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Di Sacco F, Antognetti D, Ciapini G, Nicastro M, Scaglione M, Bottai V. Teriparatide and clodronate combination as a potential treatment for complex regional pain syndrome type I in delayed consolidation after foot surgery: a case report and review of the literature. J Med Case Rep 2024; 18:142. [PMID: 38454520 PMCID: PMC10921770 DOI: 10.1186/s13256-024-04391-9] [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: 11/29/2023] [Accepted: 01/14/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Complex regional pain syndrome type I is a pathological condition characterized by an exaggerated response of tissues to low or moderate pain stimuli. The exact pathogenesis and optimal medical treatment for complex regional pain syndrome type I are still not fully understood, although bisphosphonates have shown positive effects in reducing pain. Foot surgery can be complicated by the development of complex regional pain syndrome type I, leading to functional decline and difficulties in weight-bearing. CASE PRESENTATION The authors present a clinical case involving complex regional pain syndrome type I that developed after surgical foot arthrodesis. The patient, a 42-year-old Caucasian male, did not respond to clodronate treatment but experienced successful outcomes upon the addition of teriparatide, which effectively stimulated the healing of arthrodesis. CONCLUSION Teriparatide cannot be considered the primary treatment for complex regional pain syndrome due to insufficient solid clinical data. However, when complex regional pain syndrome is associated with or caused by delayed union, teriparatide can be used to address the underlying cause of complex regional pain syndrome.
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Affiliation(s)
- F Di Sacco
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy.
| | - D Antognetti
- Section of Neurorehabilitation, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - G Ciapini
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - M Nicastro
- Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - M Scaglione
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - V Bottai
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy
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Elia E, Bruno F, Crimi G, Wańha W, Leonardi S, Mauro M, Raposeiras Roubin S, Fabris E, Giannino G, Mancone M, Severino P, Truffa A, De Filippo O, Huczek Z, Mazurek M, Gaibazzi N, Ielasi A, Cortese B, Borin A, Núñez-Gil IJ, Marengo G, Melis D, Ugo F, Bianco M, Barbieri L, Marchini F, Desperak P, Morici N, Scaglione M, Gąsior M, Gallone G, Lopiano C, Stefanini G, Campo G, Wojakowski W, Abu-Assi E, Sinagra G, de Ferrari GM, Porto I, D'Ascenzo F. Gender differences in the development of heart failure after acute coronary syndrome: Insight from the CORALYS registry. Int J Cardiol 2024; 397:131622. [PMID: 38061607 DOI: 10.1016/j.ijcard.2023.131622] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Impact of gender on heart remodeling after acute coronary syndrome (ACS) and consequently on development of heart failure (HF) remains to be elucidated. METHODS CORALYS is a multicenter, retrospective, observational registry enrolling consecutive patients admitted for ACS and treated with percutaneous coronary intervention. HF hospitalization was the primary endpoint while all-cause mortality and the composite endpoint of incidence of first HF hospitalization and cardiovascular mortality were the secondary ones. RESULTS Among 14,699 patients enrolled in CORALYS registry, 4578 (31%) were women and 10,121 (69%) males. Women were older, had more frequently hypertension and diabetes and less frequently smoking habit. History of myocardial infarction (MI), STEMI at admission and multivessel disease were less common in women. After median follow up of 2.9 ± 1.8 years, women had higher incidence of primary and secondary endpoints and female sex was an independent predictor of HF hospitalization (HR 1.26;1.05-1.50; p = 0.011) and cardiovascular death/HF hospitalization (HR 1.18;1.02-1.37; p = 0.022). At multivariable analysis women and men share as predictors of HF diabetes, history of cancer, chronic kidney disease, atrial fibrillation, complete revascularization and left ventricular ejection fraction. Chronic obstructive pulmonary disease (HR 2.34;1.70-3.22, p < 0.001) and diuretics treatment (HR 1.61;1.27-2.04, p < 0.001) were predictor of HF in men, while history of previous MI (HR 1.46;1.08-1.97, p = 0.015) and treatment with inhibitors of renin-angiotensin system (HR 0.69;0,49-0.96 all 95% CI, p = 0.030) in women. CONCLUSIONS Women are at increased risk of HF after ACS and gender seems to be an outcome-modifier of the relationship between a variable and primary outcome.
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Affiliation(s)
- Edoardo Elia
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy; DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Francesco Bruno
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy.
| | - Gabriele Crimi
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Wojciech Wańha
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Sergio Leonardi
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Italy
| | - Mattia Mauro
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | | | - Enrico Fabris
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Giuseppe Giannino
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | - Massimo Mancone
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Rome, Italy
| | - Paolo Severino
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Rome, Italy
| | | | - Ovidio De Filippo
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Maciej Mazurek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Alfonso Ielasi
- U.O. di Cardiologia Clinica ed Interventistica, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Bernardo Cortese
- Cardiovascular Research Team, San Carlo Clinic, Milano, Italy; Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
| | - Andrea Borin
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | - Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
| | - Giorgio Marengo
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | - Daniele Melis
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | - Fabrizio Ugo
- Department of Cardiology, Sant'Andrea Hospital, Vercelli, Italy
| | - Matteo Bianco
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Lucia Barbieri
- Division of Cardiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Federico Marchini
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di Ferrara, Cona (FE), Italy
| | - Piotr Desperak
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Nuccia Morici
- IRCCS S. Maria Nascente-Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Marco Scaglione
- Division of Cardiology, Ospedale Cardinal G. Massaia, Asti, Italy
| | - Mariusz Gąsior
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Guglielmo Gallone
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | - Clara Lopiano
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | | | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di Ferrara, Cona (FE), Italy
| | - Wojciech Wojakowski
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Emad Abu-Assi
- Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Gaetano Maria de Ferrari
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | - Italo Porto
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
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Scagliola R, Caponi D, Scaglione M. Atrial septal pouches and ridges: Morphological features and potential implications in clinical practice. Trends Cardiovasc Med 2023:S1050-1738(23)00115-9. [PMID: 38158028 DOI: 10.1016/j.tcm.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
Incomplete or irregular fusion of the interatrial septum may result in several anatomic variants, including atrial septal pouches and ridges, whose knowledge and recognition are still poorly widespread in clinical practice. An educational review focused on the definition, clinical significance and diagnostic work-up of these anatomic findings was performed using PubMed, MEDLINE, Embase and Cochrane Central databases up to June 2023. Atrial septal pouches and ridges have been associated with an increased difficulty of catheter-based interventions requiring a transseptal approach, due to procedural challenges for transseptal puncture and the restricted motion of guidewires and catheters through the transseptal access. Additionally, left atrial septal pouch may serve as a thrombogenic nidus and a source of systemic embolism, mostly in the presence of factors leading to higher left atrial pressure and/or atrial blood stasis, which increase the risk of thrombus formation and embolic events, rather than for the only presence of left atrial septal pouch itself. Further investigations are needed in order to better elucidate the implications of such anatomic findings in daily clinical practice, and to provide the most appropriate decision-making strategies.
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Affiliation(s)
- Riccardo Scagliola
- Division of Cardiology, Cardinal G. Massaia Hospital, C.so Dante Alighieri n. 202 - 14100, Asti, Italy.
| | - Domenico Caponi
- Division of Cardiology, Cardinal G. Massaia Hospital, C.so Dante Alighieri n. 202 - 14100, Asti, Italy
| | - Marco Scaglione
- Division of Cardiology, Cardinal G. Massaia Hospital, C.so Dante Alighieri n. 202 - 14100, Asti, Italy
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Ronchetti AB, Usai M, Savino V, Scaglione M, Tacchino CM, Bertamino M, Moretti P, Di Rocco M. Multicentric Carpo-Tarsal Osteolysis Syndrome (MCTO) and "Function Profile": a rehabilitative approach. Orphanet J Rare Dis 2023; 18:392. [PMID: 38124110 PMCID: PMC10734104 DOI: 10.1186/s13023-023-02976-z] [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: 01/02/2023] [Accepted: 11/18/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Multicentric Carpo-Tarsal Osteolysis Syndrome (MCTO) is an autosomal dominant disease with increased bone reabsorption in the carpus and tarsus and the elbows, knees and spine. The disease is extremely heterogeneous and secondary and tertiary injuries vary widely and can lead to progressive disability and severe functional limitations. In addition to the available and upcoming drug therapies, physical medicine and rehabilitation are important treatment options. Currently, the indication and plan are overlooked, nonspecific and reported only for one patient. METHODS We describe a case series of MCTO patients diagnosed and followed by a centre to identify functional deficit as a potential clinical marker of disease progression for future etiological therapies. In addition, we define a symptomatic treatment approach and specific clinical management, including a patient-centred rehabilitation approach. Functional assessments are performed independently by a multidisciplinary group to establish the functional abilities of patients and the relationship between residual motor skills and their degree of autonomy and participation. We suggest a way to identify a rehabilitation plan based on a specific disease using the International Classification of Functioning, Disability and Health Children and Youth (ICF-CY). RESULTS To define a reliable and reproducible "Function Profile", through age and over time, we used to value the disease status according to the ICF-CY domains. It could be used to determine the complexity of the illness, its overall impact on the complexity of the person and the burden on the caregiver, and an eventual short- and long-term rehabilitation plan for MCTO and other ultra-rare diseases. CONCLUSION Based on the MCTO experience, we suggest a way to determine a rehabilitation plan based on a specific disease and patient needs, keeping in mind that often the final point is not recovering the full function but improving or maintaining the starting point. In all cases, each patient at the time of diagnosis requires a functional assessment that must be repeated over time to adjust the course of rehabilitation. The evaluations revealed the importance of early rehabilitation management in enhancing independence, participation and control of stress deconditioning, shrinking of muscle tendons and loss of movement to immobility.
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Affiliation(s)
- Anna Bruna Ronchetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Marina Usai
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Valentina Savino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences, University of Genoa, Genoa, Italy
| | - Marco Scaglione
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences, University of Genoa, Genoa, Italy
| | - Chiara Maria Tacchino
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Bertamino
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paolo Moretti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maja Di Rocco
- Rare Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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D'Ascenzo F, Fabris E, Gregorio C, Mittone G, De Filippo O, Wańha W, Leonardi S, Roubin SR, Chinaglia A, Truffa A, Huczek Z, Gaibazzi N, Ielasi A, Cortese B, Borin A, Pagliaro B, Núñez-Gil IJ, Ugo F, Marengo G, Barbieri L, Marchini F, Desperak P, Melendo-Viu M, Montalto C, Bianco M, Bruno F, Mancone M, Ferrandez-Escarabajal M, Morici N, Scaglione M, Tuttolomondo D, Gąsior M, Mazurek M, Gallone G, Campo G, Wojakowski W, Assi EA, Stefanini G, Sinagra G, Ferrari GM. Corrigendum to 'Forecasting the Risk of Heart Failure Hospitalization After Acute Coronary Syndromes: the CORALYS HF Score' [American Journal of Cardiology 206 (2023) 320-329]. Am J Cardiol 2023:S0002-9149(23)01390-5. [PMID: 38114059 DOI: 10.1016/j.amjcard.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy.
| | - Enrico Fabris
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Caterina Gregorio
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Gianluca Mittone
- Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Wojciech Wańha
- Department ofCardiologyandStructuralHeart Diseases, Medical University of Silesia, Katowice, Poland
| | - Sergio Leonardi
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Alessandra Chinaglia
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | | | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Alfonso Ielasi
- U.O. di Cardiologia Clinica ed Interventistica, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Bernardo Cortese
- Cardiovascular Research Team, San Carlo Clinic, Milano, Italy; Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
| | - Andrea Borin
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | | | - Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
| | - Fabrizio Ugo
- Division of Cardiology, Ospedale Sant'Andreadi Vercelli, Vercelli, Italy
| | - Giorgio Marengo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Departement of Informatica, University of Turin, Turin, Italy
| | - Lucia Barbieri
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Division of Cardiology, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Federico Marchini
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Piotr Desperak
- Department ofCardiologyandStructuralHeart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Claudio Montalto
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Bianco
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Massimo Mancone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Nuccia Morici
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Scaglione
- Division of Cardiology, Ospedale Cardinal G. Massaia, Asti, Italy
| | | | - Mariusz Gąsior
- Departement of Informatica, University of Turin, Turin, Italy
| | - Maciej Mazurek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | | | - Emad Abu Assi
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Gaetano Mariade Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
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6
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Gaita F, Cerrato N, Giustetto C, Martino A, Bergamasco L, Millesimo M, Barbonaglia L, Carvalho P, Caponi D, Saglietto A, Bonacchi G, Bianchi F, Silvetti E, Crescenzi C, Canestrelli S, De Maio M, De Ferrari GM, Musumeci G, Rametta F, Scaglione M, Calò L. Asymptomatic Patients With Brugada ECG Pattern: Long-Term Prognosis From a Large Prospective Study. Circulation 2023; 148:1543-1555. [PMID: 37830188 PMCID: PMC10637308 DOI: 10.1161/circulationaha.123.064689] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/29/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Brugada syndrome poses significant challenges in terms of risk stratification and management, particularly for asymptomatic patients who comprise the majority of individuals exhibiting Brugada ECG pattern (BrECG). The aim of this study was to evaluate the long-term prognosis of a large cohort of asymptomatic patients with BrECG. METHODS Asymptomatic patients with BrECG (1149) were consecutively collected from 2 Italian centers and followed-up at least annually for 2 to 22 years. For the 539 asymptomatic patients (men, 433 [80%]; mean age, 46±13 years) with spontaneous type 1 documented on baseline ECG (87%) or 12-lead 24-hour Holter monitoring (13%), an electrophysiologic study (EPS) was proposed; for the 610 patients with drug-induced-only type 1 (men, 420 [69%]; mean age, 44±14 years), multiple ECGs and 12-lead Holter were advised in order to detect the occurrence of a spontaneous type-1 BrECG. Arrhythmic events were defined as sudden death or documented ventricular fibrillation or tachycardia. RESULTS Median follow-up was 6 (4-9) years. Seventeen (1.5%) arrhythmic events occurred in the overall asymptomatic population (corresponding to an event-rate of 0.2% per year), including 16 of 539 (0.4% per year) in patients with spontaneous type-1 BrECG and 1 of 610 in those with drug-induced type-1 BrECG (0.03% per year; P<0.001). EPS was performed in 339 (63%) patients with spontaneous type-1 BrECG. Patients with spontaneous type-1 BrECG and positive EPS had significantly higher event rates than patients with negative EPS (7 of 103 [0.7% per year] versus 4 of 236 [0.2% per year]; P=0.025). Among 200 patients who declined EPS, 5 events (0.4% per year) occurred. There was 1 device-related death. CONCLUSIONS The entire population of asymptomatic patients with BrECG exhibits a relatively low event rate per year, which is important in view of the long life expectancy of these young patients. The presence of spontaneous type-1 BrECG associated with positive EPS identifies a subgroup at higher risk. Asymptomatic patients with drug-induced-only BrECG have a minimal arrhythmic risk, but ongoing follow-up with 12-lead Holter monitoring is recommended to detect the appearance of spontaneous type-1 BrECG pattern.
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Affiliation(s)
- Fiorenzo Gaita
- Maria Pia Hospital, GVM Care and Research, Turin, Italy (F.G.)
