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Zappa M, Grossi S, Pignatti P, Pini L, Centis R, Migliori GB, Ardesi F, Sotgiu G, Corsico AG, Spanevello A, Visca D. Alpha-1 deficiency in severe asthma patients. Int J Tuberc Lung Dis 2024; 28:225-230. [PMID: 38659141 DOI: 10.5588/ijtld.23.0493] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Alpha-1 antitrypsin (AAT) deficiency, an autosomal co-dominant condition, decreases protein concentration and activity at both serum and tissue levels. Few studies investigated whether the type of SERPINA1 gene phenotype in patients with severe asthma can influence symptoms and disease control during follow-up.OBJECTIVE To assess whether the presence of a non-MM genotype of SERPINA1 in patients with severe asthma is associated with disease control, systemic and airway inflammation, lung function and comorbidities prevalence compared to severe asthma patients with a homozygous genotype (MM).METHODS Asthmatic patients belonging to Global Initiative for Asthma (GINA) step 5 were retrospectively analysed in an Italian reference asthma clinic. We collected clinical, biological and functional variables at baseline and for the three following years.RESULTS Out of 73 patients enrolled, 14 (19.18%) were non-MM and 59 (80.8%) were MM. Asthmatics with non-MM genotype had lower serum AAT concentration (P = 0.004) and higher emphysema prevalence than the MM group (P = 0.003) at baseline. During follow up, only MM patients showed a significant improvement of both ACQ-6 score (P < 0.0001) and eosinophilic systemic inflammation (P < 0.0001).CONCLUSIONS Our findings emphasise the importance of a screening for AAT deficiency in severe asthma, as alleles mutation may influence patient's follow-up..
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Affiliation(s)
- M Zappa
- Department of Medicine and Surgery, University of Insubria, Varese
| | - S Grossi
- Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Tradate
| | - P Pignatti
- Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia
| | - L Pini
- Department of Clinical and Experimental Sciences, University of Brescia
| | - R Centis
- Clinical Epidemiology of Respiratory Diseases Service, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate
| | - G B Migliori
- Clinical Epidemiology of Respiratory Diseases Service, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate
| | - F Ardesi
- Department of Medicine and Surgery, University of Insubria, Varese
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Pharmacological Sciences, University of Sassari, Sassari
| | - A G Corsico
- Department of Internal Medicine and Therapeutics, University of Pavia, Division of Respiratory Diseases, Fondazione IRCCS Policlinico San Matteo-University of Pavia, Pavia, Italy
| | - A Spanevello
- Department of Medicine and Surgery, University of Insubria, Varese, Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Tradate
| | - D Visca
- Department of Medicine and Surgery, University of Insubria, Varese, Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Tradate
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Porsbjerg CM, Townend J, Bergeron C, Christoff GC, Katsoulotos GP, Larenas-Linnemann D, Tran TN, Al-Lehebi R, Bosnic-Anticevich SZ, Busby J, Hew M, Kostikas K, Papadopoulos NG, Pfeffer PE, Popov TA, Rhee CK, Sadatsafavi M, Tsai MJ, Ulrik CS, Al-Ahmad M, Altraja A, Beastall A, Bulathsinhala L, Carter V, Cosio BG, Fletton K, Hansen S, Heaney LG, Hubbard RB, Kuna P, Murray RB, Nagano T, Pini L, Cano Rosales DJ, Schleich F, Wechsler ME, Amaral R, Bourdin A, Brusselle GG, Chen W, Chung LP, Denton E, Fonseca JA, Hoyte F, Jackson DJ, Katial R, Kirenga BJ, Koh MS, Ławkiedraj A, Lehtimäki L, Liew MF, Mahboub B, Martin N, Menzies-Gow AN, Pang PH, Papaioannou AI, Patel PH, Perez-De-Llano L, Peters MJ, Ricciardi L, Rodríguez-Cáceres B, Solarte I, Tay TR, Torres-Duque CA, Wang E, Zappa M, Abisheganaden J, Assing KD, Costello RW, Gibson PG, Heffler E, Máspero J, Nicola S, Perng (Steve) DW, Puggioni F, Salvi S, Sheu CC, Sirena C, Taillé C, Tan TL, Bjermer L, Canonica GW, Iwanaga T, Jiménez-Maldonado L, Taube C, Brussino L, Price DB. Association between pre-biologic T2-biomarker combinations and response to biologics in patients with severe asthma. Front Immunol 2024; 15:1361891. [PMID: 38711495 PMCID: PMC11070939 DOI: 10.3389/fimmu.2024.1361891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/29/2024] [Indexed: 05/08/2024] Open
Abstract
Background To date, studies investigating the association between pre-biologic biomarker levels and post-biologic outcomes have been limited to single biomarkers and assessment of biologic efficacy from structured clinical trials. Aim To elucidate the associations of pre-biologic individual biomarker levels or their combinations with pre-to-post biologic changes in asthma outcomes in real-life. Methods This was a registry-based, cohort study using data from 23 countries, which shared data with the International Severe Asthma Registry (May 2017-February 2023). The investigated biomarkers (highest pre-biologic levels) were immunoglobulin E (IgE), blood eosinophil count (BEC) and fractional exhaled nitric oxide (FeNO). Pre- to approximately 12-month post-biologic change for each of three asthma outcome domains (i.e. exacerbation rate, symptom control and lung function), and the association of this change with pre-biologic biomarkers was investigated for individual and combined biomarkers. Results Overall, 3751 patients initiated biologics and were included in the analysis. No association was found between pre-biologic BEC and pre-to-post biologic change in exacerbation rate for any biologic class. However, higher pre-biologic BEC and FeNO were both associated with greater post-biologic improvement in FEV1 for both anti-IgE and anti-IL5/5R, with a trend for anti-IL4Rα. Mean FEV1 improved by 27-178 mL post-anti-IgE as pre-biologic BEC increased (250 to 1000 cells/µL), and by 43-216 mL and 129-250 mL post-anti-IL5/5R and -anti-IL4Rα, respectively along the same BEC gradient. Corresponding improvements along a FeNO gradient (25-100 ppb) were 41-274 mL, 69-207 mL and 148-224 mL for anti-IgE, anti-IL5/5R, and anti-IL4Rα, respectively. Higher baseline BEC was also associated with lower probability of uncontrolled asthma (OR 0.392; p=0.001) post-biologic for anti-IL5/5R. Pre-biologic IgE was a poor predictor of subsequent pre-to-post-biologic change for all outcomes assessed for all biologics. The combination of BEC + FeNO marginally improved the prediction of post-biologic FEV1 increase (adjusted R2: 0.751), compared to BEC (adjusted R2: 0.747) or FeNO alone (adjusted R2: 0.743) (p=0.005 and <0.001, respectively); however, this prediction was not improved by the addition of IgE. Conclusions The ability of higher baseline BEC, FeNO and their combination to predict biologic-associated lung function improvement may encourage earlier intervention in patients with impaired lung function or at risk of accelerated lung function decline.
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Affiliation(s)
- Celeste M. Porsbjerg
- Department of Respiratory Medicine and Infectious Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - John Townend
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Celine Bergeron
- Department of Medicine, Centre for Lung Health, Vancouver General Hospital, Vancouver, BC, Canada
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | - Gregory P. Katsoulotos
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- School of Medicine, Sydney Campus, The University of Notre Dame, Sydney, NSW, Australia
| | | | - Trung N. Tran
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, United States
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Sinthia Z. Bosnic-Anticevich
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Mark Hew
- Allergy, Asthma and Clinical Immunology Service, Alfred Health, Melbourne, VIC, Australia
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Paul E. Pfeffer
- Department of Respiratory Medicine, Barts Health National Health Services (NHS) Trust, London, United Kingdom
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen ;University Hospital - Hvidovre, Copenhagen, Denmark
| | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
- Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Aaron Beastall
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Borja G. Cosio
- Son Espases University Hospital-Institut d’Investigació Sanitària Illes Balears (IdISBa)-Ciberes, Mallorca, Spain
| | - Kirsty Fletton
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Susanne Hansen
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Liam G. Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Richard B. Hubbard
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
- Respiratory Medicine at the School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | | | - Tatsuya Nagano
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Laura Pini
- Department of Clinical and Experimental Sciences – University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | | | - Florence Schleich
- Centre Hospitalier Universitaire (CHU) Sart-Tilman, GIGA I3, University of Liege, Liège, Belgium
| | - Michael E. Wechsler
- Department of Medicine, National Jewish Health (NJH) Cohen Family Asthma Institute, National Jewish Health, Denver, CO, United States
| | - Rita Amaral
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, National Center for Scientific Research (CNRS), The National Institute of Health and Medical Research (INSERM), Centre Hospitalier Universitaire (CHU) Montpellier, Montpellier, France
| | - Guy G. Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Departments of Epidemiology and Respiratory Medicine, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Li Ping Chung
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia
| | - Eve Denton
- Allergy, Asthma and Clinical Immunology Service, Alfred Health, Melbourne, VIC, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Joao A. Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Flavia Hoyte
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, United States
| | - David J. Jackson
- Guy’s Severe Asthma Centre, Guy’s Hospital, King’s College London, London, United Kingdom
| | - Rohit Katial
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, United States
| | - Bruce J. Kirenga
- Department of Medicine, Lung Institute, Makerere University Lung Institute, Kampala, Uganda
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mei Fong Liew
- FAST and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore, Singapore
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Bassam Mahboub
- Rashid Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
- Dubai Academic and Health Corporation, Dubai, United Arab Emirates
| | - Neil Martin
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, United States
- Department of Respiratory Medicine, University of Leicester, Leicester, United Kingdom
| | - Andrew N. Menzies-Gow
- BioPharmaceutical Medical, AstraZeneca, Cambridge, United Kingdom
- Lung Division, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Pee Hwee Pang
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Andriana I. Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Pujan H. Patel
- Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Luis Perez-De-Llano
- Pneumology Service, Lucus Augusti University Hospital, Sergas (Galician Healthcare Service) Integrated Management Structure (EOXI) Lugo, Cervo, Spain
| | - Matthew J. Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Luisa Ricciardi
- Allergy and Clinical Immunology, G. Martino Hospital, University of Messina, Messina, Italy
| | | | - Ivan Solarte
- Pulmonary Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
- School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Tunn Ren Tay
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore, Singapore
| | - Carlos A. Torres-Duque
- Centro Internacional de Investigación en Neumología (CINEUMO), Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Doctoral Biosciences, Chia, Colombia
| | - Eileen Wang
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, United States
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - John Abisheganaden
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Karin Dahl Assing
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Richard W. Costello
- Department of Respiratory Medicine, Clinical Research Centre, Smurfit Building Beaumont Hospital, Royal College of Surgeons Ireland (RCSI), Dublin, Ireland
| | - Peter G. Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia
- Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Istituto Clinico Humanitas, Humanitas Cancer Center (IRCCS) Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Jorge Máspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina
- University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Stefania Nicola
- Allergy and Immunology Unit, L'Azienda Ospedaliera (AO) Ordine Mauriziano di Torino, Turin, Italy
| | - Diahn-Warng Perng (Steve)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Istituto Clinico Humanitas, Humanitas Cancer Center (IRCCS) Humanitas Research Hospital, Rozzano, Italy
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Camille Taillé
- Department of Respiratory Diseases, Bichat Hospital, l'Assistance publique – Hôpitaux de Paris (AP-HP) Nord-Université Paris Cité, Paris, France
| | - Tze Lee Tan
- Department of Family Medicine, National University Health System, Singapore, Singapore
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Istituto Clinico Humanitas, Humanitas Cancer Center (IRCCS) Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Libardo Jiménez-Maldonado
- Universidad de La Sabana, Doctoral Biosciences, Chia, Colombia
- Fundación Neumológica Colombiana, ASMAIRE REXPIRA (Atención integral y rehabilitación en asma or Comprehensive Care and Rehabilitation in Asthma) Program, Bogotá, Colombia
| | - Christian Taube
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
| | - Luisa Brussino
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - David B. Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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Golino M, Morello M, Marazzato J, Blasi F, Chierchia V, Oliva CA, Zappa M, Ageno W, Passi A, Angeli F, De Ponti R. Sex-related differences in non-ischemic myocardial injury in the emergency department: A real-world perspective. Int J Cardiol 2024; 395:131394. [PMID: 37748523 DOI: 10.1016/j.ijcard.2023.131394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/27/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Myocardial injury is associated with adverse outcomes. No data are reported about sex differences in incidence and factors associated with myocardial injury in an emergency department (ED) setting from a real-world perspective. We aimed to assess whether sex plays a major role in the diagnosis of myocardial injury in the ED. METHODS In this subanalysis of a retrospective study, patients presenting at the ED with at least one high-sensitivity cardiac troponin T (hs-cTnT) value and without acute coronary syndromes diagnosis were compared. RESULTS 31,383 patients were admitted to the ED, 4660 had one hs-cTnT value, and 3937 were enrolled: 1943 females (49.4%) and 1994 males (50.6%). The diagnosis of myocardial injury was higher among men (36.8% vs. 32.9%, p < 0.01). Male sex was independently associated with myocardial injury. An older age, an elevated NT-proB-type Natriuretic Peptide and a lower estimated glomerular filtrate rate were independently associated with myocardial injury in both sexes. CONCLUSIONS In the ED, from a real-world perspective, myocardial injury occurred more frequently in males, and it was associated with older age and the presence of cardiac, lung, and kidney disease but not higher hs-cTnT values.
