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Castello L, Di Fusco S, Leggio M, Alonzo A, Aiello A, Imperoli G, Colivicchi F. C85 IMPACT OF QUARANTINE ON CARDIOVASCULAR RISK FACTORS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Pandemic–related quarantine has led to critical lifestyle changes with possible detrimental consequences on health. The effects of lockdown on cardiovascular (CV) risk factors have been investigated to define patient–tailored strategies aimed at reducing the negative impact on CV health.
Methods
We administered a closed response survey to consecutive patients coming to our cardiac outpatient centre over a period of 10 days. Questions focused on quarantine–related lifestyle changes during March and April 2020.
Results
We enrolled 150 patients (62% male, mean age 65 years). The vast majority of subjects (73%) did not work due to retirement/unemployment, 14% worked in office and 13% worked from home. 50% had hypertension and/or diabetes and/or dyslipidemia, 33% had atrial fibrillation, 17% coronary artery disease, 6% had heart failure and 4% had a pacemaker/ICD implanted. Physical activity did not change for 44%, increased in 2%, decreased in 33% and was stopped in 21%. Dietary pattern remained the same in 73% while 22% consumed more junk food and 5% more healthy food. Body weight was not monitored in 35%, remained unchanged in 32%, increased in 28% and decreased in 5%. Among active smokers (22%), 86% reported higher cigarette consumption while 14% reduced/unchanged number of cigarettes per day. Sleep disorders were present in 73%. Regarding health needs, 16% had to reschedule medical check–ups due to personal choice or hospital unavailability.
Conclusions
Quarantine appeared to have different effects on CV risk factors. During lockdown, on–site work was limited, which may partially account for the observed lifestyle changes. Physical activity was reduced/interrupted in more than half of the population, whereas dietary pattern did not change in the vast majority of subjects, with only a small proportion reporting worse dietary habits. Body weight increased in only a minority of subjects, though this may be underestimated because most participants did not monitor their weight. Cigarette consumption was higher for the majority of active smokers. Similarly, sleep disorders were present in the vast majority of subjects. To conclude, consistent with current literature, our real–world data confirm that quarantine seems to have affected lifestyle habits defining CV risk profile differently. A patient–tailored approach should be implemented to minimise possible detrimental effects of quarantine on CV health.
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Leggio M, Fusco A, Coraci D, Villano A, Filardo G, Mazza A, Loreti C, Serafini E, Biscotti L, Bernabei R, Padua L, Giovannini S. Exercise training and atrial fibrillation: a systematic review and literature analysis. Eur Rev Med Pharmacol Sci 2021; 25:5163-5175. [PMID: 34486691 DOI: 10.26355/eurrev_202108_26530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE There are concerns in maintaining adequate levels of physical activity in patients with atrial fibrillation (AF). This could be related to the type of exercise delivered, different among studies, as the words used to describe it as treatment. We have analysed the state-of-art of the role of the exercise in AF by a mathematical analysis. This analysis documented the connections between topics and updated the available evidence through a systematic review of the current literature. MATERIALS AND METHODS A literature search was conducted using specific terms for studies published between 2000 and 2019. For the descriptive analysis of the current literature, we used the LExical Network analysed by the Graph THeory (LENGTH) method, while to perform our review we followed the PRISMA statement. Downs and Black Quality Index was also used to assess the quality of studies. The LENGTH approach indicated nonspecific terms as "exercise", "physical" and "activity" as more representative than "rehabilitation" to describe the intervention. RESULTS The systematic review identified nine studies on 882 patients of moderate (n=4) to good (n=5) quality. Training consisted of a combination of supervised ambulatory and home-based outpatient programs, focused on aerobic elements (endurance and resistance training, walking, treadmill and bicycle ergometer). Significant improvements in 6-minute walking test distance and peak oxygen uptake and in quality of life were obtained, with high adherence to training and no serious/significant adverse events. Only one trial was based on cardiac rehabilitation principles. CONCLUSIONS Adequate exercise training can get a favourable cardiovascular outcome in patients with AF.
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Affiliation(s)
- M Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital, Rome, Italy.
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Leggio M, Tiberti C, Villano A, Fusco A, Mazza A. The Urgent Need for More Cardiac Rehabilitation in the Aim to "Preserve" Patients With Heart Failure. JACC Heart Fail 2021; 9:610. [PMID: 34325896 DOI: 10.1016/j.jchf.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 11/18/2022]
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Colivicchi F, Di Fusco SA, Arca M, Leggio M, Caldarola P, Murrone A, Valente S, Urbinati S, Roncon L, Amodeo V, Aspromonte N, Cipriani M, Domenicucci S, Francese GM, Imazio M, di Uccio FS, Di Lenarda A, Gulizia MM, Gabrielli D. Non-high-density lipoprotein cholesterol versus low-density lipoprotein cholesterol in clinical practice: ANMCO position paper. J Cardiovasc Med (Hagerstown) 2021; 22:609-617. [PMID: 33651721 DOI: 10.2459/jcm.0000000000001175] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Bloodstream cholesterol is a central contributor to atherosclerotic cardiovascular diseases. For several decades, low-density lipoprotein cholesterol (LDL-C) has been the main biomarker for the prediction of cardiovascular events and therapeutic target of lipid-lowering treatments. More recently, several findings have supported the greater reliability of non-high-density lipoprotein cholesterol (non-HDL-C) as a predictive factor and possible therapeutic target in refining antiatherogenic treatments, especially among patients with lower LDL-C and higher triglyceride values. This article discusses the limits of current standard methods for assessing LDL-C levels and emphasizes the persistent residual cardiovascular risk in patients treated with lipid-lowering agents on the basis of recommended LDL-C targets. It highlights that patients with controlled LDL-C and non-targeted non-HDL-C have a higher cardiovascular risk. The article focuses on the role of non-HDL-C as a better predictor of atherosclerotic disease as compared with LDL-C and as a therapeutic target. Finally, this article includes an executive summary aimed at refining preventive approaches in atherosclerotic cardiovascular disease.
