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Tarantini G, Cardaioli F, De Iaco G, Tuccillo B, De Angelis MC, Mauro C, Boccalatte M, Trivisonno A, Ribichini F, Vadalà G, Caramanno G, Caruso M, Lombardi M, Fischetti D, Danesi A, Abbracciavento L, Lorenzoni G, Gregori D, Panza A, Nai Fovino L, Esposito G. A more-Comers populAtion trEated with an ultrathin struts polimer-free Sirolimus stent: an Italian post-maRketing study (the CAESAR registry). Front Cardiovasc Med 2024; 10:1326091. [PMID: 38299080 PMCID: PMC10828965 DOI: 10.3389/fcvm.2023.1326091] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/11/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction The use of contemporary drug-eluting stents (DES) has significantly improved outcomes of patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). However, concerns exist regarding the long-term proinflammatory effects of durable polymer coatings used in most DES, potentially leading to long-term adverse events. First-generation polymer-free stent technologies, such as sirolimus- and probucol-eluting stents (PF-SES), have shown an excellent safety and efficacy profile. The aim of this study was to evaluate the safety and efficacy of the new ultrathin Coroflex ISAR NEO PF-SES, in a more-comers PCI population. Methods The CAESAR (a more-Comers populAtion trEated with an ultrathin struts polimer-free Sirolimus stent: An Italian post-maRketing study) registry is a multicenter, prospective study conducted in Italy, enrolling more-comers CAD patients undergoing PCI with the Coroflex ISAR NEO stent. Patients with left main (LM) disease, cardiogenic shock (CS), or severely reduced left-ventricular ejection fraction (LVEF) were excluded. The primary endpoint was target-lesion revascularization (TLR) at 1 year. Results A total of 425 patients were enrolled at 13 centers (mean age 66.9 ± 11.6 years, Diabetes mellitus 29%, acute coronary syndrome 67%, chronic total occlusion 9%). Of these, 40.9% had multivessel disease (MVD) and in 3.3% cases, the target lesion was in-stent restenosis (ISR). Clinical device success was reached in 422 (99.6%) cases. At 1 year, only two (0.5%) subjects presented ischemia-driven TLR. The 1-year rates of target vessel revascularization and MACE were 0.5% and 5.1%, respectively. Major bleeding was observed in four (1.0%) patients. Conclusion In this multicenter, prospective registry, the use of a new ultrathin Coroflex ISAR NEO PF-SES in a more-comers PCI population showed good safety and efficacy at 1 year.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Giuseppe De Iaco
- Department of Cardiology, Hospital “Cardinal G. Panico”, Tricase, Italy
| | | | | | - Ciro Mauro
- Department of Cardiology, Hospital Cardarelli, Naples, Italy
| | - Marco Boccalatte
- Interventional Cardiology Unit, Ospedale Santa Maria Delle Grazie Pozzuoli, Napoli, Italy
| | - Antonio Trivisonno
- Department of Cardiovascular Disease, “Antonio Cardarelli” Hospital, Campobasso, Italy
| | | | - Giuseppe Vadalà
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | - Giuseppe Caramanno
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Marco Caruso
- Interventional Cardiology Unit, ARNAS Civico, G. Di Cristina Benfratelli, Palermo, Italy
| | - Mario Lombardi
- Interventional Cardiology Unit, A.O. Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | | | | | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Andrea Panza
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Giovanni Esposito
- Division of Cardiology, Università Degli Studi di Napoli Federico II, Napoli, Italy
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Zullo A, De Francesco V, Amato A, Bergna I, Bendia E, Giorgini G, Buscarini E, Manfredi G, Cadoni S, Cannizzaro R, Realdon S, Ciuffi M, Ignomirelli O, Da Massa Carrara P, Finucci G, Di Somma A, Frandina C, Loria M, Galeazzi F, Ferrara F, Gemme C, Bertetti NS, Gentili F, Lotito A, Germanà B, Russo N, Grande G, Conigliaro R, Cravero F, Venezia G, Marmo R, Senneca P, Milano A, Efthymakis K, Monica F, Montalto P, Lombardi M, Morelli O, Castellani D, Nigro D, Festa R, Peralta S, Grasso M, Privitera A, Distefano ME, Scaccianoce G, Loiacono M, Segato S, Balzarini M, Usai Satta P, Lai M, Manta R. Upper Gastrointestinal Endoscopy Quality in Italy: A Nationwide Study. J Gastrointestin Liver Dis 2023; 32:433-437. [PMID: 38147598 DOI: 10.15403/jgld-5059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/02/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND AIMS International guidelines advise improving esophagogastroduodenoscopy (EGD) quality in Western countries, where gastric cancer is still diagnosed in advanced stages. This nationwide study investigated some indicators for the quality of EGD performed in endoscopic centers in Italy. METHODS Clinical, endoscopic, and procedural data of consecutive EGDs performed in one month in the participating centers were reviewed and collected in a specific database. Some quality indicators before and during endoscopic procedures were evaluated. RESULTS A total of 3,219 EGDs performed by 172 endoscopists in 28 centers were reviewed. Data found that some relevant information (family history for GI cancer, smoking habit, use of proton pump inhibitors) were not collected before endoscopy in 58.5-80.7% of patients. Pre-endoscopic preparation for gastric cleaning was routinely performed in only 2 (7.1%) centers. Regarding the procedure, sedation was not performed in 17.6% of patients, and virtual chromoendoscopy was frequently (>75%) used in only one (3.6%) center. An adequate sampling of the gastric mucosa (i.e., antral and gastric body specimens) was heterogeneously performed, and it was routinely performed only by 23% of endoscopists, and in 14.3% centers. CONCLUSIONS Our analysis showed that the quality of EGD performed in clinical practice in Italy deserves to be urgently improved in different aspects.
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Affiliation(s)
- Angelo Zullo
- Gastroenterology and Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italia.
| | | | - Arnaldo Amato
- Gastroenterology Unit, A. Manzoni Hospital, Lecco, Italy..
| | - Irene Bergna
- Gastroenterology Unit, A. Manzoni Hospital, Lecco, Italy..
| | | | | | | | - Guido Manfredi
- Gastroenterology and Endoscopy Unit, Maggiore Hospital, Crema (CR), Italy..
| | - Sergio Cadoni
- Gastroenterology Unit, CTO Hospital, Iglesias, Italy..
| | - Renato Cannizzaro
- Experimental Oncological Gastroenterology Unit, CRO Hospital, Aviano (PN), Italy..
| | - Stefano Realdon
- Experimental Oncological Gastroenterology Unit, CRO Hospital, Aviano (PN), Italy..
| | - Mario Ciuffi
- Endoscopy Unit, IRCCS CROB Hospital, Rionero in Vulture (PZ), Italy..
| | | | | | - Giovanni Finucci
- Gastroenterology Unit, ASL Toscana Nord-Ovest, San Luca Hospital, Lucca, Italy.
| | | | - Chiara Frandina
- Gastroenterology Unit, S. Giovanni di Dio Hospital, Crotone, Italy.
| | | | | | | | - Carlo Gemme
- Gastroenterology Unit, SS. Antonio, Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
| | - Noemi Sara Bertetti
- Gastroenterology Unit, SS. Antonio, Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
| | | | - Antonio Lotito
- Gastroenterology Unit, Santa Maria Hospital, Terni, Italy.
| | | | - Nunzia Russo
- Gastroenterology and Endoscopy Unit, San Martino Hospital, Belluno, Italy.
| | - Giuseppe Grande
- Gastroenterology Unit, Civile Baggiovara Hospital, Modena, Italy.
| | - Rita Conigliaro
- Gastroenterology Unit, Civile Baggiovara Hospital, Modena, Italy.
| | - Federico Cravero
- Gastroenterology Unit, Santa Croce e Carle Hospital, Cuneo, Italy.
| | - Giovanna Venezia
- Gastroenterology Unit, Santa Croce e Carle Hospital, Cuneo, Italy.
| | - Riccardo Marmo
- Gastroenterology Unit, L. Curto Hospital, Polla (SA), Italy.
| | - Piera Senneca
- Gastroenterology Unit, L. Curto Hospital, Polla (SA), Italy.
| | - Angelo Milano
- Gastroenterology and Endoscopy Unit, SS. Annunziata Hospital, Hospital, Chieti, Italy.
| | | | - Fabio Monica
- Gastroenterology Unit, San Giovanni di Dio Hospital, Gorizia; Gastroenterology and Endoscopy Unit, Cattinara Hospital, Trieste, Italy..
| | - Paolo Montalto
- Gastroenterology Unit, ASL Toscana Centro, Pistoia, Italy.
| | - Mario Lombardi
- Gastroenterology Unit, ASL Toscana Centro, Pistoia, Italy.
| | - Olivia Morelli
- Gastroenterology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy.
| | - Danilo Castellani
- Gastroenterology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy.
| | - Daniela Nigro
- Gastroenterology Unit, San Carlo Hospital, Melfi (PZ), Italy.
| | - Roberto Festa
- Gastroenterology Unit, San Carlo Hospital, Melfi (PZ), Italy.
| | - Sergio Peralta
- Gastroenterology Unit, AOU Policlinico Hospital, Palermo, Italy.
| | - Maria Grasso
- Gastroenterology Unit, AOU Policlinico Hospital, Palermo, Italy.
| | | | | | | | | | - Sergio Segato
- Gastroenterology Unit, ASST dei Sette Laghi Hospital, Varese, Italy.
| | - Marco Balzarini
- Gastroenterology Unit, ASST dei Sette Laghi Hospital, Varese, Italy.
| | | | | | - Raffaele Manta
- Gastroenterology Unit, ASL Toscana Nord-Ovest, San Luca Hospital, Lucca, Italy.
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Pica S, Di Odoardo L, Testa L, Bollati M, Crimi G, Camporeale A, Tondi L, Pontone G, Guglielmo M, Andreini D, Squeri A, Monti L, Roccasalva F, Grancini L, Gasparini GL, Secco GG, Bellini B, Azzalini L, Maestroni A, Bedogni F, Lombardi M. Collateral presence and extent do not predict myocardial viability and ischemia in chronic total occlusions: A stress-CMR study. Int J Cardiol 2023; 371:10-15. [PMID: 36181950 DOI: 10.1016/j.ijcard.2022.09.071] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/05/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Well-developed collaterals are assumed as a marker of viability and ischemia in chronic total occlusions (CTO). We aim to correlate viability and ischemia with collateral presence and extent in CTO patients by cardiac magnetic resonance (CMR). METHODS Multicentre study of 150 CTO patients undergoing stress-CMR, including adenosine if normal systolic function, high-dose-dobutamine for patients with akinetic/>2 hypokinetic segments and EF ≥35%, otherwise low-dose-dobutamine (LDD); all patients underwent late gadolinium enhancement (LGE) imaging. Viability was defined as mean LGE transmurality ≤50% for adenosine, as functional improvement for dobutamine-stress-test, ischemia as ≥1.5 segments with perfusion defects outside the scar zone. RESULTS Rentrop 3/CC 2 defined well-developed (WD, n = 74) vs poorly-developed collaterals (PD, n = 76). Viability was equally prevalent in WD vs PD: normo-functional myocardium with ≤50% LGE in 52% vs 58% segments, p = 0.76, functional improvement by LDD in 48% vs 52%, p = 0.12. Segments with none, 1-25%,26-50%,51-75% LGE showed viability by LDD in 90%,84%,81%,61% of cases, whilst in 12% if 76-100% LGE (p < 0.01). There was no difference in WD vs PD for ischemia presence (74% vs 75%, p = 0.99) and extent (2.7 vs 2.8 segments, p = 0.77). CONCLUSIONS In a large cohort of CTO patients, presence and extent of collaterals did not predict viability and ischemia by stress-CMR. Scar extent up to 75% LGE was still associated with viability, whereas ischemia was undetectable in 25% of patients, suggesting that the assessment of CTO patients with CMR would lead to a more comprehensive evaluation of viability and ischemia to guide revascularization.
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Affiliation(s)
- S Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
| | - L Di Odoardo
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - L Testa
- Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - M Bollati
- Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - G Crimi
- Interventional Cardiology, Cardio Thoraco-Vascular-Department, IRCCS Policlinico San Martino, Genoa, Italy
| | - A Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - L Tondi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - G Pontone
- Cardiology Department, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - M Guglielmo
- Cardiology Department, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - D Andreini
- Cardiology Department, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - A Squeri
- Cardiology Department, Villa Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - L Monti
- Cardiology Department, Humanitas Clinical and Research Center, IRCCS Rozzano, Milan, Italy
| | - F Roccasalva
- Cardiology Department, Humanitas Clinical and Research Center, IRCCS Rozzano, Milan, Italy
| | - L Grancini
- Cardiology Department, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - G L Gasparini
- Cardiology Department, Humanitas Clinical and Research Center, IRCCS Rozzano, Milan, Italy
| | - G G Secco
- Interventional Cardiology Department, A.O.Ss. Antonio e Biagio, Alessandria, Italy
| | - B Bellini
- Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - L Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - A Maestroni
- Cardiology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - F Bedogni
- Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - M Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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4
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Laermans P, Morisse F, Lombardi M, Gérard S, Vandevelde S, de Kuijper G, Audenaert K, Claes C. Aligning quality of life and guidelines for off-label psychotropic drugs in adults with intellectual disabilities and challenging behaviour. Int J Dev Disabil 2023; 69:398-413. [PMID: 37213586 PMCID: PMC10197992 DOI: 10.1080/20473869.2023.2195721] [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: 12/17/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 05/23/2023]
Abstract
Introduction Adults with intellectual disabilities have an increased vulnerability to mental health problems and challenging behaviour. In addition to psychotherapeutic or psychoeducational methods, off-label pharmacotherapy, is a commonly used treatment modality. Objective The aim of this study was to establish evidence-based guideline recommendations for the responsible prescription of off-label psychotropic drugs, in relation to Quality of Life (QoL). Method A list of guidelines was selected, and principles were established based on international literature, guideline review and expert evaluation. The Delphi method was used to achieve consensus about guideline recommendations among a 58-member international multidisciplinary expert Delphi panel. Thirty-three statements were rated on a 5-point Likert-scale, ranging from totally disagree to totally agree, in consecutive Delphi rounds. When at least 70% of the participants agreed (score equal or higher than 4), a statement was accepted . Statements without a consensus were adjusted between consecutive Delphi rounds based on feedback from the Delphi panel. Results Consensus was reached on 4 general:the importance of non-pharmaceutical treatments, comprehensive diagnostics and multidisciplinary treatment. Consensus was reached in 4 rounds on 29 statements. No consensus was reached on 4 statements concerning: freedom-restricting measures, the treatment plan, the evaluation of the treatment plan, and the informed consent. Conclusion The study led to recommendations and principles for the responsible prescription - aligned with the QoL perspective - of off-label psychotropic drugs for adults with intellectual disabilities and challenging behaviour. Extensive discussion is needed regarding the issues on which there was no consensus to furthering the ongoing development of this guideline.