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Affiliation(s)
- Michele Golino
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
| | - Matteo Morello
- Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy; School of Cardiology, University of Brescia, 25121 Brescia, Italy
| | - Jacopo Marazzato
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Federico Blasi
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Valentina Chierchia
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Carlo-Agostino Oliva
- Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy; School of Cardiology, University of Brescia, 25121 Brescia, Italy
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049 Tradate, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy
| | - Alberto Passi
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy
| | - Fabio Angeli
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049 Tradate, Italy; Department of Medicine and Technological Innovation (DiMIT), University of Insubria, 21100 Varese, Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy
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Angeli F, Zappa M, Verdecchia P. Global burden of new-onset hypertension associated with severe acute respiratory syndrome coronavirus 2 infection. Eur J Intern Med 2024; 119:31-33. [PMID: 37852842 DOI: 10.1016/j.ejim.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/13/2023] [Indexed: 10/20/2023]
Abstract
Several reports documented a specific effect of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on blood pressure (BP), during and after the acute phase of infection. Clinical studies demonstrated that coronavirus disease 2019 (COVID-19) is associated with an increased risk of a persistent increase in BP requiring a new or intensified anti-hypertensive treatment during hospitalization. The picture is further complicated by the evidence from large databases showing an increased risk of new-onset hypertension in COVID-19 survivors on the long term. To further elucidate the epidemiological burden of this phenomenon, we performed a pooled analysis of 4 studies reporting crude incidence rates of new-onset hypertension among COVID-19 patients and contemporary controls. Overall, COVID-19 was associated with a 65% increased risk of new-onset hypertension when compared with controls (p<0.0001); furthermore, incidence of new-onset hypertension was 9% and 5% among COVID-19 patients and controls, respectively. In both the acute phase and recovery from infection, the interaction between spike proteins of SARS-CoV-2 and angiotensin converting enzyme 2 (ACE2) receptors remain the most plausible mechanism explaining the raise in BP (ranking new onset hypertension as one of the most prevalent cardiovascular sequelae of COVID-19). In this area of research, it is worth to mention that new variants of SARS-CoV-2 exhibit specific mutations in the spike protein that promotes entry into viral cells via ACE2. Thus, the enhanced spike affinity for ACE2 of new variants has the potential to increase the risk of new-onset hypertension when compared with the original Wuhan strain.
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Affiliation(s)
- Fabio Angeli
- Department of Medicine and Technological Innovation (DiMIT), University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Italy.
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
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Angeli F, Zappa M, Verdecchia P. Newer COVID-19 vaccines: Still lights and shadows? Eur J Intern Med 2023; 118:32-35. [PMID: 37891024 DOI: 10.1016/j.ejim.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Fabio Angeli
- Department of Medicine and Technological Innovation (DiMIT), University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Italy.
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Verdecchia
- Division of Cardiology, Hospital S. Maria della Misericordia, Perugia and Fondazione Umbra Cuore e Ipertensione-ONLUS, Perugia, Italy
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Angeli F, Zappa M, Bartolini C, Verdecchia P. [Gene therapy for hypertension: focus on zilebesiran]. G Ital Cardiol (Rome) 2023; 24:948-950. [PMID: 38009345 DOI: 10.1714/4139.41339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Affiliation(s)
- Fabio Angeli
- Dipartimento di Medicina e Innovazione Tecnologica (DiMIT), Università degli Studi dell'Insubria, Varese - Dipartimento di Medicina e Riabilitazione Cardiopolmonare, Istituto di Cura e Ricerca Maugeri, IRCCS, Tradate (VA)
| | - Martina Zappa
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell'Insubria, Varese
| | - Claudia Bartolini
- Fondazione Umbra Cuore e Ipertensione-ONLUS e S.C. Cardiologia, Ospedale S. Maria della Misericordia, Perugia
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS e S.C. Cardiologia, Ospedale S. Maria della Misericordia, Perugia
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Zappa M, Verdecchia P, Andolina A, Angeli F. The old and the new: The EG.5 ('Eris') sub-variant of Coronavirus. Eur J Intern Med 2023; 117:123-125. [PMID: 37690919 DOI: 10.1016/j.ejim.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Andrea Andolina
- Istituti Clinici Scientifici Maugeri IRCCS, Divisions of General Internal Medicine and Cardiac Rehabilitation, Tradate, Italy
| | - Fabio Angeli
- Istituti Clinici Scientifici Maugeri IRCCS, Divisions of General Internal Medicine and Cardiac Rehabilitation, Tradate, Italy; Department of Medicine and Technological Innovation (DiMIT), University of Insubria, Varese, Italy.
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Zappa M, Verdecchia P, Andolina A, Spanevello A, Angeli F. Complications of SARS-CoV-2 Infection During Cardiac Rehabilitation: A Case Series. Cardiol Ther 2023; 12:533-538. [PMID: 37453974 PMCID: PMC10423178 DOI: 10.1007/s40119-023-00325-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Vaccination strongly reduces the risk of hospitalization and death due to coronavirus disease 2019 (COVID-19). However, the severity of the acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and the degree of protection exerted over time by vaccination remains to be fully elucidated among hospitalized comorbid and vulnerable patients with SARS-CoV-2 infection. METHODS We report a case series of nine hospitalized vulnerable patients who developed a SARS-CoV-2 infection during a cardiac rehabilitation inpatient program. RESULTS Age ranged from 50 to 81 years. All but one patient had received at least three doses of anti-COVID-19 vaccine more than 4 months before the cardiac event. Indications for cardiac rehabilitation included acute coronary syndromes, congestive heart failure, heart valve surgery, and coronary artery bypass graft. After the confirmed diagnosis of SARS-CoV-2 infection, all patients developed symptoms. Eight patients developed at least one SARS-CoV-2-related complication, including a significant increase in high-sensitivity troponin I levels, new-onset hypoxemia, persistent atrial fibrillation, non-sustained ventricular tachycardia and recurrent sinus arrest, pericardial effusion, and a persistent increase in blood pressure. CONCLUSION Almost all patients developed complications which, however, did not evolve towards more severe expressions of the disease. These data suggest that even in this new phase of the pandemic, vaccination may exert a potential role to reduce the risk of progression towards more severe disease of SARS-CoV-2 infection in vulnerable patients with cardiovascular comorbidities.
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Affiliation(s)
- Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Andrea Andolina
- Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Via Crotto Roncaccio 16, Tradate, VA, Italy
| | - Antonio Spanevello
- Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Via Crotto Roncaccio 16, Tradate, VA, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Fabio Angeli
- Department of Medicine and Technological Innovation (DiMIT), University of Insubria, Varese, Italy.
- Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Via Crotto Roncaccio 16, Tradate, VA, Italy.
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Angeli F, Reboldi G, Zappa M, Verdecchia P. Hypertension and myocarditis following COVID-19 vaccination. Two sides of the coin? Eur J Intern Med 2023; 113:107-109. [PMID: 37130772 PMCID: PMC10141188 DOI: 10.1016/j.ejim.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 05/04/2023]
Affiliation(s)
- Fabio Angeli
- Department of Medicine and Technological Innovation (DiMIT), University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Italy.
| | - Gianpaolo Reboldi
- Department of Medicine, and Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, Perugia, Italy
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Verdecchia
- Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy; Fondazione Umbra Cuore e Ipertensione-ONLUS, Perugia, Italy
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Zappa M, Verdecchia P, Angeli F. Is the competition between variants the end of severe acute respiratory syndrome coronavirus 2 pandemic? A journey from Wuhan to XBB.1.16. Eur J Intern Med 2023; 113:13-15. [PMID: 37087389 PMCID: PMC10113598 DOI: 10.1016/j.ejim.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023]
Affiliation(s)
- Martina Zappa
- Department of Medicine and Surgery, University of Insubria - Varese, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Fabio Angeli
- Dipartimento di Medicina e Innovazione Tecnologica (DiMIT), University of Insubria - Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Italy.
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Zappa M, Verdecchia P, Angeli F. Severe acute respiratory syndrome coronavirus 2 evolution: How mutations affect XBB.1.5 variant. Eur J Intern Med 2023; 112:128-132. [PMID: 37005200 PMCID: PMC10050278 DOI: 10.1016/j.ejim.2023.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/28/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Italy.