- Departments of Medical Sciences (F.G., C.G., M.M., A.S., G.B., G.M.D.F.), University of Turin, Italy
| | - Natascia Cerrato
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy (N.C., D.C., M.S.)
| | - Carla Giustetto
- Departments of Medical Sciences (F.G., C.G., M.M., A.S., G.B., G.M.D.F.), University of Turin, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, Turin, Italy (C.G., M.M., A.S., G.B., G.M.D.F.)
| | - Annamaria Martino
- Division of Cardiology, Policlinico Casilino, Rome, Italy (A.M., E.S., C.C., S.C., M.D.M., L.C.)
| | | | - Michele Millesimo
- Departments of Medical Sciences (F.G., C.G., M.M., A.S., G.B., G.M.D.F.), University of Turin, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, Turin, Italy (C.G., M.M., A.S., G.B., G.M.D.F.)
| | - Lorella Barbonaglia
- Division of Cardiology, Sant’Andrea Hospital, Vercelli, Italy (L.Barbonaglia., F.R.)
| | - Paula Carvalho
- Division of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Italy (P.C.)
| | - Domenico Caponi
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy (N.C., D.C., M.S.)
| | - Andrea Saglietto
- Departments of Medical Sciences (F.G., C.G., M.M., A.S., G.B., G.M.D.F.), University of Turin, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, Turin, Italy (C.G., M.M., A.S., G.B., G.M.D.F.)
| | - Giacomo Bonacchi
- Departments of Medical Sciences (F.G., C.G., M.M., A.S., G.B., G.M.D.F.), University of Turin, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, Turin, Italy (C.G., M.M., A.S., G.B., G.M.D.F.)
| | - Francesca Bianchi
- Division of Cardiology, A.O. Ordine Mauriziano, Turin, Italy (F.B., G.M.)
| | - Elisa Silvetti
- Division of Cardiology, Policlinico Casilino, Rome, Italy (A.M., E.S., C.C., S.C., M.D.M., L.C.)
| | - Cinzia Crescenzi
- Division of Cardiology, Policlinico Casilino, Rome, Italy (A.M., E.S., C.C., S.C., M.D.M., L.C.)
| | - Stefano Canestrelli
- Division of Cardiology, Policlinico Casilino, Rome, Italy (A.M., E.S., C.C., S.C., M.D.M., L.C.)
| | - Melissa De Maio
- Division of Cardiology, Policlinico Casilino, Rome, Italy (A.M., E.S., C.C., S.C., M.D.M., L.C.)
| | - Gaetano Maria De Ferrari
- Departments of Medical Sciences (F.G., C.G., M.M., A.S., G.B., G.M.D.F.), University of Turin, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, Turin, Italy (C.G., M.M., A.S., G.B., G.M.D.F.)
| | - Giuseppe Musumeci
- Division of Cardiology, A.O. Ordine Mauriziano, Turin, Italy (F.B., G.M.)
| | - Francesco Rametta
- Division of Cardiology, Sant’Andrea Hospital, Vercelli, Italy (L.Barbonaglia., F.R.)
| | - Marco Scaglione
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy (N.C., D.C., M.S.)
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Rome, Italy (A.M., E.S., C.C., S.C., M.D.M., L.C.)
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D'Ascenzo F, Fabris E, DeGregorio C, Mittone G, De Filippo O, Wańha W, Leonardi S, Roubin SR, Chinaglia A, Truffa A, Huczek Z, Gaibazzi N, Ielasi A, Cortese B, Borin A, Pagliaro B, Núñez-Gil IJ, Ugo F, Marengo G, Barbieri L, Marchini F, Desperak P, Melendo-Viu M, Montalto C, Bianco M, Bruno F, Mancone M, Ferrandez-Escarabajal M, Morici N, Scaglione M, Tuttolomondo D, Gąsior M, Mazurek M, Gallone G, Campo G, Wojakowski W, Abu Assi E, Stefanini G, Sinagra G, de Ferrari GM. Forecasting the Risk of Heart Failure Hospitalization After Acute Coronary Syndromes: the CORALYS HF Score. Am J Cardiol 2023; 206:320-329. [PMID: 37734293 DOI: 10.1016/j.amjcard.2023.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 09/23/2023]
Abstract
The present study aimed to identify patients at a higher risk of hospitalization for heart failure (HF) in a population of patients with acute coronary syndrome (ACS) treated with percutaneous coronary revascularization without a history of HF or reduced left ventricular (LV) ejection fraction before the index admission. We performed a Cox regression multivariable analysis with competitive risk and machine learning models on the incideNce and predictOrs of heaRt fAiLure After Acute coronarY Syndrome (CORALYS) registry (NCT04895176), an international and multicenter study including consecutive patients admitted for ACS in 16 European Centers from 2015 to 2020. Of 14,699 patients, 593 (4.0%) were admitted for the development of HF up to 1 year after the index ACS presentation. A total of 2 different data sets were randomly created, 1 for the derivative cohort including 11,626 patients (80%) and 1 for the validation cohort including 3,073 patients (20%). On the Cox regression multivariable analysis, several variables were associated with the risk of HF hospitalization, with reduced renal function, complete revascularization, and LV ejection fraction as the most relevant ones. The area under the curve at 1 year was 0.75 (0.72 to 0.78) in the derivative cohort, whereas on validation, it was 0.72 (0.67 to 0.77). The machine learning analysis showed a slightly inferior performance. In conclusion, in a large cohort of patients with ACS without a history of HF or LV dysfunction before the index event, the CORALYS HF score identified patients at a higher risk of hospitalization for HF using variables easily accessible at discharge. Further approaches to tackle HF development in this high-risk subset of patients are needed.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy.
| | - Enrico Fabris
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Caterina DeGregorio
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Gianluca Mittone
- Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Sergio Leonardi
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Alessandra Chinaglia
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | | | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Alfonso Ielasi
- U.O. di Cardiologia Clinica ed Interventistica, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Bernardo Cortese
- Cardiovascular Research Team, San Carlo Clinic, Milano, Italy; Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
| | - Andrea Borin
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | | | - Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
| | - Fabrizio Ugo
- Division of Cardiology, Ospedale Sant'Andrea di Vercelli, Vercelli, Italy
| | - Giorgio Marengo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Departement of Informatica, University of Turin, Turin, Italy
| | - Lucia Barbieri
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Division of Cardiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Federico Marchini
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Piotr Desperak
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Claudio Montalto
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Bianco
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Massimo Mancone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Nuccia Morici
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Scaglione
- Division of Cardiology, Ospedale Cardinal G. Massaia, Asti, Italy
| | | | - Mariusz Gąsior
- Departement of Informatica, University of Turin, Turin, Italy
| | - Maciej Mazurek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | | | - Emad Abu Assi
- Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Gaetano Maria de Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
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8
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Maglia G, Pentimalli F, Verlato R, Solimene F, Malacrida M, Aspromonte V, Bacino L, Turrini P, Infusino T, La Greca C, Perego GB, Papa AA, De Ruvo E, Zingarini G, Devecchi C, Scaglione M, Tomasi C, Pirrotta S, Stabile G. Ablation of CTI-dependent flutter using different ablation technologies: acute and long-term outcome from the LEONARDO study. J Interv Card Electrophysiol 2023; 66:1749-1757. [PMID: 36869990 DOI: 10.1007/s10840-023-01519-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/26/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND A novel ablation catheter has been released to map and ablate the cavo-tricuspid isthmus (CTI) in patients with atrial flutter (AFL), improving ablation efficiency. METHODS We evaluated the acute and long-term outcome of CTI ablation aiming at bidirectional conduction block (BDB) in a prospective, multicenter cohort study enrolling 500 patients indicated for typical AFL ablation. Patients were grouped on the basis of the AFL ablation method (linear anatomical approach, Conv group n = 425, or maximum voltage guided, MVG group, n = 75) and ablation catheter (mini-electrodes technology, MiFi group, n = 254, or a standard 8-mm ablation catheter, BLZ group, n = 246). RESULTS Complete BDB according to both validation criteria (sequential detailed activation mapping or mapping only the ablation site) was achieved in 443 patients (88.6%). The number of RF applications needed to achieve BDB was lower in the MiFi MVG group vs both the MiFi Conv group and the BLZ Conv group (3.2 ± 2 vs 5.2 ± 4 vs 9.3 ± 5, p < 0.0001 for all comparisons). Fluoroscopy time was similar among groups, whereas we observed a reduction in the procedure duration from the BLZ Conv group (61.9 ± 26min) to the MiFi MVG group (50.6 ± 17min, p = 0.048). During a mean follow-up of 548 ± 304 days, 32 (6.2%) patients suffered an AFL recurrence. No differences were found according to BDB achieved by both validation criteria. CONCLUSIONS Ablation was highly effective in achieving acute CTI BDB and long-term arrhythmia freedom irrespective of the ablation strategy or the validation criteria for CTI chosen by the operator. The use of an ablation catheter equipped with mini-electrodes technology seems to improve ablation efficiency. CLINICAL TRIAL REGISTRATION Atrial Flutter Ablation in a Real World Population. (LEONARDO). CLINICALTRIALS gov Identifier: NCT02591875.
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Affiliation(s)
- Giampiero Maglia
- Cardiology - Coronary Care Unit, Electrophysiology and Cardiac Pacing, Pugliese - Ciaccio Hospital, Via Pio X, 88100, Catanzaro, Italy.
| | - Francesco Pentimalli
- S.S. di Elettrofisiologia Cardiaca, S.C. di Cardiologia, Ospedale S. Paolo, Savona, Italy
| | - Roberto Verlato
- ULSS 6 Euganea, Ospedale di Camposampiero-Cittadella, Cittadella, Padova, Italy
- Cardiology Unit, Civil Hospital, Camposampiero, Padova, Italy
| | | | | | - Vittorio Aspromonte
- Cardiology - Coronary Care Unit, Electrophysiology and Cardiac Pacing, Pugliese - Ciaccio Hospital, Via Pio X, 88100, Catanzaro, Italy
| | - Luca Bacino
- S.S. di Elettrofisiologia Cardiaca, S.C. di Cardiologia, Ospedale S. Paolo, Savona, Italy
| | - Pietro Turrini
- Cardiology Unit, Civil Hospital, Camposampiero, Padova, Italy
| | | | | | | | - Andrea Antonio Papa
- Cardiology Unit, Department of Cardiology, Monaldi - Hospital, Naples, Italy
| | | | | | - Chiara Devecchi
- Division of Cardiology, Sant'Andrea Hospital, Vercelli, Italy
| | | | - Corrado Tomasi
- U.O.C. Cardiologia di Ravenna, Faenza e Lugo, Ospedale "S. Maria delle Croci", Ravenna, Italy
| | - Salvatore Pirrotta
- Cardiology - Coronary Care Unit, Electrophysiology and Cardiac Pacing, Pugliese - Ciaccio Hospital, Via Pio X, 88100, Catanzaro, Italy
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9
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Scaglione M, Cerrato N, Spinoni EG, Battaglia A, Geuna F, Caponi D. Electroanatomic visualization of reentrant circuit of left fascicular ventricular tachycardia guiding a fluoroless ablation. HeartRhythm Case Rep 2023; 9:745-748. [PMID: 38047191 PMCID: PMC10691950 DOI: 10.1016/j.hrcr.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Marco Scaglione
- Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy
| | | | | | | | - Francesco Geuna
- Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy
| | - Domenico Caponi
- Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy
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10
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Gullo G, Scaglione M, Laganà AS, Perino A, Andrisani A, Chiantera V, Cucinella G, Gitas G, Barra F, Riemma G. Assisted Reproductive Techniques and Risk of Congenital Heart Diseases in Children: a Systematic Review and Meta-analysis. Reprod Sci 2023; 30:2896-2906. [PMID: 37145300 PMCID: PMC10556115 DOI: 10.1007/s43032-023-01252-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
Infertility is a growing phenomenon and leads to an increased use of assisted reproductive techniques (ARTs). In recent years, concerns about the safety of these procedures emerged and ARTs were hypothesized to be a risk factor for developing congenital heart diseases (CHDs) in offspring. Our aim is to investigate the association between ART and CHD, specifying results according to various subtypes of defects. We performed a systematic review and random-effects meta-analysis following the PRISMA guidelines. MEDLINE and Google Scholar were searched from January 2011 to May 2022. Data about incidence of CHD in ART were tabulated and extracted from all the studies included. Twenty-four studies were included. Pooled incidence of CHDs after IVF pregnancies was 3% (95% CI 0.3-0.4; I2 = 99%), decreasing to 1% (95% CI 0.00-0.01; I2 = 93%) for major CHDs only. An increased risk of CHDs, especially minor (i.e., not requiring surgical correction), seems to occur in ART compared with non-ART pregnancies [RR 1.71 (95% CI 1.25-2.34; I2 = 99%)]. For major CHDs, not enough evidence is available to assess the real risk. Moreover, some confounding factors (i.e., maternal age and male infertility) seem to play a critical role to determine an increased risk of CHDs. Conflicting results emerged among the studies, setting the need for further research to validate the actual evidence and state the real risk of CHD following ART pregnancies.
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Affiliation(s)
- Giuseppe Gullo
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF Unit, University of Palermo, Palermo, Italy
| | - Marco Scaglione
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences, University of Genoa, Genoa, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli," Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Antonio Perino
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF Unit, University of Palermo, Palermo, Italy
| | - Alessandra Andrisani
- Department of Women's and Children's Health, Gynaecologic and Obstetrics Clinic, University of Padua, Padua, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli," Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Gaspare Cucinella
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF Unit, University of Palermo, Palermo, Italy
| | - Georgios Gitas
- Department of Gynecology, University Hospital Charite, Campus Mitte, Berlin, Germany
| | - Fabio Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (DINOGMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138, Naples, Italy.
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11
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Bruno F, Marengo G, De Filippo O, Wanha W, Leonardi S, Raposeiras Roubin S, Fabris E, Popovic M, Giannino G, Truffa A, Huczek Z, Gaibazzi N, Ielasi A, Cortese B, Borin A, Núñez‐Gil IJ, Melis D, Ugo F, Bianco M, Barbieri L, Marchini F, Desperak P, Montalto C, Melendo‐Viu M, Elia E, Mancone M, Buono A, Ferrandez‐Escarabajal M, Morici N, Scaglione M, Tuttolomondo D, Sardella G, Gasior M, Mazurek M, Gallone G, Pagliaro B, Lopiano C, Campo G, Wojakowski W, Abu‐Assi E, Sinagra G, De Ferrari GM, D'Ascenzo F. Impact of Complete Revascularization on Development of Heart Failure in Patients With Acute Coronary Syndrome and Multivessel Disease: A Subanalysis of the CORALYS Registry. J Am Heart Assoc 2023; 12:e028475. [PMID: 37489724 PMCID: PMC10492970 DOI: 10.1161/jaha.122.028475] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/02/2023] [Indexed: 07/26/2023]
Abstract
Background The impact of complete revascularization (CR) on the development of heart failure (HF) in patients with acute coronary syndrome and multivessel coronary artery disease undergoing percutaneous coronary intervention remains to be elucidated. Methods and Results Consecutive patients with acute coronary syndrome with multivessel coronary artery disease from the CORALYS (Incidence and Predictors of Heart Failure After Acute Coronary Syndrome) registry were included. Incidence of first hospitalization for HF or cardiovascular death was the primary end point. Patients were stratified according to completeness of coronary revascularization. Of 14 699 patients in the CORALYS registry, 5054 presented with multivessel disease. One thousand four hundred seventy-three (29.2%) underwent CR, while 3581 (70.8%) did not. Over 5 years follow-up, CR was associated with a reduced incidence of the primary end point (adjusted hazard ratio [HR], 0.66 [95% CI, 0.51-0.85]), first HF hospitalization (adjusted HR, 0.67 [95% CI, 0.49-0.90]) along with all-cause death and cardiovascular death alone (adjusted HR, 0.74 [95% CI, 0.56-0.97] and HR, 0.56 [95% CI, 0.38-0.84], respectively). The results were consistent in the propensity-score matching population and in inverse probability treatment weighting analysis. The benefit of CR was consistent across acute coronary syndrome presentations (HR, 0.59 [95% CI, 0.39-0.89] for ST-segment elevation myocardial infarction and HR, 0.71 [95% CI, 0.50-0.99] for non-ST-elevation acute coronary syndrome) and in patients with left ventricular ejection fraction >40% (HR, 0.52 [95% CI, 0.37-0.72]), while no benefit was observed in patients with left ventricular ejection fraction ≤40% (HR, 0.77 [95% CI, 0.37-1.10], P for interaction 0.04). Conclusions CR after acute coronary syndrome reduced the risk of first hospitalization for HF and cardiovascular death, as well as first HF hospitalization, and cardiovascular and overall death both in patients with ST-segment elevation myocardial infarction and non-ST-elevation acute coronary syndrome. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04895176.
