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De Luca L, Di Fusco SA, Iannopollo G, Mistrulli R, Rizzello V, Aimo A, Navazio A, Bilato C, Corda M, Di Marco M, Geraci G, Iacovoni A, Milli M, Pascale V, Riccio C, Scicchitano P, Tizzani E, Gabrielli D, Grimaldi M, Colivicchi F, Oliva F. [ANMCO Scientific statement on combination therapies and polypill in secondary prevention]. G Ital Cardiol (Rome) 2024; 25:367-381. [PMID: 38639128 DOI: 10.1714/4252.42301] [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: 04/20/2024]
Abstract
The issue of suboptimal drug regimen adherence in secondary cardiovascular prevention presents a significant barrier to improving patient outcomes. To address this, the utilization of drug combinations, specifically single pill combinations (SPCs) and polypills, was proposed as a strategy to simplify treatment regimens. This approach aims to enhance treatment accessibility, affordability, and adherence, thereby reducing healthcare costs and improving patient health. The document is an ANMCO scientific statement on simplifying drug regimens for secondary cardiovascular prevention. It discusses the underuse of treatments despite available, effective, and accessible options, highlighting a significant gap in secondary prevention across different socioeconomic statuses and countries. The statement explores barriers to implementing evidence-based treatments, including patient, healthcare provider, and system-related challenges. The paper also reviews international guidelines, the role of SPCs and polypills in clinical practice, and their economic impact, advocating for their use in secondary prevention to improve patient outcomes and adherence.
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Affiliation(s)
- Leonardo De Luca
- U.O.C. Cardiologia, Dipartimento di Scienze Cardio-Toraco-Vascolari, A.O. San Camillo Forlanini, Roma
| | - Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | | | - Raffaella Mistrulli
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Roma
| | | | - Alberto Aimo
- U.O.C. Cardiologia, Fondazione Toscana Gabriele Monasterio, Pisa
| | - Alessandro Navazio
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | - Claudio Bilato
- U.O.C. Cardiologia, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Vicenza
| | - Marco Corda
- S.C. Cardiologia, Azienda Ospedaliera "G. Brotzu", Cagliari
| | | | | | - Attilio Iacovoni
- SSD Chirurgia dei Trapianti e del Trattamento Chirurgico dello Scompenso, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Massimo Milli
- Cardiologia Firenze 1 (Ospedali S. Maria Nuova e Nuovo San Giovanni di Dio), Azienda USL Toscana Centro, Firenze
| | - Vittorio Pascale
- UTIC-Emodinamica e Cardiologia Interventistica, Ospedale Civile Pugliese, Catanzaro
| | - Carmine Riccio
- U.O.S.D. Follow-up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta
| | | | - Emanuele Tizzani
- Dipartimento di Cardiologia, Ospedale degli Infermi, Rivoli (TO)
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento di Scienze Cardio-Toraco-Vascolari, A.O. San Camillo Forlanini, Roma
| | - Massimo Grimaldi
- U.O.C. Cardiologia-UTIC, Ospedale Miulli, Acquaviva delle Fonti (BA)
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
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Di Fusco SA, Mocini E, Gori M, Iacoviello M, Bilato C, Corda M, De Luca L, Di Marco M, Geraci G, Iacovoni A, Milli M, Navazio A, Pascale V, Riccio C, Scicchitano P, Tizzani E, Gabrielli D, Grimaldi M, Colivicchi F, Oliva F. [ANMCO Position paper: Obesity in adults - A clinical primer]. G Ital Cardiol (Rome) 2024; 25:352-366. [PMID: 38639127 DOI: 10.1714/4252.42300] [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: 04/20/2024]
Abstract
Obesity is a chronic and relapsing disease due to the coexistence of a patient with predisposing individual characteristics and an obesogenic environment. The recent acquisition of detailed knowledge on the mechanisms underlying the energetic homeostasis paved the way to more effective therapeutic hypotheses as compared to traditional treatments. Since obesity is a complex issue, it requires a multidisciplinary approach which is difficult to implement. However, new drugs appear promising. Currently, therapeutic success is discrete in the short term, but unsatisfying in the long term due to the high probability of body weight gain. Cardiologists play a key role in managing patients with obesity, but they are not used to manage them. The aim of this document is to summarize knowledge that clinicians need to have to appropriately manage these patients. The paper emphasizes the pivotal role of an appropriate relationship with the patient to embark on a successful treatment journey. We analyze the criteria commonly used to diagnose obesity and point out strengths and limitations of different criteria. Furthermore, we discuss the figure of the obesitologist and the role of the cardiologist. In addition, we report the main components of an effective therapeutic strategy, from educational questions to pharmacological options.