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Affiliation(s)
- Furio Colivicchi
- Clinical and Rehabilitative Cardiology Unit, San Filippo Neri Hospital ASL Roma 1, Rome
| | | | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza University of Roma, Rome
| | - Massimo Leggio
- Clinical and Rehabilitative Cardiology Unit, San Filippo Neri Hospital ASL Roma 1, Rome
| | | | - Adriano Murrone
- Cardilogy-Intensive Care Unit, Ospedali di Città di Castello e Gubbio - Gualdo Tadino, Azienda USL Umbria 1, Perugia
| | | | | | - Loris Roncon
- Cardiology Unit, Ospedale Santa Maria della Misericordia, Rovigo
| | - Vincenzo Amodeo
- Cardilogy-Intensive Care Unit, Santa Maria degli Ungheresi Hospital, Polistena, Reggio Calabria
| | - Nadia Aspromonte
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Manlio Cipriani
- Cardiology Unit 2, ASST Grande Ospedale Metropolitano Niguarda Cà Granda, Milan
| | | | - Giuseppina Maura Francese
- Cardiology Division, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione 'Garibaldi' Catania, Catania
| | - Massimo Imazio
- Cardilogy Unit, Presidio Molinette, A.O.U. Città della Salute e della Scienza di Torino, Torino
| | | | - Andrea Di Lenarda
- Cardiovascular Center, University Hospital and Health Services of Trieste, Trieste
| | - Michele Massimo Gulizia
- Cardiology Division, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione 'Garibaldi' Catania, Catania
- Presidente Fondazione per il Tuo cuore, Heart Care Foundation, Florence
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Lupo M, Olivito G, Angelini L, Funghi G, Pignatelli F, Siciliano L, Leggio M, Clausi S. Does the cerebellar sequential theory explain spoken language impairments? A literature review. Clin Linguist Phon 2021; 35:296-309. [PMID: 32290716 DOI: 10.1080/02699206.2020.1745285] [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] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/01/2020] [Accepted: 03/17/2020] [Indexed: 06/11/2023]
Abstract
During the past decades, converging evidence from clinical, neuroimaging and neuroanatomical studies has demonstrated the key role of the cerebellum in the processing of non-motor aspects of language. Although more is known about the way in which the cerebellum participates in the mechanisms involved in written language, there is ambiguous information on its role in other aspects of language, such as in non-motor aspects of spoken language. Thus, to contribute additional insight into this important issue, in the present work, we review several original scientific papers focusing on the most frequent non-motor spoken language impairments evidenced in patients affected by cerebellar pathology, namely, verbal working memory, grammar processing and verbal fluency impairments. Starting from the collected data, we provide a common interpretation of the spoken language disorders in cerebellar patients, suggesting that sequential processing could be the main mechanism by which the cerebellum participates in these abilities. Indeed, according to the cerebellar sequential theory, spoken language impairments could be due to altered cerebellar function to supervise, synchronize and coordinate the activity of different functional modules, affecting the correct optimization of linguistic processing.
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Affiliation(s)
- M Lupo
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - G Olivito
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - L Angelini
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - G Funghi
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - F Pignatelli
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - L Siciliano
- PhD Program in Behavioral Neuroscience, Sapienza University of Rome, Rome, Italy
| | - M Leggio
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - S Clausi
- Department of Psychology, Sapienza University of Rome, Rome, Italy
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Leggio M, Villano A, Fusco A, Mazza A. Hyperlipidemia management during the COVID-19 pandemic: PCSK9 inhibitors to enhance the antiviral action of interferon. Eur Rev Med Pharmacol Sci 2021; 25:2166-2167. [PMID: 33755951 DOI: 10.26355/eurrev_202103_25205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- M Leggio
- Clinical and Rehabilitative Cardiology Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy.
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Mazza A, Bendini MG, Leggio M, De Cristofaro R, Valsecchi S, Boriani G. Continuous monitoring of sleep-disordered breathing with pacemakers: Indexes for risk stratification of atrial fibrillation and risk of stroke. Clin Cardiol 2020; 43:1609-1615. [PMID: 33179808 PMCID: PMC7724201 DOI: 10.1002/clc.23489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/19/2022] Open
Abstract
Background Sleep apnea (SA) is a risk factor for atrial fibrillation (AF). Advanced pacemakers are now able to calculate indexes of SA severity. Hypothesis We investigated the changes in pacemaker‐measured indexes of SA, we assessed their predictive value for AF occurrence and the associated risk of stroke and death at long‐term. Methods We enrolled 439 recipients of a pacemaker endowed with an algorithm for the calculation of a Respiratory Disturbance Index (RDI). The RDI variability was measured over the first 12 months after implantation, as well as its potential association with the occurrence of AF, defined as device‐detected cumulative AF burden ≥6 hoursours in a day. Results The individual RDI mean was 30 ± 18 episodes/h, and the RDI maximum was 59 ± 21 episodes/h. RDI ≥30 episodes/h was detected in 351 (80%) patients during at least one night. The proportion of nights with RDI ≥30 episodes/h was 14% (2%‐36%). AF ≥6 hours was detected in 129 (29%) patients during the first 12 months. The risk of AF was higher in patients with RDI maximum ≥63 episodes/h (HR:1.74; 95%CI: 1.22‐2.48; P = .001) and with RDI mean ≥ 46 episodes/h (HR:1.63; 95%CI: 1.03‐2.57; P = .014). The risk of all‐cause death or stroke was higher in patients with AF burden ≥6 hours (HR:1.75; 95%CI: 1.06‐2.86; P = .016). Moreover, among patients with no previous history of AF the risk was higher in those with RDI maximum ≥63 episodes/h (HR:1.96; 95%CI: 1.06‐3.63; P = .031). Conclusions Pacemaker‐detected SA showed a considerable variability during follow‐up. We confirmed the association between RDI and higher risk of AF, and we observed an association between higher RDI maximum and all‐cause death or stroke among patients with no previous history of AF.
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Affiliation(s)
- Andrea Mazza
- Cardiology Division, S. Maria della Stella Hospital, Orvieto, Italy
| | | | - Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, S. Filippo Neri Hospital, Rome, Italy
| | | | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Leggio M. Epicardial Adipose Tissue in Heart Failure With Preserved Ejection Fraction: Matter of Preference or Evidence? JACC Heart Fail 2020; 8:956. [PMID: 33121705 DOI: 10.1016/j.jchf.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/02/2020] [Indexed: 06/11/2023]
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Leggio M, Colivicchi F. Healthy Diet and Cardiovascular Prevention. J Am Coll Cardiol 2020; 76:631-632. [DOI: 10.1016/j.jacc.2020.04.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 11/17/2022]
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Leggio M, Fusco A, Loreti C, Limongelli G, Bendini MG, Mazza A, Frizziero A, Coraci D, Padua L. Fixed and Low-Dose Combinations of Blood Pressure-Lowering Agents: For the Many or the Few? Drugs 2020; 79:1831-1837. [PMID: 31602564 DOI: 10.1007/s40265-019-01209-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite the widespread availability of several effective classes of drugs, systemic arterial hypertension remains poorly controlled in the majority of patients worldwide. In this article, we discuss the different modalities and effects of combination therapy and possible future research questions. Treatment with a single antihypertensive agent can effectively reduce blood pressure in only a limited number of patients, while most require therapy with two or more agents to achieve target levels. As initial therapy, American and European guidelines suggest a combination of two antihypertensive drugs and the use of a third antihypertensive drug when hypertension is still uncontrolled. Initial combination therapy is recommended in high-risk patients for an immediate blood pressure response, improved tolerability and possibly increased patient adherence. In addition to the potential benefits of combining different drug classes with synergistic pharmacological and physiological actions, this approach is useful for increasing the patient compliance with treatment, in particular if provided at fixed doses in a single pill. The minimisation of side effects is critical for the long-term treatment of a largely asymptomatic condition such as systemic hypertension. Low-dose combinations of different drugs from classes with complementary actions may provide the best ratio of lower side effects and improved tolerability with a significant blood pressure reduction, particularly in high-risk patients. This approach could be aided by a multidisciplinary lifestyle intervention on risk factors.