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Angeli F, Reboldi G, Solano FG, Prosciutto A, Paolini A, Zappa M, Bartolini C, Santucci A, Coiro S, Verdecchia P. Interpretation of Ambulatory Blood Pressure Monitoring for Risk Stratification in Hypertensive Patients: The 'Ambulatory Does Prediction Valid (ADPV)' Approach. Diagnostics (Basel) 2023; 13:diagnostics13091601. [PMID: 37174992 PMCID: PMC10178200 DOI: 10.3390/diagnostics13091601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Several outcome-based prospective investigations have provided solid data which support the prognostic value of 24 h ambulatory blood pressure over and beyond cardiovascular traditional risk factors. Average 24 h, daytime, and nighttime blood pressures are the principal components of the ambulatory blood pressure profile that have improved cardiovascular risk stratification beyond traditional risk factors. Furthermore, several additional ambulatory blood pressure measures have been investigated. The correct interpretation in clinical practice of ambulatory blood pressure monitoring needs a standardization of methods. Several algorithms for its clinical use have been proposed. Implementation of the results of ambulatory blood pressure monitoring in the management of individual subjects with the aim of improving risk stratification is challenging. We suggest that clinicians should focus attention on ambulatory blood pressure components which have been proven to act as the main independent predictors of outcome (average 24 h, daytime, and nighttime blood pressure, pulse pressure, dipping status, BP variability).
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Affiliation(s)
- Fabio Angeli
- Department of Medicine and Technological Innovation (DiMIT), University of Insubria, 21100 Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy
| | - Gianpaolo Reboldi
- Department of Medicine, and Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, 06100 Perugia, Italy
- Division of Nephrology, Hospital S. Maria della Misericordia, 33100 Perugia, Italy
| | | | | | | | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Claudia Bartolini
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
| | - Andrea Santucci
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
| | - Stefano Coiro
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
| | - Paolo Verdecchia
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
- Fondazione Umbra Cuore e Ipertensione-ONLUS, 06100 Perugia, Italy
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Angeli F, Zappa M, Reboldi G, Gentile G, Trapasso M, Spanevello A, Verdecchia P. The spike effect of acute respiratory syndrome coronavirus 2 and coronavirus disease 2019 vaccines on blood pressure. Eur J Intern Med 2023; 109:12-21. [PMID: 36528504 PMCID: PMC9744686 DOI: 10.1016/j.ejim.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/14/2022]
Abstract
Among the various comorbidities potentially worsening the clinical outcome in patients hospitalized for the acute respiratory syndrome coronavirus-2 (SARS-CoV-2), hypertension is one of the most prevalent. However, the basic mechanisms underlying the development of severe forms of coronavirus disease 2019 (COVID-19) among hypertensive patients remain undefined and the direct association of hypertension with outcome in COVID-19 is still a field of debate. Experimental and clinical data suggest that SARS-CoV-2 infection promotes a rise in blood pressure (BP) during the acute phase of infection. Acute increase in BP and high in-hospital BP variability may be tied with acute organ damage and a worse outcome in patients hospitalized for COVID-19. In this context, the failure of the counter-regulatory renin-angiotensin-system (RAS) axis is a potentially relevant mechanism involved in the raise in BP. It is well recognized that the efficient binding of the Spike (S) protein to angiotensin converting enzyme 2 (ACE2) receptors mediates the virus entry into cells. Internalization of ACE2, downregulation and malfunction predominantly due to viral occupation, dysregulates the protective RAS axis with increased generation and activity of angiotensin (Ang) II and reduced formation of Ang1,7. Thus, the imbalance between Ang II and Ang1-7 can directly contribute to excessively rise BP in the acute phase of SARS-CoV-2 infection. A similar mechanism has been postulated to explain the raise in BP following COVID-19 vaccination ("Spike Effect" similar to that observed during the infection of SARS-CoV-2). S proteins produced upon vaccination have the native-like mimicry of SARS-CoV-2 S protein's receptor binding functionality and prefusion structure and free-floating S proteins released by the destroyed cells previously targeted by vaccines may interact with ACE2 of other cells, thereby promoting ACE2 internalization and degradation, and loss of ACE2 activities.
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Affiliation(s)
- Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, 21100, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049, Italy.
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, 21100, Italy
| | - Gianpaolo Reboldi
- Department of Medicine, and Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, Perugia, 06100, Italy
| | - Giorgio Gentile
- College of Medicine and Health. University of Exeter, Exeter, United Kingdom and Department of Nephrology, Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - Monica Trapasso
- Dipartimento di Igiene e Prevenzione Sanitaria, PSAL, Sede Territoriale di Varese, ATS Insubria, Varese, 21100, Italy
| | - Antonio Spanevello
- Department of Medicine and Surgery, University of Insubria, Varese, 21100, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049, Italy
| | - Paolo Verdecchia
- Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, and Fondazione Umbra Cuore e Ipertensione-ONLUS, Perugia, 06100, Italy
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Zappa M, Verdecchia P, Angeli F. The new phase of pandemic: Are BA.2.75 and BQ.1 competitive variants? An in silico evaluation. Eur J Intern Med 2023; 108:106-107. [PMID: 36357251 DOI: 10.1016/j.ejim.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Italy.
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Angeli F, Zappa M, Verdecchia P. Rethinking the Role of the Renin-Angiotensin System in the Pandemic Era of SARS-CoV-2. J Cardiovasc Dev Dis 2023; 10:jcdd10010014. [PMID: 36661909 PMCID: PMC9862389 DOI: 10.3390/jcdd10010014] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/26/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
After assessing the levels of spread and severity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, academic literature focused on the pathophysiology of coronavirus disease 2019 (COVID-19) [...].
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Affiliation(s)
- Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy
- Correspondence:
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS, and Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
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16
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Golino M, Marazzato J, Blasi F, Morello M, Chierchia V, Cadonati C, Ghirimorldi E, Pellitteri A, Matteo F, Licciardello C, Zappa M, Ageno W, Passi A, Angeli F, De Ponti R. 845 THE PREDICTIVE ROLE OF HIGH-SENSITIVITY CARDIAC TROPONIN T IN THE EMERGENCY ROOM: COMBINING BIOMARKERS WITH CLINICAL DATA LEADS TO THE DIAGNOSIS OF CARDIOVASCULAR DISEASE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.516] [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: 12/23/2022]
Abstract
Abstract
Background
Small amounts of high-sensitivity cardiac troponin (hs-cTn) I and T can be detected in healthy individuals or can occur in the absence of any clinical features of myocardial ischemia (myocardial injury). However, it is not possible to clinically distinguish whether and which increase in hs-cTn are due to which mechanisms. Moreover, predictive data regarding hs-cTnT in an emergency room (ER) setting are scanty. Consequently, with this monocentric retrospective study, we aimed at expanding the knowledge of this biomarker in this setting.
Methods
Consecutive adult patients presenting at the ER and hospitalized with a first abnormal hs-cTnT value (≥14 ng/L) were enrolled for 6 months. The baseline hs-cTnT value and the ensuing variations were correlated with the clinical presentation and diagnosis. Subsequently, multivariable models were built to assess which clinical and laboratory variables most influenced hospital admissions.
Results
At a first screening, 4660 patients were considered, and 4149 patients were enrolled (Figure 1). Of these, 1555 (37.5%) had a first hs-cTnT ≥14 ng/L, and 1007 (65%) were hospitalized according to the following diagnoses: acute coronary syndrome (ACS, 182; 18%), non-ACS cardiovascular disease (337; 34%) and non-cardiovascular disease (487; 48%). Higher hs-cTnT values as well as significant hs-cTnT variations were found in the ACS group (p < 0.01). Furthermore, in the latter, the mean percentage of variation of hs-cTnT was higher, while it was intermediate in the non-ACS group, and low in those with non-cardiovascular disease (407.5%, 270.6% and 12.4%, respectively). Only syncope and CRP (OR: 0.08, 95% CI: 0.02–0.39, p <0.01 and OR: 0.9988, 95% CI: 0.9979–0.9998, p = 0.02, respectively) or CRP (OR: 0.9948, 95% CI: 0.9908–0.9989, p = 0.01) and NT-proBNP (OR: 1.0002, 95% CI: 1.0000–1.0004, p = 0.02) were independent predictors of a cardiovascular disease diagnosis. On the other hand, only chest pain (OR: 22.91, 95% CI: 3.97–132.32, p < 0.01) and eGFR (OR: 1.04, 95% CI: 1.004–1.083, p = 0.03) were significantly associated with the ACS diagnosis.
Conclusion
In our study, differently from the investigated hs-cTnT, only clinical variables predicted hospitalizations in different patients’ subgroups.
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Affiliation(s)
- Michele Golino
- Department Of Medicine And Surgery, University Of Insubria , Varese ( Italy )
| | - Jacopo Marazzato
- Department Of Medicine And Surgery, University Of Insubria , Varese ( Italy )
- Ospedale Di Circolo , Asst Settelaghi, Varese ( Italy )
| | - Federico Blasi
- Department Of Medicine And Surgery, University Of Insubria , Varese ( Italy )
- Ospedale Di Circolo , Asst Settelaghi, Varese ( Italy )
| | - Matteo Morello
- Ospedale Di Circolo , Asst Settelaghi, Varese ( Italy )
- School Of Cardiology, University Of Brescia , Brescia , Italy
| | - Valentina Chierchia
- Department Of Medicine And Surgery, University Of Insubria , Varese ( Italy )
| | - Cristina Cadonati
- Department Of Medicine And Surgery, University Of Insubria , Varese ( Italy )
- Ospedale Di Circolo , Asst Settelaghi, Varese ( Italy )
| | - Elena Ghirimorldi
- Department Of Medicine And Surgery, University Of Insubria , Varese ( Italy )
- Ospedale Di Circolo , Asst Settelaghi, Varese ( Italy )
| | - Alessia Pellitteri
- Department Of Medicine And Surgery, University Of Insubria , Varese ( Italy )
- Ospedale Di Circolo , Asst Settelaghi, Varese ( Italy )
| | - Federica Matteo
- Department Of Medicine And Surgery, University Of Insubria , Varese ( Italy )
| | | | - Martina Zappa
- Department Of Medicine And Surgery, University Of Insubria , Varese ( Italy )
- Department Of Medicine And Cardiopulmonary Rehabilitation, Maugeri Care And Research Institute - Irccs , Tradate ( Italy )
| | - Walter Ageno
- Department Of Medicine And Surgery, University Of Insubria , Varese ( Italy )
- Ospedale Di Circolo , Asst Settelaghi, Varese ( Italy )
| | - Alberto Passi
- Department Of Medicine And Surgery, University Of Insubria , Varese ( Italy )
- Ospedale Di Circolo , Asst Settelaghi, Varese ( Italy )
| | - Fabio Angeli
- Department Of Medicine And Surgery, University Of Insubria , Varese ( Italy )
- Department Of Medicine And Cardiopulmonary Rehabilitation, Maugeri Care And Research Institute - Irccs , Tradate ( Italy )
| | - Roberto De Ponti
- Department Of Medicine And Surgery, University Of Insubria , Varese ( Italy )
- Ospedale Di Circolo , Asst Settelaghi, Varese ( Italy )
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Pignatti P, Visca D, Zappa M, Zampogna E, Saderi L, Sotgiu G, Spanevello A. Analysis of Patients with Asthma and Mixed Granulocytic Inflammatory Pattern in Sputum. Respiration 2022; 101:1121-1130. [DOI: 10.1159/000527125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/10/2022] [Indexed: 11/06/2022] Open
Abstract
<b><i>Background:</i></b> Patients with asthma usually present airway inflammation classified as eosinophilic, neutrophilic, mixed granulocytic, and paucigranulocytic pattern according to sputum inflammatory cells. <b><i>Objective:</i></b> The aim of the study was to analyze clinical and biological characteristics of patients with asthma and mixed granulocytic pattern in comparison with the other groups. <b><i>Methods:</i></b> Induced sputum was used to assess airway inflammation; lung function was evaluated as well as blood leukocytes and disease control. History of comorbidities was collected. <b><i>Results:</i></b> We retrospectively analyzed 231 subjects with asthma; patients with mixed granulocytic pattern were more frequently male compared with paucigranulocytic subjects, older than eosinophilic and paucigranulocytic patients with increased number and vitality of sputum cells compared to eosinophilic and paucigranulocytic patients and higher cumulative illness rating score, related to increased age. Smoking history, age of disease onset, and ICS treatment were not associated with higher mixed granulocytic pattern occurrence. Subjects with neutrophilic inflammation (mixed granulocytic and neutrophilic patterns considered altogether) were more frequently obese. In subjects under 67 years of age (median of the enrolled subjects), arterial hypertension was the only comorbidity more frequent in mixed granulocytic than in the other groups. 137/231 subjects were re-valuated during follow-up. Lung function of patients with mixed granulocytic, neutrophilic, and paucigranulocytic patterns improved less than that of eosinophilic patients. <b><i>Conclusion:</i></b> Aging and presence of comorbidities, in particular obesity and hypertension, are characteristics of patients with asthma and mixed granulocytic pattern. They could respond less well to treatment than eosinophilic patients.