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Affiliation(s)
- Francesco Bruno
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Giorgio Marengo
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Ovidio De Filippo
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Wojciech Wanha
- Department of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | - Sergio Leonardi
- Fondazione IRCCS Policlinico San MatteoCoronary Care UnitPaviaItaly
| | | | - Enrico Fabris
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano IsontinaUniversity of TriesteItaly
| | - Maja Popovic
- Department of Medical SciencesUniversity of TurinItaly
| | - Giuseppe Giannino
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | | | - Zenon Huczek
- 1st Department of CardiologyMedical University of WarsawWarszawaPoland
| | | | - Alfonso Ielasi
- U.O. di Cardiologia Clinica ed InterventisticaIstituto Clinico Sant’AmbrogioMilanItaly
| | - Bernardo Cortese
- Cardiovascular Research TeamSan Carlo ClinicMilanItaly
- Fondazione Ricerca e Innovazione CardiovascolareMilanItaly
| | - Andrea Borin
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | | | - Daniele Melis
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Fabrizio Ugo
- Department of CardiologySant’Andrea HospitalVercelliItaly
| | - Matteo Bianco
- Division of CardiologySan Luigi Gonzaga University Hospital, OrbassanoTurinItaly
| | - Lucia Barbieri
- Division of CardiologyFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
- University of MilanMilanItaly
| | - Federico Marchini
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di FerraraConaItaly
| | - Piotr Desperak
- Department of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | - Claudio Montalto
- Fondazione IRCCS Policlinico San MatteoCoronary Care UnitPaviaItaly
| | | | - Edoardo Elia
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Massimo Mancone
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e CardiovascolariSapienza Università di RomaRomaItaly
| | - Andrea Buono
- Interventional Cardiology Unit, Cardiovascular DepartmentFondazione Poliambulanza Istituto OspedalieroBresciaItaly
| | | | - Nuccia Morici
- IRCCS S. Maria Nascente‐Fondazione Don Carlo Gnocchi ONLUSMilanItaly
| | | | | | - Gennaro Sardella
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e CardiovascolariSapienza Università di RomaRomaItaly
| | - Mariusz Gasior
- Department of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | - Maciej Mazurek
- 1st Department of CardiologyMedical University of WarsawWarszawaPoland
| | - Guglielmo Gallone
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Beniamino Pagliaro
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di FerraraConaItaly
- IRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | - Clara Lopiano
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di FerraraConaItaly
- IRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di FerraraConaItaly
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | | | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano IsontinaUniversity of TriesteItaly
| | - Gaetano Maria De Ferrari
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Fabrizio D'Ascenzo
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
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12
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Patti G, Scaglione M, Maiorano NG, Rosti G, Divizia MT, Camia T, De Rose EL, Zucconi A, Casalini E, Napoli F, Di Iorgi N, Maghnie M. Abnormalities of pubertal development and gonadal function in Noonan syndrome. Front Endocrinol (Lausanne) 2023; 14:1213098. [PMID: 37576960 PMCID: PMC10422880 DOI: 10.3389/fendo.2023.1213098] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Background Noonan syndrome (NS) is a genetic multisystem disorder characterised by variable clinical manifestations including dysmorphic facial features, short stature, congenital heart disease, renal anomalies, lymphatic malformations, chest deformities, cryptorchidism in males. Methods In this narrative review, we summarized the available data on puberty and gonadal function in NS subjects and the role of the RAS/mitogen-activated protein kinase (MAPK) signalling pathway in fertility. In addition, we have reported our personal experience on pubertal development and vertical transmission in NS. Conclusions According to the literature and to our experience, NS patients seem to have a delay in puberty onset compared to the physiological timing reported in healthy children. Males with NS seem to be at risk of gonadal dysfunction secondary not only to cryptorchidism but also to other underlying developmental factors including the MAP/MAPK pathway and genetics. Long-term data on a large cohort of males and females with NS are needed to better understand the impact of delayed puberty on adult height, metabolic profile and well-being. The role of genetic counselling and fertility related-issues is crucial.
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Affiliation(s)
- Giuseppa Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Marco Scaglione
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Nadia Gabriella Maiorano
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Giulia Rosti
- Department of Clinical Genetics and Genomics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Maria Teresa Divizia
- Department of Clinical Genetics and Genomics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Tiziana Camia
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Elena Lucia De Rose
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Alice Zucconi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Emilio Casalini
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Flavia Napoli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Natascia Di Iorgi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
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13
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Lepillier A, Maggio R, De Sanctis V, Malacrida M, Stabile G, Zakine C, Champ-Rigot L, Anselmino M, Segreti L, Dell’Era G, Garnier F, Mascia G, Pandozi C, Dello Russo A, Scaglione M, Cosaro G, Ferraro A, Paziaud O, Maglia G, Solimene F. Insight into contact force local impedance technology for predicting effective pulmonary vein isolation. Front Cardiovasc Med 2023; 10:1169037. [PMID: 37476572 PMCID: PMC10354239 DOI: 10.3389/fcvm.2023.1169037] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Background Highly localized impedance (LI) measurements during atrial fibrillation (AF) ablation have the potential to act as a reliable predictor of the durability of the lesions created. Objective We aimed to collect data on the procedural parameters affecting LI-guided ablation in a large multicenter registry. Methods A total of 212 consecutive patients enrolled in the CHARISMA registry and undergoing their first pulmonary vein (PV) isolation for paroxysmal and persistent AF were included. Results In all, 13,891 radiofrequency (RF) applications of ≥3 s duration were assessed. The first-pass PV isolation rate was 93.3%. A total of 80 PV gaps were detected. At successful ablation spots, baseline LI and absolute LI drop were larger than at PV gap spots (161.4 ± 19 Ω vs. 153.0 ± 13 Ω, p < 0.0001 for baseline LI; 22.1 ± 9 Ω vs. 14.4 ± 5 Ω, p < 0.0001 for LI drop). On the basis of Receiver operating characteristic curve analysis, the ideal LI drop, which predicted successful ablation, was >21 Ω at anterior sites and >18 Ω at posterior sites. There was a non-linear association between the magnitude of LI drop and contact-force (CF) (r = 0.14, 95% CI: 0.13-0.16, p < 0.0001) whereas both CF and LI drop were inversely related with delivery time (DT) (-0.22, -0.23 to -0.20, p < 0.0001 for CF; -0.27, -0.29 to -0.26, p < 0.0001 for LI drop). Conclusion An LI drop >21 Ω at anterior sites and >18 Ω at posterior sites predicts successful ablation. A higher CF was associated with an increased likelihood of ideal LI drop. The combination of good CF and adequate LI drop allows a significant reduction in RF DT. Clinical trial registration http://clinicaltrials.gov/, identifier: NCT03793998.
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Affiliation(s)
| | | | | | | | | | | | | | - Matteo Anselmino
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gabriele Dell’Era
- Azienda Ospedaliera Universitaria “Maggiore della Carità”, Novara, Italy
| | | | | | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Ancona, Italy
| | | | | | | | | | | | - Francesco Solimene
- Department of Cardiac Electrophysiology and Arrhythmology, Clinica Montevergine, Mercogliano, Italy
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14
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Giordano G, Gullo G, Scaglione M, Buzzaccarini G, Cucinella G, Gullo D, Segreto D, Chiantera V, Laganà AS, Di Gaudio F. Transplacental permeability of heavy metals in relation to newborn sex - evidence from the neurodevelopment project. Prz Menopauzalny 2023; 22:30-36. [PMID: 37206674 PMCID: PMC10189668 DOI: 10.5114/pm.2023.126437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/16/2022] [Indexed: 05/21/2023]
Abstract
Introduction Gender medicine is an innovative medical approach that studies how some biological variables are influenced by the male or female sex and gender. This issue is under debate because it characterizes the impact of tailored or individual medicine. In this scenario, the aim of this study is to study the correlation between heavy metal exposure and pathologies of neurodevelopment, according to the sex of newborns. In particular, this is an observational study under the name of the Neurosviluppo Project, involving 217 mother-child couples. Material and methods The correlation with phenotype small for gestational age and congenital malformations were studied, but above all we focused on the pattern of placental permeability to heavy metals. Results Our results are specifically related to foetal medicine and investigate the impact of foetal sex in transplacental metal exposure. Our results did not show any significant differences related to foetal sex in terms of congenital malformations or the other variables taken into consideration. However, because these conclusions are the first related to the gender medicine in transplacental foetal medicine, they could be a marked background for further studies. Conclusions Considering the lack of data in literature regarding foetal sexual medicine and transplacental exposure, these study results are pioneering in terms of sexual foetal medicine. Possibly in the future, studies regarding the correlation between foetal sex and obstetrics outcomes will be performed.
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Affiliation(s)
- Giuseppe Giordano
- Neonatal Intensive Care Unit, Ospedali Riuniti “Villa Sofia – V. Cervello”, Palermo, Italy
| | - Giuseppe Gullo
- Department of Obstetrics and Gynaecology, “Villa Sofia – V. Cervello” Hospital, IVF UNIT, University of Palermo, Palermo, Italy
| | - Marco Scaglione
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences, University of Genoa, Genoa, Italy
| | - Giovanni Buzzaccarini
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Corresponding author: Giovanni Buzzaccarini, MD, Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, via Olgettina 60, 20132, Milan, Italy, e-mail:
| | - Gaspare Cucinella
- Department of Obstetrics and Gynaecology, “Villa Sofia – V. Cervello” Hospital, IVF UNIT, University of Palermo, Palermo, Italy
| | - Domenico Gullo
- Technical Panel on Gender Medicine, Sicily Regional Health Service, Palermo, Italy
| | - Daniela Segreto
- Technical Panel on Gender Medicine, Sicily Regional Health Service, Palermo, Italy
| | - Vito Chiantera
- Unit of Gynaecological Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Antonio Simone Laganà
- Unit of Gynaecological Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Francesca Di Gaudio
- Quality Control and Chemical Risk (CQRC), Department PROMISE, University Hospital P. Giaccone, University of Palermo, Palermo, Italy
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15
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De Filippo O, D'Ascenzo F, Wańha W, Leonardi S, Raposeiras Roubin S, Fabris E, Truffa Giachet A, Huczek Z, Gaibazzi N, Ielasi A, Cortese B, Borin A, Núñez-Gil IJ, Ugo F, Marengo G, Bianco M, Barbieri L, Marchini F, Desperak P, Melendo-Viu M, Montalto C, Bruno F, Mancone M, Ferrandez-Escarabajal M, Morici N, Scaglione M, Tuttolomondo D, Gąsior M, Mazurek M, Gallone G, Campo G, Wojakowski W, Abu Assi E, Sinagra G, de Ferrari GM. IncidenCe and predictOrs of heaRt fAiLure after acute coronarY Syndrome: The CORALYS registry. Int J Cardiol 2023; 370:35-42. [PMID: 36306949 DOI: 10.1016/j.ijcard.2022.10.146] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/29/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Previous studies investigating predictors of Heart Failure (HF) after acute coronary syndrome (ACS) were mostly conducted during fibrinolytic era or restricted to baseline characteristics and diagnoses prior to admission. We assessed the incidence and predictors of HF hospitalizations among patients treated with percutaneous coronary intervention (PCI) for ACS. METHODS AND RESULTS CORALYS is a multicenter, retrospective, observational registry including consecutive patients treated with PCI for ACS. Patients with known history of HF or reduced left ventricular ejection fraction (LVEF) were excluded. Incidence of HF hospitalizations was the primary endpoint. The composite of HF hospitalization or cardiovascular death, and cardiovascular and all-cause death were the secondary endpoints. Predictors of HF hospitalizations and the impact of HF hospitalization on cardiovascular and all-cause death were assessed by means of multivariable Cox proportional hazards model.14699 patients were included. After 2.9 ± 1.8 years, the incidence of HF hospitalizations was 12.7%. Multivariable analysis identified age, diabetes, chronic kidney disease, previous myocardial infarction, atrial fibrillation, pulmonary disease, GRACE risk-score ≥ 141, peripheral artery disease, cardiogenic shock at admission and LVEF ≤40% as independently associated with HF hospitalizations. Complete revascularization was associated with a lower risk of HF (HR 0.46,95%CI 0.39-0.55). HF hospitalization was associated with higher risk of CV and all-cause death (HR 1.89,95%CI 1.5-2.39 and HR 1.85,95%CI 1.6-2.14, respectively). CONCLUSIONS Incidence of HF hospitalizations among patients treated with PCI for ACS is not negligible and is associated with detrimental impact on patients' prognosis. Several variables may help to assess the risk of HF after ACS.
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Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Sergio Leonardi
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Italy
| | | | - Enrico Fabris
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | | | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Alfonso Ielasi
- U.O. di Cardiologia Clinica ed Interventistica, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Bernardo Cortese
- Cardiovascular Research Team, San Carlo Clinic, Milano, Italy; Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
| | - Andrea Borin
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
| | - Fabrizio Ugo
- Division of Cardiology, Sant'Andrea Hospital, Vercelli, Italy
| | - Giorgio Marengo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Matteo Bianco
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Lucia Barbieri
- Division of Cardiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Federico Marchini
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Piotr Desperak
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Claudio Montalto
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Massimo Mancone
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma; 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | | | - Nuccia Morici
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Marco Scaglione
- Division of Cardiology, Ospedale Cardinal G. Massaia, Asti, Italy
| | | | - Mariusz Gąsior
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Maciej Mazurek
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma; 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Gugliemo Gallone
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Emad Abu Assi
- Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Gaetano Maria de Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
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16
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Tosca MA, Olcese R, Girosi D, Casalini E, Scaglione M, Ciprandi G. Hyperthyroidism in a 15-year-old adolescent treated with Dupilumab for severe allergic asthma and atopic dermatitis. Allergol Immunopathol (Madr) 2023; 51:181-185. [PMID: 37169576 DOI: 10.15586/aei.v51i3.786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/13/2023] [Indexed: 05/13/2023]
Abstract
Dupilumab is a biologic, acting on IL-4 and IL-13 pathways. Dupilumab has a pediatric indication for treating severe asthma and atopic dermatitis. We report a pediatric case concerning paucisymptomatic, transient, and self-resolving hyperthyroidism. The updated literature includes the case of an adult patient who reported with hyperthyroidism, which was transient and self-resolving. Despite that these cases were transient and self-resolving, we would suggest that thyroid function assessment could be included in the follow-up of patients treated with Dupilumab. Dupilumab discontinuation is not required pending endocrinological assessment, mainly if there is an optimal clinical response to the biologic.
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Affiliation(s)
| | | | - Donata Girosi
- Pediatric Pulmonology and Respiratory Endoscopy, IRCCS Giannina Gaslini, Genoa, Italy
| | - Emilio Casalini
- Pediatric Clinic and Endocrinology, IRCCS Giannina Gaslini, Genoa, Italy
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17
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Delmas C, Scaglione M, Bouisset F, Roubille F. Post-mRNA COVID-19 vaccines myocarditis: Not so rare in cardiology practice. Archives of Cardiovascular Diseases Supplements 2023. [PMCID: PMC9800765 DOI: 10.1016/j.acvdsp.2022.10.087] [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: 12/31/2022]
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18
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Patti G, Malerba F, Calevo MG, Schiavone M, Scaglione M, Casalini E, Russo S, Fava D, Bassi M, Napoli F, Allegri AEM, D’Annunzio G, Gastaldi R, Maghnie M, Di Iorgi N. Corrigendum: Pubertal timing in children with Silver Russell syndrome compared to those born small for gestational age. Front Endocrinol (Lausanne) 2023; 14:1172736. [PMID: 37008915 PMCID: PMC10050878 DOI: 10.3389/fendo.2023.1172736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fendo.2022.975511.].
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Affiliation(s)
- Giuseppa Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - University of Genova, Genova, Italy
- *Correspondence: Giuseppa Patti, ; Mohamad Maghnie, ;
| | - Federica Malerba
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - University of Genova, Genova, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Marco Scaglione
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - University of Genova, Genova, Italy
| | - Emilio Casalini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - University of Genova, Genova, Italy
| | - Silvia Russo
- Cytogenetic and Molecular Genetics Laboratory, IRCCS, Istituto Auxologico Italiano, Milano, Italy
| | - Daniela Fava
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - University of Genova, Genova, Italy
| | - Marta Bassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - University of Genova, Genova, Italy
| | - Flavia Napoli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | | | - Roberto Gastaldi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - University of Genova, Genova, Italy
- *Correspondence: Giuseppa Patti, ; Mohamad Maghnie, ;
| | - Natascia Di Iorgi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - University of Genova, Genova, Italy
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19
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Radinovic A, Peretto G, Sgarito G, Cauti FM, Castro A, Narducci ML, Mantovan R, Scaglione M, Solimene F, Scopinaro A, Tondo C, Filippini G, Bianco E, Bonso A, Calzolari V, Ferraris F, Zardini M, Piacenti M, D'Angelo G, Bosica F, Della Bella P. Matching Ablation Endpoints to Long-Term Outcome: The Prospective Multicenter Italian Ventricular Tachycardia Ablation Registry. JACC Clin Electrophysiol 2022:S2405-500X(22)01046-5. [PMID: 36752462 DOI: 10.1016/j.jacep.2022.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/06/2022] [Accepted: 10/19/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Multicenter ventricular tachycardia (VT) ablation studies have shown poorer outcomes compared with single-center experiences. This difference could be related to heterogeneous mapping and ablation strategies. OBJECTIVES This study evaluated a homogenous simplified catheter ablation strategy for different substrates and compared the results with those of a single referral center. METHODS This was a multicenter prospective VT ablation registry of patients with the following 4 causes of VT: previous myocardial infarction; previous myocarditis; arrhythmogenic right ventricular dysplasia; or idiopathic dilated cardiomyopathy. The procedural protocol included precise mapping and ablation steps with the combined endpoint of late potential (LP) abolition and noninducibility of VT. The long-term primary efficacy endpoint was freedom from VT. RESULTS A total of 309 patients were enrolled. LPs were present in 70% of patients and were abolished in 83%. At the end of the procedure 74% of LPs were noninducible. The primary combined endpoint of LP abolition and noninducibility was achieved in 64% of patients with LPs at baseline. Freedom from VT at 12 months was observed in 67% of patients. In the overall study group, VT inducibility was the only predictor of freedom from VT (P = 0.013). In patients with LPs, the VT recurrence rate was lower both for patients with complete LP abolition (P = 0.040) and for patients meeting the composite endpoint (P = 0.035). CONCLUSIONS A standardized VT mapping and ablation technique reproduced the procedural outcomes of a single referral center in a multicenter prospective study. LP abolition and noninducibility were effective in reducing VT recurrences in patients with 4 causes of cardiomyopathy. (Ventricular Tachycardia Ablation Registry; NCT03649022).