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Affiliation(s)
- Massimo Leggio
- Cardiology Operative Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Augusto Fusco
- IRCCS Fondazione Don Carlo Gnocchi, P.le Rodolfo Morandi, 6, 20121, Milan, Italy.
| | - Claudia Loreti
- IRCCS Fondazione Don Carlo Gnocchi, P.le Rodolfo Morandi, 6, 20121, Milan, Italy
| | | | | | - Andrea Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
| | - Antonio Frizziero
- Department of Physical and Rehabilitation Medicine, University of Padova, Padua, Italy
| | - Daniele Coraci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Padua
- Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Mazza A, Bendini MG, Valsecchi S, Lovecchio M, Leggio M, De Cristofaro R, Boriani G. Occurrence of atrial fibrillation in pacemaker patients and its association with sleep apnea and heart rate variability. Eur J Intern Med 2019; 68:13-17. [PMID: 31353091 DOI: 10.1016/j.ejim.2019.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/01/2019] [Revised: 07/19/2019] [Accepted: 07/21/2019] [Indexed: 10/26/2022]
Abstract
AIMS Sleep apnea (SA) is a risk factor for atrial fibrillation (AF) occurrence. Sympathovagal imbalance is a mechanism that predisposes to the development of AF and that occurs in SA. Some pacemakers can detect SA events and continuously measure a time domain measure of heart rate variability (HRV), i.e. the standard deviation of 5-min median atrial-atrial sensed intervals (SDANN). We evaluated the association between the occurrence of AF and device-detected SA and SDANN in patients who received pacemakers. METHODS We enrolled 150 consecutive patients undergoing implantation of a dual-chamber pacemaker, capable of SA and SDANN estimation. The SA was defined as severe if the Respiratory Disturbance Index was ≥30 episodes/h for at least one night during the first week after implantation. RESULTS Sixteen patients in permanent AF were excluded from our analysis. During follow-up, AF (cumulative device-detected AF duration > 6 h/day) occurred in 24(18%) patients out of the remaining 134 patients. Severe SA was detected in 84 patients. SDANN values were available in 74 patients and the median value was 76 ms [25°-75°percentile:58-77]. The risk of AF was higher in patients with severe SA (log-rank test; p = .033). The presence of either or both conditions (severe SA and SDANN < 76 ms) was associated with shorter time to AF event (p = .042) and was an independent predictor of AF (hazard ratio: 2.37; 95%CI:1.08 to 5.21; p = .033). CONCLUSION In pacemaker patients, device-diagnosed severe SA and reduced SDANN are associated with a higher risk of AF.
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Affiliation(s)
- Andrea Mazza
- Cardiology Division, S. Maria della Stella Hospital, Orvieto, Italy
| | | | | | | | - Massimo Leggio
- Cardiology Operative Unit, S. Filippo Neri Hospital, Rome, Italy
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
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Affiliation(s)
- M Leggio
- Cardiology Operative Unit, San Filippo Neri Hospital, Rome, Italy
| | - A Villano
- Institute of Cardiology, Catholic University of the Sacred Heart, University Hospital Policlinic A. Gemelli Foundation, Rome, Italy
| | - A Fusco
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
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13
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Affiliation(s)
- M Leggio
- Cardiology Operative Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - C Tiberti
- AXA Insurance Company, Passo Corese, Italy
| | - M Armeni
- Istituto di Alta Formazione, Rome, Italy
| | - G Limongelli
- Cardiology Operative Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - A Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
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Leggio M, Tiberti C, Armeni M, Limongelli G, Mazza A. Exercise Capacity Characterization and Physical Activity Intensification Should Be Priorities in Heart Failure Patients. J Am Coll Cardiol 2019; 74:589-590. [DOI: 10.1016/j.jacc.2019.03.530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 10/26/2022]
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Leggio M, Tiberti C, Armeni M, Limongelli G, Mazza A. Physical Activity and Fitness in Heart Failure With Preserved Ejection Fraction: Ready for Prime Time? JACC Heart Fail 2019; 7:633-634. [PMID: 31248575 DOI: 10.1016/j.jchf.2019.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 11/28/2022]
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Leggio M, Tiberti C, Armeni M, Limongelli G, Mazza A. The Importance of Baseline Physical Activity Level in Heart Failure With Preserved Ejection Fraction. JACC Heart Fail 2019; 7:534-535. [PMID: 31146880 DOI: 10.1016/j.jchf.2019.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 10/26/2022]
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Leggio M, Tiberti C, Limongelli G, Mazza A. Cardiorespiratory Fitness in Healthy People: A Step Forward to Primary Cardiovascular Health Promotion. Am J Med 2019; 132:e564. [PMID: 30654909 DOI: 10.1016/j.amjmed.2018.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Massimo Leggio
- Cardiology Operative Unit, San Filippo Neri Hospital, Rome, Italy.
| | | | | | - Andrea Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
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Leggio M, Fusco A, Villano A, Limongelli G, Mazza A. Anti-inflammatory diet to reduce mortality: is it time for a precision medicine approach? J Intern Med 2019; 285:469-471. [PMID: 30450654 DOI: 10.1111/joim.12851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- M Leggio
- Cardiology Operative Unit, San Filippo Neri Hospital, Rome, Italy
| | - A Fusco
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - A Villano
- Institute of Cardiology, Catholic University of the Sacred Heart, University Hospital Policlinic A. Gemelli Foundation, Rome, Italy
| | - G Limongelli
- Cardiology Operative Unit, San Filippo Neri Hospital, Rome, Italy
| | - A Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
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Leggio M, Lombardi M, Caldarone E, D'Emidio S, Severi P, Armeni M, Fusco A. Pacemaker-detected severe sleep apnoea predicts new-onset atrial fibrillation. Europace 2018; 20:2046-2047. [PMID: 29912387 DOI: 10.1093/europace/euy047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital-Salus Infirmorum Clinic, Via della Lucchina 41, Rome, Italy
| | - Mario Lombardi
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Elisa Caldarone
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Stefania D'Emidio
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Paolo Severi
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital-Salus Infirmorum Clinic, Via della Lucchina 41, Rome, Italy.,Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Massimo Armeni
- Department of Research, EDUCAM (C.R.O.M.O.N., S.Os.I., A.I.R.O.P.), Rome, Italy
| | - Augusto Fusco
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
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Leggio M, Fusco A, D'Emidio S, Severi P, Lombardi M, Caldarone E, Armeni M, Mereu D, Bendini MG, Mazza A. Management of oral anticoagulation in patients with atrial fibrillation: newer agents, newer conundrums? J Intern Med 2018; 284:697-699. [PMID: 29658167 DOI: 10.1111/joim.12755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Rome, Italy
| | - A Fusco
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - S D'Emidio
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - P Severi
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Rome, Italy.,Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - M Lombardi
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - E Caldarone
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - M Armeni
- Department of Research, EDUCAM (C.R.O.M.O.N., S.Os.I, A.I.R.O.P.), Rome, Italy
| | - D Mereu
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - M G Bendini
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
| | - A Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
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21
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Leggio M, Bendini MG, D'Emidio S, Caldarone E, Lombardi M, Severi P, Stavri DC, Armeni M, Bravi V, Mazza A. Exercise dose in clinical practice: Right is better than more. Cardiol J 2018; 25:287-288. [PMID: 29717780 DOI: 10.5603/cj.2018.0040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Via della Lucchina 41, 00135 Rome, Italy.