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Affiliation(s)
- Martina Zappa
- Department of Medicine and Surgery, Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, University of Insubria, Via Crotto Roncaccio 16, Tradate, VA, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, University of Insubria, Via Crotto Roncaccio 16, Tradate, VA, Italy; Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Italy.
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Zappa M, Verdecchia P, Spanevello A, Angeli F. Structural evolution of severe acute respiratory syndrome coronavirus 2: Implications for adhesivity to angiotensin-converting enzyme 2 receptors and vaccines. Eur J Intern Med 2022; 104:33-36. [PMID: 35985948 PMCID: PMC9372025 DOI: 10.1016/j.ejim.2022.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Antonio Spanevello
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Italy.
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Affiliation(s)
- Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Via Crotto Roncaccio 16, Tradate, VA, Italy.
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Federico Mattia Oliva
- Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Via Crotto Roncaccio 16, Tradate, VA, Italy
| | - Antonio Spanevello
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Via Crotto Roncaccio 16, Tradate, VA, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria Della Misericordia, Perugia, Italy
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21
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Angeli F, Reboldi G, Trapasso M, Zappa M, Spanevello A, Verdecchia P. COVID-19, vaccines and deficiency of ACE 2 and other angiotensinases. Closing the loop on the "Spike effect". Eur J Intern Med 2022; 103:23-28. [PMID: 35753869 PMCID: PMC9217159 DOI: 10.1016/j.ejim.2022.06.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
The role of a dysregulated renin-angiotensin system (RAS) in the pathogenesis of COVID-19 is well recognized. The imbalance between angiotensin II (Ang II) and Angiotensin1-7 (Ang1,7) caused by the interaction between SARS-CoV-2 and the angiotensin converting enzyme 2 (ACE2) receptors exerts a pivotal role on the clinical picture and outcome of COVID-19. ACE2 receptors are not the exclusive angiotensinases in nature. Other angiotensinases (PRCP, and POP) have the potential to limit the detrimental effects of the interactions between ACE2 and the Spike proteins. In the cardiovascular disease continuum, ACE2 activity tends to decrease, and POP/PRCP activity to increase, from the health status to advanced deterioration of the cardiovascular system. The failure of the counter-regulatory RAS axis during the acute phase of COVID-19 is characterized by a decrease of ACE2 expression coupled to unchanged activity of other angiotensinases, therefore failing to limit the accumulation of Ang II. COVID-19 vaccines increase the endogenous synthesis of SARS-CoV-2 spike proteins. Once synthetized, the free-floating spike proteins circulate in the blood, interact with ACE2 receptors and resemble the pathological features of SARS-CoV-2 ("Spike effect" of COVID-19 vaccines). It has been noted that an increased catalytic activity of POP/PRCP is typical in elderly individuals with comorbidities or previous cardiovascular events, but not in younger people. Thus, the adverse reactions to COVID-19 vaccination associated with Ang II accumulation are generally more common in younger and healthy subjects. Understanding the relationships between different mechanisms of Ang II cleavage and accumulation offers the opportunity to close the pathophysiological loop between the risk of progression to severe forms of COVID-19 and the potential adverse events of vaccination.
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Affiliation(s)
- Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS, Tradate, Italy.
| | - Gianpaolo Reboldi
- Department of Medicine, and Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, Perugia, Italy
| | - Monica Trapasso
- Dipartimento di Igiene e Prevenzione Sanitaria, ATS Insubria, PSAL, Sede Territoriale di Varese, Varese, Italy
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Antonio Spanevello
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS, Tradate, Italy
| | - Paolo Verdecchia
- Division of Cardiology, Hospital S. Maria Della Misericordia, Perugia, Italy; Fondazione Umbra Cuore e Ipertensione-ONLUS, Perugia, Italy
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22
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Golino M, Marazzato J, Blasi F, Morello M, Chierchia V, Cadonati C, Matteo F, Licciardello C, Zappa M, Ageno W, Passi A, Angeli F, De Ponti R. High-Sensitivity Cardiac Troponin T and the Diagnosis of Cardiovascular Disease in the Emergency Room: The Importance of Combining Cardiovascular Biomarkers with Clinical Data. J Clin Med 2022; 11:jcm11133798. [PMID: 35807089 PMCID: PMC9267782 DOI: 10.3390/jcm11133798] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 01/27/2023] Open
Abstract
Background. Nowadays, it is still not possible to clinically distinguish whether an increase in high-sensitivity cardiac troponin (hs-cTn) values is due to myocardial injury or an acute coronary syndrome (ACS). Moreover, predictive data regarding hs-cTnT in an emergency room (ER) setting are scarce. This monocentric retrospective study aimed to improve the knowledge and interpretation of this cardiac biomarker in daily clinical practice. Methods. Consecutive adult patients presenting at the ER and hospitalized with a first abnormal hs-cTnT value (≥14 ng/L) were enrolled for 6 months. The baseline hs-cTnT value and the ensuing changes and variations were correlated with the clinical presentation and the type of diagnosis. Subsequently, multivariable models were built to assess which clinical/laboratory variables most influenced hospital admissions in the investigated population analyzed according to the final reason for hospitalization: (1) cardiovascular vs. non-cardiovascular diagnosis, and (2) ACS vs. non-ACS one. Results. A total of 4660 patients were considered, and, after a first screening, 4149 patients were enrolled. Out of 4129 patients, 1555 (37.5%) had a first hs-cTnT ≥14 ng/L, and 1007 (65%) were hospitalized with the following types of diagnosis: ACS (182; 18%), non-ACS cardiovascular disease (337; 34%) and non-cardiovascular disease (487; 48%). Higher hs-cTnT values and significant hs-cTnT variations were found in the ACS group (p < 0.01). The mean percentage of variation was higher in patients with ACS, intermediate in those with non-ACS cardiovascular disease, and low in those with non-cardiovascular disease (407.5%, 270.6% and 12.4%, respectively). Only syncope and CRP (OR: 0.08, 95% CI: 0.02−0.39, p < 0.01 and OR: 0.9988, 95% CI: 0.9979−0.9998, p = 0.02, respectively) or CRP (OR: 0.9948, 95% CI: 0.9908−0.9989, p = 0.01) and NT-proBNP (OR: 1.0002, 95% CI: 1.0000−1.0004, p = 0.02) were independent predictors of a cardiovascular disease diagnosis. On the other hand, only chest pain (OR: 22.91, 95% CI: 3.97−132.32, p < 0.01) and eGFR (OR: 1.04, 95% CI: 1.004−1.083, p = 0.03) were associated with the ACS diagnosis. Conclusions. Differently from the investigated biomarkers, in this study, only clinical variables predicted hospitalizations in different patients’ subgroups.
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Affiliation(s)
- Michele Golino
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (F.B.); (V.C.); (F.M.); (C.L.); (M.Z.); (W.A.); (A.P.); (F.A.); (R.D.P.)
- Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy; (M.M.); (C.C.)
- Correspondence:
| | - Jacopo Marazzato
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (F.B.); (V.C.); (F.M.); (C.L.); (M.Z.); (W.A.); (A.P.); (F.A.); (R.D.P.)
- Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy; (M.M.); (C.C.)
| | - Federico Blasi
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (F.B.); (V.C.); (F.M.); (C.L.); (M.Z.); (W.A.); (A.P.); (F.A.); (R.D.P.)
- Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy; (M.M.); (C.C.)
| | - Matteo Morello
- Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy; (M.M.); (C.C.)
- School of Cardiology, University of Brescia, 25121 Brescia, Italy
| | - Valentina Chierchia
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (F.B.); (V.C.); (F.M.); (C.L.); (M.Z.); (W.A.); (A.P.); (F.A.); (R.D.P.)
| | - Cristina Cadonati
- Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy; (M.M.); (C.C.)
- School of Cardiology, University of Brescia, 25121 Brescia, Italy
| | - Federica Matteo
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (F.B.); (V.C.); (F.M.); (C.L.); (M.Z.); (W.A.); (A.P.); (F.A.); (R.D.P.)
- Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy; (M.M.); (C.C.)
| | - Claudio Licciardello
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (F.B.); (V.C.); (F.M.); (C.L.); (M.Z.); (W.A.); (A.P.); (F.A.); (R.D.P.)
- Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy; (M.M.); (C.C.)
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (F.B.); (V.C.); (F.M.); (C.L.); (M.Z.); (W.A.); (A.P.); (F.A.); (R.D.P.)
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049 Tradate, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (F.B.); (V.C.); (F.M.); (C.L.); (M.Z.); (W.A.); (A.P.); (F.A.); (R.D.P.)
- Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy; (M.M.); (C.C.)
| | - Alberto Passi
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (F.B.); (V.C.); (F.M.); (C.L.); (M.Z.); (W.A.); (A.P.); (F.A.); (R.D.P.)
- Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy; (M.M.); (C.C.)
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (F.B.); (V.C.); (F.M.); (C.L.); (M.Z.); (W.A.); (A.P.); (F.A.); (R.D.P.)
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049 Tradate, Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (F.B.); (V.C.); (F.M.); (C.L.); (M.Z.); (W.A.); (A.P.); (F.A.); (R.D.P.)
- Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy; (M.M.); (C.C.)