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Affiliation(s)
- Andrea Radinovic
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Giovanni Peretto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Antonello Castro
- Cardiology unit Pertini Hospital- Azienda USL Roma B, Rome, Italy
| | | | | | | | | | - Alice Scopinaro
- Alessandria Hospital - SS. Antonio, Biagio, Cesare Arrigo, Alessandria, Italy
| | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche Università degli Studi di Miano, Milan, Italy
| | | | | | | | - Vittorio Calzolari
- Electrophysiology, Division of Cardiology, Neuro-Cardio-Vascular Department, Hospital of Treviso, ULSS 2 "Marca Trevigiana," Treviso, Italy
| | | | - Marco Zardini
- Cardiac Electrophysiology Section, Zenda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Marcello Piacenti
- CNR - Area della Ricerca di Pisa Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Giuseppe D'Angelo
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco Bosica
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
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20
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Gullo G, Scaglione M, Cucinella G, Perino A, Chiantera V, D'Anna R, Laganà AS, Buzzaccarini G. Impact of assisted reproduction techniques on the neuro-psycho-motor outcome of newborns: a critical appraisal. J OBSTET GYNAECOL 2022; 42:2583-2587. [PMID: 35959847 DOI: 10.1080/01443615.2022.2109953] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Subfertility and infertility are common problems among couples of reproductive age, and they increasingly require the use of assisted reproductive techniques (ART). Understandably, doubts about the safety of such methods are increasing among future parents. The purpose of this review is to analyse the real impact of ART, such as in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI), on the health of the unborn baby; in particular, this work is focussed on the problems related to the neuro-psycho-motor area. Twenty-four studies were reviewed and outcomes investigated were: risk of the onset of neurodevelopmental diseases, worsening of school cognitive performance and risk of developing infantile cerebral palsy (CP) or neurological sequelae. For the first two outcomes, we did not find a correlation with ART; nevertheless, the results of the included studies about risk of CP are discordant and influenced by various confounding factors, such as pre-term birth and multiple pregnancies.IMPACT STATEMENTWhat is already known on this subject? Assisted reproductive techniques (ART) are the main answer for achieving pregnancy in infertile couples. However, a wide number of studies have tried to focus on possible different outcomes in terms of maternal and foetal/new-born health. Regarding this scenario, a peculiar importance is given to diseases affecting the neuro-psycho-motor area of the new-born. Since this group of detrimental pathologies could heavily affect the new-born's quality of life and require costly social facilities, different studies have tried to focus on possible outcomes after ART.What do the results of this study add? This manuscript provides a review of the literature regarding ART procedures and neuro-psycho-motor implication. A review is strongly required due to the importance of collecting evidence from studies with different methodologies.What are the implications of these findings for clinical practice and/or further research? This manuscript provides evidence about the need for wider and more congruent studies regarding neurodevelopment disorders in new-borns after ART procedures. Data are prone to suggest a slight correlation, but several confounding factors can heavily hamper the possibility to draw a firm conclusion about the topic.
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Affiliation(s)
- Giuseppe Gullo
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF Unit, University of Palermo, Palermo, Italy
| | - Marco Scaglione
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences, University of Genoa, Genoa, Italy
| | - Gaspare Cucinella
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF Unit, University of Palermo, Palermo, Italy
| | - Antonino Perino
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF Unit, University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Rosario D'Anna
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Giovanni Buzzaccarini
- Department of Women's and Children's Health, Gynaecologic and Obstetrics Clinic, University of Padua, Padua, Italy
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21
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Abu-Omar A, Kennedy P, Yakub M, Robbins JB, Yassin A, Verma N, Scaglione M, Khosa F. Extra credit for disruption: trend of disruption in radiology academic journals. Clin Radiol 2022; 77:893-901. [PMID: 36150935 DOI: 10.1016/j.crad.2022.07.003] [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] [Received: 06/04/2022] [Accepted: 07/05/2022] [Indexed: 11/03/2022]
Abstract
AIM To identify the most disruptive publications, which are those that are cited more frequently than their own references, in academic radiology journals and their characteristics, such as the number of authors and relative time to publication. MATERIAL AND METHODS A comprehensive literature search was undertaken to identify the 100 most disruptive publications in the field of radiology. Subsequently, statistical analysis was applied to establish the distribution of disruptive scores of the isolated publications using a non-parametric probability density function. The relation between disruptive scores and citation counts was then determined, with the aid of a correlation coefficient. Finally, data regarding any significant connection between disruption scores and time of publication, number of authors, and study design were examined. RESULTS Analysing the top 100 papers in increments of 10-year periods showed no significant difference in the distribution of disruption scores over time. No correlation between an article's citation count and disruption score was established. Additionally, no significant relation between the number of authors/study design and disruption scores was identified. CONCLUSION The disruption score highlights significant impact elements not entirely accounted for by citation count. Its potential benefit in assessing scientific impact should be contemplated.
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Affiliation(s)
- A Abu-Omar
- Department of Radiology, The James Cook University Hospital NHS Foundation Trust, Middlesbrough, UK.
| | - P Kennedy
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - M Yakub
- Physiotherapy and Nutrition, California University of Science and Medicine, California, USA
| | - J B Robbins
- Faculty Development and Enrichment, University of Wisconsin School of Medicine and Public Health, Wisconsin, USA
| | - A Yassin
- Department of Radiology, Ain Shams University, Cairo, Egypt
| | - N Verma
- Abdominal and Cardiac Imaging, University of Florida, Florida, USA
| | - M Scaglione
- Department of Radiology, The James Cook University Hospital NHS Foundation Trust, Middlesbrough, UK; Department of Radiology, University of Sassari, Sardinia, Italy; Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - F Khosa
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, Canada
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22
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Saglietto A, Ballatore A, Gaita F, Scaglione M, De Ponti R, De Ferrari GM, Anselmino M. Comparative efficacy and safety of different catheter ablation strategies for persistent atrial fibrillation: a network meta-analysis of randomized clinical trials. European Heart Journal - Quality of Care and Clinical Outcomes 2022; 8:619-629. [PMID: 34498687 DOI: 10.1093/ehjqcco/qcab066] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/03/2021] [Accepted: 09/07/2021] [Indexed: 11/12/2022]
Abstract
AIMS Whereas pulmonary vein isolation (PVI) is the universally agreed target in catheter ablation of paroxysmal atrial fibrillation (AF), an ideal ablation set in persistent AF remains questioned. Aim of this study is to conduct a network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing different ablation strategies in persistent AF patients. METHODS AND RESULTS Network meta-analysis was performed in a frequentist framework with the different ablation strategies constituting the competitive arms of interest. Primary efficacy endpoint was recurrences of atrial tachyarrhythmia (AF, atrial flutter, and/or organized atrial tachycardia). Secondary endpoints included major peri-procedural complications, procedure, and fluoroscopy duration. PubMED/MEDLINE and EMBASE databases were searched through June 2020. 2548 records were screened and 57 full-text articles assessed. Eventually 24 RCTs were included, encompassing 3245 patients (median follow-up 15 months, IQR 12-18). Compared to PVI alone, PVI plus linear lesions in the left atrium and elimination of extra-PV sources was the only strategy associated with a reduced risk of arrhythmia recurrence (RR 0.49, 95%CI 0.27-0.88). Most treatment arms were associated with longer procedural time compared with PVI; however, major peri-procedural complications and fluoroscopy time did not differ. CONCLUSION A comprehensive strategy including PVI, linear lesions in the left atrium, and elimination of extra-PV sources (constrained by a heterogeneous definition across studies) was associated with reduced risk of recurrent atrial tachyarrhythmias compared to PVI alone. All investigated treatment arms yielded similar safety profiles. Further research should rely on enhanced substrate-based approach definitions to solve one of the most evident knowledge gaps in interventional electrophysiology.
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Affiliation(s)
- Andrea Saglietto
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88/90, 10126, Turin, Italy
| | - Andrea Ballatore
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88/90, 10126, Turin, Italy
| | - Fiorenzo Gaita
- Cardiology Unit, J Medical, Via Druento, 153/56, 10151, Turin, Italy
| | - Marco Scaglione
- Division of Cardiology, Cardinal Massaia Hospital, Corso Dante Alighieri, 202, 14100, Asti, Italy
| | - Roberto De Ponti
- Department of Cardiology, School of Medicine, University of Insubria, Viale Borri, 57, 21100, Varese, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88/90, 10126, Turin, Italy
| | - Matteo Anselmino
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88/90, 10126, Turin, Italy
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23
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Gullo G, Scaglione M, Cucinella G, Chiantera V, Perino A, Greco ME, Laganà AS, Marinelli E, Basile G, Zaami S. Neonatal Outcomes and Long-Term Follow-Up of Children Born from Frozen Embryo, a Narrative Review of Latest Research Findings. Medicina (Kaunas) 2022; 58:medicina58091218. [PMID: 36143894 PMCID: PMC9500816 DOI: 10.3390/medicina58091218] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022]
Abstract
In recent years, the growing use of ART (assisted reproductive techniques) has led to a progressive improvement of protocols; embryo freezing is certainly one of the most important innovations. This technique is selectively offered as a tailored approach to reduce the incidence of multiple pregnancies and, most importantly, to lower the risk of developing ovarian hyperstimulation syndrome when used in conjunction with an ovulation-triggering GnRH antagonist. The increase in transfer cycles with frozen embryos made it possible to study the effects of the technique in children thus conceived. Particularly noteworthy is the increase in macrosomal and LGA (large for gestational age) newborns, in addition to a decrease in SGA (small for gestational age) and LBW (low birth weight) newborns. The authors aimed to outline a broad-ranging narrative review by summarizing and elaborating on the most important evidence regarding the neonatal outcome of children born from frozen embryos and provide information on the medium and long-term follow- up of these children. However, given the relatively recent large-scale implementation of such techniques, further studies are needed to provide more conclusive evidence on outcomes and implications.
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Affiliation(s)
- Giuseppe Gullo
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Marco Scaglione
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences, University of Genoa, 16132 Genoa, Italy
| | - Gaspare Cucinella
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Antonino Perino
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Maria Elisabetta Greco
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Enrico Marinelli
- Department of Medico-Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, 04100 Rome, Italy
- Correspondence:
| | | | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
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24
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Scaglione M, Napoli F, Prato G, Severino M, Bertamino M, Signa S, Maghnie M. An Atypical Case of Aphasia: Transitory Ischemic Attack in a 13-Year-Old Patient with Asymptomatic SARS-CoV-2 Infection. Children 2022; 9:children9070983. [PMID: 35883967 PMCID: PMC9322507 DOI: 10.3390/children9070983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022]
Abstract
We report the case of a 13-year-old patient, female, born in Northern Italy, who presented with an acute episode of aphasia, lasting about 15 min, accompanied by left arm dysesthesia. The state of consciousness remained preserved throughout the episode. After a first clinical evaluation at second-level hospital, the patient was sent to our institute for further investigations. Brain MRI performed at admission showed no noteworthy structural alterations. Electroencephalogram was not significant, as was the echocardiographic examination. ECG was normal, except for a corrected-QT at the upper limits of the normal range for age and gender. The neurological examination was substantially normal for the entire duration of the hospital stay. The symptomatology initially described has never reappeared. Blood tests were substantially negative, in particular thrombophilic screening excluded hereditary-familial thrombophilic diseases. Color doppler ultrasound of the supra-aortic trunks, splanchnic vessels and lower limbs were also normal. Only positivity to SARS-CoV-2 serology is reported. In the recent clinical history there were no symptoms attributable to symptomatic coronavirus infection.
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Affiliation(s)
- Marco Scaglione
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (D.I.N.O.G.M.I), University of Genoa, 16132 Genoa, Italy;
- Integrated Department of Paediatric and Hemato-Oncological Sciences, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
- Correspondence: ; Tel.: +39-3331918399
| | - Flavia Napoli
- Integrated Department of Paediatric and Hemato-Oncological Sciences, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Giulia Prato
- Integrated Department of Medical and Surgical Neuroscience and Rehabilitation-Continuity of Care, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | | | - Marta Bertamino
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Sara Signa
- COVID Hospital, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Mohamad Maghnie
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (D.I.N.O.G.M.I), University of Genoa, 16132 Genoa, Italy;
- Integrated Department of Paediatric and Hemato-Oncological Sciences, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
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25
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Meynet I, Stabile G, Mantica M, Ferraro A, D’ammando M, Scaglione M, Di Cori A, Schillaci V, Ottaviano L, Mantovan R, Ferrari F, Bianchi S, Solimene F, Malacrida M, De Sanctis V. The impact of RF wattage level on local impedance and procedural parameters in AF ablation cases. Europace 2022. [DOI: 10.1093/europace/euac053.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Local impedance (LI) measurement can provide information on catheter tip contact, but also changes in LI during ablation can inform the extent and effectiveness of RF energy delivery. To date the relationship between highly LI measurements and contact force (CF) during atrial fibrillation (AF) ablation at different levels of energy delivery is still lacking.
Purpose
We aimed to evaluate the impact of power setting on LI and key procedural parameters in AF ablation cases.
Methods
A novel CF ablation catheter equipped with dedicated algorithm was used to measure LI at the distal electrode of this catheter. Radiofrequency (RF) catheter applications ≥45 watts were categorized as high power (HP) and applications <45w as standard power (SP). Ablations were also grouped according to different levels of CF (<5g, 5-14g, 15-24g and ≥25g). Data are reported as mean±SD.
Results
Sixty-two consecutive pts undergoing RF catheter ablation of AF from the CHARISMA registry were included A total of 4619 ablation spots performed around PVs were analyzed (58% paroxysmal, 84% de novo, RF deliveries per pt=76±27, RF delivery time=9.1±5s, CF=12.3±8g). The majority of these were HP applications (n=4192, 91%). The mean LI was 158±17Ω prior to ablation and 138±14Ω after ablation (p<0.0001, absolute LI drop of 21.9±8Ω) with a LI drop rate equal to 4.4±3Ω/s. HP ablations had significantly shorter RF delivery times, 8.8±4s vs 12±7s (p<0.0001), larger LI drops (22.2±8Ω vs 19.3±9Ω, p<0.0001) and higher LI drop rates (4.5±3Ω/s vs 3.6±2Ω/s, p<0.0001) than SP, respectively. For both HP and SP settings, the magnitude of LI drop increased and RF delivery time decreased with increasing amounts of CF. The largest differences between HP and SP were found when CF was <15g (RF delivery time: 9±5s at HP vs 12.9±7s at SP, percentage of difference 26.3%, p<0.0001; LI drop: 21.2±8Ω at HP vs 18.6±9Ω, percentage of difference -14.3%, p<0.0001). No major complications occurred during the procedures. All PVs were successfully isolated.
Conclusions
This preliminary experience suggests that, HP ablation is effective and safe and resulting in shorter RF delivery times and larger LI drops than SP ablation.
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Affiliation(s)
| | - G Stabile
- Montevergine Clinic, Mercogliano, Italy
| | - M Mantica
- Clinical Institute Saint Ambrogio, Milan, Italy
| | | | - M D’ammando
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | | | - A Di Cori
- University Hospital of Pisa, Pisa, Italy
| | | | - L Ottaviano
- Clinical Institute Saint Ambrogio, Milan, Italy
| | - R Mantovan
- Conegliano General Hospital, Conegliano, Italy
| | - F Ferrari
- Hospital Molinette of the University Hospital S. Giovanni Battista, Turin, Italy
| | - S Bianchi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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26
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Viola G, Stabile G, Rossi L, Figus F, Gazzale E, Casu G, Bottoni N, Deruvo E, Scaglione M, Santoro A, Armenta-Pastor J, Primo J, Ferraris F, Castro A, Donzelli S. Long term success of cavotricuspid isthmus ablation guided by the ablation index: results of the FLAI registry. Europace 2022. [DOI: 10.1093/europace/euac053.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Cavotricuspid isthmus ablation (CTIA) is an effective treatment for typical atrial flutter (AFL) with a recurrence rate of about 10%. A prospective multicentric registry (FLAI registry) has recently shown that a protocol including ‘point by point’ CTI ablation targeting an a quality lesion marker (Ablation Index AI) ≥ 500 and a maximum inter-lesion distance (ILD) measurement of ≤6 mm allowed an acute success rate of 98.3%. In this study, we aimed to describe the incidence and predictors of recurrence of both AFL and atrial fibrillation (AF) in a long-term follow-up of the patients enrolled in the FLAI registry.