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Affiliation(s)
- Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Edoardo Mocini
- Dipartimento di Medicina Sperimentale, Sapienza Università di Roma, Roma
| | - Mauro Gori
- SSD Chirurgia dei Trapianti e del Trattamento Chirurgico dello Scompenso, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | | | - Claudio Bilato
- U.O.C. Cardiologia, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Vicenza
| | - Marco Corda
- S.C. Cardiologia, Azienda Ospedaliera "G. Brotzu", Cagliari
| | - Leonardo De Luca
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | | | - Giovanna Geraci
- U.O. Cardiologia, P.O. Sant'Antonio Abate, ASP Trapani, Erice (TP)
| | - Attilio Iacovoni
- SSD Chirurgia dei Trapianti e del Trattamento Chirurgico dello Scompenso, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Massimo Milli
- Cardiologia Firenze 1 (Ospedali S. Maria Nuova e Nuovo San Giovanni di Dio), Azienda USL Toscana Centro, Firenze
| | - Alessandro Navazio
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | - Vittorio Pascale
- S.O.C. Cardiologia-UTIC-Emodinamica e Cardiologia Interventistica, Presidio Ospedaliero "Pugliese", Azienda Ospedaliero-Universitaria "Renato Dulbecco", Catanzaro
| | - Carmine Riccio
- U.O.S.D. Follow-up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta
| | | | - Emanuele Tizzani
- Dipartimento di Cardiologia, Ospedale degli Infermi, Rivoli (TO)
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Massimo Grimaldi
- U.O.C. Cardiologia-UTIC, Ospedale Miulli, Acquaviva delle Fonti (BA)
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
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Di Fusco SA, Zilio F, Zuin M, Bilato C, Cavallini C, Corda M, De Luca L, Di Marco M, Geraci G, Iacovoni A, Milli M, Musumeci G, Navazio A, Pascale V, Riccio C, Scicchitano P, Tizzani E, Gabrielli D, Colivicchi F, Grimaldi M, Oliva F. [ANMCO Position paper: States General 2023 - Scientific societies and training: the role of ANMCO]. G Ital Cardiol (Rome) 2024; 25:274-280. [PMID: 38526364 DOI: 10.1714/4244.42209] [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: 03/26/2024]
Abstract
Scientific societies promote numerous activities, including the training of professionals. With the continuous growing of knowledge and the availability of new evidence in the cardiological field, the achievement and maintenance of knowledge and know-how is difficult. The evolving educational needs of professionals in cardiology have been analyzed during the 2023 ANMCO General States. Furthermore, the initiatives implemented to meet professionals' needs after the university medical training have been discussed. In this document, we report the main and most innovative training activities promoted by ANMCO, from distance training to simulation training, including courses for master's degree, training to and through clinical research and the potential role of teaching hospitals.