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23
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Angeli F, Reboldi G, Trapasso M, Santilli G, Zappa M, Verdecchia P. Blood Pressure Increase following COVID-19 Vaccination: A Systematic Overview and Meta-Analysis. J Cardiovasc Dev Dis 2022; 9:150. [PMID: 35621861 PMCID: PMC9147472 DOI: 10.3390/jcdd9050150] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/23/2022] [Accepted: 05/07/2022] [Indexed: 02/04/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) vaccines proved a strong clinical efficacy against symptomatic or moderate/severe COVID-19 and are considered the most promising approach for curbing the pandemic. However, some questions regarding the safety of COVID-19 vaccines have been recently raised. Among adverse events to vaccines and despite a lack of signal during phase III clinical trials, an increase in blood pressure (BP) after COVID-19 vaccination has been reported as a potential adverse reaction. We systematically analyze this topic and undertook a meta-analysis of available data to estimate the proportion of patients with abnormal BP or raise in BP after vaccination. Six studies entered the final analysis. Overall, studies accrued 357,387 subjects with 13,444 events of abnormal or increased BP. After exclusion of outlier studies, the pooled estimated proportion of abnormal/increased BP after vaccination was 3.20% (95% CI: 1.62-6.21). Proportions of cases of stage III hypertension or hypertensive urgencies and emergencies was 0.6% (95% CI: 0.1% to 5.1%). In conclusion, abnormal BP is not rare after COVID-19 vaccination, but the basic mechanisms of this phenomenon are still unclear and require further research.
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Affiliation(s)
- Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
- Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy
| | - Gianpaolo Reboldi
- Department of Medicine, and Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, 06100 Perugia, Italy; (G.R.); (G.S.)
| | - Monica Trapasso
- Dipartimento di Igiene e Prevenzione Sanitaria, PSAL, Sede Territoriale di Varese, ATS Insubria, 21100 Varese, Italy;
| | - Gabriella Santilli
- Department of Medicine, and Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, 06100 Perugia, Italy; (G.R.); (G.S.)
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy;
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24
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Angeli F, Reboldi G, Spanevello A, De Ponti R, Visca D, Marazzato J, Zappa M, Trapasso M, Masnaghetti S, Fabbri LM, Verdecchia P. Electrocardiographic features of patients with COVID-19: One year of unexpected manifestations. Eur J Intern Med 2022; 95:7-12. [PMID: 34670682 PMCID: PMC8514650 DOI: 10.1016/j.ejim.2021.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Italy.
| | - Gianpaolo Reboldi
- Department of Medicine, and Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, Perugia, Italy
| | - Antonio Spanevello
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Dina Visca
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Italy
| | - Jacopo Marazzato
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Monica Trapasso
- Dipartimento di Igiene e Prevenzione Sanitaria, PSAL, Sede Territoriale di Varese, ATS Insubria, Varese, Italy
| | - Sergio Masnaghetti
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Italy
| | - Leonardo M Fabbri
- Department of Respiratory and Internal Medicine, University of Modena&Reggio Emilia, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS, Perugia - Italy and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
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25
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Angeli F, Zappa M, Reboldi G, Trapasso M, Cavallini C, Spanevello A, Verdecchia P. The pivotal link between ACE2 deficiency and SARS-CoV-2 infection: One year later. Eur J Intern Med 2021; 93:28-34. [PMID: 34588140 PMCID: PMC8450306 DOI: 10.1016/j.ejim.2021.09.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Italy
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Gianpaolo Reboldi
- Department of Medicine, and Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, Perugia, Italy
| | - Monica Trapasso
- Dipartimento di Igiene e Prevenzione Sanitaria, PSAL, Sede Territoriale di Varese, ATS Insubria, Varese, Italy
| | - Claudio Cavallini
- Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Antonio Spanevello
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Italy
| | - Paolo Verdecchia
- Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy; Fondazione Umbra Cuore e Ipertensione-ONLUS, Perugia, Italy.
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26
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Affiliation(s)
- Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Antonio Spanevello
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Italy
| | - Dina Visca
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Italy.
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27
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Zampogna E, Ambrosino N, Saderi L, Sotgiu G, Bottini P, Pignatti P, Centis R, Migliori GB, Spanevello A, Zappa M, Visca D. Time course of exercise capacity in patients recovering from COVID-19-associated pneumonia. ACTA ACUST UNITED AC 2021; 47:e20210076. [PMID: 34287504 PMCID: PMC8332654 DOI: 10.36416/1806-3756/e20210076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/02/2021] [Indexed: 01/08/2023]
Abstract
Objective: High prevalences of muscle weakness and impaired physical performance in hospitalized patients recovering from COVID-19-associated pneumonia have been reported. Our objective was to determine whether the level of exercise capacity after discharge would affect long-term functional outcomes in these patients. Methods: From three to five weeks after discharge from acute care hospitals (T0), patients underwent a six-minute walk test (6MWT) and were divided into two groups according to the distance walked in percentage of predicted values: <75% group and ≥75% group. At T0 and three months later (T1), patients completed the Short Physical Performance Battery and the Euro Quality of Life Visual Analogue Scale, and pulmonary function and respiratory muscle function were assessed. In addition, a repeat 6MWT was also performed at T1. Results: At T0, 6MWD values and Short Physical Performance Battery scores were lower in the <75% group than in the ≥75% group. No differences were found in the Euro Quality of Life Visual Analogue Scale scores, pulmonary function variables, respiratory muscle function variables, length of hospital stay, or previous treatment. At T1, both groups improved their exercise capacity, but only the subjects in the <75% group showed significant improvements in dyspnea and lower extremity function. Exercise capacity and functional status values returned to predicted values in all of the patients in both groups. Conclusions: Four weeks after discharge, COVID-19 survivors with exercise limitation showed no significant differences in physiological or clinical characteristics or in perceived health status when compared with patients without exercise limitation. Three months later, those patients recovered their exercise capacity.
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Affiliation(s)
- Elisabetta Zampogna
- . Divisione di Pneumologia Riabilitativa, Istituti Clinici Scientifici Maugeri - IRCCS - Tradate, Italia
| | - Nicolino Ambrosino
- . Divisione di Pneumologia Riabilitativa, Istituti Clinici Scientifici Maugeri - IRCCS - Montescano, Italia
| | - Laura Saderi
- . Unità di Epidemiologia Clinica e Statistica Medica, Dipartimento di Scienze Mediche Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italia
| | - Giovanni Sotgiu
- . Unità di Epidemiologia Clinica e Statistica Medica, Dipartimento di Scienze Mediche Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italia
| | - Paola Bottini
- . Dipartimento di Medicina e Chirurgia, Malattie Respiratorie, Università degli Studi dell'Insubria, Varese/Como, Italia
| | - Patrizia Pignatti
- . U.O.C. di Medicina del Lavoro sezione di Allergologia-CRR, Istituti Clinici Scientifici Maugeri - IRCCS - Pavia, Italia
| | - Rosella Centis
- . Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri - IRCCS - Tradate, Italia
| | - Giovanni Battista Migliori
- . Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri - IRCCS - Tradate, Italia
| | - Antonio Spanevello
- . Divisione di Pneumologia Riabilitativa, Istituti Clinici Scientifici Maugeri - IRCCS - Tradate, Italia.,. Dipartimento di Medicina e Chirurgia, Malattie Respiratorie, Università degli Studi dell'Insubria, Varese/Como, Italia
| | - Martina Zappa
- . Dipartimento di Medicina e Chirurgia, Malattie Respiratorie, Università degli Studi dell'Insubria, Varese/Como, Italia
| | - Dina Visca
- . Divisione di Pneumologia Riabilitativa, Istituti Clinici Scientifici Maugeri - IRCCS - Tradate, Italia.,. Dipartimento di Medicina e Chirurgia, Malattie Respiratorie, Università degli Studi dell'Insubria, Varese/Como, Italia
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28
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Visca D, Migliori GB, Dinh-Xuan AT, Centis R, Belli S, Vitacca M, Aliani M, Zampogna E, Feci D, Pignatti P, Zappa M, Saderi L, Sotgiu G, Spanevello A. The Role of Blood Gas Analysis in the Post-Acute Phase of COVID-19 Pneumonia. Arch Bronconeumol 2021; 58:513-516. [PMID: 34188352 PMCID: PMC8223643 DOI: 10.1016/j.arbres.2021.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, 21049 Tradate, Italy.,Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, 21100 Varese-Como, Italy
| | - Giovanni Battista Migliori
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, 21049 Tradate, Italy
| | - Anh Tuan Dinh-Xuan
- Respiratory Physiology Unit, Department of Respiratory Medicine, Cochin Hospital, Université de Paris, 75013 Paris, France
| | - Rosella Centis
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, 21049 Tradate, Italy
| | - Stefano Belli
- Istituti Clinici Scientifici Maugeri, IRCCS, Respiratory Rehabilitation Unit of the Institute of 28010 Veruno, Novara, Italy
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri, IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, 25065 Brescia, Italy
| | - Maria Aliani
- Istituti Clinici Scientifici Maugeri, IRCCS, Respiratory Rehabilitation Unit of the Institute of Cassano Delle Murge, 70124 Bari, Italy
| | - Elisabetta Zampogna
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, 21049 Tradate, Italy
| | - Davide Feci
- Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, 21100 Varese-Como, Italy
| | - Patrizia Pignatti
- Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, 27100 Pavia, Italy
| | - Martina Zappa
- Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, 21100 Varese-Como, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, 21049 Tradate, Italy.,Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, 21100 Varese-Como, Italy
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Zampogna E, Ambrosino N, Centis R, Cherubino F, Migliori GB, Pignatti P, Lo Bello G, Saderi L, Sotgiu G, Zappa M, Spanevello A, Visca D. Minimal clinically important difference of the 6-min walking test in patients with asthma. Int J Tuberc Lung Dis 2021; 25:215-221. [PMID: 33688810 DOI: 10.5588/ijtld.20.0928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: The 6-min walking test (6MWT) is responsive to physiological changes and pulmonary rehabilitation (PR) in patients with asthma. The minimal clinically important difference (MCID) has not been established yet.OBJECTIVE: To determine the MCID of 6MWT in patients with asthma.METHODS: Using the perceived change in walking ability and the modified Medical Research Council (mMRC) score as anchors, receiver operating characteristic curves and quantile regression, we evaluated 6MWT before and after PR in these patients. The St George Respiratory Questionnaire (SGRQ), the COPD assessment test (CAT) and other outcome measures were also assessed.RESULTS: Of 142 patients with asthma, 37 were enrolled. After PR, 6MWT increased from 453.4 m ± 88.8 to 493.0 m ± 97.2 (P = 0.0001); other outcome measures also increased. There was a slight correlation between baseline 6MWT and SGRQ, CAT and mMRC. No significant correlations were found between post-PR changes in 6MWT and in other outcome measures. Comparing different methods of assessment, the MCID ranged from 26 m to 27 m.CONCLUSION: The most conservative estimate of the MCID of 6MWT after PR was 26 m in patients with asthma. This estimate may be useful in clinical interpretation of data, particularly in response to intervention studies.