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Affiliation(s)
- P. Laermans
- EQUALITY//ResearchCollective, University College Ghent, Ghent, Belgium
- Correspondence to: Pauline Laermans, EQUALITY//ResearchCollective, University College Ghent.
| | - F. Morisse
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - M. Lombardi
- EQUALITY//ResearchCollective, University College Ghent, Ghent, Belgium
| | - S. Gérard
- Superior Health Council, Brussels, Belgium
| | - S. Vandevelde
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - G. de Kuijper
- Centre for Intellectual Disabilities & Mental Health, Mental Healthcare Drenthe, the Netherlands
| | - K. Audenaert
- Department of Psychiatry, Ghent University, Ghent, Belgium
| | - C. Claes
- EQUALITY//ResearchCollective, University College Ghent, Ghent, Belgium
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Martucci A, Tam PL, Aversa A, Lombardi M, Nyborg L. The effect of PBF‐LB/M powder reuse on the surface chemical composition of the Scalmalloy powder. SURF INTERFACE ANAL 2022. [DOI: 10.1002/sia.7176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A. Martucci
- Department of Applied Science and Technology, Politecnico di Torino Torino Italy
| | - P. L. Tam
- Department of Industrial and Materials Science Chalmers University of Technology Gothenburg Sweden
| | - A. Aversa
- Department of Applied Science and Technology, Politecnico di Torino Torino Italy
| | - M. Lombardi
- Department of Applied Science and Technology, Politecnico di Torino Torino Italy
| | - L. Nyborg
- Department of Industrial and Materials Science Chalmers University of Technology Gothenburg Sweden
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Tondi L, Figliozzi S, Badano LP, Torlasco C, Disabato G, Pica S, Camporeale A, Muraru D, Lombardi M. Cardiac magnetic resonance feature-tracking analysis of left atrial volumes and function in standard vs left-atrial focused images. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left atrial (LA) volume and function have shown prognostic value in several cardiac conditions. Routine cardiac magnetic resonance (CMR) evaluation of the LA is obtained from standard 2- and 4-chamber long-axis cine images focused on the left ventricle. Previous echocardiographic data showed that LA-focused apical views provide a more accurate estimation of LA maximum volume, as compared to standard apical images. CMR LA-focused imaging could improve the accuracy of LA morpho-functional analysis. CMR feature-tracking (CMR-FT) analysis is emerging as a feasible semi-automatic tool for the evaluation of LA volumes and function.
Purpose
To investigate the potential of LA-focused CMR cine images using LA CMR-FT analysis.
Methods
100 consecutive patients clinically referred to CMR were included in this prospective, observational, multicenter study. LA volumes (LAVmax, LAVmin), emptying fraction (EF), atrial strain reservoir (ɛs), conduit (ɛe), booster (ɛa) and strain rate reservoir (SRɛs) were calculated by CMR-FT analysis on both standard and LA-focused 2- and 4-chamber long-axis cine images. Manual segmentation of a short-axis cine stack covering the LA was used as the reference method (RefMeth) for LA volumes and EF.
Results
In comparison to the RefMeth, the standard acquisitions underestimated LA volumes (LAVmax: bias = −8ml, LOA = +20, −35ml; LAVmin: bias = −6 ml, LOA = +15, −27ml) and slightly overestimated EF (bias = +3%, LOA = +17, −11%). Conversely, LA-focused images provided a more accurate estimation (LAV max bias = −1ml, LOA = +11, −9ml; LAV min bias = −2ml, LOA = +12, −7ml) and EF (bias = −2%, LOA = +9, −12%). All three LA strain (εs: bias 7%, LOA = 25, −11%; εe: bias 4%, LOA = 15, −8%; εa: bias 3%, LOA = 14, −8%) and SRεs (bias 0.2 s–1, LOA = 1.13, −0.7 s–1) were significantly higher in standard vs LA-focused images (all p<0.001).
Conclusions
Assessment of LA volumes using CMR-FT applied to dedicated LA-focused long-axis cine images is more accurate than the use of standard acquisitions. LA strain and SRɛs obtained from LA-focused images are significantly lower than those obtained from standard LA acquisitions, possibly due to the inclusion in LA-focused images of LA posterior wall, where pulmonary veins convey and atrial deformation is blunted.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Tondi
- IRCCS San Donato Polyclinic, Multimodality Cardiac Imaging Section , Milan , Italy
| | - S Figliozzi
- Humanitas Research Hospital, Cardiology , Milan , Italy
| | - L P Badano
- IRCCS Istituto Auxologico Italiano, Cardiology , Milan , Italy
| | - C Torlasco
- IRCCS Istituto Auxologico Italiano, Cardiology , Milan , Italy
| | - G Disabato
- Policlinic Foundation San Matteo IRCCS , Pavia , Italy
| | - S Pica
- IRCCS San Donato Polyclinic, Multimodality Cardiac Imaging Section , Milan , Italy
| | - A Camporeale
- IRCCS San Donato Polyclinic, Multimodality Cardiac Imaging Section , Milan , Italy
| | - D Muraru
- IRCCS Istituto Auxologico Italiano, Cardiology , Milan , Italy
| | - M Lombardi
- IRCCS San Donato Polyclinic, Multimodality Cardiac Imaging Section , Milan , Italy
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Abstract
Abstract
Some studies have shown the association between ventricular and atrial arrhythmias, dilated cardiomyopathy and the R222Q mutation of the SCN5A gene. The mutation causes impaired activation of the sodium channel, the genesis of extrasystoles and the development of dilated cardiomyopathy; both respond better to antiarrhythmic therapy with flecainide and amiodarone than therapy for heart failure. Other studies have shown the efficacy of hydroquinidine.
Purpose of the Study
To observe the clinical characteristics and the response to drug therapy of pediatric subjects carrying the R222Q mutation.
Materials and methods
we observed subjects received at our centre for arrhythmias, carriers of the R222Q variant, subjected to ECG, Echocardiogram, Holter, stress test and follow up.
Results
4 patients were observed, 3 males and 1 female, with ages ranging from 0 to 12 years. The first patient was familiar with dilated cardiomyopathy and rhythm disturbances; he had arrhythmia already in foetal age, he then developed first and second–degree BAV, junctional rhythm and polyform TVNS. Echocardiography and exercise testing were normal. Arrhythmia control was achieved with flecainide. The second patient, with negative familiarity, from the age of 8 is under observation for polyform ventricular ectopic beats, repetitive, unresponsive to propafenone, flecainide, nadolol and sotalol. Echocardiography showed minimal impairment of the contractile function of the left ventricle. Ventricular extrasystoles did not disappear during exertion. At 15, a defibrillator was implanted and hydroquinidine was associated. The third patient presented with foetal tachyarrhythmias; at the age of 6, atrial tachycardia, well–controlled by sotalol, and ventricular ectopic beats were detected. The fourth patient, a cousin of the previous one, developed repetitive ventricular ectopic beats and periods of atrial and junctional rhythm at 12 years; he responded to flecainide.
Conclusions
The R222Q mutation of the SCN5A gene is responsible for arrhythmias already from the pediatric age and is expressed with a variable phenotype. Only one patient with therapy–resistant arrhythmia had contractile dysfunction. Dilated cardiomyopathy could be a consequence of a high arrhythmic burden and occur at a later age if the arrhythmia is not treated. An early and genetic diagnosis is essential.
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Affiliation(s)
| | | | - U Vairo
- OSPEDALE GIOVANNI XXIII, BARI
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Rubino F, Mandic-Rajcevic S, Ariano E, Fargnoli, Laurendi V, Lombardi M, Puri D, Colosio C. The PESTIRISK tool for personal planning of pesticide safe use by field users: concept and development. Saf Health Work 2022. [DOI: 10.1016/j.shaw.2021.12.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Guglielmi G, Mollo A, Bandera F, Camporeale A, Frigelli M, Alfonzetti E, Lombardi M, Pieroni M, Pieruzzi F, Guazzi M. Functional capacity and gender-related differences in Fabry disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Fabry disease (FD) is a rare x-linked lysosomal storage disease characterized by accumulation of glicosphingolipids in several organs, including the heart. Cardiac involvement manifests as left ventricular (LV) hypertrophy, often complicated by myocardial fibrosis. The impact of disease on functional capacity is not well defined, as well as the potential gender-related differences.
Aim
To evaluate the functional capacity in a cohort of FD patients with different degree of cardiac involvement.
Methods
Seventy-two patients were prospectively enrolled from March 2015 to December 2019. Patients underwent cardiac magnetic resonance (CMR) and cardiopulmonary exercise test (CPET) with cycle ergometer. In addition to standard CPET parameters, Chronotropic Index (CI) was calculated as (HR max − HR rest) / (HR max predicted − HR rest), adjusting with HR max predicted calculated as 119 + (HR rest/2) − (age/2) in case of beta-blockers treatment.
Results
CMR showed left ventricle (LV) hypertrophy (LV mass greater than normal reference value) in 36.1% of patients, LGE and reduced T1 values were detected in 30.6% and 59.7% of subjects respectively. Twenty-eight patients were males (39%), the median age was 40 (28–54) [median (25th–75th)] years and only 11 (15%) subjects were on beta-blockers. All subjects performed a maximal test [RQ max = 1.21 (1.14–1.26)] using a ramp protocol of 15 (15–20) Watt. The absolute peakVO2 was 18.2 (15.75–24.08) mL/min/kg, whilst the percentage of predicted peakVO2 was 67.7 (57.3–76.6)%. The chronotropic response of the overall population was characterized by reduced peak heart rate (HRmax) [80.3 (73.8–87.6)% of predicted], and diminished chronotropic index (CI) [0.67 (0.55–0.77) normal value: 0.80], but preserved heart rate reserve (HRR) [21 (12–28) bpm]. Ventilatory efficiency was preserved [VE/VCO2 = 25.70 (23.18–28.00)]. At gender analysis, men showed higher absolute peakVO2 [men vs females: 19.95 (17.20–28.28) vs 17.80 (15.50–21.28) mL/min/kg, p=0.02] but lower percentage of predicted [64.24 (52.58–70.61) vs 70.75 (59.05–78.02)%, p<0.001] than females. No differences between genders were observed in chronotropic response [HRmax = 138 (108–154) vs 142 (135–153) bpm, p=0.38; HRR = 22 (13–36) vs 20 (11–26), p=0.097; CI: 0.67 (0.51–0.76) vs 0.67 (0.58–0.79), p=0.33], whilst females showed a lower peak O2 pulse (VO2/HR) than males [men vs females: 12.08 (10.04–13.64) vs 7.76 (6.88–9.22), p<0.001], possibly related to gender differences in LV dimensions and stroke volume.
Conclusions
This large cohort of FD patients with different degree of cardiac involvement showed a significantly impaired functional capacity, mainly characterized by relevant chronotropic incompetence (independent from the use of beta-blockers), consistent with systemic autonomic dysfunction. The degree of chronotropic incompetence was similar between the genders, but females showed higher predicted peakVO2 despite a lower peak O2 pulse.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Guglielmi
- IRCCS Policlinico San Donato, Cardiology University Department, San Donato Milanese, Italy
| | - A Mollo
- IRCCS Policlinico San Donato, Cardiology University Department, San Donato Milanese, Italy
| | - F Bandera
- IRCCS Policlinico San Donato, Cardiology University Department, San Donato Milanese, Italy
| | - A Camporeale
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Section, San Donato Milanese, Italy
| | - M Frigelli
- IRCCS Policlinico San Donato, Cardiology University Department, San Donato Milanese, Italy
| | - E Alfonzetti
- IRCCS Policlinico San Donato, Cardiology University Department, San Donato Milanese, Italy
| | - M Lombardi
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Section, San Donato Milanese, Italy
| | - M Pieroni
- San Donato Hospital of Arezzo, Department of Cardiology, Arezzo, Italy
| | - F Pieruzzi
- San Gerardo Hospital, Nephrology and Dialysis Unit, Monza, Italy
| | - M Guazzi
- San Paolo Hospital, Cardiology University Department, Milan, Italy
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10
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Camporeale A, Bandera F, Pieroni M, Pieruzzi F, Bersano A, Econimo L, Lanzillo C, Limongelli G, Mignani R, Motta I, Olivotto I, Milani V, Guazzi M, Lombardi M. Effect of migalastat on cardiac involvement in Fabry disease: preliminary results from MAIORA study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Fabry Disease (FD) is a rare X-linked lysosomal storage disorder. Since 2016, pharmacological chaperone Migalastat has been approved for treatment of FD patients with amenable mutations to stabilize defective forms of the enzyme α-galactosidase A. A small but significant reduction in left ventricular (LV) mass after 18 months of Migalastat treatment has been previously reported by echocardiography. However, an integrated assessment of the effect of Migalastat on cardiac involvement, combining LV morphology and tissue composition by CMR with exercise capacity by cardiopulmonary test, is lacking.
Purpose
To determine the effects of 18 month treatment with Migalastat on LV mass, native T1 value and functional capacity in naïve patients with genetically confirmed FD cardiomyopathy.
Methods
Sixteen treatment naïve FD patients (4 females, mean age 46.4±16.2) with amenable mutations and signs of cardiac involvement underwent CMR with T1 mapping and cardio-pulmonary testing before and after 18 months of migalastat therapy as a part of MAIORA Study. Cardiac involvement was defined as presence of reduced native T1 values at CMR (a surrogate of myocardial glycosphingolipid storage) and/or LV hypertrophy (LVH). Nine patients (56%, 2 females, mean age 56.4±12.7 years) had LVH at baseline.
Results
Migalastat treatment was well tolerated in all patients, with no serious adverse event. No change in LV mass was detected at 18 months compared to baseline (95.2 (66.0–184.0) vs 103.0 (71.0–182.0) g/m2; p=0.5516). The same result was found after stratifying patients according to presence/absence of Late Gadolinium Enhancement (LGE) (LGE+ n=8, 2 females, mean age 56.2±13.1 years). There was a trend towards an increased native septal T1 value (870.0 (848–882) vs 860.0 (833.0–875.0) ms at baseline; p 0.056) with unchanged extracellular volume (ECV) (0.26 (0.23–0.028) vs 0.26 (0.22–0.29) at baseline; p 0.276) in the overall cohort. An improvement in functional capacity with a trend towards an increase in percent-predicted peak VO2 (72.0 (61.25–80.75) vs 67.0 (45.2–79.2) at baseline; p 0.056) and a significant increase in VO2 at anaerobic threshold (14.8 (12.6–20.0) vs 13.10 (6.8–18.6) ml/kg/min at baseline; p 0.004) was reported in the total population.
Conclusion
In treatment naïve FD patients with amenable mutations and signs of early or overt cardiac involvement, 18-month treatment with Migalastat stabilized LV mass both in patients with and without LGE and was associated with an improvement in exercise tolerance. The trend towards an increase in T1 value associated with unchanged ECV suggests partial clearance of cardiomyocyte glycoshingolipid storage. These real-world data are consistent with a beneficial impact of migalastat on the progression of cardiac involvement in FD.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Amicus Therapeutics
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Affiliation(s)
- A Camporeale
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - F Bandera
- IRCCS Policlinico San Donato, University Cardiology Department, San Donato Milanese, Italy
| | - M Pieroni
- San Donato Hospital of Arezzo, Department of Cardiology, Arezzo, Italy
| | - F Pieruzzi
- San Gerardo Hospital, Nephrology and Dialysis Unit, Monza, Italy
| | - A Bersano
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Cerebrovascular Unit, Milan, Italy
| | - L Econimo
- Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Nephrology Unit, Brescia, Italy
| | - C Lanzillo
- Polyclinic Casilino of Rome, Department of Cardiology, Rome, Italy
| | - G Limongelli
- Second University of Naples, Department of Cardiology, Naples, Italy
| | - R Mignani
- Infermi Hospital of Rimini, Nephrology and Dialysis Department, Rimini, Italy
| | - I Motta
- Foundation Hospital Maggiore Polyclinic IRCCS, UOC General Medicine, Milan, Italy
| | - I Olivotto
- Careggi University Hospital, Cardiomyopathy Unit, Florence, Italy
| | - V Milani
- IRCCS Policlinico San Donato, Scientific Directorate, San Donato Milanese, Italy
| | - M Guazzi
- University of Milan, Department of Biomedical Sciences for Health, Milan, Italy
| | - M Lombardi
- IRCCS, Policlinico San Donato, Multimodality Cardiac Imaging Unit, San Donato Milanese, Italy
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11
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Lombardi M, Molisana M, Genovesi E, De Innocentiis C, Limbruno U, Misuraca L, Di Vito L, Zimarino M, Renda G, Di Nicola M, De Caterina R. Prevention of contrast-induced nephropathy with urine alkalinization: the TEATE study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Contrast-induced acute kidney injury (CI-AKI) after coronary angiography and percutaneous interventions (PCI) impacts on hospitalization duration and mortality. Pre-procedural hydration is the sole strategy currently recommended for preventing CI-AKI. The role of sodium bicarbonate (SB) although attractive, since urine alkalinization suppresses the production of reactive oxygen species, is still controversial, and the optimal dosing to attain adequate urine alkalinization is still undefined.