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Affiliation(s)
- Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Filippo Zilio
- U.O. Cardiologia, Ospedale Santa Chiara, APSS Trento
| | - Marco Zuin
- Dipartimento di Medicina Traslazionale, Università degli Studi, Ferrara
| | - Claudio Bilato
- U.O.C. Cardiologia, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Vicenza
| | | | - Marco Corda
- S.C. Cardiologia, Azienda Ospedaliera "G. Brotzu", Cagliari
| | - Leonardo De Luca
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | | | - Giovanna Geraci
- U.O. Cardiologia, P.O. Sant'Antonio Abate, ASP Trapani, Erice (TP)
| | - Attilio Iacovoni
- SSD Chirurgia dei Trapianti e del Trattamento Chirurgico dello Scompenso, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Massimo Milli
- Cardiologia Firenze 1 (Ospedali S. Maria Nuova e Nuovo San Giovanni di Dio), Azienda USL Toscana Centro, Firenze
| | - Giuseppe Musumeci
- S.C. Cardiologia, Azienda Ospedaliera Ordine Mauriziano Umberto I, Torino
| | - Alessandro Navazio
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | - Vittorio Pascale
- S.O.C. Cardiologia-UTIC-Emodinamica e Cardiologia Interventistica, Presidio Ospedaliero "Pugliese", Azienda Ospedaliero-Universitaria "Renato Dulbecco", Catanzaro
| | - Carmine Riccio
- U.O.S.D. Follow-up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta
| | | | - Emanuele Tizzani
- Dipartimento di Cardiologia, Ospedale degli Infermi, Rivoli (TO)
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Massimo Grimaldi
- U.O.C. Cardiologia-UTIC, Ospedale Miulli, Acquaviva delle Fonti (BA)
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
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Bernardini A, Paoletti Perini A, Padeletti M, Signorini U, Ciliberti D, Poli C, Milli M, Giomi A. Impact of dexmedetomidine on electrophysiological properties and arrhythmia inducibility in adult patients referred for reentrant supraventricular tachycardia ablation. J Interv Card Electrophysiol 2024; 67:371-378. [PMID: 37773558 DOI: 10.1007/s10840-023-01640-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Drugs used for sedation/analgesia may affect the basic cardiac electrophysiologic properties or even supraventricular tachycardia (SVT) inducibility. Dexmedetomidine (DEX) is a selective alpha-2 adrenergic agonist with sedative and analgesic properties. A comprehensive evaluation on use of DEX for reentrant SVT ablation in adults is lacking. The present study aims to systematically assess the impact of DEX on cardiac electrophysiology and SVT inducibility. METHODS Hemodynamic, electrocardiographic, and electrophysiological parameters and SVT inducibility were assessed before and after DEX infusion in patients scheduled for ablation of reentrant SVT. RESULTS The population of this prospective observational study included 55 patients (mean age of 58.7 ± 14 years, 29 males [52.7%]). A decrease in systolic and diastolic blood pressure and in heart rate was observed after DEX infusion (p = 0.001 for all). DEX increased corrected sinus node refractory time, atrial effective refractory period, AH interval, AV Wenckebach cycle length, and AV node effective refractory period without affecting the His-Purkinje conduction or ventricular myocardium refractoriness. No AV blocks or sinus arrests occurred during DEX infusion. Globally, there was no difference in SVT inducibility in basal condition or after DEX infusion (46/55 [83.6%] vs. 43/55 [78.1%] patients; p = 0.55), without a difference in isoprenaline use (p = 1.0). In 4 (7.3%) cases, the SVT was inducible only after DEX infusion. In 34.5% of cases, DEX infusion unmasked the presence of an obstructive sleeping respiratory pattern, represented mainly by snoring. CONCLUSIONS DEX depresses sinus node function and prolongs atrioventricular refractoriness without significantly affecting the rate of SVT inducibility in patients scheduled for reentrant SVT ablation.
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Affiliation(s)
- Andrea Bernardini
- Cardiology and Electrophysiology Unit, Santa Maria Nuova Hospital, Piazza di Santa Maria Nuova 1, Florence, Italy.