Methods
The FLAI registry was a multicentric non-randomized study that enrolled 412 consecutive patients (mean age 64.9±9.8; 72.1% males; 27.7% with structural heart disease). Patients with typical AFL underwent an AI-guided cavotricuspid isthmus ablation. The procedures targeted an AI of 500 and an ILD measurement of ≤ 6mm. The primary endpoints were CTI ‘first pass’ block and persistent block after a 20-minute waiting period. The CTI bidirectional "first pass block" was reached in 355 patients (88.3%), whereas CTI block at the end of the waiting period was achieved in 405 patients (98.3%). No complications were reported.
The mean time of follow-up was 21±4.24 months and it was available for 397 patients. The FU included outpatient clinical evaluation, ECG and 24-h Holter ECG at three, six- and 12-months post-ablation, followed by an annual clinical evaluation and ECG. Documented ECG Atrial fibrillation events, in follow up, were also included in the data set.
Results
Atrial flutter recurrence: 22 AFL events were observed (5.5%) at 34 months. According to the Kaplan Meier analysis, the growth of recurrence rate was constant between 6 and 12 months, after 19 months recurrences were unlikely. At the univariate analysis predictors of AFL recurrence were: absence of bidirectional block after the waiting time period (p= 0,001); failure of the CTIA index procedure (p=<0,0005); ablation line lengths > 32 mm (p=0.,018), number of automatic ablation lesion tags (VISITAG) > 20 (p=0,.005) and At the increathe reported numbers of ‘g"gap’" in the ablation line lengths: the more the gaps increase the more the probability of AFL recurrence in FU increases (p=0.,037).
In the Multivariate aAnalysis, the independent predictors of AFL recurrence were: the procedural success and the number of VISITAG (OR =1.062)
Atrial fibrillation recurrence: 45 patients developed atrial fibrillation after CTI ablation (11.3%). In the multivariate analysis, the major independent predictor was a documented pre-procedural Afib and the risk increases with the younger age (< 53 yo).
Conclusions
The FLAI protocol is safe, reproducible and effective in the follow-up, with a long term success of 94,5%. The reported incidence of atrial fibrillation in FU was 11,3%
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Affiliation(s)
- G Viola
- SS. Annunziata Hospital, Cardiology, Sassari, Italy
| | - G Stabile
- Montevergine Clinic, Cardiology, Mercogliano, Italy
| | - L Rossi
- Guglielmo da Saliceto Hospital, Cardiology, Piacenza, Italy
| | - F Figus
- SS. Annunziata Hospital, Cardiology, Sassari, Italy
| | - E Gazzale
- SS. Annunziata Hospital, Cardiology, Sassari, Italy
| | - G Casu
- SS. Annunziata Hospital, Cardiology, Sassari, Italy
| | - N Bottoni
- Santa Maria Nuova Hospital, Cardiology, Reggio Emilia, Italy
| | - E Deruvo
- Polyclinic Casilino, Rome, Italy
| | - M Scaglione
- Cardinal Massaia Hospital, Cardiology, Asti, Italy
| | - A Santoro
- Polyclinic Santa Maria alle Scotte, Cardiology, Siena, Italy
| | | | - J Primo
- Hospital da Luz Arrabida, Cardiology, Vila Nova de Gaia, Portugal
| | | | - A Castro
- Sandro Pertini Hospital, Cardiology, Rome, Italy
| | - S Donzelli
- Hospital Santa Maria, Cardiology, Terni, Italy
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27
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Battaglia A, Calvanese R, Pandozi C, Tola G, Solimene F, Rossi L, Cauti F, Pedretti S, Mantovan R, Pelargonio G, Castro A, Gagliardi M, Izzo G, Malacrida M, Scaglione M. Ventricular tachycardia channels ablation incorporating automated high-density mapping guidance: data from the CHARISMA registry. Europace 2022. [DOI: 10.1093/europace/euac053.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Ventricular tachycardia (VT) ablation targeting conducting channels (CC)s based on timing of late potentials (LPs) during sinus rhythm (dechanneling) may facilitate a scar homogenization strategy without the need for extensive ablation and possibly lead to higher successful rate.
Purpose
We evaluated the feasibility and safety of a CC identification and ablation approach by means of an ultra-high density mapping system with a novel automated algorithm in ischemic VT procedures.
Methods
Consecutive patients indicated for ischemic VT ablation were prospectively included. A complete map of the left ventricle was performed prior and after ablation through the Rhythmia mapping system. Channels were defined as any signal activity bounded by anatomic and functional barriers and characterized through the Lumipoint (LM) tool and continuous activation was used on the whole ventricular substrate. Procedural end point was the elimination of all identified CCs by ablation at the CC entrance and exit followed by abolition of any residual LPs inside the CC. The ablation endpoint was noninducibility. Data are reported as mean±SD.
Results
A total of 36 channels were identified through LM from 28 patients (1.2±0.5 per patient): 21 (75%) patients had 1 CC, 6 (21.4%) had 2 CCs and 1 (3.6%) had 3 CCs. LPs were identified inside CCs in 19 cases (67.9%). In 8 cases (28.6%) LPs were present both inside and outside and in 1 (3.6%) case LPs were present only outside the CC. LPs inside channels covered an area of 7.6±5 mm2 with a ratio between LPs area and CCs’ area of 67.4±31.8%. In 12 (43%) cases LPs area covered more than 90% of the CCs’ area. At voltage map analysis a total of 34 CC were identified: 1 CC was present in 75% of the cases, 2 CCs in 17.9% and 3 CCs in 3.6%. LPs were identified only inside CCs in 46.4% of the cases, both inside and outside in 42.9% and only outside in 10.7%. Healthy tissue (voltage level≥0.5mV) was prevalent (68.2±17%), followed by intermediate voltage areas (0.5-0.05 mV; 31.1±17%) and very low voltage areas (<0.05mV; 0.7±1%). LPs were found mostly at intermediate voltage areas (57.0±34% of the covered area; 39.1±33% at healthy tissue and 3.4±13% at very low voltage areas). LM was more accurate than traditional voltage mapping in identifying CCs: in 6 (21.4%) cases voltage map overestimated LPs areas, in 2 (7.1%) cases failed to fully identify LPs and only in 19 out 28 (67.8%) LM and voltage map had a complete agreement. All CCs’ entrance and exit were successfully ablated and abolition of any residual LPs inside the CC was achieved in all patients. No complication occurred. Noninducibility was achieved in all (100%) the cases.
Conclusions
In this experience, a channel identification approach through the advanced Lumipoint tool was more accurate than traditional voltage mapping and seems to be safe, feasible, and effective at least in the acute setting of ischemic VT ablation.
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Affiliation(s)
| | | | - C Pandozi
- San Filippo Neri Hospital, Rome, Italy
| | - G Tola
- AO Brotzu Hospital, Cagliari, Italy
| | | | - L Rossi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - F Cauti
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | | | | | - G Pelargonio
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - A Castro
- Sandro Pertini Hospital, Rome, Italy
| | | | - G Izzo
- Ospedale Del Mare, Naples, Italy
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28
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Bricco G, Coppolino A, Valeri L, Amoroso G, Cavallero E, Iacovino C, Barbero U, Battisti A, Scaglione M, Correndo L, Bessignana A, De Benedictis M. P172 AN ACCESSORY PATHWAY WITHOUT REENTRANT TACHYCARDIA. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.165] [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
A 65–year–old patient, hypertensive, dyslipidemic, strong smoker. He has heart disease with hypokinetic evolution EF 47%, mild MI. Negative Dipyridamole–stress echocardiography dated January 2008. Recently atrial fibrillation (AF) is found and anticoagulant therapy was started. Dyspnea and weight loss occurred in past two months. Detected keratinizing squamous pulmonary Ca with negative markers. This injury was judged to be inoperable, and the patient get indications for chemotherapy and radiotherapy. The patient also starts complaining of dyspnea and chest pain on exertion: Not serological modification, not ischemic ECG. Echocardiogram LVEF 47–50% highlights diffuse hypokinesia, regular valves. Ergometric test was not evaluable for ischemia. Coronary angiography shows stenosis of proximal and middle anterior interventricular coronary and non–critical lesions of circumflex and right coronary. Ecodobutamine test was positive for ischemia and arrhythmias (AF and wide QRS tachycardias in recovery phase), but negative for angor. The patient was treated with CT and IVA I – II. angioplasty Monitoring shows AF with high penetrance, wide QRS tachycardia runs and very short TVNS. ECG 1: During atrial tachycardia, show broad QRS conduction to BBSX alternating with narrow QRS with the same RR interval. ECG 2. show fusion between the wavefront conducted with narrow QRS and that with wide QRS. These are supraventricular arrhythmias that run along the atrioventricular nodal pathway (NAV) in the narrow QRS tracts and take an accessory pathway in the wide QRS run.
The Mahaim fibers have decremental conductivities like the AV node, therefore high ventricular frequencies does not occur AF appeared during ecodobutamine, but some beats were conducted by an anomalous path in a discontinuous way); they are generally directed from the atrium or the NAV, towards another part of the right ventricular conduction system, with atrium wave or NAV – RB, therefore the early activation of the RB generates a widened QRS, with a LBB morphology. ECG 3 Re–entry on Mahaim pathway, ventricular activation widened through Mahaim fiber, which generate LBB morphology with retrograde atrial depolarization. In this case there is no reentry, but we have an atrial tachycardia conducted alternately on an accessory pathway and across the NAV. Given the patient‘s clinical problems and the total absence of symptoms, the patient remains asymptomatic during therapy with amiodarone and beta–blocker.
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Affiliation(s)
- G Bricco
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - A Coppolino
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - L Valeri
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - G Amoroso
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - E Cavallero
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - C Iacovino
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - U Barbero
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - A Battisti
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - M Scaglione
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - L Correndo
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - A Bessignana
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
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Botto GL, Mantovani LG, Cortesi PA, De Ponti R, D'Onofrio A, Biffi M, Capucci A, Casu G, Notarstefano P, Scaglione M, Zanotto G, Boriani G. The value of wearable cardioverter defibrillator in adult patients with recent myocardial infarction: Economic and clinical implications from a health technology assessment perspective. Int J Cardiol 2022; 356:12-18. [PMID: 35395289 DOI: 10.1016/j.ijcard.2022.04.003] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/16/2022] [Accepted: 04/01/2022] [Indexed: 01/19/2023]
Abstract
AIMS Sudden cardiac death (SCD) causes high mortality and substantial societal burdens for healthcare systems (HSs). The risk of SCD is significantly increased in patients with reduced left ventricular ejection fraction after myocardial infarction (MI). Current guidelines recommend re-evaluation of cardioverter-defibrillator implantation 40 days post-MI, earliest. Medical therapy alone does not provide sufficient protection against SCD, especially in the first month post-MI, and needs time. Consequently, there is a gap in care of high-risk patients upon hospital discharge. The wearable cardioverter defibrillator (WCD) is a proven safe, effective therapy, which temporarily protects from SCD. Little information on WCD cost-effectiveness exists. We conducted this research to demonstrate the medical need of the device in the post-MI setting defining WCD cost-effectiveness. METHODS & RESULTS Based on a randomized clinical trials (RCTs) and Italian and international data, we developed a Markov-model comparing costs, patient survival, and quality-of-life, and calculated the Incremental Cost-Effectiveness Ratio (ICER) of a WCD vs. current standard of care in post-MI patients. The rather conservative base case analysis - based on the RCT intention-to-treat results - produced an ICER of €47,709 per Quality Adjusted Life Year (QALY) gained, which is far lower than the accepted threshold of €60,000 in the Italian National HS. The ICER per Life Year (LY) gained was €38,276. CONCLUSION WCD utilization in post-MI patients is clinically beneficial and cost-effective. While improving guideline directed patient care, the WCD can also contribute to a more efficient use of resources in the Italian HS, and potentially other HSs as well.
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Affiliation(s)
- Giovanni Luca Botto
- Cardiology - Electrophysiology Division, Department of Medicine, Ospedale di Circolo Rho, Ospedale Salvini Garbagnate M.se, ASST Rhodense, Milan, Italy.
| | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy; Value-Based Healthcare Unit, IRCCS Multimedica, Sesto San Giovanni, Italy
| | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo-University of Insubria, Varese, Italy
| | - Antonio D'Onofrio
- Cardiology Division - Electrophysiology Department - AORN dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Mauro Biffi
- Cardiology Division - Electrophysiology Department, Policlinico S.Orsola Malpighi, Bologna, Italy
| | - Alessandro Capucci
- Cardiology and Arrhytmology Clinic, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Gavino Casu
- Cardiology and Intensive Care Unit, Ospedale "San Francesco" Nuoro, Italy
| | | | | | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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Gullo G, Scaglione M, Cucinella G, Riva A, Coldebella D, Cavaliere AF, Signore F, Buzzaccarini G, Spagnol G, Laganà AS, Noventa M, Zaami S. Congenital Zika Syndrome: Genetic Avenues for Diagnosis and Therapy, Possible Management and Long-Term Outcomes. J Clin Med 2022; 11:jcm11051351. [PMID: 35268441 PMCID: PMC8911172 DOI: 10.3390/jcm11051351] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023] Open
Abstract
Zika virus (ZIKV) was discovered in Uganda in 1947 and was originally isolated only in Africa and Asia. After a spike of microcephaly cases in Brazil, research has closely focused on different aspects of congenital ZIKV infection. In this review, we evaluated many aspects of the disease in order to build its natural history, with a focus on the long-term clinical and neuro-radiological outcomes in children. The authors have conducted a wide-ranging search spanning the 2012–2021 period from databases PubMed, PubMed Central, Web of Science, Medline, Scopus. Different sections reflect different points of congenital ZIKV infection syndrome: pathogenesis, prenatal diagnosis, clinical signs, neuroimaging and long-term developmental outcomes. It emerged that pathogenesis has not been fully clarified and that the clinical signs are not only limited to microcephaly. Given the current absence of treatments, we proposed schemes to optimize diagnostic protocols in endemic countries. It is essential to know the key aspects of this disease to guarantee early diagnosis, even in less severe cases, and an adequate management of the main chronic problems. Considering the relatively recent discovery of this congenital infectious syndrome, further studies and updated long-term follow-up are needed to further improve management strategies for this disease.
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Affiliation(s)
- Giuseppe Gullo
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital IVF UNIT, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.)
| | - Marco Scaglione
- School of Medicine and Surgery, University of Palermo, 90127 Palermo, Italy;
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90133 Palermo, Italy
| | - Gaspare Cucinella
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital IVF UNIT, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.)
| | - Arianna Riva
- Department of Women’s and Children’s Health, Padova Hospital, 35128 Padova, Italy;
| | - Davide Coldebella
- Department of Women’s and Children’s Health, Gynaecological Clinic, University of Padova, 35128 Padova, Italy; (D.C.); (G.B.); (G.S.); (M.N.)
| | - Anna Franca Cavaliere
- Department of Gynecology and Obstetrics, Santo Stefano Hospital, ULS Toscana Centro, 59100 Rome, Italy;
| | - Fabrizio Signore
- Department of Gynecology and Obstetrics, Sant’Eugenio Hospital, 00144 Rome, Italy;
| | - Giovanni Buzzaccarini
- Department of Women’s and Children’s Health, Gynaecological Clinic, University of Padova, 35128 Padova, Italy; (D.C.); (G.B.); (G.S.); (M.N.)
| | - Giulia Spagnol
- Department of Women’s and Children’s Health, Gynaecological Clinic, University of Padova, 35128 Padova, Italy; (D.C.); (G.B.); (G.S.); (M.N.)
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy;
| | - Marco Noventa
- Department of Women’s and Children’s Health, Gynaecological Clinic, University of Padova, 35128 Padova, Italy; (D.C.); (G.B.); (G.S.); (M.N.)