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Affiliation(s)
- E Zampogna
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate
| | - N Ambrosino
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano
| | - R Centis
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate
| | - F Cherubino
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate
| | - G B Migliori
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate
| | - P Pignatti
- Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia
| | - G Lo Bello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate
| | - L Saderi
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Medicine, University of Sassari, Sassari
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Medicine, University of Sassari, Sassari
| | - M Zappa
- Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy
| | - A Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy
| | - D Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy
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Zampogna E, Pignatti P, Ambrosino N, Cherubino F, Maria Fadda A, Zappa M, Spanevello A, Visca D. The 5-Repetition Sit-to-Stand Test as an Outcome Measure for Pulmonary Rehabilitation in Subjects With Asthma. Respir Care 2021; 66:769-776. [PMID: 33593936 PMCID: PMC9994123 DOI: 10.4187/respcare.08452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The 5-repetition sit-to-stand test (5STS) is valid and responsive in subjects with COPD, but there is a lack of information in subjects with asthma. We aimed to evaluate the usefulness of the 5STS as an outcome measure of pulmonary rehabilitation in subjects with asthma as compared to subjects with COPD. METHODS We conducted a retrospective evaluation of subjects with asthma or COPD who underwent pulmonary rehabilitation. Both before and after in-patient pulmonary rehabilitation, subjects underwent the 5STS and the 6-min walk test; dyspnea was assessed with the Medical Research Council scale and the Barthel Index for dyspnea, and the burden of symptoms was assessed with the COPD Assessment Test. RESULTS Of 475 patients admitted during the study period, 103 subjects with asthma and 108 with COPD were included. After pulmonary rehabilitation, the 5STS improved significantly in both populations (by a median value of -1.7 s [interquartile range -4.2 to -0.5] and -1.1 s [interquartile range -3.4 to 0.0] in subjects with asthma and COPD, respectively; P < .001 for both, P = .17 between groups) independent of body mass index, as did other outcome measures. The baseline 5STS correlated slightly but significantly with age, the 6-min walk test, and the Barthel Index for dyspnea in both populations, whereas it correlated significantly with the Medical Research Council scale only in subjects with asthma and correlated with COPD Assessment Test only in subjects with COPD. No significant correlations between changes in the 5STS and in other assessed outcome measures before and after pulmonary rehabilitation were observed in subjects with asthma, whereas changes in the 5STS correlated slightly but significantly only with changes in 6-min walk test in subjects with COPD. CONCLUSIONS The 5STS was a reliable outcome measure of pulmonary rehabilitation in subjects with asthma. It must be specifically assessed and may be included in the tools for assessment of effects of pulmonary rehabilitation also in these patients.
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Affiliation(s)
- Elisabetta Zampogna
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy.
| | - Patrizia Pignatti
- Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Nicolino Ambrosino
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, Italy
| | - Francesca Cherubino
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | - Anna Maria Fadda
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | - Martina Zappa
- Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese. Italy
| | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
- Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese. Italy
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
- Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese. Italy
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Zampogna E, Migliori GB, Centis R, Cherubino F, Facchetti C, Feci D, Palmiotto G, Pignatti P, Saderi L, Sotgiu G, Spanevello A, Zappa M, Visca D. Functional impairment during post-acute COVID-19 phase: Preliminary finding in 56 patients. Pulmonology 2021; 27:452-455. [PMID: 33454281 PMCID: PMC7833519 DOI: 10.1016/j.pulmoe.2020.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/26/2020] [Accepted: 12/15/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- E Zampogna
- Respiratory Rehabilitation of the Institute of Tradate, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy.
| | - G B Migliori
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | - R Centis
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | - F Cherubino
- Respiratory Rehabilitation of the Institute of Tradate, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | - C Facchetti
- Respiratory Rehabilitation of the Institute of Tradate, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | - D Feci
- Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - G Palmiotto
- Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - P Pignatti
- Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - L Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - A Spanevello
- Respiratory Rehabilitation of the Institute of Tradate, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy; Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - M Zappa
- Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - D Visca
- Respiratory Rehabilitation of the Institute of Tradate, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy; Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
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Rivolta S, Ponti A, Deandrea S, Campari C, Zorzi M, Zappa M. Manual on the creation of quality indicators for population based cancer screening programs in Italy. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1131] [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
Issue
In many countries the organized screening programs have been in the frontline in developing and implementing the evaluation of the quality of screening and of the entire process of care following a positive test. Over the years, the three Italian Screening Groups (GIS) have separately published indicators and standards concerning the programs for breast, cervical and colorectal cancers they were responsible for, thus hampering coherence, homogeneity. In addition, at local level, an increasing number of indicators have been observed with difficult to monitor all of them.
Description of the Problem
The Screening Indicators Manual, prepared by a multidisciplinary working group, represents the guidance agreed upon by the Italian Screening Network (ONS) and the three GIS on how to develop, implement, communicate and maintain a set of quality indicators for the evaluation of cancer screening programs.
Results
The Manual indicates that the three GIS must first constitute, with ONS, the common steering committee made of six-nine experts. The involvement of the public and the management of the conflicts of interests are foreseen. The conceptual framework distinguishes indicators of context, coverage and process. It is based on six dimensions: efficacy, efficiency, security, appropriateness, person centeredness, equity. There are four macro-processes: invitation; test, further assessment and diagnosis; treatment and follow-up; evaluation. The methods include: a survey of the existent indicators, their selection with the Delphi method, the evaluation of the completeness of the resulting indicators set, its integration, when needed, by means of a public call, and finally a new Delphi round. Appropriate standards, empirical or evidence based, are then identified. Last, indicators are assigned to core or library list based on priority.
Lessons
Select, define and measure an indicator is a way to understand what we are aiming at even more than provide the measure of how we do it.
Key messages
The creation of the Manual allows to build a coherent evaluation framework for the three screening programs. The Manual promotes the adoption of rigorous methods and make feasible the monitoring activity according to its purpose, level of observation and detail of information needed.
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Affiliation(s)
- S Rivolta
- Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - A Ponti
- SSD Epidemiologia e screening, CPO, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - S Deandrea
- DG Welfare, Lombardy Region, Milan, Italy
- Department of Hygiene and Health Prevention, Agency for Health Protection, Pavia, Italy
| | - C Campari
- Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
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Hugosson J, Roobol MJ, Månsson M, Tammela TLJ, Zappa M, Nelen V, Lott F. Editorial Comment: A 16-yr Follow-up of the European Randomized study of Screening for Prostate Cancer. Int Braz J Urol 2020; 46:465-466. [PMID: 32167717 PMCID: PMC7088492 DOI: 10.1590/s1677-5538.ibju.2020.03.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | - V Nelen
- Provinciaal Instituut voor Hygiëne, Belgium
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Abstract
Asthma is a chronic inflammatory disease characterized by airflow limitation and variable respiratory symptoms. It is characterized by variable symptoms such as cough, wheeze, chest tightness, and shortness of breath which vary in intensity and time. In order to reach a comprehensive approach of disease management, the importance of non-pharmacological treatment in addition to pharmacological therapy has been recently highlighted. Studies have documented that pulmonary rehabilitation has beneficial effects in patients with asthma, at any stage of the disease, improving exercise capacity, asthma control, and quality of life and reducing wheezing, anxiety, depression, and bronchial inflammation. Although several evidences suggest a role of pulmonary rehabilitation in patients with asthma, additional information is required to identify a specific program in order to improve clinical care based on specific patient’s needs.
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Affiliation(s)
- Elisabetta Zampogna
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Istitute of Tradate (VA), Tradate, Italy
| | - Martina Zappa
- Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - Antonio Spanevello
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Istitute of Tradate (VA), Tradate, Italy.,Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - Dina Visca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Istitute of Tradate (VA), Tradate, Italy.,Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
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Barat M, Paisant A, Calame P, Purcell Y, Lagadec M, Curac S, Zappa M, Vilgrain V, Ronot M. Unenhanced CT for clinical triage of elderly patients presenting to the emergency department with acute abdominal pain. Diagn Interv Imaging 2019; 100:709-719. [DOI: 10.1016/j.diii.2019.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/28/2019] [Accepted: 05/18/2019] [Indexed: 02/06/2023]
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Aarts AMWM, Duffy SW, Geurts SME, Vulkan DP, Houssami N, Zappa M, Nagtegaal ID, Verbeek ALM, Broeders MJM. Towards evidence-based follow-up intervals for breast cancer survivors: Estimates of the preclinical detectable phase of contralateral second breast cancer. Breast 2019; 45:70-74. [PMID: 30884341 DOI: 10.1016/j.breast.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/01/2019] [Accepted: 03/07/2019] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Follow-up schemes in breast cancer survivors are predominantly consensus-based. To determine evidence-based follow-up intervals, estimates of sensitivity of the screening test(s) and duration of the preclinical detectable phase (PCDP) are key. We estimated the sensitivity and the duration of the PCDP of clinical breast examination (CBE) and mammography for the detection of contralateral second breast cancers (CBC) in breast cancer survivors. METHODS Women with a CBC (N = 589) diagnosed in Florence between 1980 and 2005 were included. Test sensitivity and the duration of PCDP were estimated using a simple exponential model of PCDP duration. Analyses were stratified by follow-up period (0-5 vs. >5 years after primary diagnosis) and age at CBC diagnosis (<50 vs. ≥50 years). RESULTS For CBE, test sensitivity was 55% and the duration of the PCDP 16 months. Mammography sensitivity was 91% and duration of the PCDP 35 months. Stratified analyses showed a higher test sensitivity for CBE for women aged <50 (70% vs. 51%). No difference in the duration of PCDP of CBE was found. For mammography, test sensitivity and the duration of the PCDP were higher for women with longer follow-up and in older women. CONCLUSIONS Poor test sensitivity for CBE with a shorter duration of the PCDP compared with mammography were observed. Mammography had high test sensitivity and the potential to detect CBCs early. The estimated duration of the PCDP (35 months) was considerably longer than the recommended follow-up interval (12 months). Future studies are needed to determine whether a longer follow-up interval is appropriate.
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Affiliation(s)
- A M W M Aarts
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - S W Duffy
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S M E Geurts
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - D P Vulkan
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - N Houssami
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - M Zappa
- Instituto per Lo Studio e La Prevenzione Oncologica (ISPO), Florence, Italy
| | - I D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A L M Verbeek
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M J M Broeders
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands
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Pineton de Chambrun G, Pariente B, Seksik P, Altwegg R, Vuitton L, Stefasnescu C, Nancey S, Aubourg A, Serrero M, Peyrin-Biroulet L, Filippi J, Viennot S, Abitbol V, Boualit M, Boureille A, Moreau J, Buisson A, Roblin X, Nachury M, Zappa M, Lambert J, Bouhnik Y. Adalimumab for patients with Crohn's disease complicated by intra-abdominal abscess: a multicentre, prospective, observational cohort study. J Crohns Colitis 2019; 13:S616. [PMID: 30794285 DOI: 10.1093/ecco-jcc/jjz045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
doi:10.1093/ecco-jcc/jjy222 Abstract P528 from the 'Poster presentations' section of the main abstract book has been withdrawn and re-inserted as DOP63 in the 'Late-breaking abstracts' section.