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Alessandro Paoletti Perini
- Cardiology and Electrophysiology Unit, Santa Maria Nuova Hospital, Piazza di Santa Maria Nuova 1, Florence, Italy
| | - Margherita Padeletti
- Cardiology and Electrophysiology Unit, Santa Maria Nuova Hospital, Piazza di Santa Maria Nuova 1, Florence, Italy
| | - Umberto Signorini
- Cardiology and Electrophysiology Unit, Santa Maria Nuova Hospital, Piazza di Santa Maria Nuova 1, Florence, Italy
| | - Davide Ciliberti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Claudio Poli
- Anesthesiology Unit, Santa Maria Nuova Hospital, Florence, Italy
| | - Massimo Milli
- Cardiology and Electrophysiology Unit, Santa Maria Nuova Hospital, Piazza di Santa Maria Nuova 1, Florence, Italy
| | - Andrea Giomi
- Cardiology and Electrophysiology Unit, Santa Maria Nuova Hospital, Piazza di Santa Maria Nuova 1, Florence, Italy
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Di Fusco SA, Zilio F, Zuin M, Bilato C, Corda M, De Luca L, Di Lenarda A, Di Marco M, Francese GM, Gensini GF, Geraci G, Giubilato S, Iacovoni A, Lucà F, Mazzanti M, Milli M, Navazio A, Orso F, Pascale V, Riccio C, Rocca P, Scicchitano P, Tavazzi L, Tizzani E, Gabrielli D, Colivicchi F, Grimaldi M, Oliva F. [ANMCO Position paper: States General 2023 - Digital medicine in cardiology: evidence and state of progress in Italy]. G Ital Cardiol (Rome) 2024; 25:179-186. [PMID: 38410900 DOI: 10.1714/4209.42005] [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: 02/28/2024]
Abstract
Technological innovation provides easily accessible tools capable of simplifying healthcare processes. Notably, digital technology application in the cardiology field can improve prognosis, reduce costs, and lead to an overall improvement in healthcare. The digitization of health data, with the use of electronic health records and of electronic health files in Italy, represents one of the fields of application of digital technologies in medicine. The 2023 States General of the Italian Association of Hospital Cardiologists (ANMCO) provided an opportunity to focus attention on the potential benefits and critical issues associated with the implementation of the aforementioned digital tools, artificial intelligence, and telecardiology. This document summarizes key aspects that emerged during the event.
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Affiliation(s)
- Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Filippo Zilio
- U.O. Cardiologia, Ospedale Santa Chiara, APSS Trento
| | - Marco Zuin
- Dipartimento di Medicina Traslazionale, Università degli Studi, Ferrara
| | - Claudio Bilato
- U.O.C. Cardiologia, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Vicenza
| | - Marco Corda
- S.C. Cardiologia, Azienda Ospedaliera "G. Brotzu", Cagliari
| | - Leonardo De Luca
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | - Andrea Di Lenarda
- S.C. Cardiovascolare e Medicina dello Sport, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Trieste
| | | | - Giuseppina Maura Francese
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | | | - Giovanna Geraci
- U.O. Cardiologia, P.O. Sant'Antonio Abate, ASP Trapani, Erice (TP)
| | - Simona Giubilato
- U.O.C. Cardiologia con UTIC ed Emodinamica, Azienda Ospedaliera Cannizzaro, Catania
| | - Attilio Iacovoni
- SSD Chirurgia dei Trapianti e del Trattamento Chirurgico dello Scompenso, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Fabiana Lucà
- Divisione di Cardiologia, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria
| | | | - Massimo Milli
- Cardiologia Firenze 1 (Ospedali S. Maria Nuova e Nuovo San Giovanni di Dio), Azienda USL Toscana Centro, Firenze
| | - Alessandro Navazio
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | - Francesco Orso
- Centro Studi ANMCO, Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Vittorio Pascale
- S.O.C. Cardiologia-UTIC-Emodinamica e Cardiologia Interventistica, Presidio Ospedaliero "Pugliese", Azienda Ospedaliero-Universitaria "Renato Dulbecco", Catanzaro
| | - Carmine Riccio
- U.O.S.D. Follow-up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta
| | | | | | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA)
| | - Emanuele Tizzani
- Dipartimento di Cardiologia, Ospedale degli Infermi, Rivoli (TO)
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Massimo Grimaldi
- U.O.C. Cardiologia-UTIC, Ospedale Miulli, Acquaviva delle Fonti (BA)
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