Purpose
The PrevenTion of contrast-inducEd nephropathy with urine alkalinization (TEATE) study was a prospective 3-center 3-arm single-blind randomized controlled trial testing the hypothesis that adequate urine alkalinization is associated with CI-AKI prevention. Secondary endpoints were the efficacy of SB vs saline in achieving adequate urine alkalinization and reducing the incidence of CI-AKI compared with saline.
Methods
Patients candidate to coronary angiography and/or PCI with moderate-to-severe chronic kidney disease [eGFR of 15 to 60 mL/min/1.73 m2, by the Modification of Diet in Renal Disease Study equation (MDRD)] were randomly assigned to saline hydration (control), oral SB or i.v. SB. The study protocol was registered. We evaluated urinary pH at the time of hospitalization, immediately before coronary angiography and 24–48 hours after angiography. According to urine pH immediately before the procedure, patients were divided in two groups above or below a pH cut-off of 6.
Results
We enrolled a total of 241 patients: 81 were randomly assigned to the control group, 82 to i.v. SB and 78 to oral SB. Patients achieving a urinary pH >6 before angiography had a lower incidence of CI-AKI (46%) than patients with urinary pH ≤6 (54%) [OR=0.48 (95% CI 0.25–0.9) p=0.023]. The number of patients with urine pH >6 was higher in both the i.v. (71%) and the oral SB (65%) groups compared to the hydration-only group (44%, p=0.004). We found however no difference in the incidence of CI-AKI in the 3 treatment arms (20% in hydration alone, 21% in oral SB group and 22% in iv SB group) (p=0.94). Subgroup analyses according to basal urine pH and eGFR ranges failed to identify statistically significant differences in the development of CI-AKI according to treatment allocation.
Conclusions
Urinary pH before the administration of contrast medium is an inverse correlate of CI-AKI incidence, and SB is superior to hydration alone in achieving urinary alkalinization. Since, however, SB did not reduce the incidence of CI-AKI, we conclude that urinary pH is a marker and not a mediator of CI-AKI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Lombardi
- G. d Annunzio University, Institute of Cardiology, Chieti, Italy
| | - M Molisana
- G. d Annunzio University, Institute of Cardiology, Chieti, Italy
| | - E Genovesi
- G. d Annunzio University, Institute of Cardiology, Chieti, Italy
| | - C De Innocentiis
- G. d Annunzio University, Institute of Cardiology, Chieti, Italy
| | - U Limbruno
- Azienda USL Toscana Sud Est, Cardiology Department, Grosseto, Italy
| | - L Misuraca
- Azienda USL Toscana Sud Est, Cardiology Department, Grosseto, Italy
| | - L Di Vito
- Cardiology ASUR-AV5 Mazzoni Hospital, Ascoli Piceno, Italy
| | - M Zimarino
- G. d Annunzio University, Institute of Cardiology, Chieti, Italy
| | - G Renda
- G. d Annunzio University, Institute of Cardiology, Chieti, Italy
| | - M Di Nicola
- G. d Annunzio University, Department of Medical, Oral and Biotechnological Sciences, Chieti, Italy
| | - R De Caterina
- University of Pisa, Institute of Cardiology, Pisa, Italy
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12
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Moroni A, Tondi L, Camporeale A, Milani V, Pica S, Pieroni M, Pieruzzi F, Ferri L, Arosio R, Chow K, Lombardi M. Left atrial morpho-functional changes in hypertrophic cardiomyopathy and Fabry disease: a CMR-feature tracking study. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Left ventricular (LV) diastolic dysfunction (DD) is a hallmark of hypertrophic cardiomyopathy (HCM) and its phenocopies, such as Fabry disease (FD). Together with left atrial (LA) size, LA function is emerging as a sensitive marker of the adaptive changes to backward transmission of LV cardiac filling pressure, thus implementing DD assessment. Additionally, both HCM and FD are characterized by a primitive atrial myopathy, but LA morpho-functional changes in HCM and FD have never been directly compared. More recently, LA strain by Cardiovascular Magnetic Resonance Feature Tracking (CMR-FT) has been demonstrated to be a feasible and reproducible tool to explore LA function.
Purpose
To compare LA morpho-functional changes in HCM and FD and to explore their correlation with tissue alterations.
Methods
15 HCM and 15 sex-, age- and LV mass index-matched FD patients underwent CMR (Magnetom Aera 1.5T, Siemens) and Doppler Echocardiography for LV diastolic function assessment (E/e’ and DD grading from 0 to 3). LA phasic function was evaluated by CMR-FT strain (Qstrain Medis). The software output included passive (εe, conduit function), active (εa, booster pump function) and total strain (εs, reservoir function), along with LA volumes and ejection fraction (EF). Late gadolinium enhancement (LGE) was quantified as a percentage of LV mass using the standard deviations (SDs) method (≥ 5 SDs). Interstitial fibrosis was assessed by extracellular volume (ECV) quantification in remote myocardium. All patients were in sinus rhythm.
Results
In the HCM group, the proportion of patients with DD grade 2-3 was only slightly higher than in FD (p 0.26). Accordingly, no significant difference was found in E/e’ value (p 0.78). Compared to FD, HCM patients showed more severe LA morpho-functional changes, including larger LA end-systolic volume (ESV) (113 ± 35 vs 84 ± 23 ml), lower LA EF (37 ± 7 vs 44 ± 9 %) and a greater reduction of εs (-20 ± 5 vs -25 ± 6 %) and εa (-10 ± 4 vs -15 ± 4 %) (all p < 0.05). LV size and function and the burden of fibrosis (LGE quantification and ECV) were comparable between the two groups. Interestingly, in HCM population, unlike in FD, LA morpho-functional measurements significantly correlated with tissue characterization parameters (LA ESV with LGE, r 0.56, p 0.03; εs and εa with ECV, r -0.51, p 0.05 and r -0.59, p 0.02, respectively).
Conclusions
LA morpho-functional alterations are much more severe in HCM compared to FD with similar degree of LV hypertrophy. A more severe atrial myopathy or different mechanisms of atrial damage in the two cardiomyopathies may explain these findings. LA CMR-FT analysis may represent a sensitive tool to discriminate between HCM and FD, although larger studies are needed to confirm this finding and the possible correlation with the occurrence of atrial arrhythmias and thromboembolic risk.
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Affiliation(s)
- A Moroni
- IRCCS Policlinico San Donato, Cardiology University Department, San Donato Milanese, Italy
| | - L Tondi
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Unit, San Donato Milanese, Italy
| | - A Camporeale
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Unit, San Donato Milanese, Italy
| | - V Milani
- IRCCS Policlinico San Donato, Scientific Directorate, San Donato Milanese, Italy
| | - S Pica
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Unit, San Donato Milanese, Italy
| | - M Pieroni
- San Donato Hospital of Arezzo, Department of Cardiology, Arezzo, Italy
| | - F Pieruzzi
- San Gerardo Hospital, Department of Medicine and Surgery, University of Milano Bicocca, Nephrology and Dialysis Unit, Monza, Italy
| | - L Ferri
- University of Verona, Division of Cardiology, Department of Medicine, Verona, Italy
| | - R Arosio
- IRCCS Policlinico San Donato, Cardiology University Department, San Donato Milanese, Italy
| | - K Chow
- Siemens Medical Solutions USA, Inc., Chicago, United States of America
| | - M Lombardi
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Unit, San Donato Milanese, Italy
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13
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Moschetti K, Kwong RY, Petersen SE, Lombardi M, Garot J, Atar D, Rademakers FE, Sierra-Galan LM, Mavrogeni S, Li K, Lara Fernandes J, Antiochos P, Bruder O, Marholdt H, Schwitter J. Cost-Minimization analysis for cardiac revascularization in 12 healthcare systems based on the EuroCMR/SPINS registries. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): EuroCMR registry (Life Sciences GE Healthcare, Medtronic Inc., Minneapolis MN, USA; Novartis International AG, Basel, Switzerland; Siemens Healthcare, Erlangen, Germany), SPINS registry (Siemens Healthineers, Erlangen, Germany; Bayer AG, Leverkusen, Germany)
Background
Coronary artery disease (CAD) is a major contributor to the public health burden. Stress perfusion cardiac magnetic resonance (CMR) has an excellent accuracy to detect CAD, but data on its cost effectiveness are scarce.
Purpose
To compare the costs of a CMR-guided strategy vs 2 invasive strategies based on 2 large international CMR registries.
Methods
In the EuroCMR registry (n = 3’647, 59 centers, 18 countries) and the US-based SPINS registry (n = 2’349, 13 centers, 11 states) costs were calculated for 12 healthcare systems (8 Europe, US, 2 Latin America, 1 Asia). They included diagnostic examinations (CMR, X-ray coronarography (CXA) with/without FFR), revascularizations, and complications during a 1-year follow-up. Endpoints in both registries were all-cause and cardiovascular (CV) death, sudden cardiac death (SCD), aborted SCD, non-fatal myocardial infarction (nf-MI), and stroke. 7 sub-group analyses covered low to high-risk cohorts. Patients with ischemia-positive CMR underwent CXA and revascularization (percuteneous and surgical intervention) at the treating physician’s discretion (=CMR + CXA-strategy). In the hypothetical invasive CXA + FFR-strategy, costs were calculated for an initial CXA and an FFR in vessels with ≥50% stenoses assuming the same proportion of revascularizations/complications as in the CMR + CXA-strategy and FFR positive rates as given in the literature. In the CXA-only strategy, costs included CXA and revascularizations of ≥50% stenoses.
Results
Revascularizations were performed in 8.0% and 6.2% (p < 0.01) of SPINS and EuroCMR patients, respectively. Consistent cost savings were observed for the CMR + CXA strategy vs CXA + FFR in all 12 healthcare systems ranging from 42 ± 20% and 52 ± 15% in the low-risk EuroCMR and SPINS patients with atypical chest pain (CV-death and nf-MI 0.4-0.7%/y), respectively, to 31 ± 16% in the high-risk SPINS patients (CV-death and nf-MI 3.2%/y) with known CAD (p < 0.0001 vs 0 in all groups, Fig 1/2). Cost savings were even higher vs CXA-only with 63 ± 11%, 73 ± 6%, and 52 ± 9%, respectively (p < 0.0001 vs 0 in all groups, Fig 2).
Conclusions
In 12 healthcare systems, a CMR + CXA-strategy yielded consistent moderate to high cost savings compared to a hypothetical CXA + FFR-strategy over the entire spectrum of risk. Cost savings were consistently high vs a CXA-only strategy for all risk groups.
Figure 1: SPINS refers to the subgroup of patients with suspected CAD (n = 1’530), EuroCMR (= suspected CAD; n = 3’647). EuroCMR vs SPINS ns. Countries per region are listed in alphabetical order.
Figure 2: Top: CMR + CXA vs CXA + FFR: ANOVA: overall p = 0.0017, * vs EuroCMR typ angina: p < 0.005 (Scheffe post-hoc testing). Bottom: CMR + CXA vs CXA-only: ANOVA overall p < 0.0001, * vs SPINS with CAD and vs EuroCMR typ A: p < 0.0001; † vs SPINS with CAD: p < 0.03; ‡ vs EuroCMR typ A: p < 0.0001; § vs SPINS with CAD: p < 0.002; ║ vs EuroCMR typ: p < 0.002 (Scheffe post-hoc tesing)
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Affiliation(s)
- K Moschetti
- Centre for Primary Care and Public Health (Unisante), Health Technology Assessment Unit, Lausanne, Switzerland
| | - RY Kwong
- Brigham And Women"S Hospital, Harvard Medical School, Boston, United States of America
| | - SE Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Center, Queen Mary University, London, United Kingdom of Great Britain & Northern Ireland
| | - M Lombardi
- I.R.C.C.S. Policlinics of San Donato, Milano, Italy
| | - J Garot
- Institut Cardiovasculaire Paris Sud, Hopital prive Jacques Cartier, Ramsay Santé, Paris, France
| | - D Atar
- Oslo University Hospital Ulleval, Institute of clinical sciences, University of Oslo, Oslo, Norway
| | | | - LM Sierra-Galan
- American British Cowdray Medical Center, Mexico City, Mexico
| | - S Mavrogeni
- Onassis Cardiac Surgery Center, Kapoditrian University of Athens, Athens, Greece
| | - K Li
- Xuan Wu Hospital Affiliated to Capital Medical University, Beijing, China
| | - J Lara Fernandes
- Campinas Medical Center, Jose Michel Kalaf Research Institute, Campinas, Brazil
| | - P Antiochos
- Brigham And Women"S Hospital, Harvard Medical School, Boston, United States of America
| | - O Bruder
- Ruhr University Bochum and Elisabeth Hospital, Cardiology and Angiology, Essen, Germany
| | - H Marholdt
- Robert Bosch Hospital, Stuttgart, Germany
| | - J Schwitter
- University Hospital Centre Vaudois (CHUV), University of Lausanne, UniL, Lausanne, Switzerland
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14
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Ferri L, Pica S, Tondi L, Camporeale A, Arosio R, Moroni A, Chow K, Lombardi M. Left atrial strain analysis in hypertensive heart disease and hypertrophic cardiomyopathy by cardiovascular magnetic resonance feature tracking. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Increasing evidence suggests that left atrial (LA) deformation is a sensitive marker of diastolic dysfunction in hypertrophic phenotypes. However, there is little data about the impact of hypertension on LA function; furthermore, LA deformation in hypertensive heart disease (HHD) and hypertrophic cardiomyopathy (HCM) has not been compared yet.
Purpose
The aim of this study is to compare atrial dimensions and function, evaluated by cardiovascular magnetic resonance feature tracking (CMR-FT) in patients with HHD, HCM and healthy subjects (HS).
Methods
67 patients (20 HHD, 27 HCM, 20 HS) underwent CMR and were included in the study. Patients were matched for age, sex and BSA; HHD and HCM were also comparable for LV mass index and ejection fraction (EF). CMR-FT atrial strain analysis was performed using Qstrain, Medis software to obtain i) LA conduit function, ii) LA booster pump function), iii) LA reservoir function, iv) LA volumes and EF. Tissue Doppler echocardiography was used to assess diastolic function, including E/e’. LA stiffness was calculated as the ratio between E/e’ and LA reservoir.
Both focal and interstitial myocardial fibrosis were assessed with LGE and extracellular volume (ECV) quantification.
Results
HHD and HCM showed impaired LA reservoir, conduit function and higher LA volumes vs HS (reservoir: 28 ± 11% and 28 ± 13% vs 41 ± 17%; conduit: 13 ± 7% and 13 ± 7% vs 22 ± 11%; LAESV: 76 ± 21 and 87 ± 22 vs 57 ± 19 ml respectively; all p ≤ 0.03).
HHD and HCM were comparable for bi-ventricular morpho-functional parameters and ECV. HHD showed lower E/e’ values (8 ± 2 vs 16 ± 7, p = 0.002) and LA stiffness (0.23 ± 0.3 vs 0.74 ± 0.6, p 0.03), LA dimensions (LA area 13 ± 3 vs 16 ± 3 cm2/m2, p = 0.02 , LAESVi 41 ± 12 vs 48 ± 11 ml/m2, p = 0.05) and LGE extent (1 ± 2% vs 5 ± 5%, p = 0.001) as compared to HCM. Interestingly, HHD revealed a comparable reduced LA reservoir and conduit function (all p = 0.9) vs HCM.
In HHD patients LA reservoir function was correlated with E/e’ (r -0.8, p = 0.02), but not in HCM. Conversely, LA reservoir function was correlated with LV mass index in HCM (r -0.5, p < 0.01).
