numerous 3-MeO-PCP- and 3-MMC-related intoxication cases have been reported worldwide. Identification of the positional isomers of MeO-PCP and MMC families are particularly challenging for clinical and forensic laboratories; this is mostly due to their difficult chromatographic separation (particularly when using liquid chromatography–LC) and similar mass spectrometric behaviors. 3-MeO-PCP and 3-MMC were identified in two powders, detained by two subjects and seized by the police, by different analytical techniques, including liquid chromatography-high-resolution accurate-mass Orbitrap mass spectrometry (LC-HRAM-Orbitrap-MS), and solid deposition gas chromatography-Fourier transform infrared spectroscopy (sd-GC-FTIR). LC-HRAM-Orbitrap-MS allowed us to assign the elemental formulae C18H27NO (MeO-PCP) and C11H15NO (MMC) through accurate mass measurement of the two MH+ ions, and the comparison of experimental and calculated MH+ isotopic patterns. However, MH+ collision-induced product ions spectra were not conclusive in discriminating between the positional isomers [(3-MeO-PCP vs. 4-MeO-PCP) and (3-MMC vs. 4-MMC and 2-MMC)]. Likewise, sd-GC-FTIR easily allowed us to differentiate between the MeO-PCP and MMC positional isomers unambiguously, confirming the presence of 3-MeO-PCP and 3-MMC, due to the high-quality match factor of the experimental FTIR spectra against the target FTIR spectra of MeO-PCP and MMC isomers in a dedicated library. 3-MeO-PCP (in contrast to 3-MMC) was also detected in blood and urine samples of both subjects and analyzed in the context of routine forensic casework by LC-HRAM-Orbitrap-MS following a simple deproteinization step. In addition, this untargeted approach allowed us to detect dozens of phase I and phase II 3-MeO-PCP metabolites in all biological specimens. Analysis of the extracted samples by sd-GC-FTIR revealed the presence of 3-MeO-PCP, thus confirming the intake of such specific methoxy-PCP isomer in both cases. These results highlight the effectiveness of LC-HRAM-Orbitrap-MS and sd-GC-FTIR data in attaining full structural characterization of the psychoactive drugs, even in absence of reference standards, in both non-biological and biological specimens.
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Affiliation(s)
- Giampietro Frison
- Laboratory of Environmental Hygiene and Forensic Toxicology, DMPO Department, AULSS 3, Venice, Italy
| | - Flavio Zancanaro
- Laboratory of Environmental Hygiene and Forensic Toxicology, DMPO Department, AULSS 3, Venice, Italy
| | - Samuela Frasson
- Laboratory of Environmental Hygiene and Forensic Toxicology, DMPO Department, AULSS 3, Venice, Italy
| | - Laura Quadretti
- Emergency Department Unit, Madonna della Salute Hospital, AULSS 5, Porto Viro (Rovigo), Italy
| | - Michele Agnati
- Emergency Department Unit, Madonna della Salute Hospital, AULSS 5, Porto Viro (Rovigo), Italy
| | - Francesca Vlassich
- Intensive Care Unit, Madonna della Salute Hospital, AULSS 5, Porto Viro (Rovigo), Italy
| | - Giuseppe Gagliardi
- Department of Anesthesiology and Intensive Care, AULSS 5, Porto Viro (Rovigo), Italy
| | - Tania Maria Grazia Salerno
- BeSep S.r.l., c/o Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Paola Donato
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy
| | - Luigi Mondello
- BeSep S.r.l., c/o Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy.,Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy.,Chromaleont S.r.l., c/o Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy.,Research Unit of Food Science and Nutrition, Department of Science and Technology for Humans and the Environment, Campus Bio-Medico University of Rome, Rome, Italy
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Fiorencis A, Quadretti L, Bacich D, Chiodi E, Mele D, Fiorencis R. [Acute cerebral ischemia: an unusual clinical presentation of isolated left ventricular noncompaction in an adult patient]. G Ital Cardiol (Rome) 2013; 14:79-82. [PMID: 23258208 DOI: 10.1714/1207.13376] [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: 06/01/2023]
Abstract
Isolated left ventricular noncompaction in adults is uncommon. The most frequent clinical manifestations are heart failure due to left ventricular systolic dysfunction and supraventricular and ventricular arrhythmias, which may be sustained and associated with sudden death. Thromboembolic complications are also possible. We report the case of an adult patient with isolated left ventricular noncompaction who came to our observation because of acute cerebral ischemia, an initial presentation of the disease only rarely described.
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Affiliation(s)
- Andrea Fiorencis
- UO di Cardiologia, Azienda Ospedaliero-Universitaria, Ferrera, Italy
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