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
- Correspondence:
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Agostini G, Angelini I, Citarelli C, Andreani L, Carmassi F, Scaglione M, Capanna R. Clinical and radiographical outcome after surgical treatment of periprosthetic type B proximal femur fractures: a retrospective study. Musculoskelet Surg 2022; 106:83-87. [PMID: 32949004 DOI: 10.1007/s12306-020-00676-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 07/30/2018] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Periprosthetic fractures after hip prosthesis represent a constantly increasing clinical problem and a challenging complication to treat surgically. Among these, type B proximal femur fractures should be diagnosed correctly to be treated surgically. The aim of this study was to re-evaluate the type of surgical treatment of periprosthetic fractures. METHODS We examined the cases treated between January 2012 and February 2018, classifying them according to the U.C.S. AO/OTA. We evaluated the radiographic outcome according to the Beals and Tower criteria. Patients still alive were also re-evaluated according to the H.H.S. and the WOMAC score. RESULTS We treated 48 patients (12 men, 35 women, average age 81 years), divided into 24 type B1, 14 type B2 and 10 type B3 fractures. The overall consolidation rate was 95.4%, while the major complication (implant dislocation, pseudoarthrosis and deep infection) rate was 12.5%. Clinically, it was possible to reassess 34 patients with a mean follow-up of 38.4 months, an average HHS of 75.89 and a mean WOMAC score of 79.93. CONCLUSIONS Periprosthetic type B fractures are difficult to manage and require careful preoperative planning and appropriate intraoperative management. However, the overall clinical and radiographic result was satisfactory, although patients should still be aware of the risk of complications associated with this type of fracture.
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Affiliation(s)
- G Agostini
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy.
| | - I Angelini
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - C Citarelli
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - L Andreani
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - F Carmassi
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - M Scaglione
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - R Capanna
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
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Scaglione M, Benanti F, Iatrino N. Critical aspects of dystocic delivery and neonatal outcome. Acta Biomed 2022; 93:e2022320. [PMID: 36533743 PMCID: PMC9828904 DOI: 10.23750/abm.v93i6.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/11/2022] [Indexed: 01/21/2023]
Affiliation(s)
- Marco Scaglione
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences, University of Genoa, Genoa, Italy
| | - Filippo Benanti
- Obstetrics and Gynaecology, Villa Sofia Cervello Hospital, University of Palermo, Palermo, Italy
| | - Nicolò Iatrino
- Obstetrics and Gynaecology, Villa Sofia Cervello Hospital, University of Palermo, Palermo, Italy
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Scaglione M, Leone MC, Mugavero M. The multiple roles of inositol in fertility and newborn outcomes. Acta Biomed 2022; 93:e2022344. [PMID: 36533741 PMCID: PMC9828912 DOI: 10.23750/abm.v93i6.13788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/16/2022] [Indexed: 01/21/2023]
Affiliation(s)
- Marco Scaglione
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences, University of Genoa, 16132 Genoa, Italy
| | - Maria Clara Leone
- Obstetrics and Gynaecology, Villa Sofia Cervello Hospital, University of Palermo, Palermo, Italy
| | - Marilena Mugavero
- Obstetrics and Gynaecology, Villa Sofia Cervello Hospital, University of Palermo, Palermo, Italy
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Solimene F, De Sanctis V, Maggio R, Malacrida M, Segreti L, Anselmino M, Schillaci V, Mantica M, Scaglione M, Dello Russo A, Cauti FM, Zingarini G, Pandozi C, Cavaiani M, Ferraro A, Maglia G, Stabile G. When local impedance meets contact force: preliminary experience from the CHARISMA registry. J Interv Card Electrophysiol 2022; 63:749-758. [PMID: 35322330 PMCID: PMC9151535 DOI: 10.1007/s10840-022-01163-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/16/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Highly localized impedance (LI) measurements during atrial fibrillation (AF) ablation have emerged as a viable real-time indicator of tissue characteristics and the consequent durability of the lesions created. We investigated the impact of catheter-tissue contact force (CF) on LI behavior during pulmonary vein isolation (PVI). METHODS Forty-five consecutive patients of the CHARISMA registry undergoing de novo AF radiofrequency (RF) catheter ablation with a novel open-irrigated-tip catheter endowed with CF and LI measurement capabilities (Stablepoint™ catheter, Boston Scientific) were included. RESULTS A total of 2895 point-by-point RF applications were analyzed (RF delivery time (DT) = 8.7±4s, CF = 13 ±±8 g, LI drop = 23 ±±7 Ω). All PVs were successfully isolated in an overall procedure time of 118 ±±34 min (fluoroscopy time = 13 ±±8 min). The magnitude of LI drop weakly correlated with CF (r = 0.13, 95% confidence interval (CI): 0.09 to 0.16, p < 0.0001), whereas both CF and LI drop inversely correlated with DT (r = -0.26, 95%CI: -0.29 to -0.22, p < 0.0001 for CF; r = -0.36, 95%CI: -0.39 to -0.33, p < 0.0001 for LI). For each 10 g of CF, LI drop markedly increased from 22.4 ± 7 Ω to 24.0 ± 8 Ω at 5 to 25 g CF intervals (5-14 g of CF vs 15-24 g of CF, p < 0.0001), whereas it showed smooth transition over 25 g (24.8 ± 7Ω at ≥ 25 g CF intervals, p = 0.0606 vs 15-24 g of CF). No major complications occurred during the procedures or within 30 days. CONCLUSIONS CF significantly affects LI drop and probable consequent lesion formation during RF PVI. The benefit of higher contact (> 25 g) between the catheter and the tissue appears to have less impact on LI drop. TRIAL REGISTRATION Catheter Ablation of Arrhythmias With High Density Mapping System in the Real World Practice (CHARISMA). URL: http://clinicaltrials.gov/ Identifier: NCT03793998.
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Affiliation(s)
| | - Valerio De Sanctis
- Department of Cardiac Electrophysiology and Pacing, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.
| | | | | | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Matteo Anselmino
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Massimo Mantica
- Department of Cardiac Electrophysiology and Pacing, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Ancona, Italy
| | - Filippo Maria Cauti
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli, Isola Tiberina, Rome, Italy
| | | | - Claudio Pandozi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | | | | | | | - Giuseppe Stabile
- Clinica Montevergine, Avellino, Mercogliano, Italy
- Anthea Hospital, Bari, Italy
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Del Chiaro A, Marchetti S, Parchi PD, Caprili G, Ipponi E, Scaglione M. Use of Statins and Hip Fracture Risk: a Case-Control Study. Acta Chir Orthop Traumatol Cech 2022; 89:104-107. [PMID: 35621399] [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: 06/15/2023]
Abstract
PURPOSE OF THE STUDY To evaluate a possible association between hip fracture and statin use. MATERIAL AND METHODS In this case-control study we compared the use of statins between two groups of 210 patients: the first group (case group) included patients hospitalized for hip fractures while the second group (control group) included patients who did not suffer femur bone injuries. The two groups were matched for age, sex, year of hospitalization and possible confounding factors. Inside the group of cases, we also evaluated the differences in terms of fracture type, presence of previous fragility fracture and mortality between statin users and non-users. RESULTS The use of statins was most common among patients without previous fractures (OR=0.54; 95% CI=0.33-0.89; p=0.0138), especially in older patients (OR=0.40; 95% CI=0.22-0.76). We did not find any significant difference in statin intake between men and women in the control group. In the case group, those who did not use statins were more likely to undergo a medial hip fracture (28.5% vs 16.1%). Patients from case group also presented a greater mortality (27.9% vs 19.35%) and an higher percentage of previous hip fractures (20.11% vs 9.7%). However, they didn't presented a significant higher rate of fragility fractures in other sites. DISCUSSION AND CONCLUSIONS Our study suggests a reduced hip fracture risk, especially in cases aged 80 or more, a different fracture pattern (lower percentage of medial fractures) and a reduced mortality at 9 months in patients treated with HMG-CoA reductase inhibitors, confirming the previous evidences reported in literature. Key words: statin, hip fractures, fracture risk, osteoporosis.
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Affiliation(s)
- A Del Chiaro
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - S Marchetti
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - P D Parchi
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - G Caprili
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - E Ipponi
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - M Scaglione
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
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Patti G, Malerba F, Calevo MG, Schiavone M, Scaglione M, Casalini E, Russo S, Fava D, Bassi M, Napoli F, Allegri AEM, D’Annunzio G, Gastaldi R, Maghnie M, Di Iorgi N. Pubertal timing in children with Silver Russell syndrome compared to those born small for gestational age. Front Endocrinol (Lausanne) 2022; 13:975511. [PMID: 36093089 PMCID: PMC9451521 DOI: 10.3389/fendo.2022.975511] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Data on pubertal timing in Silver Russell syndrome (SRS) are limited. DESIGN AND METHODS Retrospective observational study including twenty-three SRS patients [11p15 loss of methylation, (11p15 LOM, n=10) and maternal uniparental disomy of chromosome 7 (mUPD7, n=13)] and 21 small for gestational age (SGA). Clinical (thelarche in females; testis volume ≥ 4 ml in males; pubarche), BMI SD trend from the age of 5 to 9 years to the time of puberty, biochemical parameters of puberty onset [Luteinizing hormone (LH), 17-β-estradiol, testosterone], and bone age progression were evaluated. RESULTS Pubertal onset and pubarche occurred significantly earlier in children with SRS than in SGA (p 0.03 and p 0.001, respectively) and clinical signs of puberty onset occurred earlier in mUPD7 than in 11p15LOM group (p 0.003). Five SRS children experienced central precocious puberty and LH, 17-β-estradiol, testosterone were detected earlier in SRS than in SGA (p 0.01; p 0.0001). Bone age delay in SRS children was followed by rapid advancement; the delta between bone age and chronological age in SRS group became significantly higher than in SGA group at the age of 9-11 years (p 0.007). 11p15LOM patients were underweight at the age of 5 years and showed a progressive normalization of BMI that was significantly higher than in mUPD7 (p 0.04) and SGA groups (p 0.03) at puberty onset. CONCLUSION Timing of puberty is affected in SRS and occurred earlier in mUPD7 compared to 11p15LOM. The impact of early puberty on adult height and metabolic status deserves long-term evaluation.
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Affiliation(s)
- Giuseppa Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - University of Genova, Genova, Italy
- *Correspondence: Giuseppa Patti, ; Mohamad Maghnie, ;
| | - Federica Malerba
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - University of Genova, Genova, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Marco Scaglione
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - University of Genova, Genova, Italy
| | - Emilio Casalini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - University of Genova, Genova, Italy
| | - Silvia Russo
- Cytogenetic and Molecular Genetics Laboratory, IRCCS, Istituto Auxologico Italiano, Milano, Italy
| | - Daniela Fava
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - University of Genova, Genova, Italy
| | - Marta Bassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - University of Genova, Genova, Italy
| | - Flavia Napoli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | | | - Roberto Gastaldi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - University of Genova, Genova, Italy
- *Correspondence: Giuseppa Patti, ; Mohamad Maghnie, ;
| | - Natascia Di Iorgi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - University of Genova, Genova, Italy
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Toso E, Gagliardi M, Peyracchia M, Angelini F, Anselmino M, Ferraris F, Giustetto C, Scaglione M, Gaita F. Long-term efficacy and impact on quality of life of atrial fibrillation catheter ablation in competitive athletes. J Sports Med Phys Fitness 2021; 62:1266-1271. [PMID: 34931787 DOI: 10.23736/s0022-4707.21.13257-8] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Limited data are available on the efficacy of catheter ablation (CA) for sport-associated atrial fibrillation (AF), in particular at long term follow up. Moreover, the impact of AF CA on quality of life (QoL) in this population remains unknown. We aimed to determine AF CA efficacy in athletes, to assess the impact on athletes' QoL (with SF36 score) and on training capabilities in a long term follow up (FU). METHODS A total of 1215 AF patients' candidates to CA between January 2007 and December 2012, were retrospectively screened. Athletes were defined as patients performing ≥ 5h/week of vigorous sports, achieving a total of ≥1500 h lifetime sports activity, for at least one year before AF first symptomatic episode. RESULTS Out of 1215 AF patients, 133 were considered competitive athletes and underwent to CA. Overall, 43% of our cohort showed typical or atypical atrial flutter, which required a more extensive ablation procedure. Before AF, athletes used to practice for a mean of 8.5±2.7 h/week, while after the first AF episode the mean practice duration decreased to 2.82.5 h/week. At 10-year follow up, 83% of athletes did not present any recurrent event, and training capabilities increased up to 5.6±3.6 h/week after the procedure. Moreover, intense physical activity before AF CA was related to longterm AF recurrence rates (P = 0.05). QoL scores significantly improved in each single domains (P < 0.05). CONCLUSIONS AF CA represents an effective procedure to maintain sinus rhythm in athletes, with a significant improvement in QoL.
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Affiliation(s)
- Elisabetta Toso
- Cardiology Division, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy - .,Cardiology Consultant at Juventus Football Club, Turin, Italy -
| | - Marco Gagliardi
- Cardiology Division, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Mattia Peyracchia
- Cardiology Division, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Filippo Angelini
- Cardiology Division, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Matteo Anselmino
- Cardiology Division, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Federico Ferraris
- Cardiology Division, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Carla Giustetto
- Cardiology Division, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Marco Scaglione
- Cardiology Division, Cardinal Massaia Hospital of Asti, Asti, Italy
| | - Fiorenzo Gaita
- Cardiology Division, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.,Cardiology Consultant at Juventus Football Club, Turin, Italy
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Carini F, Margherita Mazzola, Gagliardo C, Scaglione M, Giammanco M, Tomasello G. Inflammatory bowel disease and infertility: analysis of literature and future perspectives. Acta Biomed 2021; 92:e2021264. [PMID: 34738579 PMCID: PMC8689300 DOI: 10.23750/abm.v92i5.11100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND inflammatory bowel diseases (IBD) are chronic disorders that affect the gastrointestinal tract but which also present extraintestinal manifestations. One of the problems related to IBD is the presence of both female and male infertility. AIM determine the correlation between IBD and male and female infertility by analyzing the literature. MATERIAL AND METHODS Studies carried out in the last twenty years have been selected through the pubmed search engine. Only studies were selected that in their conclusions showed a real correlation between IBD and infertility. RESULTS the first cause of infertility in both sexes is related to the surgical interventions that patients have to face during the course of the disease, but there are also psychological causes or causes related to the use of drugs used for therapy. CONCLUSIONS further studies are needed to understand what are the real mechanisms underlying infertility in subjects suffering from IBD.
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Anselmino M, Ballatore A, Giaccardi M, Agresta A, Chieffo E, Floris R, Racheli M, Scaglione M, Casella M, Maines M, Marini M, De Ferrari GM, De Ponti R, Del Greco M. X-ray management in electrophysiology: a survey of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC). J Cardiovasc Med (Hagerstown) 2021; 22:751-758. [PMID: 34009182 DOI: 10.2459/jcm.0000000000001210] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Radiation use in medicine has significantly increased over the last decade, and cardiologists are among the specialists most responsible for X-ray exposure. The present study investigates a broad range of aspects, from specific European Union directives to general practical principles, related to radiation management among a national cohort of cardiologists. METHODS AND RESULTS A voluntary 31-question survey was run on the Italian Arrhythmology and Pacing Society (AIAC) website. From June 2019 to January 2020, 125 cardiologists, routinely performing interventional electrophysiology, participated in the survey. Eighty-seven (70.2%) participants are aware of the recent European Directive (Euratom 2013/59), although only 35 (28.2%) declare to have read the document in detail. Ninety-six (77.4%) participants register the dose delivered to the patient in each procedure, in 66.1% of the cases both as fluoroscopy time and dose area product. Years of exposition (P = 0.009) and working in centers performing pediatric procedures (P = 0.021) related to greater degree of X-ray equipment optimization. The majority of participants (72, 58.1%) did not recently attend radioprotection courses. The latter is related to increased awareness of techniques to reduce radiation exposure (96% vs. 81%, P = 0.022), registration of the delivered dose in each procedure (92% vs. 67%, P = 0.009), and X-ray equipment optimization (50% vs. 36%, P = 0.006). CONCLUSION Italian interventional cardiologists show an acceptable level of radiation awareness and knowledge of updated European directives. However, there is clear space for improvement. Comparison to other health professionals, both at national and international levels, is needed to pursue proper X-ray management and protect public health.