Conclusions
HHD patients showed a similar and significant impairment of LA function, with lower LA dimensions and E/e’ compared to HCM with similar LV mass index and preserved function.
CMR-FT atrial strain analysis could represent a useful tool for HHD management, able to detect diastolic dysfunction (and/or atrial dysfunction) earlier than traditional markers. Further studies are needed to explore the relationship of LA deformation to heart failure symptoms and atrial fibrillation occurrence and potential changes related to response to therapy.
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Affiliation(s)
- L Ferri
- Azienda Ospedaliera Universitaria Integrata of Verona, Division of Cardiology, Verona, Italy
| | - S Pica
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Unit, San Donato Milanese, Italy
| | - L Tondi
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Unit, San Donato Milanese, Italy
| | - A Camporeale
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Unit, San Donato Milanese, Italy
| | - R Arosio
- IRCCS Policlinico San Donato, Cardiology University Department, San Donato Milanese, Italy
| | - A Moroni
- IRCCS Policlinico San Donato, Cardiology University Department, San Donato Milanese, Italy
| | - K Chow
- Siemens Medical Solutions USA Inc., Chicago, United States of America
| | - M Lombardi
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Unit, San Donato Milanese, Italy
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15
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Pasqualin G, Riva A, Sturla F, Lanaro A, Bevilacqua F, Giese D, Saracino A, Chessa M, Giamberti A, Carminati M, Redaelli A, Votta E, Lombardi M. 4D Flow analysis of intracavitary blood flow dynamics and energetics in the systemic right ventricle. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Italian Ministry of Health
Background
The systemic position of a morphologically right ventricle (SRV) makes it vulnerable to fail, leading to high incidence of heart failure and cardiac death [1]. Understanding SRV intracavitary blood flow dynamics and energetics could improve patient risk stratification.
Purpose
Testing the potential of three-dimensional time-resolved phase contrast cardiac magnetic resonance (4D Flow) in quantifying SRV blood flow dynamics and energetics.
Methods
4D Flow prototype sequences were acquired on 3 patients (1 male, 2 females) with SRV in D-loop transposition of great arteries after atrial switch operation (D-TGA/ASO), 3 male patients with SRV in L-loop TGA (L-TGA) and healthy controls (2 males, 1 female).
Kinetic energy (KE), viscous energy loss (EL), dissipation index (DI) calculated as EL to KE ratio, and hemodynamics forces (HFs) resulting from pressure gradients, were computed for the D-TGA/ASO and L-TGA SRVs, and for the control left ventricles (LVs) and right ventricles (RVs). HFs were decomposed in inferior-anterior, septal-lateral and basal-apical components (HFIA, HFSL, HFBA, respectively)
Results
Figure 1 reports the time-course of HF components and the general features of the enrolled subjects.
In systole, all SRVs (Figure 1a-1b) presented a dominant HFIA and a minor HFSL, similarly to RVs (Figure 1c); however, HFSL had a positive peak, indicating septal contraction towards the SRV cavity, opposite to its normal motion. HFBA magnitude was similar to LVs (Figure 1d), suggesting that the shortening of the tricuspid anulus towards the apex is more pronounced than in RVs (Figure 1c).
Over the whole cardiac cycle, DI values were highest in D-TGA/ASO SVRs (0.40-0.55); in L-TGA SRVs, DI values (0.24-0.45) were comparable to healthy LVs (0.22-0.37) and RVs (0.23-0.36). This difference may be related to the fact that in DTGA/ASO the left atrium is functionally replaced by a pulmonary venous baffle, which lacks efficient contraction, as highlighted by the absence of a distinctive A-wave in the KE time-course (Figure 2a).
Due to the adaptation to systemic afterload, SRVs were hypertrophic (Figure 1a-1b), with indexed mass higher than normal RVs (Figure 1c), and presented reduced compliance to the diastolic filling, as suggested by increased KE E-wave slope in L-TGA (Figure 2b) compared to controls (Figure 2c-2d).
Conclusions
Intracavitary HFs in SRVs reveal a partial shift from a RV towards LV pattern. This occurs at the expenses of a higher energetic consumption in D-TGA/ASO than L-TGA, enlightening the crucial role of atrial contribution to impaired SRV diastolic filling. These findings corroborate the previous evidence that patients with D-TGA/ASO have abnormal decrease in stroke volume during exercise whereas L-TGA patients can reach values comparably to healthy controls [2].
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Affiliation(s)
| | - A Riva
- Politecnico di Milano, Milan, Italy
| | - F Sturla
- IRCCS Polyclinic San Donato, Milan, Italy
| | - A Lanaro
- Politecnico di Milano, Milan, Italy
| | | | - D Giese
- Siemens Healthcare, Erlangen, Germany
| | - A Saracino
- IRCCS Polyclinic San Donato, Milan, Italy
| | - M Chessa
- IRCCS Polyclinic San Donato, Milan, Italy
| | | | | | | | - E Votta
- Politecnico di Milano, Milan, Italy
| | - M Lombardi
- IRCCS Polyclinic San Donato, Milan, Italy
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16
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Alcusky M, Thomas RB, Jafari N, Keith SW, Kee A, Del Canale S, Lombardi M, Maio V. Reduction in unplanned hospitalizations associated with a physician focused intervention to reduce potentially inappropriate medication use among older adults: a population-based cohort study. BMC Geriatr 2021; 21:218. [PMID: 33789589 PMCID: PMC8011227 DOI: 10.1186/s12877-021-02172-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background A multimodal general practitioner-focused intervention in the Local Health Authority (LHA) of Parma, Italy, substantially reduced the prevalence of potentially inappropriate medication (PIM) use among older adults. Our objective was to estimate changes in hospitalization rates associated with the Parma LHA quality improvement initiative that reduced PIM use. Methods This population-based longitudinal cohort study was conducted among older residents (> 65 years) using the Parma LHA administrative healthcare database. Crude and adjusted unplanned hospitalization rates were estimated in 3 periods (pre-intervention: 2005–2008, intervention: 2009–2010, post-intervention: 2011–2014). Multivariable negative binomial models estimated trends in quarterly hospitalization rates among individuals at risk during each period using a piecewise linear spline for time, adjusted for time-dependent and time-fixed covariates. Results The pre-intervention, intervention, and post-intervention periods included 117,061, 107,347, and 121,871 older adults and had crude hospitalization rates of 146.2 (95% CI: 142.2–150.3), 146.8 (95% CI: 143.6–150.0), and 140.8 (95% CI: 136.9–144.7) per 1000 persons per year, respectively. The adjusted pre-intervention hospitalization rate was declining by 0.7% per quarter (IRR = 0.993; 95% CI: 0.991–0.995). The hospitalization rate declined more than twice as fast during the intervention period (1.8% per quarter, IRR = 0.982; 95% CI: 0.979–0.985) and was nearly constant post-intervention (IRR: 0.999; 95% CI: 0.997–1.001). Contrasting model predictions for the intervention period (Q1 2009 to Q4 2010), the intervention was associated with 1481 avoided hospitalizations. Conclusion In a large population of older adults, a multimodal general practitioner-focused intervention to decrease PIM use was associated with a decline in the unplanned hospitalization rate. Such interventions to reduce high risk medication use among older adults warrant consideration by health systems seeking to improve health outcomes and reduce high-cost acute care utilization. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02172-3.
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Affiliation(s)
- M Alcusky
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Albert Sherman Building, 6th Floor, 368 Plantation Street, Worcester, MA, USA.
| | - R B Thomas
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10th Floor, Philadelphia, PA, 19107, USA
| | - N Jafari
- Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - S W Keith
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - A Kee
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10th Floor, Philadelphia, PA, 19107, USA
| | - S Del Canale
- Azienda Unità Sanitaria Locale di Parma (Local Health Authority of Parma), Parma, Italy
| | - M Lombardi
- Azienda Unità Sanitaria Locale di Parma (Local Health Authority of Parma), Parma, Italy
| | - V Maio
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10th Floor, Philadelphia, PA, 19107, USA.
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17
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Figliozzi S, Camporeale A, Pieroni M, Pieruzzi F, Namdar M, Lusardi P, Spada M, Mignani R, Burlina A, Scolari F, Carrubbi F, Battaglia Y, Graziani F, Boveri S, Lombardi M. Progressive electrocardiographic changes in parallel with cardiac magnetic resonance findings in fabry disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac Magnetic Resonance (CMR) allows to detect progressive stages of cardiac involvement in Fabry Disease (FD). A systematic description of electrocardiographic (ECG) alterations occurring in FD is currently missing.
Purpose
To explore ECG changes in progressive stages of FD cardiomyopathy.
Methods
71 FD patients and 17 healthy controls underwent CMR with T1 mapping and 12-lead ECG. ECG analysis included the duration of the P-wave and the interval between the end of P-wave and the beginning of QRS (PendQ). FD patients in the test cohort were divided into 3 groups with increasing severity of cardiac involvement: A) normal T1, no LVH; B) low T1, no LVH; C) low T1, LVH.
Results
An increase of Pwave/PendQ ratio was observed in Group A compared to Controls (1.08 vs. 0.75, p<0.0001). Higher Pwave/PendQ ratio (1.50 vs. 1.08, p<0.0001), shorter PQc interval (127.9 vs. 159.5, p=0.0007), increased Sokolow-Lyon Index (SLI) (3.2 vs. 2.4, p<0,001) and T wave amplitude (0.6 vs. 0.4 mV, p=0.002) characterized Group B in comparison with Group A. A higher prevalence of left bundle branch blocks (13.6% vs. 0%, p=0.03) and repolarization abnormalities (77.3% vs. 5.7%), wider QRS (120 vs 95 msec, p<0.0001) and QT (460 vs 400 msec, p=0.003) intervals were found in Group C compared to Group B. SLI (AUC 0.769), Pwave/PendQ (AUC 0.778), QRS (AUC 0.703) and QT (AUC 0.769) durations resulted to be independent predictors of low T1 values on CMR at stepwise multivariate analysis.
Conclusion
FD is characterized by progressive ECG changes. The identification of ECG parameters able to predict a lowering of myocardial T1 values on CMR may promote early detection of cardiac involvement, helping to target the therapeutic approach.
Progressive ECG and CMR changes in FD
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): This study was partially supported by Ricerca Corrente funding from the Italian Ministry of Health to IRCCS Policlinico San Donato.
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Affiliation(s)
- S Figliozzi
- King's College London, School of Biomedical Engineering and Imaging Sciences - St Thomas' Hospital, London, United Kingdom
| | - A Camporeale
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Section, San Donato Milanese, Italy
| | - M Pieroni
- San Donato Hospital of Arezzo, Department of Cardiology, Arezzo, Italy
| | - F Pieruzzi
- San Gerardo Hospital, Nephrology and Dialysis Unit, Monza, Italy
| | - M Namdar
- University Hospital of Geneva, Cardiology Division, Geneva, Switzerland
| | - P Lusardi
- Gradenigo Hospital, Department of Cardiology, Turin, Italy
| | - M Spada
- University of Turin, Department of Pediatrics, Turin, Italy
| | - R Mignani
- Infermi Hospital of Rimini, Nephrology and Dialysis Department, Rimini, Italy
| | - A Burlina
- Bassano del Grappa General Hospital, Neurological Unit, Bassano Del Grappa, Italy
| | - F Scolari
- Civil Hospital of Brescia, Nephrology and Dialysis Unit, Brescia, Italy
| | - F Carrubbi
- University of Modena & Reggio Emilia, Metabolic Medicine Unit, Modena, Italy
| | - Y Battaglia
- FER University Hospital - Ospedale S. Anna, Nephrology and Dialysis Unit, Ferrara, Italy
| | - F Graziani
- Gemelli University Hospital, Department of Cardiovascular and Thoracic Sciences, Roma, Italy
| | - S Boveri
- IRCCS Policlinico San Donato, Scientific Directorate, San Donato Milanese, Italy
| | - M Lombardi
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Section, San Donato Milanese, Italy
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18
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Tondi L, Mecarocci V, Sturla F, Pica S, Giannelli L, Ciconte G, Camporeale A, Santinelli V, Lombardi M, Pappone C. Right ventricular functional changes detected by CMR during ajmaline challenge in patients with Brugada syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
3D echocardiography has recently revealed alterations of right ventricular (RV) function in Brugada syndrome (BrS) during ajmaline challenge (AC). Cardiac magnetic resonance (CMR) is the gold standard for functional and anatomical RV assessment. CMR feature-tracking (FT) analysis is able to detect subtle functional changes in the underlying myocardial substrate.
Purpose
To investigate RV functional changes during AC in BrS patients using CMR-FT analysis.
Methods
24 consecutive BrS and 28 matched controls underwent CMR. CMR protocol included paraxial and parasagittal cine bSSFP sequences, acquired before and 2÷5 minutes after ajmaline infusion (1 mg/kg in 5 minutes), to obtain a comprehensive evaluation of the RV free wall. All patients were closely monitored with ECG. Semi-automatic threshold-based quantification of ventricular volumes, function and mass was performed in QMass. CMR-FT analysis of RV function was performed in QStrain. Values of longitudinal strain (LS) and transverse displacement (TD) of the RV wall before and after AC were compared in BrS patients and in the control group.
Results
AC induced Type 1 ECG pattern in all BrS patients and no ECG changes in controls. In BrS patients TD of the RV free wall was significantly reduced (P≤0.003) at peak ajmaline effect; controls reported sub-millimetric TD changes. LS of the RV wall was significantly impaired in BrS patients (P<0.0001) on both b SSFP sequences; LS remained comparable (P=0.62) in controls on the parasagittal sequence; minor but not negligible (P=0.01) LS changes were noticed on the paraxial stack. (Table 1)
Conclusions
In patients with BrS CMR-FT analysis during AC unveils dysfunctional RV wall mechanics in areas generally associated with abnormal electrical activity.
TD and LS in a Brs patient post AC
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Tondi
- IRCCS Polyclinic San Donato, Milan, Italy
| | | | - F Sturla
- IRCCS Polyclinic San Donato, Milan, Italy
| | - S Pica
- IRCCS Polyclinic San Donato, Milan, Italy
| | | | - G Ciconte
- IRCCS Polyclinic San Donato, Milan, Italy
| | | | | | - M Lombardi
- IRCCS Polyclinic San Donato, Milan, Italy
| | - C Pappone
- IRCCS Polyclinic San Donato, Milan, Italy
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19
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Riva A, Camporeale A, Sturla F, Pica S, Tondi L, Giese D, Castelvecchio S, Menicanti L, Redaelli A, Votta E, Lombardi M. Quantitative 4D Flow CMR analysis of intracardiac blood flow energetics in ischemic cardiomyopathy patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Ischemic cardiomyopathy (ICM) is often associated with negative LV remodelling after myocardial infarction, sometimes resulting in impaired LV function and dilation (iDCM). 4D Flow CMR has been recently exploited to assess intracardiac hemodynamic changes in presence of LV remodelling.
Purpose
To quantify 4D Flow intracardiac kinetic energy (KE) and viscous energy loss (EL) and investigate their relation with LV dysfunction and remodelling.
Methods
Patients with prior anterior myocardial infarction underwent a CMR study with 4D Flow sequences acquisition; they were divided into ICM (n=10) and iDCM (n=10, EDV>208 ml and EF<40%). 10 controls were used for comparison. LV was semi-automatically segmented using short axis CMR stacks and co-registered with 4D Flow. Global KE and EL were computed over the cardiac cycle. NT-proBNP measurements were correlated with average and peak values, during systole and diastole.
Results
Both LV volume and EF significantly differ (P<0.0001) between iDCM (EDV=294±56 ml, EF=24±8%), ICM (EDV=181±32 ml, EF=34±6%) and controls (EDV=124±29 ml, EF=72±5%). If compared to controls, both ICM and iDCM showed significantly lower KE (P≤0.0008); though lower than controls, EL was higher in iDCM than ICM. Within the iDCM subgroup, diastolic mean KE and peak EL reported good inverse correlation with NT-proBNP (r=−0.75 and r=−0.69, respectively). EL indexed (ELI) to average KE during systole was higher in the entire ischemic group as compared to controls (ELI(ischemic) = 0.17 vs. ELI(controls) = 0.10, P=0.0054).