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22
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Leggio M, Fusco A, Severi P, Armeni M, D'Emidio S, Caldarone E, Lombardi M, Bendini MG, Mazza A. Exercise Training in Obese Patients with Heart Failure: Time to Tackle the Burden. Am J Med 2018; 131:e425. [PMID: 29891172 DOI: 10.1016/j.amjmed.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/04/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital-Salus Infirmorum Clinic, Rome, Italy
| | - Augusto Fusco
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Paolo Severi
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital-Salus Infirmorum Clinic, Rome, Italy; Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Massimo Armeni
- Department of Research, EDUCAM (C.R.O.M.O.N., S.Os.I., A.I.R.O.P.), Rome, Italy
| | - Stefania D'Emidio
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Elisa Caldarone
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Mario Lombardi
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | | | - Andrea Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
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23
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Leggio M, Fusco A, Severi P, Lombardi M, Caldarone E, D'Emidio S, Armeni M, Mereu D, Bendini MG, Mazza A. Antithrombotic Therapy After Percutaneous Coronary Intervention in Atrial Fibrillation: The Triple Trouble. Drugs 2018; 78:1309-1319. [PMID: 30132258 DOI: 10.1007/s40265-018-0957-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
One of the most common conundrums in all cardiovascular medicine pertains to the care of patients with atrial fibrillation after percutaneous coronary intervention, because of both dual antiplatelet therapy and oral anticoagulant therapy would seem to be necessary to reduce risks of stent thrombosis and thromboembolism, respectively, but also with an inevitable trade-off of more bleeding. Patients who require triple therapy are at high risk of both ischaemia and bleeding; therefore, defining a personalised secondary prevention strategy aimed at achieving the best net clinical benefit is essential. The good news is that we have entered an era of increased perceived and tangible safety that applies to both non-vitamin K-antagonist oral anticoagulants and newer drug-eluting stents. Even if the consistency across the major trials and the significantly lower risk of bleeding with dual therapy make it hard to argue that triple therapy should be used routinely, the aggregate evidence suggests that the net clinical benefit of dual therapy should give cardiologists confidence to drop aspirin when they are using a contemporary percutaneous coronary intervention strategy with drug-eluting stents. Waiting for more randomised trials and meta-analyses, for the time being, in patients not in clinical trials, full-dose oral triple therapy with dual antiplatelet agents and full-dose anticoagulation should be avoided as a routine practice, and the choice of the proper, that is, safer, oral anticoagulant, namely a non-vitamin K-antagonist oral anticoagulant, may be regarded by now as an additional bleeding avoiding strategy in patients with atrial fibrillation undergoing percutaneous coronary intervention.
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Affiliation(s)
- Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital, Salus Infirmorum Clinic, Via della Lucchina 41, 00135, Rome, Italy.
| | | | - Paolo Severi
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital, Salus Infirmorum Clinic, Via della Lucchina 41, 00135, Rome, Italy.,Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Mario Lombardi
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Elisa Caldarone
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Stefania D'Emidio
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Massimo Armeni
- Department of Research, EDUCAM (C.R.O.M.O.N., S.Os.I., A.I.R.O.P.), Rome, Italy
| | - Daniela Mereu
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | | | - Andrea Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
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24
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Leggio M, D’Emidio S, Fusco A, Bendini MG, Mazza A. Physical Activity to Reduce Weight and Cardiovascular Events. J Am Coll Cardiol 2018; 72:238-239. [PMID: 29976298 DOI: 10.1016/j.jacc.2018.03.543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 10/28/2022]
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25
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Lamendola P, Villano A, Fusco A, Leggio M. Low-dose aspirin for primary cardiovascular prevention in diabetic patients: the issue to believe it or not. Ann Transl Med 2018; 6:219. [PMID: 30023382 DOI: 10.21037/atm.2018.04.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Priscilla Lamendola
- Institute of Cardiology, Catholic University of the Sacred Heart, University Hospital Policlinic A. Gemelli Foundation, Rome, Italy
| | - Angelo Villano
- Institute of Cardiology, Catholic University of the Sacred Heart, University Hospital Policlinic A. Gemelli Foundation, Rome, Italy
| | - Augusto Fusco
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Rome, Italy
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26
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Leggio M, Bendini M, Caldarone E, Lombardi M, Severi P, D’Emidio S, Stavri D, Armeni M, Bravi V, Mazza A. Low-dose aspirin for primary prevention of cardiovascular events in patients with diabetes: Benefit or risk? Diabetes & Metabolism 2018; 44:217-225. [DOI: 10.1016/j.diabet.2017.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/05/2017] [Accepted: 11/05/2017] [Indexed: 01/13/2023]
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27
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Leggio M, Lombardi M, Caldarone E, Mazza A, Fusco A. High body mass index, healthy metabolic profile and low visceral adipose tissue: The paradox is to call it obesity again. Eur J Intern Med 2018; 52:e15-e16. [PMID: 29636273 DOI: 10.1016/j.ejim.2018.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Rome, Italy.
| | - Mario Lombardi
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Elisa Caldarone
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Andrea Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
| | - Augusto Fusco
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
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28
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Leggio M, Fusco A, Armeni M, D'Emidio S, Severi P, Calvaruso S, Limongelli G, Sgorbini L, Bendini MG, Mazza A. Pulmonary hypertension and exercise training: a synopsis on the more recent evidences. Ann Med 2018; 50:226-233. [PMID: 29363985 DOI: 10.1080/07853890.2018.1432887] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The benefits of exercise training in virtually all humans, including those with a clinically stable chronic disease are numerous. The potential value lies in the fact that functional capacity is oftentimes significantly compromised. Exercise training not only play a role in reversing some of the pathophysiologic processes associated with chronic diseases but also improves clinical trajectory. Given the significant pathologic consequences associated with pulmonary hypertension and its implications for deteriorating right ventricular function as well as the perceived potential for a precipitous and possibly critical drop in cardiac output during periods of physical exertion, exercise training was historically not recommended for these patients. More recently, a promising body of literature demonstrating the safety and efficacy of exercise training (with benefit on exercise capacity, peak oxygen consumption and quality of life) in pulmonary hypertension patients has emerged, but the conclusion about the effects of exercise training were non-exhaustive and therefore there is still a lack of knowledge regarding exercise training for these patients. Thus, we aim to ascertain the current effectiveness of exercise rehabilitation for pulmonary hypertension by performing a brief overview on the latest currently available evidences in such an "at a glance" synopsis addressed to summarize/quantify the more recent existing body of literature. KEY MESSAGES Exercise training was historically not recommended in pulmonary hypertension. Recently, exercise training safety-efficacy in pulmonary hypertension has emerged. Exercise training should be recommended in addition to optimal medical therapy.