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Affiliation(s)
- Matteo Anselmino
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin
| | - Andrea Ballatore
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin
| | - Marzia Giaccardi
- Cardiology and Electrophysiology Unit, Department of Medicine, 'Santa Maria Nuova' Hospital, Florence
| | | | | | - Roberto Floris
- Ospedale di Nostra Signora di Bonaria, San Gavino Monreale
| | | | - Marco Scaglione
- Division of Cardiology, 'Cardinal Massaia' Hospital, Asti, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital, Ancona
| | | | | | - Gaetano Maria De Ferrari
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo-University of Insubria, Varese, Italy
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Viola G, Stabile G, Bandino S, Rossi L, Marrazzo N, Pecora D, Bottoni N, Solimene F, Schillaci V, Scaglione M, Ocello S, Baiocchi C, Santoro A, Donzelli S, De Ruvo E, Lavalle C, Sanchez-Gomez JM, Pastor JFA, Grandio PC, Ferraris F, Castro A, Rebellato L, Marchese P, Adao L, Primo J, Barra S, Casu G. Safety, efficacy, and reproducibility of cavotricuspid isthmus ablation guided by the ablation index: acute results of the FLAI study. Europace 2021; 23:264-270. [PMID: 33212484 DOI: 10.1093/europace/euaa215] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/06/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Ablation index (AI) is a marker of lesion quality during catheter ablation that incorporates contact force, time, and power in a weighted formula. This index was originally developed for pulmonary vein isolation as well as other left atrial procedures. The aim of our study is to evaluate the feasibility and efficacy of the AI for the ablation of the cavotricuspid isthmus (CTI) in patients presenting with typical atrial flutter (AFL). METHODS AND RESULTS This prospective multicentre non-randomized study enrolled 412 consecutive patients with typical AFL undergoing AI-guided cavotricuspid isthmus ablation. The procedure was performed targeting an AI of 500 and an inter-lesion distance measurement of ≤6 mm. The primary endpoints were CTI 'first-pass' block and persistent block after a 20-min waiting time. Secondary endpoints included procedural and radiofrequency duration and fluoroscopic time. A total of 412 consecutive patients were enrolled in 31 centres (mean age 64.9 ± 9.8; 72.1% males and 27.7% with structural heart disease). The CTI bidirectional 'first-pass' block was reached in 355 patients (88.3%), whereas CTI block at the end of the waiting time was achieved in 405 patients (98.3%). Mean procedural, radiofrequency, and fluoroscopic time were 56.5 ± 28.1, 7.8 ± 4.8, and 1.9 ± 4.8 min, respectively. There were no major procedural complications. There was no significant inter-operator variability in the ability to achieve any of the primary endpoints. CONCLUSION AI-guided ablation with an inter-lesion distance ≤6 mm represents an effective, safe, and highly reproducible strategy to achieve bidirectional block in the treatment of typical AFL.
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Affiliation(s)
- Graziana Viola
- San Francesco Hospital, Via Mannironi 1, 08100 Nuoro, Italy
| | | | | | - Luca Rossi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - Domenico Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Joao Primo
- Hospital da Luz Arrabida, Vila Nova de Gaia, Portugal
| | - Sergio Barra
- Hospital da Luz Arrabida, Vila Nova de Gaia, Portugal.,Royal Papworth Hospital NHS Trust, Cambridge, UK
| | - Gavino Casu
- San Francesco Hospital, Via Mannironi 1, 08100 Nuoro, Italy.,Department of Biomedical Science, University of Sassari, Sassari, Italy
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41
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Scaglione M, Battaglia A, Lamanna A, Cerrato N, Di Donna P, Bertagnin E, Muro M, Alberto Caruzzo C, Gagliardi M, Caponi D. Adjunctive hypnotic communication for analgosedation in subcutaneous implantable cardioverter defibrillator implantation. A prospective single center pilot study. Int J Cardiol Heart Vasc 2021; 35:100839. [PMID: 34307829 PMCID: PMC8287220 DOI: 10.1016/j.ijcha.2021.100839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/18/2021] [Accepted: 06/30/2021] [Indexed: 11/04/2022]
Abstract
Background Subcutaneous implantable cardioverter defibrillator (S-ICD) is a well-established therapy for sudden death prevention. Considering the painful nature of the procedure anaesthesia may be required for analgo-sedation. Hypnosis is emerging as a promising therapeutic strategy for pain control. Few data are available regarding the use of hypnosis as adjunctive technique for pain control during S-ICD implantation. Methods Thirty consecutive patients referred to our centre for S-ICD implantation were prospectively and alternatively allocated with 1:1 ratio in two groups: A) Standard analgo-sedation approach (Hypnosis non responder patients) B) Standard analgo-sedation approach with the addition of hypnotic communication (Hypnosis responder patients). Peri-procedural pain perception and anxiety, perceived procedural length, type and dosage of administered analgesic drugs have been measured using validate scores and compared. Results Hypnotic communication was offered to 15 patients of which was successful in 11 patients (73%). There were no statistical differences between the two study groups according to baseline characteristics. Hypnosis communication resulted in significant pain perception reduction (Group A 6,9 ± 1,6 Vs Group B 1,1 ± 0,9, p value < 0,01), peri-procedural anxiety (Group A 3,5 ± 1,6 Vs Group B 1,9 ± 0,5, p value < 0,01) and reduced perceived procedural length (Group A 58,7 ± 13,4 min Vs Group B 44,7 ± 5,5 min, p value < 0,01). Fentanyl dosage was significantly lower in Group B patients. Conclusions Our results demonstrated a significant reduction of perceived pain, anxiety, procedural time and use of analgesic drugs in hypnosis responder patients. These results reinforce the beneficial effects of the hypnotic technique in patients undergoing S-ICD implantation.
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Affiliation(s)
- Marco Scaglione
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
| | | | - Andrea Lamanna
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
| | - Natascia Cerrato
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
| | - Paolo Di Donna
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
| | - Enrico Bertagnin
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
| | - Milena Muro
- Pain Therapy and Palliative Care, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Italy
| | | | - Marco Gagliardi
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
| | - Domenico Caponi
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
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42
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Segreti L, De Simone A, Schillaci V, Pandozi C, Bongiorni MG, Stabile G, Arestia A, Giannotti Santoro M, Pelargonio G, Scaglione M, Rossi P, Pecora D, Stocco C, Malacrida M, Solimene F. Early rhythm-control ablation therapy in preventing AF recurrences: insight from the CHARISMA Registry. Europace 2021. [DOI: 10.1093/europace/euab116.192] [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] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
An early and comprehensive rhythm-control therapy emerges as a need to treat AF in an effective way and to improve the ablation outcomes, in terms of arrhythmia-free survival.
Purpose
We aimed to investigate the importance of timing of ablation in preventing AF recurrences.
Methods
153 consecutive patients (pts) undergoing AF ablation from the CHARISMA registry at 8 Italian centres were included. Ablations were guided by a novel radiofrequency ablation catheter with local impedance (LI)-sensing capability through a dedicated algorithm (DirectSense, Boston Scientific). Pts were grouped as early treated (ET) if the procedure was performed within 1 year after the first AF episode and as delayed treated (DT) if admitted for ablation after more than 1 year. The ablation endpoint was PVI as assessed by entrance and exit block. Post-ablation follow-up was scheduled at 3, 6 and 12 months. AF and atrial tachycardia (AT) recurrences were considered as long-term endpoint.
Results
Of the 153 pts enrolled (69.9% male, 59 ± 10 years, 61.4% paroxysmal AF, 38.6% persistent AF), 123 (80.4%) met Class I indications, 23 (15%) Class IIa indications and 7 (4.6%) Class IIb indications according to current ESC AF guidelines. The mean time to ablation procedure from the first AF episode was 1034 ± 1483 days. Eighty pts (52.3%) were included in ET group, whereas 73 pts (47.7%) in DT group. No differences were found between AF type in terms of ablation strategy (53.3% of the cases -52 out 94- were classified as ET for paroxysmal AF vs 47.5% of the cases -28 out 59- were ET for persistent AF, p = 0.4346). At the end of the procedures, all PVs had been successfully isolated in all study pts. During a mean follow-up of 366 ± 130 days, 18 pts (11.8%) suffered an AF/AT recurrence after the 90-day blanking period. Recurrences occurred mostly in the DT group compared to the ET one (13 out 73 -17.8%- vs 5 out 80 -6.3%-, p = 0.042) and the time to AT/AF recurrence was longer in the ET group (HR = 0.2876, 95%CI: 0.1029 to 0.8038; p = 0.0181). On multivariate logistic analysis adjusted for baseline confounders, only hypertension (HR = 4.66, 95%CI: 1.5 to 14.48, p = 0.0081) was independently associated with recurrences. An early rhythm-control therapy was associated with a low risk of recurrences beyond the hypertension risk factor, ranging from 2% (no hypertension and an ET ablation therapy) to 30.3% (with hypertension and a DT procedure) (Figure 1).
Conclusion
A LI-guided ablation strategy for PVI proved to be safe and effective and resulted in a very high recurrence-free rate. An early rhythm-control therapy in the absence of common risk factors was associated with the lowest rate of recurrences. Abstract Figure. AT/AF Recurrence
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Affiliation(s)
- L Segreti
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - V Schillaci
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - C Pandozi
- San Filippo Neri Hospital, Rome, Italy
| | - MG Bongiorni
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - G Stabile
- Casa di cura San Michele, Maddaloni, Italy
| | - A Arestia
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | | | - G Pelargonio
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - P Rossi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - C Stocco
- Boston Scientific Italy, Milan, Italy
| | | | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
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Scaglione M, Calvanese R, Pandozi C, Pedretti S, Rossi L, Pelargonio G, Mantovan R, Solimene F, Canciello M, Fonte G, Biagi A, Caponi D, Cerrato N, Malacrida M, Battaglia A. Impact of channels identification and ablation in ventricular tachycardia patients through high-density mapping: preliminary experience from an Italian registry. Europace 2021. [DOI: 10.1093/europace/euab116.352] [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] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Ventricular tachycardia (VT) ablation techniques in ischemic cardiomyopathy have evolved during the recent years. However, the long-term success rate remains disappointing. A technique based on channel identification and ablation through a novel automated algorithm may limit the extent of ablation needed and possibly lead to higher successful rate.
Purpose
To report preliminary data on feasibility and safety of a channel identification approach and to characterize late potentials (LPs) features using an ultra-high density mapping system with a novel analysis tool in ischemic VT procedures.
Methods
Consecutive patients (pts) indicated for ischemic VT ablation were enrolled in the CHARISMA study. A complete map of the left ventricle was performed prior and after ablation through the Rhythmia mapping system. For our purpose channels were defined as any signal activity bounded by anatomic and functional barriers and characterized through a novel map analysis tool (Lumipoint-LM-) that automatically identifies fragmented late potentials (LPs) and continuous activation was used on the whole ventricular substrate. Procedural endpoint was the elimination of all identified conducting channels (CCs) by ablation at the CC entrance and exit followed by abolition of any residual LPs inside the CC. The ablation endpoint was noninducibility.
Results
A total of 18 channels were identified through LM from 14 pts: 71.4% of the pts had 1 CC, 28.6% had 2 CCs. In the majority of the cases LPs where identified only inside CCs (57.1%), whereas in 6 cases (42.9%) LPs were present both inside and outside. The mean conduction time inside CCs was 50.3 ± 30ms, the mean CC length was 32.6 ± 17mm and the conduction velocity was 0.8 ± 0.5 mm/ms. LPs covered a mean area of 7.0 ± 5mm2 (ratio between LPs area and CCs’ area = 52.4 ± 33.7%). At voltage map analysis 1 CC was present in 78.6% of the cases (2 CCs in 21.4%). LPs were identified only inside CCs in 42.9% of the cases, both inside and outside in 50% and only outside in 7.1%. Healthy tissue (voltage level≥0.5mV) was prevalent (61.2 ± 13.8%), followed by intermediate voltage areas (0.5-0.05mV; 37.5 ± 13.7%) and very low voltage areas (<0.05mV; 1.2 ± 2%). LPs were found mostly at intermediate voltage areas (54.1 ± 31.7% of the covered area; 39.1 ± 28.4% at healthy tissue and 6.8 ± 17.8% at very low voltage areas). Agreement in CCs identification between advanced analysis through LM and voltage map was fair (9/14 with complete agreement). In 3 cases voltage map overestimated LPs areas, in 2 cases failed to fully identify LPs. All CCs’ entrance and exit were successfully ablated and abolition of any residual LPs inside the CC was achieved in all pts. No complication occurred. Noninducibility was achieved in all the cases.
Conclusions
In our preliminary experience, a new channel identification approach through the advanced Lumipoint algorithm seems to be safe, feasible and effective at least in the acute setting of ischemic VT ablation.
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Affiliation(s)
| | | | - C Pandozi
- San Filippo Neri Hospital, Rome, Italy
| | | | - L Rossi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - G Pelargonio
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - R Mantovan
- Conegliano General Hospital, Conegliano, Italy
| | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | | | - G Fonte
- Sant"Anna Hospital, Como, Italy
| | - A Biagi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - D Caponi
- Cardinal Massaia Hospital, Asti, Italy
| | - N Cerrato
- Cardinal Massaia Hospital, Asti, Italy
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Ziacchi M, Capucci A, Tola G, Scaglione M, D"onofrio A, Guerra F, Scalone A, Battaglia A, D"alterio G, Biffi M. Wearable Cardioverter Defibrillator (WCD) in Italy: results from the nationwide multicenter registry WEAR-ITA. Europace 2021. [DOI: 10.1093/europace/euab116.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
The Wearable Cardioverter Defibrillators (WCD) has been used extensively in Italy since 2015, following long years of experience in other countries. This technology provides temporary protection from Sudden Cardiac Death (SCD) for patients with an evolving risk profile that may not yet be eligible for an Implantable Cardioverter Defibrillator (ICD). Collecting national data on use of the device can help build a picture that will enable an understanding on how to use the WCD appropriately in the future.
PURPOSE
Our purpose has been to investigate WCD usage on a nationwide level. This is in terms of target population, average wear time, patient compliance, diagnosed and treated arrhythmic events and patient outcome once they stopped wearing the device.
METHODS
WEAR-ITA is a nationwide, multi-centre retrospective observational project. Patient data was retrospectively collected from the Italian hospitals that agreed to take part in the data collection for all patients fitted with a WCD between April 2015 to May 2018. All data refers to the range from the first day of wear until the end of use.
RESULTS
We collected data for 411 patients from 15 (75%) Italian regions. WCD use among the different regions was heterogeneous with a median of 0.5 (0.2-1.2) WCD wore/105 inhabitants. The mean age of the population was 55(±14) and the majority of patients were male (79%). Main WCD indication was non-ischemic cardiomyopathy with reduced ejection fraction (51%), ischemic etiology with severe systolic dysfunction (31%), uncertain or unidentified diagnosis (10%) that then revealed to be predominantly channelopathies or myocarditis and after ICD extraction (8%). Patients wore the WCD for a median of 59 (33-90) days and the median daily weartime was 23 (22,7-23,8) hours. In 15 patients (4%), the WCD recorded non sustained ventricular tachycardia (VT), 10 patients (2%) had hemodynamically well-tolerated sustained VT not needing a shock. 8 patients (2%) received effective appropriate shocks. Time to episodes were respectively 61 (14-61) days for non-sustained VT and 28 (19-70) days for VT/VF. 2 patients (0.5%) received inappropriate shocks for sinus tachycardia and atrial fibrillation (AF) respectively. WCD recorded new onset of supra ventricular tachycardia episodes in 12 patients (3%) and of atrial fibrillation (AF) in 7 patients (2%). 7 patients (2%) died while wearing WCD; none of them from SCD. At the end of the WCD use, 195 patients (47%) did not receive an ICD while 209 patients (51%)were implanted.
CONCLUSIONS
WCD is an effective therapy for the treatment of SCD with a very low complication rates. The indication and penetration in Italy is quite heterogeneous. The patient’s compliance is high over time. The incidence of appropriate shock is not negligible; only half of patients, who wore WCD, received an ICD. There is however still a requirement to conduct further randomized trials to understand which patients could most benefit from the use of WCD. Abstract Figure. Wereable Cardioverter Defibrillator
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Affiliation(s)
- M Ziacchi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Capucci
- Marche Polytechnic University of Ancona, Cardiology and Arrhythmology Clinic, University Hospital Umberto, Lancisi, Salesi, Ancona, Italy
| | - G Tola
- AO Brotzu Hospital, Division of Cardiology, Cagliari, Italy
| | - M Scaglione
- Cardinal Massaia Hospital, Division of Cardiology, Asti, Italy
| | - A D"onofrio
- Ospedale Monaldi, Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Naples, Italy
| | - F Guerra
- Marche Polytechnic University of Ancona, Cardiology and Arrhythmology Clinic, University Hospital Umberto, Lancisi, Salesi, Ancona, Italy
| | - A Scalone
- AO Brotzu Hospital, Division of Cardiology, Cagliari, Italy
| | - A Battaglia
- Cardinal Massaia Hospital, Division of Cardiology, Asti, Italy
| | - G D"alterio
- Ospedale Monaldi, Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Naples, Italy
| | - M Biffi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
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45
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La Greca C, Cauti FM, Piro A, Di Belardino N, Anselmino M, Scaglione M, Pecora D, Rossi L, Di Cori A, Tola G, Pedretti S, Mantovan R, Solimene F, Rossi P, Bianchi S. Minimal fluoroscopic approaches and factors associated with radiation dose when high-definition mapping is used for supraventricular tachycardia ablation: insight from the CHARISMA registry. Europace 2021. [DOI: 10.1093/europace/euab116.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Limited data exist on factors associated with radiation exposure during ablation procedures when a high definition mapping technology is used.