Conclusions
4D Flow analyses effectively mapped post-ischemic LV energetic changes, highlighting the disproportionate intraventricular EL relative to produced KE; preliminary good correlation between LV energetic changes and NT-proBNP will deserve further investigation in order to contribute to early detection of heart failure.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Italian Ministry of Health
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Affiliation(s)
- A Riva
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - A Camporeale
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - F Sturla
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - S Pica
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - L Tondi
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - D Giese
- Siemens Healthcare GmbH, Erlangen, Germany
| | | | - L Menicanti
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - A Redaelli
- Politecnico di Milano, Dipartimento di Elettronica, Informazione e Bioingegneria, Milan, Italy
| | - E Votta
- Politecnico di Milano, Dipartimento di Elettronica, Informazione e Bioingegneria, Milan, Italy
| | - M Lombardi
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
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20
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Pisano A, Le Pera L, Lombardi M, Ferre F, Carletti R, Cerbelli B, Lazzeroni D, Alfieri O, Foglieni C, Camici P, D'Amati G. Gene expression profiling and enrichment functional analyses to compare coronary microvessels and cardiomyocytes in patients with hypertrophic cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Hypertrophic cardiomyopathy (HCM) is characterized by severe alterations of cardiac architecture and function involving cardiomyocytes (CM) and coronary microvessels (MV). Coronary microvascular dysfunction, cardiomyocyte hypertrophy and disarray, sarcomeric alterations and interstitial fibrosis are HCM features. The transcriptome profile associated with coronary MV and CM in HCM patients is presently unknown.
Purpose
Aim of this study was to improve knowledge of the molecular and biological pahways involved in HCM. To this purpose, the gene expression profile of coronary MV and CM was investigated.
Methods
Interventricular septum myectomies from patients with obstructive HCM and donors' hearts (CTR) were collected. Coronary MV (HCM=20, CTR=6) and CM (HCM=10, CTR=5) were laser capture microdissected. RNA-seq was performed by Illumina Nextseq 500, with 76 nt long single-reads. Adapter trimming and quality filtering of the sequenced reads were performed before alignment to the human reference genome. Univocally mapped reads estimated gene expression/sample. Normalized expressed gene levels were quantified. Statistical tests compared HCM and CTR to identify differentially expressed genes (DEG), i.e. up- and down-expressed genes in CM and MV samples. Functional enrichment analysis was performed. Biological categories, i.e. KEGG and Reactome pathways, Gene Ontology terms, protein domains in InterPro database, putative interactors collected in the Intact database and protein annotations in UniProt were considered for inter group comparison of DEGs.
Results
Transcriptome analysis identified 392 genes significantly up-regulated and 514 down-regulated in CM samples of HCM vs. CTR, while in MV 681 genes were up-regulated and 815 down-regulated. Although some DEGs were shared between MV and CM (26 and 146 are up- and down-expressed in both sample types), the majority of DEGs displayed a sample-specific pattern. A comparative functional analysis of DEGs highlighted some statistically enriched biological categories including an enrichment of phosphoproteins, with down-expressed genes both in CM (490) and MV (314). Other biological categories annotated as “ubiquitin-like protein conjugation” or “acetylation” in Uniprot database were enriched in down-regulated genes, both in MV and CM. Interestingly, “ribosomal protein” and “ribonucleoprotein” categories resulted as enriched up-regulated DEGs in MV. Conversely, the “citrullination” category was specifically present in annotations associated to down-regulated DEGs in MV from HCM compared to CTR.
Conclusions
Our preliminary results support the suitability of RNA-seq analysis to assess: i. the transcriptome profiles and pathways associated to coronary MV and CM; ii. the possible relationship/interplay of MV and CM profiles and HCM disease. The enrichment functional analysis provides preliminary data on candidate DEGs and target proteins for in vitro studies on HCM-related mechanisms.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Ministry of Health
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Affiliation(s)
- A Pisano
- Sapienza University of Rome, Department of Radiological, Oncological and Pathological Sciences, Rome, Italy
| | - L Le Pera
- The Institute of Biomembrane and Bioenergetics (IBBE), Bari, Italy
| | - M Lombardi
- IRCCS - MultiMedica, Cardiovascular Research Area, Milano, Italy
| | - F Ferre
- University of Bologna, Department of Pharmacy and Biotechnology (FaBiT), Bologna, Italy
| | - R Carletti
- Sapienza University of Rome, Department of Radiological, Oncological and Pathological Sciences, Rome, Italy
| | - B Cerbelli
- Sapienza University of Rome, Department of Radiological, Oncological and Pathological Sciences, Rome, Italy
| | - D Lazzeroni
- IRCCS - MultiMedica, Cardiovascular Research Area, Milano, Italy
| | - O Alfieri
- IRCCS - MultiMedica, Cardiac Surgery Unit, Milano, Italy
| | - C Foglieni
- IRCCS - MultiMedica, Cardiovascular Research Area, Milano, Italy
| | - P Camici
- IRCCS - MultiMedica, Cardiovascular Research Area, Milano, Italy
| | - G D'Amati
- Sapienza University of Rome, Department of Radiological, Oncological and Pathological Sciences, Rome, Italy
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21
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Tondi L, Pica S, Camporeale A, Figliozzi S, Bernardini A, Pluchinotta F, Secchi F, Lombardi M. Increased remote extracellular volume measured by CMR T1 mapping allows early identification of left atrial dysfunction in hypertrophic cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Myocardial fibrosis is a hallmark of hypertrophic cardiomyopathy (HCM). Cardiac magnetic resonance (CMR) detects replacement fibrosis (RF) through late gadolinium enhancement (LGE) and interstitial fibrosis (IF) in apparently unscarred myocardium by T1 mapping-derived increased extracellular volume (ECV). Differently from LGE, to date only few small studies have explored the clinical significance of IF in HCM and a correlation between IF and diastolic dysfunction (DD) has been proposed. However, DD detection is challenging in this population since the accuracy of standard echocardiographic parameters is controversial, especially in presence of left ventricular outflow tract obstruction (LVOTO). Left atrial (LA) dysfunction is associated with high left ventricular (LV) filling pressures and may represent an early marker of DD in HCM.
Purpose
To explore the correlation between IF and LA dysfunction in HCM patients with preserved systolic function.
Methods
93 consecutive HCM patients with preserved EF underwent a standard CMR scan. Semi-automatic threshold-based quantification of ventricular volumes, function and mass was performed. LA volumes (LAV) and function were evaluated by CMR feature-tracking (FT) analysis. The three atrial phasic functions were analyzed: (i) passive strain (εe), (ii) active strain (εa) and (iii) total strain (εs). LGE was quantified using the standard deviations (SDs) method (≥4 SDs). IF was assessed by T1 mapping-derived ECV quantification in remote myocardium (r-ECV). A matched group of 15 healthy subjects (HS) served as controls.
Results
Compared to HS, HCM patients showed increased LAV (LAV max: HS 39±9ml, HCM 59±20 ml; LAV min: HS 16±4 ml, HCM 34±17 ml; p<0.001), reduced LA EF (HS 61±3%, HCM 45±12%, p<0.001), impaired εs (HS 40±7%, HCM 29±11%, p<0.001) and εe (HS 26±7%, HCM 15±7%, p<0.001). No differences in εa were observed (HS 13±4%, HCM 14±7%, p 0.56). HCM patients were divided into 2 groups according to the presence of IF, defined as r-ECV values ≥29%. The two ECV groups did not differ in terms of LV EF, LA EF, LAV, LA area, E/E', LGE, LV mass, maximal wall thickness and LVOTO (all p>0.05). HCM patients with increased r-ECV showed significantly impaired LA function in terms of all three strain parameters vs. normal r-ECV group (HCM r-ECV <29%: εs 31±12%, εe15±7%, εa 15±5%; HCM r-ECV≥29%: εs 24±7%, εe 12±4%, εa 12±5%; all p<0.05).
Conclusions
In HCM patients increased r-ECV correlates with LA dysfunction, hinting towards a possible role for IF in determining altered LV relaxation and DD.
LA strain in controls and HCM ECV groups
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Tondi
- IRCCS Polyclinic San Donato, Milan, Italy
| | - S Pica
- IRCCS Polyclinic San Donato, Milan, Italy
| | | | - S Figliozzi
- Guys and St Thomas Hospital, School of Biomedical Engineering & Imaging Sciences, London, United Kingdom
| | | | | | - F Secchi
- IRCCS Polyclinic San Donato, Milan, Italy
| | - M Lombardi
- IRCCS Polyclinic San Donato, Milan, Italy
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22
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Gargani L, Pugliese N, Meloni A, Bruni C, Todiere G, Guiducci S, Moggi-Pignone A, Lombardi M, Mavrogeni S, Matucci-Cerinic M, Pepe A. Late Gadolinium Enhancement at cardiac magnetic resonance predicts malignant ventricular arrhythmias in systemic sclerosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Malignant arrhythmias due to cardiac involvement are a frequent cause of death in systemic sclerosis (SSc). Cardiac involvement, which is linked to both ischaemic and non-ischaemic fibrotic deposition, is often subclinical. Cardiovascular magnetic resonance (CMR) is the non-invasive gold standard for myocardial tissue characterization and can detect macroscopic myocardial fibrosis through late Gadolinium enhancement (LGE).
Aim
To evaluate the role of LGE to predict malignant arrhythmias requiring implantable cardioverter defibrillator (ICD) in SSc.
Methods
289 SSc patients underwent a thorough clinical evaluation and CMR exam using a 1.5 T scanner. Biventricular function parameter by SSFP cine images, oedema by STIR T2 images, and macroscopic fibrosis by LGE were assessed. Patients were followed-up and malignant ventricular arrhythmias requiring ICD implantation was considered as event.
Results
Out of 289 patients, 111 (38.4%) showed LGE and 83/111 (28.7% of the total population) showed a non-junctional distribution. During the follow-up (45±27 months), 10 patients needed ICD after malignant ventricular arrhythmias (7 patients with LGE, 3 patients without LGE). CMR predictors of cardiac events by univariate analysis were left and right ventricular ejection fractions, indexed right atrial area and non-junctional LGE. At multivariate analysis, macroscopic myocardial fibrosis detected by LGE was an independent predictor (hazard ratio 5.4; 95% C.I. 1.1–28.8, p<0.05; see figure for Kaplan-Meier curves).
Conclusions
Presence of ventricular LGE at CMR may represent an independent predictor for further malignant ventricular arrhythmias requiring ICD implantation in SSc patients.
Kaplan-Meier curves
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Gargani
- Institute of Clinical Physiology - National Research Council, Pisa, Italy
| | - N.R Pugliese
- University of Pisa, Department of Clinical and Experimental Medicine, Pisa, Italy
| | - A Meloni
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - C Bruni
- Careggi University Hospital, Department of Experimental and Clinical Medicine, Florence, Italy
| | - G Todiere
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - S Guiducci
- Careggi University Hospital, Department of Experimental and Clinical Medicine, Florence, Italy
| | - A Moggi-Pignone
- Careggi University Hospital, Department of Experimental and Clinical Medicine, Florence, Italy
| | - M Lombardi
- IRCCS Polyclinic San Donato, Multimodality Cardiac Imaging Section, Milan, Italy
| | - S Mavrogeni
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece
| | - M Matucci-Cerinic
- Careggi University Hospital, Department of Experimental and Clinical Medicine, Florence, Italy
| | - A Pepe
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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Vitale G, Di Nicola F, Tanini I, Camporeale A, Graziani F, Ditaranto R, Zanoni R, Ferrara V, Lombardi M, Olivotto I, Rapezzi C, Galie N, Biagini E. Electrocardiographic differences between Anderson-Fabry and sarcomeric hypertrophic cardiomyopathy and correlation with cardiac magnetic resonance. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Differential diagnosis between Anderson-Fabry (AF) and sarcomeric hypertrophic cardiomyopathy (HCM) is often very challenging particularly in AF patients with late onset cardiac involvement.
Purpose
To gain new insights from standard electrocardiogram (ECG) in AF disease for differential diagnosis from sarcomeric HCM. Additionally, to better understand ECG features in AF patients, a correlation substudy ECG-cardiac magnetic resonance (CMR) has been performed.
Methods
From 162 patients with definite diagnosis of AF disease, 111 [65 males, median age 57 (51–67) years] with pathologic left ventricular hypertrophy (LVH) (Group A) were compared with 111 sarcomeric HCM patients (Group B) sex, age and maximal wall thickness matched by 1:1 propensity score.
Results
AF patients showed shorter PR interval [155 (140–180) vs 163 (149–184) msec; p=0.005) and wider QRS interval [110 (100–134) vs 100 (90–106) msec; p<0.0001). Additionally AF patients had a higher prevalence of complete (22% vs 3%; p<0.0001) and incomplete (13% vs 1%; p<0.0001) right bundle branch block (RBBB) and a higher percentage of ST segment depression (12% vs 1%; p=0.001) and inferior negative T waves (34% vs 19%; p=0.01). No differences in terms of Sokolow-Lyon and Cornell scores were found whereas total QRS score was higher in Group A [20 (16–27) vs 18 [14–22] mV; p=0.0004). Low QRS voltages and inferior Q waves were not present in AF patients. Among the 69 AF patients who underwent MRI, the 44 with late gadolinium enhancement (LGE) were older [59 (52–66) vs 53 (40–59) years; p=0.017] and had more frequently negative T waves on ECG, particularly in the inferior leads (64% vs 8%; p<0.0001), compared to the 25 without LGE. At multivariate analysis, age and negative T waves were independently associated to the presence of LGE on CMR.
Conclusions
Compared to matched sarcomeric HCM, AF patients had a shorter PR, wider QRS and a higher percentage of RBBB in relation to to the different aetiology (storage vs “pure” hypertrophy). The higher total QRS score and the absence of inferior Q waves could reflect the more frequent concentric distribution of LVH. Additionally negative T waves, especially in inferior leads, are related to the presence of LGE on CMR (often in the postero-lateral wall).
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Vitale
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - F Di Nicola
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - I Tanini
- Careggi University Hospital (AOUC), Cardiomyopathy Unit, Florence, Italy
| | - A Camporeale
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Section (A.C., S.P., M.L.), San Donato Milanese, Italy
| | - F Graziani
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences, Roma, Italy
| | - R Ditaranto
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - R Zanoni
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - V Ferrara
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - M Lombardi
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Section (A.C., S.P., M.L.), San Donato Milanese, Italy
| | - I Olivotto
- Careggi University Hospital (AOUC), Cardiomyopathy Unit, Florence, Italy
| | - C Rapezzi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - N Galie
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - E Biagini
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
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24
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Acuti Martellucci C, Montagna V, Acquaviva G, Masiero A, Biardi L, Ciotti M, Lombardi M, Mariotti A. Trends in selected socio-economic determinants of depression in Italy, 2013 through 2017. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1063] [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
Background
In Italy, in 2015 suicide rate was 6.5/100,000 inhabitants, while in 2017 depressive disorders were estimated to represent 2.3% of total DALYs. The indicator for monitoring mental health is the suicide rate, but surveys such as the European Health Interview Survey (EHIS) of 2015 have identified several predictors of depression. We aim to assess trends in factors associated to depression in Italy, from 2013 to 2017.
Methods
Data from the Aspects of Daily Living survey (AVQ) carried out by the Italian Statistics Institute, from years 2013 to 2017, were used in this analysis. Investigated factors were those identified as predictors of depression in Italy according to the EHIS 2015: (1) education until middle high school and (2) high school, (3) poor social support (single-person households without friends, neighbours, or relatives to count on), (4) unemployment, (5) chronic disease, (6) moderate limitations of daily activity due to poor health, and (7) severe limitations. We calculated the prevalence of these factors, and 95% Confidence Intervals (CI), by sex and year.