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Zilio F, Di Fusco SA, Zuin M, Ammirati E, Bilato C, Corda M, De Luca L, Di Marco M, Geraci G, Iacovoni A, Maggioni AP, Milli M, Navazio A, Pascale V, Riccio C, Scicchitano P, Tizzani E, Gabrielli D, Colivicchi F, Grimaldi M, Oliva F. [ANMCO Position paper: States General 2023 - Role of ANMCO in the setting of clinical research in Cardiology in Italy: current state and future perspectives]. G Ital Cardiol (Rome) 2024; 25:187-191. [PMID: 38410901 DOI: 10.1714/4209.42006] [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: 02/28/2024]
Abstract
For over 40 years, clinical research has been one of the most important aims of the Italian Association of Hospital Cardiologists (ANMCO), being an essential tool in pursuing promotion and fulfillment of good clinical practices in prevention, treatment and rehabilitation of cardiovascular diseases. Since 1992, with the creation of the Research Center (now part of the Heart Care Foundation), ANMCO is capable of independently and professionally managing all the aspects related to planning, management, and publication of the results of clinical studies. The other strength of ANMCO is the network built in Cardiology Departments on the whole territory of Italy, a human capital that allows ANMCO to deal with the new scientific challenges, in a context of profound changes in the social, economic, technological, and methodological setting. This document is based on the debate about the state of clinical research in Italy and the role of ANMCO in this setting that took place during the 2023 ANMCO States General.
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Affiliation(s)
- Filippo Zilio
- U.O. Cardiologia, Ospedale Santa Chiara, APSS Trento
| | - Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Marco Zuin
- Dipartimento di Medicina Traslazionale, Università degli Studi, Ferrara
| | - Enrico Ammirati
- Cardiologia 2-Insufficienza Cardiaca, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Claudio Bilato
- U.O.C. Cardiologia, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Vicenza
| | - Marco Corda
- S.C. Cardiologia, Azienda Ospedaliera "G. Brotzu", Cagliari
| | - Leonardo De Luca
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | | | - Giovanna Geraci
- U.O. Cardiologia, P.O. Sant'Antonio Abate, ASP Trapani, Erice (TP)
| | - Attilio Iacovoni
- SSD Chirurgia dei Trapianti e del Trattamento Chirurgico dello Scompenso, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Aldo Pietro Maggioni
- Centro Studi ANMCO, Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Massimo Milli
- Cardiologia Firenze 1 (Ospedali S. Maria Nuova e Nuovo San Giovanni di Dio), Azienda USL Toscana Centro, Firenze
| | - Alessandro Navazio
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | - Vittorio Pascale
- S.O.C. Cardiologia-UTIC-Emodinamica e Cardiologia Interventistica, Presidio Ospedaliero "Pugliese", Azienda Ospedaliero-Universitaria "Renato Dulbecco", Catanzaro
| | - Carmine Riccio
- U.O.S.D. Follow-up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta
| | | | - Emanuele Tizzani
- Dipartimento di Cardiologia, Ospedale degli Infermi, Rivoli (TO)
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Massimo Grimaldi
- U.O.C. Cardiologia-UTIC, Ospedale Miulli, Acquaviva delle Fonti (BA)
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
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7
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Zuin M, Di Fusco SA, Zilio F, Barisone M, Bilato C, Corda M, De Luca L, Di Marco M, Geraci G, Iacovoni A, Milli M, Navazio A, Pascale V, Riccio C, Scicchitano P, Scherillo M, Tizzani E, Gabrielli D, Colivicchi F, Grimaldi M, Oliva F. [ANMCO Position paper - 2023 ANMCO States General: The shortage of healthcare personnel in the cardiology field]. G Ital Cardiol (Rome) 2024; 25:115-120. [PMID: 38270368 DOI: 10.1714/4187.41761] [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: 01/26/2024]
Abstract
Over the latest years, a worrying progressive reduction of medical specialists has been observed in Italy and in other European and non-European countries. This trend is assuming alarming proportions, especially considering the continuous population aging and the concomitant increase in the prevalence of chronic cardiovascular disease. The underlying reasons are complex and multifactorial. The purpose of this document, derived from the collegial discussion held during the 2023 ANMCO States General is to highlight the current critical issues regarding the lack of healthcare personnel in the cardiology field, examining the current and future Italian situation and proposing some potential strategies to counteract this alarming phenomenon.