Purpose
To report factors associated with radiation exposure and data on feasibility and safety of a minimal fluoroscopic approach using the Rhythmia mapping system in supraventricular tachycardia (SVT) ablation procedures.
Methods
Consecutive patients indicated for arrhythmia ablation were enrolled in the CHARISMA study at 12 centers. We included in this analysis consecutive right-side procedures performed through a minimal fluoroscopy approach with the Rhythmia mapping system were analyzed. A 3D geometry of chambers of interest was reconstructed on the basis of the electroanatomic information taken from the mapping system. Fluoroscopy was used only if deemed necessary. The effective dose (ED) was calculated using accepted formula. For our purpose high dose exposure was defined as an ED greater than the median value of ED of the population exposed to radiation.
Results
This analysis included 325 patients (mean age = 56 ± 17 years, 57% male) undergoing SVT procedures (152 AVNRT, 116 AFL, 41 AP and 16 AT). During the study, 27481 seconds of fluoroscopy was used (84.6 ± 224 seconds per procedure), resulting in a mean equivalent ED of 1.1 ± 3.7 mSv per patient. The mean reconstructed RA volume was 99 ± 54 ml in a mean mapping time of 12.2 ± 7 min. The mean number of radiofrequency ablations (RFC) to terminate each arrhythmia was 9.4 ± 9 (mean RFC delivery time equal to 6.7 ± 6 min). 192 procedures (59.1%) were completed without any use of fluoroscopy; during the remaining 133 procedures (39.9%), 206.6 ± 313.4 seconds of fluoroscopy was used (median ED = 1.2 mSv). In a minority of the cases (n = 25, 7.7%) the fluoroscopy time was higher than 5 minutes (median ED = 6.5 mSv), whereas radiologic exposure time greater than 1 minute occurred in ninety cases (27.7%, median ED = 2.1 mSv). On multivariate logistic analysis adjusted for baseline confounders the RFC application time (OR = 1.0014, 95%CI: 1.0007 to 1.0022; p = 0.0001) was independently associated to an ED greater than 1.2 mSv, whereas female gender had an inverse association (0.54, 0.29 to 0.98; p = 0.0435). Acute success was reached in 97.8% of the cases. During a mean of 290.7 ± 169.6 days follow-up, no major adverse events related to the procedure were reported. Overall, the recurrence rate of the primary arrhythmia during follow-up was 2.5%.
Conclusions
In our experience, arrhythmias ablation through minimal fluoroscopy approach with the use of a novel ablation technology is safe, feasible, and effective in common right atrial arrhythmias. High-dose exposure occurred in a very limited number of cases, without any reduction of the safety and acute and long-term effectiveness profile.
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Affiliation(s)
- C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Cardiology, Brescia, Italy
| | - FM Cauti
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - A Piro
- Umberto I Polyclinic of Rome, Rome, Italy
| | | | | | | | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Cardiology, Brescia, Italy
| | - L Rossi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - A Di Cori
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - G Tola
- AO Brotzu Hospital, Cagliari, Italy
| | | | - R Mantovan
- Conegliano General Hospital, Conegliano, Italy
| | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - P Rossi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - S Bianchi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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46
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Solimene F, Giannotti Santoro M, De Simone A, Malacrida M, Stabile G, Pandozi C, Pelargonio G, Cauti FM, Scaglione M, Pecora D, Bongiorni MG, Arestia A, Grimaldi G, Russo M, Narducci ML, Segreti L. Pulmonary vein isolation in atrial fibrillation patients guided by a novel local impedance algorithm: 1-year outcome from the CHARISMA study. J Cardiovasc Electrophysiol 2021; 32:1540-1548. [PMID: 33851484 DOI: 10.1111/jce.15041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Highly localized impedance (LI) measurements during atrial fibrillation (AF) ablation have recently emerged as a viable real-time indicator of tissue characteristics and durability of the lesions created. We report the outcomes of acute and long-term clinical evaluation of the new DirectSense algorithm in AF ablation. METHODS Consecutive patients undergoing AF ablation were included in the CHARISMA registry. RF delivery was guided by the DirectSense algorithm, which records the magnitude and time-course of the impedance drop. The ablation endpoint was pulmonary vein isolation (PVI), as assessed by the entrance and exit block. RESULTS 3556 point-by-point first-pass RF applications of >10 s duration were analyzed in 153 patients (mean age=59 ± 10 years, 70% men, 61% paroxysmal AF, 39% persistent AF). The mean baseline LI was 105 ± 15 Ω before ablation and 92 ± 12 Ω after ablation (p < .0001). Both absolute drops in LI and the time to LI drop (LI drop/τ) were greater at successful ablation sites (n = 3122, 88%) than at ineffective ablation sites (n = 434, 12%) (14 ± 8 Ω vs 6 ± 4 Ω, p < .0001 for LI; 0.73 [0.41-1.25] Ω/s vs. 0.35[0.22-0.59 Ω/s, p < .0001 for LI drop/τ). No major complications occurred during or after the procedures. All PVs had been successfully isolated. During a mean follow-up of 366 ± 130 days, 18 patients (11.8%) suffered an AF/atrial tachycardia recurrence after the 90-day blanking period. CONCLUSION The magnitude and time-course of the LI drop during RF delivery were associated with effective lesion formation. This ablation strategy for PVI guided by LI technology proved safe and effective and resulted in a very low rate of AF recurrence over 1-year follow-up.
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Affiliation(s)
- Francesco Solimene
- Department of Electrophysiology, Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Mario Giannotti Santoro
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Antonio De Simone
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | | | - Giuseppe Stabile
- Department of Electrophysiology, Clinica Montevergine, Mercogliano, Avellino, Italy.,Department of Electrophysiology, Anthea Hospital, Bari, Italy
| | - Claudio Pandozi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Gemma Pelargonio
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Filippo Maria Cauti
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli, Isola Tiberina, Rome, Italy
| | - Marco Scaglione
- Department of Electrophysiology, Cardinal Massaia Hospital, Asti, Italy
| | - Domenico Pecora
- Electrophysiology Unit, Cardiovascular Department, Poliambulanza Institute Hospital Foundation, Brescia, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alberto Arestia
- Department of Electrophysiology, Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Gabriella Grimaldi
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Maurizio Russo
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Maria Lucia Narducci
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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47
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Lepillier A, Strisciuglio T, De Ruvo E, Scaglione M, Anselmino M, Sebag FA, Pecora D, Gallagher MM, Rillo M, Viola G, Pisanò E, Abbey S, Lamberti F, Pani A, Zucchelli G, Sgarito G, De Simone A, Bertaglia E, Solimene F, Stabile G. Impact of ablation index settings on pulmonary vein reconnection. J Interv Card Electrophysiol 2021; 63:133-142. [PMID: 33570717 DOI: 10.1007/s10840-021-00944-w] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Ablation index (AI) is a radiofrequency lesion quality marker. The AI value that allows effective and safe pulmonary vein isolation (PVI) is still debated. We evaluated the incidence of acute and late PV reconnection (PVR) with different AI settings and its predictors. METHODS The Ablation Index Registry is a multicenter study that included patients with paroxysmal/persistent atrial fibrillation (AF) who underwent first-time ablation. Each operator performed the ablation using his preferred ablation catheter (ThermoCool® SmartTouch or Surround Flow) and AI setting (380 posterior-500 anterior and 330 posterior-450 anterior). We divided the study population into two groups according to the AI setting used: group 1 (330-450) and group 2 (380-500). Incidence of acute PVR was validated within 30 min after PVI, whereas the incidence of late PVR was evaluated at repeat procedure. RESULTS Overall, 490 patients were divided into groups 1 (258) and 2 (232). There was no significant difference in the procedural time, fluoroscopy time, and rate of the first-pass PVI between the two study groups. Acute PVR was observed in 5.6% PVs. The rate of acute PVR was slightly higher in group 2 (64/943, 6.8%, PVs) than in group 1 (48/1045, 4.6% PVs, p = 0.04). Thirty patients (6%) underwent a repeat procedure and late PVR was observed in 57/116 (49%) PVs (number of reconnected PV per patient of 1.9 ± 1.6). A similar rate of late PVR was found in the two study groups. No predictors of acute and late PVR were found. CONCLUSION Ablation with a lower range of AI is highly effective and is not associated with a higher rate of acute and late PVR. No predictors of PV reconnection were found.
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Affiliation(s)
- A Lepillier
- Centre Cardiologique du Nord, St Denis, Paris, France
| | - T Strisciuglio
- Clinica Montevergine, Mercogliano, Avellino, Italy.,University of Naples Federico II, Naples, Italy
| | | | | | - M Anselmino
- A.O.U. Citta della Salute e della Scienza di Torino, Department of Medical Sciences, University of Turin, Turin, Italy
| | - F A Sebag
- Institut Mutualiste Montsouris, Paris, France
| | - D Pecora
- Fondazione Poliambulanza, Brescia, Italy
| | | | - M Rillo
- Casa di Cura Villa Verde, Taranto, Italy
| | - G Viola
- Ospedale San Francesco, Nuoro, Italy
| | - E Pisanò
- Ospedale Vito Fazzi, Lecce, Italy
| | - S Abbey
- Hôpital Privé Du Confluent (HPCN), Nantes, France
| | | | - A Pani
- Ospedale di Lecco, Lecco, Italy
| | | | - G Sgarito
- A.R.N.A.S. Civico Cristina Benfratelli, Palermo, Italy
| | - A De Simone
- Clinica San Michele, via Montella 16, 81024, Maddaloni, Caserta, Italy
| | - E Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - F Solimene
- Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Giuseppe Stabile
- Clinica Montevergine, Mercogliano, Avellino, Italy. .,Clinica San Michele, via Montella 16, 81024, Maddaloni, Caserta, Italy. .,Anthea Hospital, Bari, Italy.
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48
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Castagno D, Di Donna P, Olivotto I, Frontera A, Calò L, Scaglione M, Arretini A, Anselmino M, Giustetto C, De Ferrari GM, Cecchi F, Haissaguerre M, Gaita F. Transcatheter ablation for atrial fibrillation in patients with hypertrophic cardiomyopathy: Long-term results and clinical outcomes. J Cardiovasc Electrophysiol 2021; 32:657-666. [PMID: 33428271 DOI: 10.1111/jce.14880] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/01/2020] [Accepted: 12/05/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Radiofrequency transcatheter ablation (RFCA) for atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM) has been proven feasible. However, the long-term results of RFCA and its impact on clinical course of HCM are unknown. The aim of this study was to analyse clinical outcomes and long-term efficacy of RFCA in a multicentre cohort of patients with HCM and concomitant AF. METHODS Patients with HCM and AF consecutively undergoing RFCA were included. Ablation failure was defined as recurrence of AF, atrial tachycardia, or flutter lasting more than 3 min and occurring after the blanking period. RESULTS Overall, 116 patients with symptomatic AF refractory to antiarrhythmic drugs were included. Over a median follow-up of 6.0 years (interquartile range: 3.0-8.9 years) recurrence rate after a single RFCA was 32.3 per 100 patient/years with 26% of patients free from AF relapses at 6-year follow-up. Among patients experiencing AF recurrence, 51 (66%) underwent at least one redo-procedure. The overall recurrence rate considering redo-procedures was 12.6 per 100 patients/years with 53% of patients free from AF relapses at 6 years. At last follow-up, with an average of 1.6 procedures, 67 (61%) patients were in sinus rhythm (SR). Patients remaining in SR showed better functional status compared with those experiencing arrhythmic recurrences (NYHA Class 1.6 ± 0.1 vs. 2.0 ± 0.1, p = .009). CONCLUSIONS RFCA of AF in HCM patients is an effective and safe strategy favoring long-term SR maintenance, reduction of atrial arrhythmic events, and improved functional status. However, most patients need repeat procedures and continuation of antiarrhythmic drugs.
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Affiliation(s)
- Davide Castagno
- Division of Cardiology, Department of Medical Sciences, "Città della Salute della Scienza" Hospital, University of Turin, Turin, Italy
| | - Paolo Di Donna
- Division of Cardiology, Department of Internal Medicine, Cardinal Massaia Hospital, Asti, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Antonio Frontera
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University, Bordeaux, France.,University Hospital (CHU), Pessac-Bordeaux, France
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, ASL Rome B, Rome, Italy
| | - Marco Scaglione
- Division of Cardiology, Department of Internal Medicine, Cardinal Massaia Hospital, Asti, Italy
| | - Anna Arretini
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, "Città della Salute della Scienza" Hospital, University of Turin, Turin, Italy
| | - Carla Giustetto
- Division of Cardiology, Department of Medical Sciences, "Città della Salute della Scienza" Hospital, University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, "Città della Salute della Scienza" Hospital, University of Turin, Turin, Italy
| | - Franco Cecchi
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Michel Haissaguerre
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University, Bordeaux, France.,University Hospital (CHU), Pessac-Bordeaux, France
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, "Città della Salute della Scienza" Hospital, University of Turin, Turin, Italy
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49
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Lepillier A, Solimene F, De Ruvo E, Scaglione M, Anselmino M, Sebag F, Pecora D, Gallagher M, Rillo M, Stabile G. Reproducibility of pulmonary vein isolation guided by the ablation index: One-year outcome of the AIR registry. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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50
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Ghaleb R, Anselmino M, Gaido L, Quaranta S, Giustetto C, Salama MK, Salh A, Scaglione M, Fathy E, Gaita F. Prevalence and Clinical Significance of Latent Brugada Syndrome in Atrial Fibrillation Patients Below 45 Years of Age. Front Cardiovasc Med 2020; 7:602536. [PMID: 33330665 PMCID: PMC7710870 DOI: 10.3389/fcvm.2020.602536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022] Open
Abstract
Aim: This study aims to describe prevalence and clinical significance of latent Brugada syndrome (BrS) in a young population with atrial fibrillation (AF). Methods: Between September 2015 and November 2017, among 111 AF patients below 45 years of age, those without pre-existing pathologies and/or known risk factors were selected for the study. Based on baseline 12-lead−24-h Holter electrocardiogram (ECG), previous class 1C antiarrhythmic drug therapy, or ajmaline testing, patients were stratified as latent type 1 BrS or not. Results: Within the 78 enrolled patients, 13 (16.7%; group 1) revealed a type 1 BrS ECG pattern, while 65 (83.3%; group 2) did not. Mean age was 37 ± 8 vs. 35 ± 7 (p = 0.42), and males were 7 (54%) vs. 54 (83%) (p = 0.02) in the two groups, respectively. Family history of BrS was significantly more common within group 1 patients (2, 15% vs. 0; p = 0.03), and 4 (31%) patients experienced syncope in group 1 vs. 5 (8%) in group 2 (p = 0.02). After a mean follow-up of 42 ± 18 months from the index AF event, more than 80% of the patients, in both study groups, were in sinus rhythm. Conclusion: In young patients with AF without pre-existing pathologies and/or known risk factors, latent BrS should be suspected. Syncope and a family history of BrS emerge as easily identifiable factors related to BrS. Long-term sinus rhythm maintenance appears satisfactory, either in the presence or not of BrS.
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Affiliation(s)
- Ramadan Ghaleb
- Department of Cardiovascular Medicine, Aswan University Hospital, Aswan, Egypt
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
| | - Luca Gaido
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
| | - Stefano Quaranta
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
| | - Carla Giustetto
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
- *Correspondence: Carla Giustetto
| | - Mohammed Kamal Salama
- Department of Cardiovascular Medicine, Kafr El-Sheikh University Hospital, Kafr El-Sheikh, Egypt
| | - Ayman Salh
- Department of Cardiovascular Medicine, Ain Shams University Hospital, Cairo, Egypt
| | - Marco Scaglione
- Division of Cardiology, “Cardinal Massaia” Hospital, Asti, Italy
| | - Enas Fathy
- Department of Cardiovascular Medicine, Aswan University Hospital, Aswan, Egypt
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
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