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Affiliation(s)
| | - B Pariente
- Lille University Hospital, Gastroenterology, Lille, France
| | - P Seksik
- Saint-Antoine University Hospital, Gastroenterology, Paris, France
| | - R Altwegg
- Montpellier University Hospital, Gastroenterology, Montpellier, France
| | - L Vuitton
- Besancon University Hospital, Gastroenterology, Besancon, France
| | - C Stefasnescu
- Beaujon University Hospital, Gastroenterology, Clichy, France
| | - S Nancey
- Lyon University Hospital, Gastroenterology, Lyon, France
| | - A Aubourg
- Tours University Hospital, Gastroenterology, Tours, France
| | - M Serrero
- Marseille University Hospital, Gastroenterology, Marseille, France
| | - L Peyrin-Biroulet
- Nancy University Hospital, Gastroenterology, Vandoeuvre-les-Nancy, France
| | - J Filippi
- Nice University Hospital, Gastroenterology, Nice, France
| | - S Viennot
- Caen University Hospital, Gastroenterology, Caen, France
| | - V Abitbol
- Cochin University Hospital, Gastroenterology, Paris, France
| | - M Boualit
- Valenciennes General Hospital, Gastroenterology, Valenciennes, France
| | - A Boureille
- Nantes University Hospital, Gastroenterology, Nantes, France
| | - J Moreau
- Toulouse University Hospital, Gastroenterology, Toulouse, France
| | - A Buisson
- Clermont-Ferrand University Hospital, Gastroenterology, Clermont-Ferrand, France
| | - X Roblin
- Saint-Etienne University Hospital, Gastroenterology, Saint-Etienne, France
| | - M Nachury
- Lille University Hospital, Gastroenterology, Lille, France
| | - M Zappa
- Beaujon University Hospital, Radiology, Clichy, France
| | - J Lambert
- Saint-Louis University Hospital, Biostatistics, Paris, France
| | - Y Bouhnik
- Beaujon University Hospital, Gastroenterology, Clichy, France
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Abstract
Background Quality of care is today a major issue in oncology, and much attention is given to research on the outcome of breast cancer care. Too little attention has been devoted in the scientific literature to the consequences of treatment in long-term survivors, and in particular to the possible side effects. The specific aim of this contribution is to present population-based data about the long-term impact of breast cancer care in women who had an incident cancer in 1985/1986. Patients and Methods The cases are 476 breast cancers incident in the City of Florence in 1985-86. Women still living 5 years later were invited to have an interview and a physical examination. Lymphedema, peripheral nerve lesions and damage to the shoulder were assessed. Results Of the 346 5-year survivors, 238 accepted our invitation: 35.2% of the women reported some early postoperative sequelae, 30.2% had a chronic lymphedema and 18.9% a shoulder deficit. Comparing breast-conserving surgery with radical mastectomy, the risk of chronic lymphedema (OR=1.62; 95% CI: 0.91-2.88) and other lesions was higher for women who had a radical surgery. Women who had a breast-conserving surgery more often reported an early lymphedema (OR=1.60; 95% CI: 0.88-2.88). Conclusions The proportion of women who complained of (or manifested at the physical examination) a minor or major disability of the arm in our study was high. The impact of these functional problems in terms of quality of life should also be assessed, but it is our impression that there is need for much greater attention to the issue of long-term survivor sequelae.
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Affiliation(s)
- E Paci
- Centro per lo Studio e la Prevenzione Oncologica, Epidemiological Unit, Florence, Italy
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Ciatto S, Cecchini S, Bonardi R, Grazzini G, Mazzotta A, Zappa M. A Feasibility Study of Screening for Endometrial Carcinoma in Postmenopausal Women by Ultrasonography. Tumori 2018; 81:334-7. [PMID: 8804449 DOI: 10.1177/030089169508100506] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Abnormal endometrial thickness assessed by ultrasonography has been reported as a reliable indicator for early asymptomatic endometrial carcinoma. Study design We evaluated the feasibility and the performance of screening by ultrasonography in a consecutive series of postmenopausal volunteers. Results A total of 2,025 women were screened, and 117 (5.8%) showed abnormal endometrial thickness. Ninety-eight subjects consented to be assessed by outpatient endometrial biopsy, which was not possible in 32 for cervical stenosis. Three cancers were detected among 66 assessed subjects, 34 not-assessed subjects were controlled by repeat sonography (no change), and 17 were lost to follow-up. No other cancer was recorded by the local Cancer Registry among screened subjects. The prevalence/incidence ratio was 2.65:1, and the cost per screen-detected cancer was 18,571,000 Italian lire. Conclusions Screening by endometrial sonography is feasible on a practical basis, but its efficacy needs to be proven by prospective controlled studies which would enroll large populations to ensure sufficient statistical power, considering the low incidence and the low lethality of the disease. Studies of screening for other carcinomas may be considered of higher priority.
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Affiliation(s)
- S Ciatto
- Centro per lo Studio e la Prevenzione Oncologica, Florence, Italy
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Ciatto S, Bonardi R, Mazzotta A, Lombardi C, Santoni R, Cardini S, Zappa M. Comparing Two Modalities of Screening for Prostate Cancer: Digital Rectal Examination + Transrectal Ultrasonography Vs. Prostate-Specific Antigen. Tumori 2018; 81:225-9. [PMID: 8540115 DOI: 10.1177/030089169508100401] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background To evaluate the performance and feasibility of screening for prostate cancer by comparing screening modalities. Methods Prospective study of two comparable cohorts of healthy resident males aged 60 to 75 years. Screening attenders in the two invited cohorts were screened either by digital rectal examination (DRE) and transrectal ultrasonography (TRUS), or by serum prostate-specific antigen determination (PSA: cutoff 4 ng/ml). Attendance and biopsy rates, predictive values, prevalence of screen-detected cancers, as well as screening costs were determined, and the efficiency of the two screening modalities was compared. Results 1425 subjects were screened by DRE + TRUS. Attendance rate was 33.7%, the biopsy rate was 2.7%, and the prevalence of detected cancers was 1.82%. A total of 1315 subjects was screened by PSA. Attendance rate was 66.9%, the biopsy rate was 2.8%, and the prevalence of detected cancers was 1.67%. Screen-detected cancer stage was more favorable than observed in clinical practice, and early detection was evident, with the prevalence/incidence ratio higher than 10:1 in both programs. The cost per subject screened was about 34,000 Lire for DRE + TRSU and about 30,000 Lire for PSA program. Conclusions The study confirms that early detection of prostate cancer is possible and that screening is practically feasible. Both screening modalities achieved comparable results as regards early detection, but screening by PSA had a higher compliance and lower costs. PSA seems the ideal test to be used in prospective controlled studies aimed at demonstrating screening efficacy.
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Affiliation(s)
- S Ciatto
- Centro per lo Studio e la Prevenzione Oncologica, Florence, Italy
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Abstract
Aims and Background General practitioners could play a key role in preventive programs against tobacco-related diseases. However, they seldom take action in the office even with minimal advice counselling. Such behaviour might reflect the lack of academic teaching and the lack of practice with motivational and dependence questionnaires, considered basic tools to help smokers to quit successfully. The study was aimed to investigate the awareness of a sample of Italian family doctors as regards tobacco epidemiology and smoking cessation strategies. Methods A total of 428 family doctors were administered a questionnaire with a set of questions on their personal smoking habits and on personal initiatives in the office towards smokers. Another set of questions regarded their knowledge on tobacco issues, with special attention to carbon monoxide, which is widely perceived as a very dangerous poison and works as a motivational tool on smokers and adolescents. Carbon monoxide measurement was carried out on all participants to obtain objective data on smoking and to show the feasibility of the test. Results The percentage of self-reported current smokers among general practitioners was 24%, with a high prevalence of ex-smokers (46%), and 29% of never smokers. Family doctors were more keen to counsel adolescents than adults about tobacco, and they were very interested in continuing medical education on the issue. The doctors who took part in our study showed a surprising limited knowledge of all the issues associated with smoking cessation and prevention such as epidemiology, cigarette characteristics, success rate of smoking cessation programs, Fagerström's tolerance questionnaire, safety of nicotine replacement therapy and the knowledge of carbon monoxide as a product of cigarette smoke. Conclusions The scenario depicted by our survey underscores the necessity to improve the knowledge and performance of primary care physicians on tobacco-related issues in order to implement primary and secondary prevention in clinical practice.
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Paci L, Perfetti P, Zappa M, Lazzoni E, Giorgi D, Paci E, del Turco MR. First Results of a Mammographic Screening Program in Two Municipalities of Massa-Carrara Province (Italy). Tumori 2018; 79:26-9. [PMID: 8497917 DOI: 10.1177/030089169307900105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background A mammographic screening for breast cancer was started in 1989 in two municipalities of Massa-Carrara province. This paper describes the results of the first two years and evaluates the quality of the program via early indicators. Methods We calculated the attendance rate at first screening, the proportion of women recalled for further examinations (recall rate), the ratio between benign lesions and carcinomas detected by screening, the staging of the screen detected cancers and the ratio between detection rate and expected incidence (P/l ratio). Results Out of 14826 invited women 10407 (70.2 %) attended the first screening; 266 (2.6%) of them were referred for further investigations but only 63 (0.6%) required surgical biopsy. A histological confirmed malignancy was found in 39 women corresponding to a detection rate of 3.7/1000. According to pTNM classification 89.1 % of all cancers were either Tis or in stage T1; and in two third of the cases there was no nodes involvment. Conclusion The results achieved so far, evaluated via early indicators, show a good start of the program.
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Affiliation(s)
- L Paci
- Servizio di Radiologia, Ospedale Generale di Massa, Italy
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Cecchini S, Ciatto S, Bonardi R, Mazzotta A, Pacini P, Muraca MG, Zappa M. Risk of Endometrial Cancer in Breast Cancer Patients under Long-Term Adjuvant Treatment with Tamoxifen. Tumori 2018; 84:21-3. [PMID: 9619708 DOI: 10.1177/030089169808400104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims To evaluate the relative risk of endometrial cancer with respect to the expected underlying incidence in breast cancer patients undergoing long-term adjuvant tamoxifen therapy. Methods A total of 1010 postmenopausal breast cancer patients receiving adjuvant tamoxifen and with a first negative endometrial ultrasonography (cutoff for abnormal endometrial thickness >5 mm) were followed by annual transvaginal ultrasonography. Abnormal endometrial thickness prompted an outpatient endometrial biopsy or curettage under anesthesia in the case of cervical stenosis and increasing endometrial thickness. The standardized incidence ratio (SIR) with respect to underlying incidence was determined. Results A total of 1,010 eligible subjects who had been receiving tamoxifen for an average of 51 months were enrolled and followed for a total of 2,361 patient-years between January 1993 and December 1996. Five cases of endometrial cancer were observed in the study period: 1 was detected at screening, and 4 were diagnosed for vaginal bleeding in the interval between screening examinations. SIR was 4.0 (95% confidence interval, 1.39.4) and increased to 4.8 (CI, 1.6-10.5) when the single cancer detected at first screening was considered as incident. Conclusions This study adds evidence to the hypothesis that long-term tamoxifen treatment may be responsible for a relevant increase in the risk of developing endometrial cancer. Surveillance based on endometrial ultrasonography was poorly sensitive, but the favorable stage at diagnosis of screen-detected or interval endometrial cancers does not support a more aggressive screening approach.