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Affiliation(s)
- Massimo Leggio
- a Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit , San Filippo Neri Hospital - Salus Infirmorum Clinic , Rome , Italy
| | - Augusto Fusco
- b Physical Medicine and Neurorehabilitation Operative Unit , Salus Infirmorum Clinic , Rome , Italy
| | - Massimo Armeni
- c Department of Research , EDUCAM (C.R.O.M.O.N., S.Os.I., A.I.R.O.P.) , Rome , Italy
| | - Stefania D'Emidio
- b Physical Medicine and Neurorehabilitation Operative Unit , Salus Infirmorum Clinic , Rome , Italy
| | - Paolo Severi
- a Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit , San Filippo Neri Hospital - Salus Infirmorum Clinic , Rome , Italy.,b Physical Medicine and Neurorehabilitation Operative Unit , Salus Infirmorum Clinic , Rome , Italy
| | | | - Giorgio Limongelli
- e Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit , Santo Spirito Hospital - Villa Betania Clinic , Rome , Italy
| | - Luca Sgorbini
- e Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit , Santo Spirito Hospital - Villa Betania Clinic , Rome , Italy
| | | | - Andrea Mazza
- f Cardiology Division , Santa Maria della Stella Hospital , Orvieto , Italy
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29
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Leggio M, Fusco A. Open Questions about Pulmonary Hypertension and Exercise Training: A Critical Review. CRMR 2018. [DOI: 10.2174/1573398x14666180129162008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - CDC Salus Infirmorum, Rome, Italy
| | - Augusto Fusco
- Neuromotor Rehabilitation, CDC Salus Infirmorum, Rome, Italy
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30
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Mazza A, Bendini M, Valsecchi S, Lovecchio M, Leggio M, De Cristofaro R, Boriani G. P870Occurrence of atrial fibrillation in pacemaker patients and its association with sleep apnea and heart rate variability. Europace 2018. [DOI: 10.1093/europace/euy015.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Mazza
- Cardiology Department, Orvieto, Italy
| | - M Bendini
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
| | | | | | - M Leggio
- San Filippo Neri Hospital, Salus Infirmorum, Rome, Italy
| | - R De Cristofaro
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
| | - G Boriani
- Polyclinic Hospital of Modena, Modena, Italy
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31
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Leggio M, Sgorbini L, Limongelli G. Metabolically Healthy Obese and Cardiovascular Diseases: A Phenotype Misunderstanding. J Am Coll Cardiol 2018; 71:813-814. [PMID: 29447748 DOI: 10.1016/j.jacc.2017.10.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/09/2017] [Indexed: 12/29/2022]
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32
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Leggio M, Fusco A, Limongelli G, Sgorbini L. Exercise training in patients with pulmonary and systemic hypertension: A unique therapy for two different diseases. Eur J Intern Med 2018; 47:17-24. [PMID: 28911936 DOI: 10.1016/j.ejim.2017.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 02/07/2023]
Abstract
Pulmonary hypertension is a potentially life-threatening condition. Given its evolving definition, the incidence and prevalence of the disease is difficult to define, but registries suggest an increased global awareness. The management of patients with pulmonary arterial hypertension is highly specialised and requires multi-disciplinary input from a range of healthcare professionals, including cardiologists, respiratory physicians, rheumatologists, rehabilitation physicians and cardio-pulmonary physiotherapists. Historically, exercise training in pulmonary hypertension has not been recommended because of safety concerns. However, an increasing number of studies have demonstrated the benefit of exercise training on exercise capacity, peak oxygen consumption and quality of life. Systemic hypertension is one of the most important risk factors for cardiovascular disease, and has been ranked as the leading cause for death and disability worldwide: therefore, adequate control of blood pressure is important for public health. Lowering of blood pressure and prevention of hypertension is in first instance preferable by lifestyle changes. These include weight loss, moderation of alcohol intake, a diet with increased fresh fruit and vegetables, reduced saturated fat, reduced salt intake, reduced stress, and, finally, increased physical activity. With regard to the latter, former guidelines predominantly recommended aerobic exercises such as walking, jogging, and cycling for lowering blood pressure. The main focus of this narrative overview paper is to briefly examine and summarize the benefit of exercise training in patients with pulmonary and systemic hypertension, suggest mechanisms by which exercise may improve symptoms and function and provide evidence-based recommendations regarding the frequency and intensity of exercise in these patients.
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Affiliation(s)
- Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Rome, Italy.
| | - Augusto Fusco
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Giorgio Limongelli
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, Santo Spirito Hospital - Villa Betania Clinic, Rome, Italy
| | - Luca Sgorbini
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, Santo Spirito Hospital - Villa Betania Clinic, Rome, Italy
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33
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Adamaszek M, D'Agata F, Ferrucci R, Habas C, Keulen S, Kirkby KC, Leggio M, Mariën P, Molinari M, Moulton E, Orsi L, Van Overwalle F, Papadelis C, Priori A, Sacchetti B, Schutter DJ, Styliadis C, Verhoeven J. Consensus Paper: Cerebellum and Emotion. Cerebellum 2017; 16:552-576. [PMID: 27485952 DOI: 10.1007/s12311-016-0815-8] [Citation(s) in RCA: 324] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Over the past three decades, insights into the role of the cerebellum in emotional processing have substantially increased. Indeed, methodological refinements in cerebellar lesion studies and major technological advancements in the field of neuroscience are in particular responsible to an exponential growth of knowledge on the topic. It is timely to review the available data and to critically evaluate the current status of the role of the cerebellum in emotion and related domains. The main aim of this article is to present an overview of current facts and ongoing debates relating to clinical, neuroimaging, and neurophysiological findings on the role of the cerebellum in key aspects of emotion. Experts in the field of cerebellar research discuss the range of cerebellar contributions to emotion in nine topics. Topics include the role of the cerebellum in perception and recognition, forwarding and encoding of emotional information, and the experience and regulation of emotional states in relation to motor, cognitive, and social behaviors. In addition, perspectives including cerebellar involvement in emotional learning, pain, emotional aspects of speech, and neuropsychiatric aspects of the cerebellum in mood disorders are briefly discussed. Results of this consensus paper illustrate how theory and empirical research have converged to produce a composite picture of brain topography, physiology, and function that establishes the role of the cerebellum in many aspects of emotional processing.
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Affiliation(s)
- M Adamaszek
- Department of Clinical and Cognitive Neurorehabilitation, Klinik Bavaria Kreischa, An der Wolfsschlucht, 01731, Kreischa, Germany.
| | - F D'Agata
- Department of Neuroscience, University of Turin, Turin, Italy
| | - R Ferrucci
- Fondazione IRCCS Ca' Granda, Granada, Italy
- Università degli Studi di Milano, Milan, Italy
| | - C Habas
- Service de NeuroImagerie (NeuroImaging department) Centre Hospitalier national D'Ophtalmologie des 15/20, Paris, France
| | - S Keulen
- Department of Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Language and Cognition Groningen, Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - K C Kirkby
- Psychiatry, School of Medicine, University of Tasmania, Hobart, Australia
| | - M Leggio
- I.R.C.C.S. Santa Lucia Foundation, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - P Mariën
- Department of Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurology and Memory Clinic, ZNA Middelheim Hospital, Antwerp, Belgium
| | - M Molinari
- I.R.C.C.S. Santa Lucia Foundation, Rome, Italy
| | - E Moulton
- P.A.I.N. Group, Center for Pain and the Brain, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - L Orsi
- Neurologic Division 1, Department of Neuroscience and Mental Health, Città della Salute e della Scienza di Torino, Turin, Italy
| | - F Van Overwalle
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - C Papadelis
- Fetal-Neonatal Neuroimaging and Developmental Center, Boston Children's Hospital, Boston, MA, USA
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - A Priori
- Fondazione IRCCS Ca' Granda, Granada, Italy
- Università degli Studi di Milano, Milan, Italy
- III Clinica Neurologica, Polo Ospedaliero San Paolo, San Paolo, Italy
| | - B Sacchetti
- Department of Neuroscience, Section of Physiology, University of Turin, Torino, Italy
| | - D J Schutter
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - C Styliadis
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - J Verhoeven
- Department of Language and Communication Science, City University, London, UK
- Computational Linguistics and Psycholinguistics Research Center (CLIPS), Universiteit Antwerpen, Antwerp, Belgium
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Caldarone E, Severi P, Lombardi M, D'Emidio S, Mazza A, Bendini MG, Leggio M. Hypertensive response to exercise and exercise training in hypertension: odd couple no more. Clin Hypertens 2017; 23:11. [PMID: 28588902 PMCID: PMC5455108 DOI: 10.1186/s40885-017-0067-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/21/2017] [Indexed: 11/29/2022] Open
Abstract
The diagnostic and prognostic implication of exaggerated blood pressure response to exercise has been controversial, with opinions ranging from a benign process to a harbinger of potential cardiovascular morbidity. Nonetheless, lowering of blood pressure and prevention of hypertension is in first instance preferable by lifestyle changes, and many studies have shown the inverse association between physical activity level and the incidence of cardiovascular diseases suggesting low aerobic fitness as a strong predictor for future cardiovascular disease and all-cause mortality in both healthy and cardiovascular disease patients, including those with hypertension. Endothelial function, large artery stiffness and neurohormonal response are surely implicated both in the development of exaggerated blood pressure response to exercise and in the positive effect of physical exercise in the prevention and management of hypertension and cardiovascular disease in general. In their interesting and well documented review published in this issue Kim and Ha broadly described the possible pathophysiologic mechanisms of exaggerated blood pressure response to exercise and its clinical implications: in this regard, a very interesting issue could be represented by the role of exercise training. In fact, there is an the ample evidence in the literature that physical activity could positively affect endothelial function, arterial stiffness, neurohormonal response and finally blood pressure levels both in healthy men and in hypertensive patients and so should be considered a very important element in the prevention and management of cardiovascular disease.