Results
The prevalence of poor social support rose, differing significantly in men between 1.5% (95% CI 1.3% - 1.8%) in 2013 and 2.1% (95% CI 1.9% - 2.3%) in 2017. Unemployment decreased in men, from 12.7% (95% CI 12.0% - 13.4%) to 10.4% (95% CI 10.0% - 10.8%), whereas chronic diseases and moderate limitations grew significantly in both sexes, at respectively 24.6% (95% CI 24.0% - 25.2%) and 16.1% (95% CI 15.6% - 16.6%) for men, and 29.0% (95% CI 28.4% - 29.6%) and 19.4% (95% CI 18.9% - 19.9%) for women in 2017.
Conclusions
The growing proportions, in Italy, of people with poor social support, chronic diseases, and moderate limitations of daily activities, suggest that health care programming at the national level should prepare for a rising burden of mental disease in these groups, and take into account measures to promote well-being.
Key messages
Among factors associated with depression, poor social support, chronic diseases, and moderate physical limitations due to disease showed a growing trend in Italy from 2013 to 2017. The Italian yearly AVQ survey investigates predictors of mental disease, particularly depression, and could provide early data for effective health care programming and mental health promotion.
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Affiliation(s)
- C Acuti Martellucci
- Section of Hygiene and Preventive Medicine, University of the Marche Region, Ancona, Italy
| | - V Montagna
- Section of Hygiene and Preventive Medicine, University of the Marche Region, Ancona, Italy
| | - G Acquaviva
- Section of Hygiene and Preventive Medicine, University of the Marche Region, Ancona, Italy
| | - A Masiero
- Section of Hygiene and Preventive Medicine, University of the Marche Region, Ancona, Italy
| | - L Biardi
- Section of Hygiene and Preventive Medicine, University of the Marche Region, Ancona, Italy
| | - M Ciotti
- Section of Hygiene and Preventive Medicine, University of the Marche Region, Ancona, Italy
| | - M Lombardi
- Section of Hygiene and Preventive Medicine, University of the Marche Region, Ancona, Italy
| | - A Mariotti
- Section of Hygiene and Preventive Medicine, University of the Marche Region, Ancona, Italy
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25
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Di Marzo F, Sartelli M, Cennamo R, Toccafondi G, Coccolini F, La Torre G, Tulli G, Lombardi M, Cardi M. Recommendations for general surgery activities in a pandemic scenario (SARS-CoV-2). Br J Surg 2020; 107:1104-1106. [PMID: 32323878 PMCID: PMC7264544 DOI: 10.1002/bjs.11652] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/03/2020] [Indexed: 02/05/2023]
Affiliation(s)
- F Di Marzo
- UOC Chirurgia Generale, Ospedale Valtiberina - Sansepolcro, Usl Toscana Sud-Est, Italy
| | - M Sartelli
- UOC Chirurgia Generale, Ospedale di Macerata, Italy
| | - R Cennamo
- UOC Chirurgia Generale, Ospedale Valtiberina - Sansepolcro, Usl Toscana Sud-Est, Italy
| | | | - F Coccolini
- UOC Chirurgia Generale e d'urgenza, AOU Pisa, Italy
| | - G La Torre
- Dipartimento di Sanità Pubblica e Malattie Infettive, "Sapienza" Università di Roma, Italy
| | - G Tulli
- Agenzia Regionale di Sanità Toscana, Firenze, Italy
| | - M Lombardi
- UOC Chirurgia Generale, NOA - Marina di Massa, Usl Toscana Nord-Ovest, Italy
| | - M Cardi
- Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Italy
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26
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Chiabrando J, Lombardi M, Vescovo GM, Biondi Zoccai G, Abbate A, Wohlford G, Berrocal DH, Guzman L. P5752Which is the best stenting technique for coronary bifurcation lesions? Evidence from a network meta-analysis of randomized clinical trials. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Bifurcation lesions represent 20% of all coronary lesions treated by percutaneous coronary interventions (PCI). Although provisional technique with 1 stent in the main branch and balloon angioplasty of the side branch is considered the standard approach, the implantation of 2 stents is often being pursued with a wide variety of bifurcation stenting techniques. We thus conducted a systematic review and network meta-analysis of randomized clinical trials (RCTs) to compare clinical cardiovascular outcomes involving stenting techniques in coronary bifurcation lesions.
Methods
We searched on Pubmed, Google Scholar, Embase and Cochrane Library, up to October 2018 for published and unpublished RCTs that compared clinical cardiovascular outcomes in patients with bifurcation lesions treated with 7different techniques (crush [Cr]; culotte [Cu]; double kissing crush [DKCr], mini-crush [mCr], routine T-stenting [RTS], T-stenting and small protrusion [TAP], and provisional (1 stent technique)). We performed a frequentist fixed-effect network meta-analysis to estimate relative risks (RR) of major adverse cardiovascular events (“MACE”, typically defined as death, myocardial infarction and target vessel revascularization), target vessel revascularization (TVR), target lesion revascularization (TLR), and stent thrombosis (ST).
Results
We identified 14 studies, yielding data on 4285 patients. DKCr and mCr yielded significant reductions in MACE, TVR, and TLR when compared with the 1-stent technique (RR 0.31–0.55 [all P<0.01] and RR 0.42–0.45 [all P<0.02], respectively) and with the rest of the bifurcation techniques (RR 0.44–0.55 [all P<0.05] for DKCr and RR 0.37–0.45 [all P<0.05] for mCr). On the other hand, Cu and Cr were associated with an increased risk for ST compared to 1-stent technique (RR 3.25–4.27 [both P<0.05]) and to DKCr (RR 3.02–3.99 [both P<0.05]). We found no heterogeneity nor inconsistency between studies.
Conclusions
The various PCI bifurcation stenting techniques are associated with different cardiovascular outcomes, with double kissing crush and mini crush being more effective than others, including the 1-stent approach, whereas culotte and crush are associated with increased risk of stent thrombosis.
Acknowledgement/Funding
None
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Affiliation(s)
- J Chiabrando
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - M Lombardi
- VCU Pauley Heart Center, Clinical Research Unit, Richmond, United States of America
| | - G M Vescovo
- University of Padova, Dept. Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - G Biondi Zoccai
- Sapienza University of Rome, Department of Medical-Surgical Sciences and Biotechnologies, Rome, Italy
| | - A Abbate
- VCU Pauley Heart Center, Clinical Research Unit, Richmond, United States of America
| | - G Wohlford
- VCU Pauley Heart Center, Clinical Research Unit, Richmond, United States of America
| | - D H Berrocal
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - L Guzman
- VCU Pauley Heart Center, Clinical Research Unit, Richmond, United States of America
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27
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Lombardi M, Lazzeroni D, Rimoldi O, Girolami F, Pisano A, Benedetti G, Alfieri O, D'Amati G, Foglieni C, Camici P. 1177Insights on mitochondrial energetics in obstructive hypertrophic cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy, heterogeneous in phenotype and clinical course. The genotype-phenotype relationship and associated molecular mechanisms are still incompletely understood. In the HCM milieu, increased energy cost of force production, impairing performance and mitochondrial function, may be associated to patients' genotype and/or phenotype.
Purpose
To determine abnormalities in mitochondrial energetics in HCM and their possible relationship with genotype and clinical phenotype of patients.
Methods
Septal myectomies from characterized patients with obstructive HCM (HOCM, n=18) and donor hearts discarded from transplantation (CTRL, n=8) have been compared. HOCM patients were screened and demographic, clinical and instrumental data (routine ECG, echocardiography and cardiac magnetic resonance-CMR) were collected.
Genetic analysis was performed on total DNA extracted from myectomies by NGS on MiSeq platform using the TruSight Cardio Sequencing kit and testing a panel of 26 genes.
Activity and amount of mitochondrial enzymes generating/scavenging reactive oxygen species were investigated.
Results
Within the HOCM cohort 30% of patients was bearing mutations in sarcomeric genes associated with HCM.
The amount and/or activity of mitochondrial Complex I NADH dehydrogenase, of SOD2 and (m)-aconitase were upregulated in HOCM vs. CTRL. NADH dehydrogenase level was inversely correlated with the degree of mitral valve regurgitation and mitral valve backward volume by CMR (Spearman R=−0.5 and −0.8, respectively).
The Complex V enzyme ATP synthase activity decreased, whilst its amount was comparable in HOCM vs. CTRL. Analogously the SOD1 activity was similar in HOCM and CTRL.
No difference in mitochondrial DNA (mtDNA) copy number was found.
Results were unrelated to HCM-associated mutations.
Conclusions
HOCM hearts are characterized by mitochondrial hyperactivity aimed at quenching reactive oxygen species, but decreased ATP synthase activity. Overall, these data suggest an abnormal mitochondrial activity in the myocardium of HOCM patients independent of the presence of HCM-associated mutations. Moreover, our results underpin the markedly abnormal cellular energetics of HOCM, identifying potential therapeutic targets.
Acknowledgement/Funding
NET-2011-02347173, Italian Minister of Health
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Affiliation(s)
- M Lombardi
- San Raffaele Scientific Institute, Milan, Italy
| | - D Lazzeroni
- San Raffaele Scientific Institute, Milan, Italy
| | - O Rimoldi
- Institute of Biomedical Technologies, Institute of Molecular Bioimaging and Physiology IBFM, Segrate (Milan), Italy
| | - F Girolami
- Meyer Children's Hospital, Florence, Italy
| | - A Pisano
- Sapienza University of Rome, Rome, Italy
| | - G Benedetti
- San Raffaele Scientific Institute, Milan, Italy
| | - O Alfieri
- San Raffaele Scientific Institute, Milan, Italy
| | - G D'Amati
- Sapienza University of Rome, Rome, Italy
| | - C Foglieni
- San Raffaele Scientific Institute, Milan, Italy
| | - P Camici
- San Raffaele Scientific Institute, Milan, Italy
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28
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Lazzeroni D, Camporeale A, Moroni F, Garibaldi S, Pica S, Chow K, Camici P, Lombardi M. P5273Trabecular complexity as a subclinical structural alteration in Fabry cardiomyopathy: a cardiac magnetic resonance study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart involvement represents the main cause of death in Fabry Disease (FD), thus its early detection is important to define the optimal therapeutic strategy. Recently, a disproportionate increase in myocardial trabeculation has been described in FD by cardiac magnetic resonance (CMR), even in early (prehypertrophic) stage of the disease. In addition, CMR with T1 mapping can identity the presence of myocardial sphingolipid storage (causing lowering of native T1 values) in more than 50% of FD patients with no LVH. However, it is not clear whether a relationship exists between trabecular complexity and sphingolipid storage in FD.
Aim
To explore the association between myocardial trabecular complexity, quantified by endocardial border fractal analysis, and sphingolipid storage, described by CMR T1 mapping, in different stages of Fabry cardiomyopathy.
Methods
Study population included 60 subjects: 15 FD patients with no detectable signs of cardiac involvement (no LVH, normal T1; 2 M, age 30.6±14; Group 1); 15 FD patients with early sphingolipid storage (no LVH, low T1; 9 M, age 33±9.6; Group 2); 15 FD patients with LVH (11 M, age 53.5±9.6; Group 3); 15 healthy controls (9 M, age 34±10). Patients and controls underwent CMR with T1 mapping; disease severity was quantified using Mainz Severity Score Index (MSSI). Myocardial trabecular fractal dimension was evaluated, blinded to patients'characteristics, on short axis cine images using the Image J dedicated plug-in FracLac, deriving the following parameters: total, basal, mid-ventricular and apical fractal dimensions.
Results
Total fractal dimension was higher in all Fabry groups compared to controls. Indeed, a gradient of total fractal dimension was observed, with this parameter gradually increasing from healthy controls to Groups 3 (1.27±0.02 in controls vs 1.29±0.02 in Group 1 vs 1.30±0.02 in Group 2 vs 1.34±0.02 in Group 3; p<0.001) (Figure 1A). Interestingly, both total and basal fractal dimensions were significantly higher in Group 1 compared to controls (1.27±0.02 vs 1.29±0.02, p=0.044 and 1.26±0.04 vs 1.30±0.03; p=0.007, respectively). Moreover, considering the total population, fractal dimension showed significant correlations with: i) T1 values (r=−0.567; p<0.001 - Figure 1B); ii) LV mass (r=0.674, p<0.001); iii) trabecular mass expressed as percentage of global LV mass (r=0.611; p<0.001); iv) MSSI (r=0.535; p<0.001).
Conclusion
Cardiac involvement in FD is characterized by a progressive increase in fractal dimension of endocardial trabeculae (Figure 1C). Both total and basal myocardial trabeculation are increased in Fabry patients even before the presence of detectable sphingolipid storage, thus representing a very early sign of cardiac involvement.