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Affiliation(s)
- S Cecchini
- Centro per lo Studio e la Prevenzione Oncologica, Florence, Italy
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Abstract
Aims and background The objective of this study was to investigate the detection rate of cervical intraepithelial neoplasia grade III (CIN 3) in previously unscreened women, in order to reveal trends over time in the prevalence of CIN 3 in the District of Florence, where a population-based screening for cervical cancer has been going on since 1973. Study design We considered the women, recorded in the computerized archives of CSPO, who had had no pap test for at least 10 years. Trends of CIN 3 (histologically proven) were analyzed within age groups; the effect of age, cohort and period were considered by means of a Poisson regression model. Results A total of 648 cases of histologically proven CIN 3 were detected in the study period. The detection rates of CIN 3 increased steadly within age groups over birth cohort and calendar period simultaneously. The Poisson regression analysis showed that only the model with age + time trend was statistically significant. Conclusions Although several biases should be taken into account, the analysis seemed to indicate a real increase in CIN 3 prevalence. An increase in frequency of precancerous lesions for cervical cancer in more recent birth cohorts supports the need to keep screening coverage and efficiency as high as possible.
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Affiliation(s)
- S Cecchini
- Centro per lo Studio e la Prevenzione Oncologica (CSPO), Florence, Italy
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Ciatto S, Del Turco MR, Marrazzo A, Mazzoleni G, Foglietta F, Cappelli MC, Ravaioli A, Bonzanini M, Carnaghi P, Nava D, Modena S, Zanza A, Benassuti C, Falconieri G, Zappa M. Time Trends of Benign/Malignant Breast Biopsy Ratios a Multicenter Italian Study. Tumori 2018; 82:325-8. [PMID: 8890964 DOI: 10.1177/030089169608200406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Although they have been decreasing over time due to improved specificity of diagnostic assessment, benign biopsies of the breast are still common. Benign biopsies should be regarded as negative events, due to their economical and psychological cost and their possible negative impact on cosmesis and on further diagnostic evaluation. Methods Retrospective data on benign/malignant breast biopsies ratio (B/M) were collected in 9 Italian centers for a period of 10-15 years. The time trend of B/M and its association to age or to single centers was evaluated. Results Overall 31,001 cases were considered. A strong association of B/M to age was evident (average B/M values were 5.0, 1.3, 0.6, and 0.2 for women aged <40, 40-49, 50-59, and >59 years). A significant trend of decreasing B/M over time was observed only for one center. Age standardized B/M was significantly different (P<0.000001) between centers, ranging between 0.34 and 1.69. Multivariate analysis confirmed an independent significant association of age and center to B/M. Conclusions Marked differences in B/M are evident between centers, which cannot be explained by the confounding effect of age or by any apparent difference in the diagnostic protocol. The observed differences are likely ascribed to individual variations in diagnostic aggressivity. A progressive increase of the predictive value of calls for surgical biopsy may be achieved over time and centers with a high B/M should make every effort to optimize their performance. Acceptable (<40=5, 40-49=1.5, 50-59=0.75, >59=0.3) and desirable (2.5, 0.75, 0.35, 0.15) age specific reference standards for B/M are proposed.
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Affiliation(s)
- S Ciatto
- Centro per lo Studio e la Prevenzione Oncologica, Firenze, Italy
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Abstract
Aims and background False-negative cytological diagnoses represent the critical point of a screening program for early detection of cervical cancer. Computer-assisted reading using neural network technology has been suggested as a possible approach to manage the problem. The study assessed the performance and the cost-outcome ratio of computer-assisted versus conventional manual Pap smear reading. Methods One thousand routine smears, seeded with 81 false-negative smears, were independently interpreted by two readers by conventional and PAPNET-assisted reading. Results of both readings were compared in terms of: a)sensitivity for false-negative smears, b)specificity, and c) cost-outcome (cost per CIN2+ lesion detected). Results PAPNET-assisted reading showed a small increase in sensitivity only for one reader. Including the cost of PAPNET, the cost per detected lesion would be $7,543 and the cost per additional detected lesion would be $25,748. Conclusions The present study provides further evidence that PAPNET-assisted screening may allow the detection of a few extra cases of CIN2+ lesions with respect to conventional reading, though at a very high cost.
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Affiliation(s)
- G M Troni
- Department of Cytopathology, Center for Cancer Study and Prevention, Florence, Italy
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Ronco G, Iossa A, Naldoni C, Pilutti S, Anghinoni E, Zappa M, Dalla Palma P, Ciatto S, Segnan N. A First Survey of Organized Cervical Cancer Screening Programs in Italy. Tumori 2018; 84:624-30. [PMID: 10080665 DOI: 10.1177/030089169808400602] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Italy, where no national screening program for cervical cancer exists, organized programs have developed on a local basis. We performed the first survey of existing organized programs by mailing a standard questionnaire to a large network of possibly involved services. For the present survey, a program was defined as organized if personal invitations were sent. We identified 29 already active organized programs and 4 others in a starting phase. The target population of active programs included 2,074,820 women in the age range 25-64 years, corresponding to 13.5% of the Italian female population of the same age. The situation is rapidly evolving since many regional programs are being implemented. Most programs followed Italian and European recommendations as regards the age limits, interval between screening rounds, presence of a fail-safe system for women referred for colposcopy, presence of protocols for diagnostic workup and treatment, and presence of referral centers for such phases. However, many programs did not meet national guidelines as regards the size of laboratories interpreting smears, which were frequently small. Second-level referral centers also frequently had a very small activity. The average (weighted for size of the invited population) compliance to invitation and coverage (proportion of women with at least one test in the last 3 years) was 32.6% and 66.0%, respectively, therefore needing to be improved. Compliance to colposcopy (weighted for number of referred women) was 81.4%. We found a very high variability in the proportion of women referred for colposcopy that could only be partly explained by different referral protocols and could depend on different criteria of smear interpretation: the average (weighted for number of tested women) was 2.01%. A need for improvement in the process of evaluation and for homogenization of criteria of cytology interpretation was identified: work in this regard is on-going.
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Affiliation(s)
- G Ronco
- Department of Oncology, ASL TOI, Center for Cancer Epidemiology and Prevention (CPO), Regione Piemonte, Torino, Italy
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Grazzini G, Castiglione G, Isu A, Mantellini P, Rubeca T, Sani C, Turco P, Zappa M. Colorectal Cancer Screening by Fecal Occult Blood Testing: Results of a Population-Based Experience. Tumori 2018; 86:384-8. [PMID: 11130566 DOI: 10.1177/030089160008600503] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The study evaluated the results of an experimental screening protocol for colorectal cancer by fecal occult blood testing in a municipality of the Province of Florence. Methods A total of 15,235 subjects aged 50–70 years were invited to perform a 1-day immunochemical fecal occult blood testing without any dietary restrictions. All eligible subjects were sent a personal invitation letter, followed by a postal reminder to non-responders. Subjects with a negative stool test were advised to repeat screening after 2 years. Subjects with a positive screening test were invited to undergo full colonoscopy or a combination of left colonoscopy and a double contrast barium enema. Results A total of 6,418 subjects performed the screening test, with an overall compliance of 42.1%. A total of 268 compilers had positive test results. The positivity rate was 4.2%. Detection rate for cancer and for adenomas was 5.1‰ and 11.6‰, respectively. The positive predictive value was 14.3% for cancer and 32.5% for adenoma. A higher compliance was recorded in subjects born in the province of Florence or living in the centre of the town, in married subjects, and in women. The best results in compliance were associated with the direct distribution of fecal occult blood testing kits by general practitioners to their outpatients. Conclusions The study provides useful information about the efficiency and feasibility of a screening program for colorectal cancer using fecal occult blood testing. Compliance results confirm the importance of GP involvement in oncological screening.
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Affiliation(s)
- G Grazzini
- CSPO Presidio per la Prevenzione Oncologica, Azienda Ospedaliera Careggi, Florence, Italy.
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Abstract
Aim and background To evaluate the cost effectiveness of screening by colposcopy compared to conventional cytology. Methods A prospective study was performed in the Florence District screening center on 3,000 consecutive women, self referring, who were examined by cytology and colposcopy in a blind fashion. Further assessment was based on cytologic report or on colposcopy-directed punch biopsy. Actual costs of the whole screening process were known. The cost effectiveness of different possible simulated screening scenarios was then determined. Results Overall, 18 high-grade lesions (CIN3 = 9, CIN2 = 9) were detected. Four different screening scenarios were compared, namely a) cytology alone, b) cytology + repeat smear for ASCUS (atypical squamous cells of undeterminate significance) cases, c) colposcopy + cytology for cases of condyloma at punch biopsy, and d) colposcopy alone. Although they had a higher cost per examined woman (a) = 17.98, b) = 19.40, c) = 23.86, d)= 22.10 US$), scenarios c) and d) had a higher relative sensitivity (a = 44.4, b = 61.1, c = 100, d = 88.8%) and a lower cost per high-grade lesion detected (a = 6,743, b = 5,291, c = 3,977, d = 4,144 US$). Conclusions Screening by colposcopy is a feasible procedure which is more sensitive and more cost effective than conventional cytologic screening. At least in those settings where access to cytopathology may be difficult, screening by colposcopy should be considered as a possible alternative.
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Affiliation(s)
- S Cecchini
- Centro per lo Studio e la Prevenzione Oncologica, Florence, Italy
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Ciatto S, Bonardi R, Lombardi C, Cappelli G, Castagnoli A, D'Agata A, Zappa M, Gervasi G. Predicting Prostate Biopsy Outcome by Findings at Digital Rectal Examination, Transrectal Ultrasonography, PSA, PSA Density and Free-To-Total PSA Ratio in a Population-Based Screening Setting. Int J Biol Markers 2018; 16:179-82. [PMID: 11605730 DOI: 10.1177/172460080101600304] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The study offers a retrospective analysis of the positive predictive value (PPV) of several variables, i.e. digital rectal examination (DRE), transrectal ultrasonography (TRUS), PSA value, PSA density (PSAD), and free/total PSA ratio (F/T), for the histologic outcome of 179 prostate biopsies performed within a population-based screening trial. The ratio of spared benign biopsies to missed cancers (SBB/MC) if biopsy results had been decided on the basis of single variables was also evaluated. PPV was 82.9% for DRE, 56.3% for TRUS, 26.6% for PSA (cutoff ≥4 ng/mL), 47.4% for PSA (cutoff ≥10 ng/mL), 42.0% for PSAD (cutoff 0.15), 59.2% for PSAD (cutoff 0.20), 34.9% for F/T (cutoff 0.20) and 40.0% for F/T (cutoff 0.15). SBB/MC was 121/23 for DRE, 96/12 for TRUS, 11/10 for PSA (cutoff ≥4 ng/mL), 107/34 for PSA (cutoff ≥10 ng/mL), 87/23 for PSAD (cutoff 0.15), 109/26 for PSAD (cutoff 0.20), 45/8 for F/T (cutoff 0.20) and 70/14 for F/T (cutoff 0.15). Multivariate analysis of the association with biopsy outcome showed the highest odds ratio for TRUS (13.24, 95% CI=4.4–30.7), and considerably lower values for DRE (4.17, 95% CI=2.0–8–9), PSAD (cutoff 0.20: 3.24, 95% CI=–1.8–5.7) and F/T (cutoff <0.15: 3.16, 95% CI =1.7–1.8). None of the possible variable combinations was clinically useful: the highest PPV (83.3%) was obtained with a combination of suspicious DRE/TRUS, PSAD >0.20 and F/T <0.15, which nevertheless missed 20 of 52 cancers.
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Affiliation(s)
- S Ciatto
- Centro per lo Studio e la Prevenzione Oncologica, Florence, Italy
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