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Affiliation(s)
- Elisa Caldarone
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Paolo Severi
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy.,Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Via della Lucchina 41, 00135 Rome, Italy
| | - Mario Lombardi
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Stefania D'Emidio
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Andrea Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
| | | | - Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Via della Lucchina 41, 00135 Rome, Italy
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35
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Olivito G, Cercignani M, Lupo M, Iacobacci C, Clausi S, Romano S, Masciullo M, Molinari M, Bozzali M, Leggio M. Neural substrates of motor and cognitive dysfunctions in SCA2 patients: A network based statistics analysis. Neuroimage Clin 2017; 14:719-725. [PMID: 28393013 PMCID: PMC5377430 DOI: 10.1016/j.nicl.2017.03.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/07/2017] [Accepted: 03/24/2017] [Indexed: 01/04/2023]
Abstract
Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant neurodegenerative disease characterized by a progressive cerebellar syndrome, which can be isolated or associated with extracerebellar signs. It has been shown that patients affected by SCA2 present also cognitive impairments and psychiatric symptoms. The cerebellum is known to modulate cortical activity and to contribute to distinct functional networks related to higher-level functions beyond motor control. It is therefore conceivable that one or more networks, rather than isolated regions, may be dysfunctional in cerebellar degenerative diseases and that an abnormal connectivity within specific cerebello-cortical regions might explain the widespread deficits typically observed in patients. In the present study, the network-based statistics (NBS) approach was used to assess differences in functional connectivity between specific cerebellar and cerebral “nodes” in SCA2 patients. Altered inter-nodal connectivity was found between more posterior regions in the cerebellum and regions in the cerebral cortex clearly related to cognition and emotion. Furthermore, more anterior cerebellar lobules showed altered inter-nodal connectivity with motor and somatosensory cerebral regions. The present data suggest that in SCA2 a cerebellar dysfunction affects long-distance cerebral regions and that the clinical symptoms may be specifically related with connectivity changes between motor and non-motor cerebello-cortical nodes. A cerebellar dysfunction affects long-distance cerebral regions in SCA2 patients. Connectivity changes affect sensorimotor and cognitive cerebello-cortical nodes. Cerebellar symptoms may be related to altered cerebello-cerebral connectivity.
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Affiliation(s)
- G Olivito
- Ataxia Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - M Cercignani
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Clinical Imaging Science Center, Brighton and Sussex Medical School, Brighton, UK
| | - M Lupo
- Ataxia Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - C Iacobacci
- Ataxia Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Psychology, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - S Clausi
- Ataxia Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Psychology, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - S Romano
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), "Sapienza" University of Rome-Sant'Andrea Hospital, Rome, Italy
| | - M Masciullo
- SPInal REhabilitation Lab, IRCCS Fondazione Santa Lucia,Rome, Italy
| | - M Molinari
- Neurorehabilitation 1 and Spinal Center, Robotic Neurorehabilitation Lab, IRCCS Santa Lucia Foundation, Rome, Italy
| | - M Bozzali
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - M Leggio
- Ataxia Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Psychology, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
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Mazza A, Bendini MG, De Cristofaro R, Lovecchio M, Valsecchi S, Leggio M, Boriani G. Prevalence and clinical significance of left bundle branch block according to classical or strict definition criteria in permanent pacemaker patients. Clin Cardiol 2017; 40:377-382. [PMID: 28294356 DOI: 10.1002/clc.22673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/07/2016] [Accepted: 12/20/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Previous studies have shown that the presence of left bundle branch block (LBBB) is associated with an increased risk of cardiac mortality and heart failure (HF). Recently, new criteria to define strict LBBB have been proposed: QRS duration ≥140 ms for men and ≥130 ms for women, along with mid-QRS notching or slurring in ≥2 contiguous leads. HYPOTHESIS We assessed the prevalence and prognostic significance of LBBB according to classical (QRS duration ≥120ms) and strict criteria in permanent pacemaker patients. METHODS We retrospectively enrolled 723 consecutive patients who had undergone single- or dual-chamber pacemaker implantation at the study center from July 2002 to December 2014. Patients with a left ventricular ejection fraction ≤35% or a prior diagnosis of HF were excluded. RESULTS LBBB was reported in 54 (7%) patients, and strict-LBBB in 15 (2%) patients. During a median follow-up of 48 months (range, 18-92 months), 147 (20%) patients reached the combined endpoint of death or HF hospitalization. Patients with LBBB and those with strict-LBBB displayed significantly higher rates of death or HF hospitalization (log-rank test, all P < 0.0001). In particular, strict-LBBB was associated with the worst outcome. The presence of LBBB according to classical definition criteria (hazard ratio [HR] = 1.98, confidence interval [CI]: 1.23-3.19, P = 0.005) and to strict criteria (HR = 2.20; CI: 1.04-4.65; P = 0.039) were both confirmed as independent predictors of death or HF hospitalization after adjustment for relevant clinical covariates. CONCLUSIONS Among patients who had undergone standard pacemaker implantation, the prevalence of LBBB was 7% according to classical definition criteria and 2% according to strict criteria. The presence of LBBB, and particularly of strict-LBBB, at the baseline predicted a poor outcome in terms of death or HF hospitalization.