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Affiliation(s)
- D Lazzeroni
- San Raffaele Hospital of Milan (IRCCS), Cardiothoracic and Vascular Departement, Milan, Italy
| | - A Camporeale
- IRCCS, Policlinico San Donato, Multimodality Cardiac Imaging Section, San Donato Milanese, Italy
| | - F Moroni
- San Raffaele Hospital of Milan (IRCCS), Cardiothoracic and Vascular Departement, Milan, Italy
| | - S Garibaldi
- University Hospital of Parma, Department of Cardiology, Parma, Italy
| | - S Pica
- IRCCS, Policlinico San Donato, Multimodality Cardiac Imaging Section, San Donato Milanese, Italy
| | - K Chow
- Siemens Healthcare GmbH, Erlangen, Germany
| | - P Camici
- San Raffaele Hospital of Milan (IRCCS), Cardiothoracic and Vascular Departement, Milan, Italy
| | - M Lombardi
- IRCCS, Policlinico San Donato, Multimodality Cardiac Imaging Section, San Donato Milanese, Italy
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29
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Camporeale A, Moroni F, Lazzeroni D, Garibaldi S, Pica S, Chow K, Camici P, Lombardi M. 551Trabecular complexity as a subclinical structural alteration in fabry cardiomyopathy: a cardiac magnetic resonance study. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez125.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Camporeale
- IRCCS, Policlinico San Donato, Multimodality Cardiac Imaging Unit, San Donato Milanese, Italy
| | - F Moroni
- San Raffaele Hospital of Milan (IRCCS), Cardiothoracic and Vascular Department, Milan, Italy
| | - D Lazzeroni
- San Raffaele Hospital of Milan (IRCCS), Cardiothoracic and Vascular Department, Milan, Italy
| | - S Garibaldi
- University Hospital of Parma, Department of Cardiology, Parma, Italy
| | - S Pica
- IRCCS, Policlinico San Donato, Multimodality Cardiac Imaging Unit, San Donato Milanese, Italy
| | - K Chow
- Siemens Healthcare GmbH, Erlangen, Germany
| | - P Camici
- San Raffaele Hospital of Milan (IRCCS), Cardiothoracic and Vascular Department, Milan, Italy
| | - M Lombardi
- IRCCS, Policlinico San Donato, Multimodality Cardiac Imaging Unit, San Donato Milanese, Italy
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30
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Pica S, Piatti F, Milani P, Mussinelli R, Foli A, Basset M, Camporeale A, Geppert C, Giese D, Chow K, Perlini S, Merlini G, Palladini G, Lombardi M. 5234D flow CMR for diastolic function assessment in cardiac amyloidosis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez124.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Pica
- IRCCS Polyclinic San Donato, Multimodality Cardiac Imaging, Milan, Italy
| | - F Piatti
- IRCCS, Policlinico San Donato, 3D and Computer Simulation Laboratory, San Donato Milanese, Italy
| | - P Milani
- Amyloidosis Research and Treatment Center, Department of Molecular Medicine University of Pavia, Pavia, Italy
| | - R Mussinelli
- Amyloidosis Research and Treatment Center, Department of Molecular Medicine University of Pavia, Pavia, Italy
| | - A Foli
- Amyloidosis Research and Treatment Center, Department of Molecular Medicine University of Pavia, Pavia, Italy
| | - M Basset
- Amyloidosis Research and Treatment Center, Department of Molecular Medicine University of Pavia, Pavia, Italy
| | - A Camporeale
- IRCCS Polyclinic San Donato, Multimodality Cardiac Imaging, Milan, Italy
| | - C Geppert
- Siemens Healthcare GmbH, Erlangen, Germany
| | - D Giese
- Siemens Healthcare GmbH, Erlangen, Germany
| | - K Chow
- Siemens Healthcare GmbH, Erlangen, Germany
| | - S Perlini
- Amyloidosis Research and Treatment Center, Department of Molecular Medicine University of Pavia, Pavia, Italy
| | - G Merlini
- Amyloidosis Research and Treatment Center, Department of Molecular Medicine University of Pavia, Pavia, Italy
| | - G Palladini
- Amyloidosis Research and Treatment Center, Department of Molecular Medicine University of Pavia, Pavia, Italy
| | - M Lombardi
- IRCCS Polyclinic San Donato, Multimodality Cardiac Imaging, Milan, Italy
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31
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Camporeale A, Pieroni M, Pieruzzi F, Lusardi P, Pica S, Spada M, Mignani R, Burlina A, Bandera F, Guazzi M, Graziani F, Chow K, Boveri S, Ambrogi F, Lombardi M. 251Predictors of clinical evolution in prehypertrophic Fabry Disease. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez120.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Camporeale
- IRCCS, Policlinico San Donato, Multimodality Cardiac Imaging Unit, San Donato Milanese, Italy
| | - M Pieroni
- San Donato Hospital, Cardiology, Arezzo, Italy
| | - F Pieruzzi
- San Gerardo Hospital, Nephrology and Dialysis Unit, Monza, Italy
| | - P Lusardi
- Humanitas Hospital, Department of Cardiology, Turin, Italy
| | - S Pica
- IRCCS, Policlinico San Donato, Multimodality Cardiac Imaging Unit, San Donato Milanese, Italy
| | - M Spada
- University of Turin, Department of Pediatrics, Turin, Italy
| | - R Mignani
- Infermi Hospital of Rimini, Nephrology and Dialysis Unit, Rimini, Italy
| | - A Burlina
- Bassano del Grappa General Hospital, Department of Neurology, Bassano Del Grappa, Italy
| | - F Bandera
- IRCCS, Policlinico San Donato, University Cardiology Department, San Donato Milanese, Italy
| | - M Guazzi
- IRCCS, Policlinico San Donato, University Cardiology Department, San Donato Milanese, Italy
| | - F Graziani
- Polyclinic Agostino Gemelli, Department of Cardiothoracic Sciences, Rome, Italy
| | - K Chow
- Siemens, Erlangen, Germany
| | - S Boveri
- IRCCS, Policlinico San Donato, Scientific Directorate, San Donato Milanese, Italy
| | - F Ambrogi
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - M Lombardi
- IRCCS, Policlinico San Donato, Multimodality Cardiac Imaging Unit, San Donato Milanese, Italy
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32
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Melita V, Pica S, Camporeale A, Geppert C, Chow K, Crea F, Lombardi M. P118When coronary angiography is not enough: the role of cardiac magnetic resonance in differential diagnosis of atypical chest pain and left ventricular systolic dysfunction. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez110.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Melita
- Catholic University of the Sacred Heart, Istituto di Cardiologia, Rome, Italy
| | - S Pica
- IRCCS, Policlinico San Donato, Imaging Cardiaco Multimodale, San Donato Milanese, Italy
| | - A Camporeale
- IRCCS, Policlinico San Donato, Imaging Cardiaco Multimodale, San Donato Milanese, Italy
| | - C Geppert
- Siemens HealthcareGmbH, Erlangen, Germany
| | - K Chow
- Siemens HealthcareGmbH, Erlangen, Germany
| | - F Crea
- Catholic University of the Sacred Heart, Istituto di Cardiologia, Rome, Italy
| | - M Lombardi
- IRCCS, Policlinico San Donato, Imaging Cardiaco Multimodale, San Donato Milanese, Italy
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Sturla F, Piatti F, Jaworek M, Lucherini F, Siryk S, Geppert C, Tresova D, Pluchinotta F, Vismara R, Redaelli A, Tasca G, Lombardi M. 5194d flow MR hemodynamic mapping of surgical pericardial valves. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez124.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- F Sturla
- IRCCS, Policlinico San Donato, 3D and Computer Simulation Laboratory, San Donato Milanese, Italy
| | - F Piatti
- IRCCS, Policlinico San Donato, 3D and Computer Simulation Laboratory, San Donato Milanese, Italy
| | - M Jaworek
- Milan Polytechnic , Electronic, Information and Bioengineering, Milan, Italy
| | - F Lucherini
- Milan Polytechnic , Electronic, Information and Bioengineering, Milan, Italy
| | - S Siryk
- National Technical University of Ukraine "Igor Sikorsky Kyiv Polytechnic Institute", Kiev, Ukraine
| | - C Geppert
- Siemens Healthcare GmbH, Erlangen, Germany
| | - D Tresova
- IRCCS Polyclinic San Donato, Multimodality Cardiac Imaging, Milan, Italy
| | - F Pluchinotta
- IRCCS Polyclinic San Donato, Multimodality Cardiac Imaging, Milan, Italy
| | - R Vismara
- Milan Polytechnic , Electronic, Information and Bioengineering, Milan, Italy
| | - A Redaelli
- Milan Polytechnic , Electronic, Information and Bioengineering, Milan, Italy
| | - G Tasca
- Alessandro Manzoni Hospital, Cardiovascular Department, Cardiac Surgery Unit, Lecco, Italy
| | - M Lombardi
- IRCCS Polyclinic San Donato, Multimodality Cardiac Imaging, Milan, Italy
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Leggio M, Lombardi M, Caldarone E, D'Emidio S, Severi P, Armeni M, Fusco A. Pacemaker-detected severe sleep apnoea predicts new-onset atrial fibrillation. Europace 2018; 20:2046-2047. [PMID: 29912387 DOI: 10.1093/europace/euy047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital-Salus Infirmorum Clinic, Via della Lucchina 41, Rome, Italy
| | - Mario Lombardi
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Elisa Caldarone
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Stefania D'Emidio
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Paolo Severi
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital-Salus Infirmorum Clinic, Via della Lucchina 41, Rome, Italy.,Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Massimo Armeni
- Department of Research, EDUCAM (C.R.O.M.O.N., S.Os.I., A.I.R.O.P.), Rome, Italy
| | - Augusto Fusco
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
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Leggio M, Fusco A, D'Emidio S, Severi P, Lombardi M, Caldarone E, Armeni M, Mereu D, Bendini MG, Mazza A. Management of oral anticoagulation in patients with atrial fibrillation: newer agents, newer conundrums? J Intern Med 2018; 284:697-699. [PMID: 29658167 DOI: 10.1111/joim.12755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Rome, Italy
| | - A Fusco
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - S D'Emidio
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - P Severi
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Rome, Italy.,Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - M Lombardi
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - E Caldarone
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - M Armeni
- Department of Research, EDUCAM (C.R.O.M.O.N., S.Os.I, A.I.R.O.P.), Rome, Italy
| | - D Mereu
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - M G Bendini
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
| | - A Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
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Grimaldi A, Cassano V, Troise D, Lombardi M, Vairo U, Scalzo G. RF31 IS ISOLATED TYPE I VENTRICULAR SEPTAL DEFECT STILL RARE IN ITALIAN POPULATION COMPARED TO ASIAN? J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550054.96427.ff] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Leggio M, Bendini MG, D'Emidio S, Caldarone E, Lombardi M, Severi P, Stavri DC, Armeni M, Bravi V, Mazza A. Exercise dose in clinical practice: Right is better than more. Cardiol J 2018; 25:287-288. [PMID: 29717780 DOI: 10.5603/cj.2018.0040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Via della Lucchina 41, 00135 Rome, Italy.
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Tarallo L, Lombardi M, Zambianchi F, Giorgini A, Catani F. Distal biceps tendon rupture: advantages and drawbacks of the anatomical reinsertion with a modified double incision approach. BMC Musculoskelet Disord 2018; 19:364. [PMID: 30305070 PMCID: PMC6180654 DOI: 10.1186/s12891-018-2278-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 09/25/2018] [Indexed: 11/19/2022] Open
Abstract
Background Distal biceps tendon rupture occurs more often in middle-aged male population, involving the dominant arm. In this retrospective study, it’s been described the occurrence of the most frequent adverse events and the clinical outcomes of patients undergoing surgical repair of distal biceps tendon rupture with the modified Morrey’s double-incision approach, to determine better indications for patients with acute tendon injury. Methods Sixty-three patients with acute distal biceps tendon rupture treated with a modified double-incision technique between 2003 and 2015 were retrospectively evaluated at a mean 24 months of follow-up. Clinical evaluation including range of motion (ROM) and isometric strength recovery compared to the healthy contralateral side assessment, together with documentation of nerve injury, was performed. Patients were asked to answer DASH, OES and MEPS scores. Results The ROM recovery showed excellent results compared to the healthy contralateral side. The reported major complications included: one case of proximal radio-ulnar synostosis, 3 cases of posterior interosseous nerve (PIN) palsy and one case of a-traumatic tendon re-rupture. Concerning minor complications, intermittent pain, ROM deficiency < 30° in flexion/extension and pronation/supination, isometric flexion strength deficiency < 30% and isometric supination strength deficiency < 60%, lateral antebrachial cutaneous nerve (LACBN) injury, were observed. The average DASH score was 8.5; the average OES was 41.5 and the MEPS was 96.3. Conclusion The Morrey modified double-incision technique finds its indication in young and active patients if performed within 2 weeks from injury. If performed by experienced surgeons, the advantages can exceed the drawbacks of possible complications.
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Affiliation(s)
- L Tarallo
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
| | - M Lombardi
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - F Zambianchi
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - A Giorgini
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - F Catani
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
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Leggio M, Fusco A, Severi P, Armeni M, D'Emidio S, Caldarone E, Lombardi M, Bendini MG, Mazza A. Exercise Training in Obese Patients with Heart Failure: Time to Tackle the Burden. Am J Med 2018; 131:e425. [PMID: 29891172 DOI: 10.1016/j.amjmed.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/04/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital-Salus Infirmorum Clinic, Rome, Italy
| | - Augusto Fusco
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Paolo Severi
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital-Salus Infirmorum Clinic, Rome, Italy; Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Massimo Armeni
- Department of Research, EDUCAM (C.R.O.M.O.N., S.Os.I., A.I.R.O.P.), Rome, Italy
| | - Stefania D'Emidio
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Elisa Caldarone
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Mario Lombardi
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | | | - Andrea Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
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Sardella G, Stefanini GG, Briguori C, Tamburino C, Fabbiocchi F, Rotolo F, Tomai F, Paggi A, Lombardi M, Gioffrè G, Sclafani R, Rolandi A, Sciahbasi A, Scardaci F, Signore N, Calcagno S, Mancone M, Chiarito M, Giordano A. Safety and efficacy of polymer-free biolimus-eluting stents in all-comer patients: the RUDI-FREE study. EUROINTERVENTION 2018; 14:772-779. [DOI: 10.4244/eij-d-18-00148] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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41
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Leggio M, Fusco A, Severi P, Lombardi M, Caldarone E, D'Emidio S, Armeni M, Mereu D, Bendini MG, Mazza A. Antithrombotic Therapy After Percutaneous Coronary Intervention in Atrial Fibrillation: The Triple Trouble. Drugs 2018; 78:1309-1319. [PMID: 30132258 DOI: 10.1007/s40265-018-0957-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
One of the most common conundrums in all cardiovascular medicine pertains to the care of patients with atrial fibrillation after percutaneous coronary intervention, because of both dual antiplatelet therapy and oral anticoagulant therapy would seem to be necessary to reduce risks of stent thrombosis and thromboembolism, respectively, but also with an inevitable trade-off of more bleeding. Patients who require triple therapy are at high risk of both ischaemia and bleeding; therefore, defining a personalised secondary prevention strategy aimed at achieving the best net clinical benefit is essential. The good news is that we have entered an era of increased perceived and tangible safety that applies to both non-vitamin K-antagonist oral anticoagulants and newer drug-eluting stents. Even if the consistency across the major trials and the significantly lower risk of bleeding with dual therapy make it hard to argue that triple therapy should be used routinely, the aggregate evidence suggests that the net clinical benefit of dual therapy should give cardiologists confidence to drop aspirin when they are using a contemporary percutaneous coronary intervention strategy with drug-eluting stents. Waiting for more randomised trials and meta-analyses, for the time being, in patients not in clinical trials, full-dose oral triple therapy with dual antiplatelet agents and full-dose anticoagulation should be avoided as a routine practice, and the choice of the proper, that is, safer, oral anticoagulant, namely a non-vitamin K-antagonist oral anticoagulant, may be regarded by now as an additional bleeding avoiding strategy in patients with atrial fibrillation undergoing percutaneous coronary intervention.
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Affiliation(s)
- Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital, Salus Infirmorum Clinic, Via della Lucchina 41, 00135, Rome, Italy.
| | | | - Paolo Severi
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital, Salus Infirmorum Clinic, Via della Lucchina 41, 00135, Rome, Italy.,Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Mario Lombardi
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Elisa Caldarone
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Stefania D'Emidio
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Massimo Armeni
- Department of Research, EDUCAM (C.R.O.M.O.N., S.Os.I., A.I.R.O.P.), Rome, Italy
| | - Daniela Mereu
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | | | - Andrea Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
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Pica S, Di Giovine G, Bollati M, Testa L, Bedogni F, Camporeale A, Pontone G, Andreini D, Monti L, Gasparini G, Grancini L, Secco GG, Maestroni A, Ambrogi F, Milani V, Lombardi M. Cardiac magnetic resonance for ischaemia and viability detection. Guiding patient selection to revascularization in coronary chronic total occlusions: The CARISMA_CTO study design. Int J Cardiol 2018; 272:356-362. [PMID: 30173921 DOI: 10.1016/j.ijcard.2018.08.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/21/2018] [Accepted: 08/20/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND It is debated whether percutaneous revascularization (PCI) of total coronary chronic occlusion (CTO) is superior to optimal medical therapy (OMT) in improving symptoms, left ventricular (LV) function and major adverse cardiac/cerebrovascular events (MACCE). Furthermore, CTO-PCI is a challenging technique, with lower success rate than in other settings. A systematic analysis of baseline LV function, infarction extent and ischaemic burden to predict response to revascularization has never been performed. PURPOSES To establish a CMR protocol to identify patients (pts) who can benefit most from CTO-PCI. Myocardial viability/ischaemia retains high biological plausibility as predictors of response to revascularization. Therefore, baseline viability (necrotic tissue extent, response to inotropic stimulation) and ischaemia (perfusion defect, wall motion abnormality during stress) will be studied as potential predictors of mechanical LV segmental improvement and ischaemic burden reduction in CTO territory (primary endpoint), LV remodelling and global function, Seattle Angina Questionnaire, and MACCE improvement (secondary endpoints) in the follow-up. METHODS Pts with CTO suitable for PCI undergo stress-CMR for viability/ischaemia assessment. Pts with normal LV function undergo adenosine, those with moderately-reduced ejection fraction (EF) and wall motion abnormalities high-dose dobutamine, pts with EF <35% low-dose dobutamine. All pts undergo late gadolinium enhancement and repeat the same scan at 12 ± 3 months, regardless of PCI success or decision for OMT. CONCLUSIONS A multi-parameter CMR protocol tailored on pts characteristics to study viability/ischaemia could help in identifying responders in terms of LV function, ischaemic burden and clinical outcome among pts suitable for CTO-PCI, improving selection of best candidates to percutaneous revascularization.
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Affiliation(s)
- S Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
| | - G Di Giovine
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - M Bollati
- Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - L Testa
- Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - F Bedogni
- Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - A Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - G Pontone
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - D Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - L Monti
- Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - G Gasparini
- Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - L Grancini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - G G Secco
- A.O.Ss. Antonio e Biagio, Alessandria, Italy
| | - A Maestroni
- ASTT Valle Olona, Busto Arsizio, Varese, Italy
| | - F Ambrogi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - V Milani
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - M Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Piatti F, Camporeale A, Pozzi S, Di Giovine G, Pica S, Castelvecchio S, Menicanti L, Greiser A, Votta E, Redaelli A, Lombardi M. P5641CMR and 4dflow-based analysis of alterations in post ischemic dilated cardiomiopathy before and after surgical ventricular restoration. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Piatti
- Milan Polytechnic, Electronic, Information and Bioengineering, Milan, Italy
| | - A Camporeale
- IRCCS Polyclinic San Donato, Multimodality Cardiac Imaging, Milan, Italy
| | - S Pozzi
- Milan Polytechnic, Electronic, Information and Bioengineering, Milan, Italy
| | - G Di Giovine
- IRCCS Polyclinic San Donato, Multimodality Cardiac Imaging, Milan, Italy
| | - S Pica
- IRCCS Polyclinic San Donato, Multimodality Cardiac Imaging, Milan, Italy
| | - S Castelvecchio
- IRCCS, Policlinico San Donato, Department of Cardiac Surgery, San Donato Milanese, Italy
| | - L Menicanti
- IRCCS, Policlinico San Donato, Department of Cardiac Surgery, San Donato Milanese, Italy
| | - A Greiser
- Siemens Healthcare GmbH, Erlangen, Germany
| | - E Votta
- Milan Polytechnic, Electronic, Information and Bioengineering, Milan, Italy
| | - A Redaelli
- Milan Polytechnic, Electronic, Information and Bioengineering, Milan, Italy
| | - M Lombardi
- IRCCS Polyclinic San Donato, Multimodality Cardiac Imaging, Milan, Italy
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Leggio M, Bendini M, Caldarone E, Lombardi M, Severi P, D’Emidio S, Stavri D, Armeni M, Bravi V, Mazza A. Low-dose aspirin for primary prevention of cardiovascular events in patients with diabetes: Benefit or risk? Diabetes & Metabolism 2018; 44:217-225. [DOI: 10.1016/j.diabet.2017.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/05/2017] [Accepted: 11/05/2017] [Indexed: 01/13/2023]
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Leggio M, Lombardi M, Caldarone E, Mazza A, Fusco A. High body mass index, healthy metabolic profile and low visceral adipose tissue: The paradox is to call it obesity again. Eur J Intern Med 2018; 52:e15-e16. [PMID: 29636273 DOI: 10.1016/j.ejim.2018.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Rome, Italy.
| | - Mario Lombardi
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Elisa Caldarone
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Andrea Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
| | - Augusto Fusco
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
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46
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Benati E, Pampena R, Bombonato C, Borsari S, Lombardi M, Longo C. Dermoscopy and reflectance confocal microscopy for monitoring the treatment of actinic cheilitis with ingenol mebutate gel: Report of three cases. Dermatol Ther 2018; 31:e12613. [PMID: 29687567 DOI: 10.1111/dth.12613] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 11/24/2017] [Accepted: 03/18/2018] [Indexed: 12/16/2022]
Abstract
Actinic cheilitis (AC) can precede the development of squamous cell carcinoma (SCC) of the lip, a location with higher risk of invasiveness and metastasis. Herein, we reported the use of ingenol mebutate (IngMeb) 0.015% gel on three consecutive days to treat three patients suffering from AC. All the three patients achieved complete clearance of AC with rapid clinical effect, favorable safety profile, good patient's compliance related to short time of applications, and few local skin reactions. So IngMeb is an attractive new therapy for AC. Moreover, the present case report adds further evidence to the usefulness of dermoscopy and Reflectance confocal microscopy (RCM) in the assessment and monitoring of treatment outcome.
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Affiliation(s)
- E Benati
- Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - R Pampena
- Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - C Bombonato
- Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - S Borsari
- Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - M Lombardi
- Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - C Longo
- Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy.,Dermatology Department, University of Modena and Reggio Emilia, Modena, Italy
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47
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Djatche L, Lee S, Singer D, Hegarty SE, Lombardi M, Maio V. How confident are physicians in deprescribing for the elderly and what barriers prevent deprescribing? J Clin Pharm Ther 2018; 43:550-555. [PMID: 29682764 DOI: 10.1111/jcpt.12688] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [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: 12/22/2017] [Accepted: 03/23/2018] [Indexed: 01/30/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Deprescribing is the process of discontinuing or reducing the dosage of medications that are no longer appropriate or aligned with goals of care, which is paramount in elderly patients with multiple comorbidities and polypharmacy. The objective of this study was to assess the perceptions of primary care physicians on deprescribing for elderly patients and potential barriers to deprescribing that physicians experience in the Local Health Authority (LHA) of Parma, Emilia-Romagna, Italy. METHODS One hundred and sixty physicians (57% of the total number of primary care physicians in Parma) attended an educational session related to deprescribing and were asked to anonymously complete a paper survey. Participants were asked to assess their level of agreement on nine questions about their perception of deprescribing and potential factors affecting the deprescribing process using a seven-point Likert-type scale. A correlation coefficient was calculated to assess the association between physicians' confidence in deprescribing and attitudes or barriers associated with deprescribing. RESULTS AND DISCUSSION Many physicians (72%) reported general confidence in their ability to deprescribe. Most respondents (78%) reported they were comfortable deprescribing preventive medications, yet only half (53%) were comfortable deprescribing guideline-recommended therapies. Lack of evidence on discontinuing preventive medicines and concern about withdrawal side effects were reported to impede deprescribing by more than one-third of physicians. When medications were initially prescribed by another physician, 40% of physicians reported hesitance in deprescribing them. About half of physicians (45%) did not feel comfortable deprescribing when patients/caregivers believed that continuation of the medication was needed. Lack of time and difficulty engaging patients/caregivers in the deprescribing process were cited as barriers by about one in four physicians. There was no strong correlation between physicians' confidence and attitudes or barriers associated with deprescribing. WHAT IS NEW AND CONCLUSION The study results show that physicians believe they are generally comfortable with deprescribing, although there are still several factors that hamper their ability to engage in the process. An improved understanding of physicians' views on deprescribing may help guide further research, and policies to help patients remain healthy while streamlining their medication regimen.
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Affiliation(s)
- L Djatche
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - S Lee
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - D Singer
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - S E Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Lombardi
- Parma Local Health Authority, Parma, Italy
| | - V Maio
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
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48
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Lepore G, Bonfanti R, Bozzetto L, Di Blasi V, Girelli A, Grassi G, Iafusco D, Laviola L, Rabbone I, Schiaffini R, Bruttomesso D, Mammì F, Bruzzese M, Schettino M, Nuzzo M, Di Blasi V, Fresa R, Lambiase C, Iafusco D, Zanfardino A, Confetto S, Bozzetto L, Annuzzi G, Alderisio A, Riccardi G, Gentile S, Marino G, Guarino G, Zucchini S, Maltoni G, Suprani T, Graziani V, Nizzoli M, Acquati S, Cavani R, Romano S, Michelini M, Manicardi E, Bonadonna R, Dei Cas A, Dall'aglio E, Papi M, Riboni S, Manicardi V, Manicardi E, Manicardi E, Pugni V, Lasagni A, Street M, Pagliani U, Rossi C, Assaloni R, Brunato B, Tortul C, Zanette G, Li Volsi P, Zanatta M, Tonutti L, Agus S, Pellegrini M, Ceccano P, Pozzilli G, Anguissola B, Buzzetti R, Moretti C C, Leto G, Pozzilli P, Manfrini S, Maurizi A, Leotta S, Altomare M, Abbruzzese S, Carletti S, Suraci C, Filetti S, Manca Bitti M, Arcano S, Cavallo M, De Bernardinis M, Pitocco D, Caputo S, Rizzi A, Manto A, Schiaffini R, Cappa M, Benevento D, Frontoni S, Malandrucco I, Morano S, Filardi T, Lauro D, Marini M, Castaldo E, Sabato D, Tuccinardi F, Forte E, Viterbori P, Arnaldi C, Minuto N, d'Annunzio G, Corsi A, Rota R, Scaranna C, Trevisan R, Valentini U, Girelli A, Bonfadini S, Zarra E, Plebani A, Prandi E, Felappi B, Rocca A, Meneghini E, Galli P, Ruggeri P, Carrai E, Fugazza L, Baggi V, Conti D, Bosi E, Laurenzi A, Caretto A, Molinari C, Orsi E, Grancini V, Resi V, Bonfanti R, Favalli V, Bonura C, Rigamonti A, Bonomo M, Bertuzzi F, Pintaudi B, Disoteo O, Perseghin G, Perra S, Chiovato L, De Cata P, Zerbini F, Lovati E, Laneri M, Guerraggio L, Bossi A, De Mori V, Galetta M, Meloncelli I, Aiello A A, Di Vincenzo S, Nuzzi A, Fraticelli E, Ansaldi E, Battezzati M, Lombardi M, Balbo M, Lera R, Secco A, De Donno V, Cadario F, Savastio S, Ponzani C, Aimaretti G, Rabbone I, Ignaccolo G, Tinti D, Cerutti F, Bari F, Giorgino F, Piccinno E, Zecchino O, Cignarelli M, Lamacchia O, Picca G, De Cosmo S, Rauseo A, Tomaselli L, Tumminia A, Egiziano C, Scarpitta A, Maggio F, Cardella F, Roppolo R, Provenzano V, Fleres M, Scorsone A, Scatena A, Gregori G, Lucchesi S, Gadducci F, Di Cianni S, Pancani S, Del Prato S, Aragona M, Crisci I, Calianno A, Fattor B, Crazzolara D, Reinstadler P, Longhi S, Incelli G, Rauch S, Romanelli T, Orrasch M, Cauvin V, Franceschi R, Lalli C, Pianta A, Marangoni A, Aricò C, Marin N, Nogara N, Simioni N, Filippi A, Gidoni Guarneri G, Contin M.L M, Decata A, Bondesan L, Confortin L, Coracina A, Lombardi S, Costa Padova S, Cipponeri E, Scotton R, Galasso S, Boscari F, Zanon M, Vinci C, Lisato G, Gottardo L, Bonora E, Trombetta M, Negri C, Brangani C, Maffeis C, Sabbion A, Marigliano M. Metabolic control and complications in Italian people with diabetes treated with continuous subcutaneous insulin infusion. Nutr Metab Cardiovasc Dis 2018; 28:335-342. [PMID: 29428572 DOI: 10.1016/j.numecd.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/31/2017] [Accepted: 12/02/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIM The objective of this cross-sectional study was to evaluate the degree of glycaemic control and the frequency of diabetic complications in Italian people with diabetes who were treated with continuous subcutaneous insulin infusion (CSII). METHODS AND RESULTS Questionnaires investigating the organisation of diabetes care centres, individuals' clinical and metabolic features and pump technology and its management were sent to adult and paediatric diabetes centres that use CSII for treatment in Italy. Information on standard clinical variables, demographic data and acute and chronic diabetic complications was derived from local clinical management systems. The sample consisted of 6623 people with diabetes, which was obtained from 93 centres. Of them, 98.8% had type 1 diabetes mellitus, 57.2% were female, 64% used a conventional insulin pump and 36% used a sensor-augmented insulin pump. The median glycated haemoglobin (HbA1c) level was 60 mmol/mol (7.6%). The HbA1c target (i.e. <58 mmol/mol for age <18 years and <53 mmol/mol for age >18 years) was achieved in 43.4% of paediatric and 23% of adult participants. Factors such as advanced pump functions, higher rate of sensor use, pregnancy in the year before the study and longer duration of diabetes were associated with lower HbA1c levels. The most common chronic complications occurring in diabetes were retinopathy, microalbuminuria and hypertension. In the year before the study, 5% of participants reported ≥1 episode of severe hypoglycaemic (SH) episodes (SH) and 2.6% reported ≥1 episode of ketoacidosis. CONCLUSIONS Advanced personal skills and use of sensor-based pump are associated with better metabolic control outcomes in Italian people with diabetes who were treated with CSII. The reduction in SH episodes confirms the positive effect of CSII on hypoglycaemia. CLINICAL TRIAL REGISTRATION NUMBER NCT 02620917 (ClinicalTrials.gov).
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49
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Fornasari P, Riva G, Piccolo G, Cosi V, Lombardi M. Short and Long-Term Clinical Effects of Plasma-Exchange in 33 Cases of Myasthenia Gravis. Int J Artif Organs 2018. [DOI: 10.1177/039139888500800310] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - G. Riva
- Centro Emotrasfusionale A.V.I.S., Pavia
| | - G. Piccolo
- Istituto Neurologico “C. Mondino”, Clinica Neurologica dell'Università di Pavia
| | - V. Cosi
- Istituto Neurologico “C. Mondino”, Clinica Neurologica dell'Università di Pavia
| | - M. Lombardi
- Istituto Neurologico “C. Mondino”, Clinica Neurologica dell'Università di Pavia
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50
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Pampena R, Benati E, Borsari S, Bombonato C, Lombardi M, Raucci M, Mirra M, Lallas A, Apalla Z, Papadimitriou I, Moscarella E, Kyrgidis A, Argenziano G, Pellacani G, Longo C. Tracking actinic keratosis of face and scalp treated with 0.015% ingenol mebutate to identify clinical and dermoscopic predictors of treatment response. J Eur Acad Dermatol Venereol 2018; 32:1461-1468. [PMID: 29356164 DOI: 10.1111/jdv.14803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 01/03/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ingenol mebutate (IngMeb) 0.015% gel is an approved field treatment option for non-hyperkeratotic non-hypertrophic actinic keratosis (AK) of face and scalp. Efficacy of IngMeb has been assessed only on a clinical ground, in the majority of studies. Dermoscopy is a pivotal tool for the diagnosis of AK, while its role in evaluating the response to non-surgical therapies for AK has not been fully defined. OBJECTIVES Our study aims to determine whether some dermoscopic features of AK of the face and scalp areas may independently predict the response to IngMeb therapy. METHODS Clinical and dermoscopic responses, 1 month after 0.015% IngMeb therapy, were retrospectively evaluated using a per-patient and per-lesion approach. Safety was evaluated through local skin reaction composite score calculation. Demographic, clinical and dermoscopic factors were then evaluated via univariate and multivariate logistic regression analysis to assess independent predictors of response. RESULTS Fifty-five patients with 245 AKs were enrolled. Clinically, per-patient response evaluation identified 25 (45.4%) poor/partial and 30 (54.5%) complete responders, corresponding on a per-lesion approach to 66 (26.9%) and 179 (73.1%) AKs, respectively. Dermoscopy reclassified 14 patients in the per-patient and 48 AKs in the per-lesion analysis from complete to poor/partial responders. Multivariate logistic regression analysis showed that AKs dermoscopically characterized by red pseudonetwork and located on the face were independently associated with a complete dermoscopic response to 0.015% IngMeb therapy, while microerosions were negative predictors. CONCLUSION Specific dermoscopic features of AK may predict the response to 0.015% IngMeb therapy, together with the location on the face.
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Affiliation(s)
- R Pampena
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - E Benati
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - S Borsari
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - C Bombonato
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - M Lombardi
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - M Raucci
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - M Mirra
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - A Lallas
- First Department of Dermatology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Z Apalla
- First Department of Dermatology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - I Papadimitriou
- First Department of Dermatology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Moscarella
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - A Kyrgidis
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
| | - G Pellacani
- Dermatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - C Longo
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.,Dermatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy
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