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Affiliation(s)
- Andrea Mazza
- Cardiology Department, Santa Maria della Stella Hospital, Orvieto, Italy
| | | | | | | | | | - Massimo Leggio
- Salus Infirmorum Clinic, San Filippo Neri Hospital, Rome, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena Hospital, Modena, Italy
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Dayan M, Olivito G, Molinari M, Cercignani M, Bozzali M, Leggio M. Impact of cerebellar atrophy on cortical gray matter and cerebellar peduncles as assessed by voxel-based morphometry and high angular resolution diffusion imaging. Funct Neurol 2017; 31:239-248. [PMID: 28072384 DOI: 10.11138/fneur/2016.31.4.239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In recent years the cerebellum has been attributed amore important role in higher-level functions than previously believed. We examined a cohort of patients suffering from cerebellar atrophy resulting in ataxia, with two main objectives: first to investigate which regions of the cerebrum were affected by the cerebellar degeneration, and second to assess whether diffusion magnetic resonance imaging (dMRI) metrics within the medial (MCP) and superior cerebellar peduncle (SCP) - namely fractional anisotropy (FA) and radial diffusivity (RD) - could be used as a biomarker in patients with this condition. Structural and dMRI data of seven patients with cerebellar atrophy (2 with spinocerebellar atrophy type 2, 1 with Friedreich's ataxia, 4 with idiopathic cerebellar ataxia) and no visible cortical lesions or cortical atrophy were investigated with Freesurfer and voxel-based morphometry (VBM) of gray matter (GM) as well as MCP and SCP FA maps. Correlations of MCP and SCP mean FA with ataxia scores and subscores were also evaluated. Freesurfer showed that patients had significantly reduced volume of the thalamus, ventral diencephalon and pallidum. VBM also demonstrated significantly lower local GM volumes in patients, notably in the head of the caudate nucleus, posterior cingulate gyrus and orbitofrontal cortex bilaterally, as well as in Broca's area in the left hemisphere, and a significant increase in RD in the MCP and SCP of both hemispheres. A significant correlation was found between MCP mean FA and total ataxia score (R=-0.7, p=0.03), and subscores for kinetic functions (R=-0.74, p=0.03) and oculomotor disorders (R=-0.70, p=0.04). The regions of the cerebrum found to have significantly lower local GM volumes have been described to be involved in higher-level cerebellar functions such as initiation of voluntary movements, emotional control, memory retrieval and general cognition. Our findings corroborate recent research pointing to a more extensive corticocerebellar system than previously thought. The significant difference in the MCP and SCP dMRI metrics between patients and controls as well as the significant correlation with ataxia total score and subscores support the use of dMRI metrics as an imaging biomarker for cerebellar degeneration and ataxia.
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Mazza A, Bendini MG, Leggio M, Riva U, Ciardiello C, Valsecchi S, De Cristofaro R, Giordano G. Author reply. Europace 2014; 16:617-8. [DOI: 10.1093/europace/eut389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mazza A, Bendini MG, Cristofori M, Leggio M, Nardi S, Giordano A, De Cristofaro R, Giordano G. C-reactive protein and P-wave in hypertensive patients after conversion of atrial fibrillation. J Cardiovasc Med (Hagerstown) 2013; 14:520-7. [DOI: 10.2459/jcm.0b013e32835224b5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Boboc G, Leggio M, Fontana A, Serraino F, Arcangeli G. EP-1051: Adjuvant hypofractionated radiation therapy after conserving surgery for early breast cancer. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33357-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mazza A, Bendini MG, Leggio M, Riva U, Ciardiello C, Valsecchi S, De Cristofaro R, Giordano G. Incidence and predictors of heart failure hospitalization and death in permanent pacemaker patients: a single-centre experience over medium-term follow-up. Europace 2013; 15:1267-72. [DOI: 10.1093/europace/eut041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pugliese M, Minardi G, Vitali A, Natale E, De Girolamo P, Zampi G, Leggio M, Chiarelli A, Pappalardo A, Avella A, Laurenzi F, Fera MS. Influence of myocardial viability on responsiveness to cardiac resynchronization in ischemic dilated cardiomyopathy: a prospective observational cohort study. ACTA ACUST UNITED AC 2012; 12:132-41. [PMID: 22281793 DOI: 10.5152/akd.2012.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To understand whether patients with post-ischemic dilated cardiomyopathy and myocardial viability (MV) could benefit from cardiac resynchronization therapy (CRT) in terms of clinical, echocardiographic and neuro- hormonal parameters compared to patients without MV. METHODS One hundred and four consecutive patients were enrolled in a prospective observational cohort study. Using dobutamine stress echocardiography, 2 groups were identified: group A of 51 patients with MV and group B of 53 patients without MV. All patients were implanted with biventricular pacing devices combined with an internal cardioverter-defibrillator. Clinical, echocardiographic and neuro-hormonal parameters were evaluated at baseline and at six month follow-up. Analysis of variance for repeated measures on each variable suggestive of remodeling was performed. We considered responder every patient with: decrease of > 15% in left ventricular volumes and/or improvement in left ventricular ejection fraction of > 5% in addition to NYHA class improvement. RESULTS All the variables improved in both groups (time effect). Comparing the two groups (group effect), the following variables were significantly better in group A: N-terminal pro-B-type natriuretic peptide (p=0.02), NYHA class (p=0.003), reverse remodeling (RR) (p=0.007), dP/dt (p=0.005), left ventricular ejection fraction (p=0.009), 3rd sound (p=0.01), and left ventricular end-systolic volume after the first week (p=0.035). RR occurred at the first week after CRT only in Group A and was maintained for all the time of this study. The maximum difference of the decrease of left ventricular volumes between the two groups occurred after the first week (p<0.001). CONCLUSION Patients with MV responded better than patients without MV with a significant improvement after the first week from CRT.
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Affiliation(s)
- Marco Pugliese
- Cardiovascular Intensive Cardiac Unit, San Camillo Hospital, Rome-Italy
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Leggio M, Cruciani G, Sgorbini L, Mazza A, Bendini MG, Pugliese M, Leggio F, Jesi AP. Obesity-related adjunctive systo–diastolic ventricular dysfunction in patients with hypertension: echocardiographic assessment with tissue Doppler velocity and strain imaging. Hypertens Res 2011; 34:468-73. [DOI: 10.1038/hr.2010.266] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Mazza A, Bendini MG, Cristofori M, Nardi S, Leggio M, De Cristofaro R, Giordano A, Cozzari L, Giordano G, Cappato R. Baseline apnoea/hypopnoea index and high-sensitivity C-reactive protein for the risk of recurrence of atrial fibrillation after successful electrical cardioversion: a predictive model based upon the multiple effects of significant variables. Europace 2009; 11:902-9. [DOI: 10.1093/europace/eup107] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Leggio M, Sgorbini L, Cruciani G, Cristinziani G, Mazza A, Bendini M, Leggio F, Jesi A. 5.14 Obesity-Related Adjunctive Systo-Diastolic Ventricular Dysfunction in Patients with Hypertension: Echocardiographic Evaluation with Tissue Velocity and Strain Imaging. High Blood Press Cardiovasc Prev 2008. [DOI: 10.1007/bf03263634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Sgorbini L, Scuteri A, Leggio M, Gianni W, Nevola E, Leggio F. Carotid intima–media thickness, carotid distensibility and mitral, aortic valve calcification: a useful diagnostic parameter of systemic atherosclerotic disease. J Cardiovasc Med (Hagerstown) 2007; 8:342-7. [PMID: 17443100 DOI: 10.2459/01.jcm.0000268128.74413.1b] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Mitral (MAC) and aortic (AVC) calcification are observed more frequently in the elderly and are associated with coronary artery disease, aortic atheroma and peripheral arterial atherosclerotic disease. Common carotid intima-media thickness (cIMT) and distensibility (cDIST) are also independent predictors of adverse cardiovascular outcomes. We examined the relationship between the degree of MAC-AVC and cIMT and cDIST. METHODS AND RESULTS One hundred and forty-three patients referred for transthoracic echocardiography and carotid artery echo-Doppler were evaluated; the variables measured were: systemic blood pressure, pulse pressure; body mass index, traditional risk factors, cIMT, cDIST (cDIST = [(csD - cdD)/PP]/csD; where csD and cdD were systolic and diastolic carotid diameters, respectively). MAC and AVC score, based on acoustic densitometry, were: 1 = absence of annular/valvular (av) sclerosis/calcification; 2 = av sclerosis; 3 = av calcification; 4 = av calcification; 5 = av calcification with no recognition of the leaflets; the resulting score was the highest for either valvular annulus. Mean cIMT increased linearly with increasing valvular calcification score (P < 0.0001) whereas cDIST decreased for scores 1 to 5 (P < 0.0001). Distribution of cIMT quartiles showed that 75% of the patients in the lowest quartile had a score of 1 and 70% of patients in the highest quartile had a score of 5; 47% of the patients in the highest quartile of cDIST had a score of 1, whereas 60% of patients in the lowest quartile of cDIST had a score of 4. CONCLUSIONS The MAC and AVC score identifies subgroups of patients with different cIMT and cDIST. These data may confirm MAC-AVC as a useful important diagnostic parameter of systemic atherosclerotic disease.
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Affiliation(s)
- Luca Sgorbini
- Unit of Cardiology, INRCA-IRCCS Hospital, Rome, Italy.
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Bendini MG, Lanza GA, Mazza A, Giordano A, Leggio M, Menichini G, De Cristofaro R, Moriconi E, Cozzari L, Farina SM, Giordano G. [Risk factors for cardiovascular diseases: what is the role for homocysteine?]. G Ital Cardiol (Rome) 2007; 8:148-60. [PMID: 17461357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Cardiovascular diseases are commonly related to classical risk factors, but other risk markers have been identified, including homocysteine. Homocysteine is a sulphurated amino acid which derives from methionine. The causes of hyperhomocysteinemia are multifactorial, such as genetic defects, pathophysiological conditions, lifestyle and drugs-related. Hyperhomocysteinemia favors atherothrombosis through endothelial dysfunction, enhancement of inflammation and thrombophilic profile. A number of clinical and laboratory trials exist regarding the association between homocysteine levels and an increased risk of cardiovascular disease. However, the lack of homogeneity in the data, together with the high number of factors capable of influencing homocysteine plasma levels, and the disappointing results of therapeutic trials do not permit us at present to consider homocysteine as an independent and major risk factor for cardiovascular disease.
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Leggio M, Sgorbini L, Pugliese M, Mazza A, Bendini MG, Fera MS, Giovannini E, Leggio F. Systo-diastolic ventricular function in patients with hypertension: an echocardiographic tissue doppler imaging evaluation study. Int J Cardiovasc Imaging 2006; 23:177-84. [PMID: 16972147 DOI: 10.1007/s10554-006-9139-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Accepted: 07/18/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tissue Doppler imaging (TDI) has evolved to become a useful non invasive method that can complement other echocardiographic techniques in the assessment of left ventricular function in different clinical conditions. Spectral pulsed TDI can provide measurements of regional systolic and diastolic myocardial velocities and is particularly useful in detecting abnormalities of left ventricular systolic and diastolic function. We investigated the presence of systo-diastolic dysfunction in patients (pts) with hypertension compared with pts affected by hypertensive cardiomyopathy and normal control subjects. METHODS We evaluated 214 pts with traditional echocardiography and TDI: 69 normal control subjects (Group A); 145 pts with hypertension, divided according to base echocardiographic evaluation in 74 with no evidence of hypertensive cardiomyopathy (diastolic dysfunction and ventricular hypertrophy, Group B), and 71 with evidence of hypertensive cardiomyopathy (Group C). Pts groups were matched for age, sex, heart rate, smoking status and body surface area. RESULTS There were no significant differences in ventricular diameters, volumes, shortening and ejection fraction values; TDI showed a progressive systolic wave peak reduction from Group A to B and from Group B to C. Routinely Doppler diastolic function did not show any significant difference between Group A and B; TDI showed progressive E wave peak velocity decrease and A wave peak velocity increase from Group A to B and C and from Group B to C. CONCLUSIONS TDI evaluation showed a ventricular systolic dysfunction in pts with hypertensive cardiomyopathy; in addition, an early mild systo-diastolic dysfunction was detected in subjects with hypertension but no evidence of hypertensive cardiomyopathy.
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Affiliation(s)
- Massimo Leggio
- Cardiovascular Department, Cardiac Rehabilitation Operative Unit (S.I.), San Filippo Neri Hospital, Via della Lucchina 41, Rome 00135, Italy.
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Mazza A, Fera MS, Pugliese M, Leggio M, Bendini MG, Poli V, Manzara C, Minardi G, Pino PG, Pompa D, Fiorella AT, De Santis F, Giovannini E. Biphasic transoesophageal vs. transthoracic electrical cardioversion of persistent atrial fibrillation. J Cardiovasc Med (Hagerstown) 2006; 7:594-600. [PMID: 16858238 DOI: 10.2459/01.jcm.0000237907.88258.7e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of transoesophageal (TOC) vs. transthoracic (TTC) electrical cardioversion, both with biphasic shocks, for sinus rhythm (SR) restoration in patients with persistent atrial fibrillation (AF). METHODS We randomised 210 patients (151 male, 59 female, mean age 66 +/- 9 years) with persistent AF into two groups: group 1 (n = 104) undergoing TOC with a step-up protocol of 30, 50, 70 and 100 J, and group 2 (n = 106) undergoing TTC with a step-up protocol of 70, 100, 120 and 150 J. RESULTS The two groups were homogeneous as for clinical and instrumental characteristics, except for left ventricular ejection fraction (50.5 +/- 10% in group 1 vs. 53 +/- 8% in group 2, P < 0.05) and thoracic impedance (63 +/- 8 Omega in group 1 vs. 66 +/- 6 Omega in group 2, P < 0.005). SR was restored in 98 (94%) group 1 patients vs. 99 (93%) group 2 patients (P = NS). First shock was effective in 48 (46%) group 1 patients vs. 54 (51%) group 2 patients (P = NS). Mean delivered energy was 50.4 +/- 23.6 and 95.1 +/- 29.6 J; mean effective energy was 47.3 +/- 20.7 and 91.2 +/- 26.6 J in group 1 and group 2, respectively. Cross-over to the highest energy level was never effective. TOC tolerability was optimal (mean discomfort score 1.2 on a 1-4 grading scale). Markers of myocardial necrosis did not increase and no procedure-related complications occurred. On logistic regression analysis, the most predictive variables of unsuccessful cardioversion were AF duration (P = 0.0001) and low left atrial appendage emptying velocity (P = 0.02). CONCLUSIONS Both TOC and TTC with biphasic shocks are effective and safe for SR restoration in patients with persistent AF; however, the considerably lower levels of delivered and effective energies for SR restoration allow TOC to be performed during mild sedation with optimal tolerability, thus avoiding general anaesthesia.
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Affiliation(s)
- Andrea Mazza
- 1st Cardiology Operative Unit, Cardiovascular Department, San Camillo-Forlanini Hospital, Rome, Italy
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