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Affiliation(s)
- Marco Zuin
- Dipartimento di Medicina Traslazionale, Università degli Studi, Ferrara
| | - Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Filippo Zilio
- U.O. Cardiologia, Ospedale Santa Chiara, APSS Trento
| | - Michela Barisone
- Centro Controllo Direzionale, Azienda Sociosanitaria Ligure ASL2, Savona
| | - Claudio Bilato
- U.O.C. Cardiologia, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Vicenza
| | - Marco Corda
- S.C. Cardiologia, Azienda Ospedaliera G. Brotzu, Cagliari
| | - Leonardo De Luca
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | | | - Giovanna Geraci
- U.O. Cardiologia, P.O. Sant'Antonio Abate, ASP Trapani, Erice (TP)
| | - Attilio Iacovoni
- SSD Chirurgia dei Trapianti e del Trattamento Chirurgico dello Scompenso, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Massimo Milli
- Cardiologia Firenze 1 (Ospedali S. Maria Nuova e Nuovo San Giovanni di Dio), Azienda USL Toscana Centro, Firenze
| | - Alessandro Navazio
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | - Vittorio Pascale
- UTIC-Emodinamica e Cardiologia Interventistica, Ospedale Civile Pugliese, Catanzaro
| | - Carmine Riccio
- U.O.S.D. Follow-up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta
| | | | - Marino Scherillo
- U.O.C. Cardiologia-UTIC con Emodinamica Interventistica, P.O. Gaetano Rummo, AORN San Pio, Benevento
| | - Emanuele Tizzani
- Dipartimento di Cardiologia, Ospedale degli Infermi, Rivoli (TO)
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Massimo Grimaldi
- U.O.C. Cardiologia-UTIC, Ospedale Miulli, Acquaviva delle Fonti (BA)
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
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Zuin M, Di Fusco SA, Zilio F, Bilato C, Corda M, De Luca L, Di Marco M, Geraci G, Iacovoni A, Milli M, Navazio A, Pascale V, Riccio C, Scicchitano P, Urbinati S, Caldarola P, Tizzani E, Gabrielli D, Colivicchi F, Grimaldi M, Oliva F. [ANMCO Position paper - 2023 ANMCO States General: Towards a modern Cardiological Community Care]. G Ital Cardiol (Rome) 2024; 25:121-125. [PMID: 38270369 DOI: 10.1714/4187.41762] [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: 01/26/2024]
Abstract
Over the last two decades, cardiovascular diseases have become the leading cause of chronic disease morbidity and mortality in Italy. Therefore, the chronic cardiovascular care landscape has evolved rapidly in an era of unprecedented demand. Furthermore, the COVID-19 pandemic has highlighted significant deficiencies in existing health and social care systems, especially in the management of chronic cardiovascular disease. In this scenario, the National Reform for Recovery and Resilience (PNRR) may represent a unique opportunity for the development of a new integrated care system between hospital and community. The Italian Association of Hospital Cardiologists (ANMCO) recognizes the need for a statement on the integrated cardiological community care to guide health professionals caring for people with chronic cardiovascular conditions. The aim of the present statement is to outline the evidence for a modern integrated cardiological community care identifying challenges and offering advice for a future transdisciplinary and multi-organizational approach to ensure best practice in the management of chronic cardiovascular disease.
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Affiliation(s)
- Marco Zuin
- Dipartimento di Medicina Traslazionale, Università degli Studi, Ferrara
| | - Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Filippo Zilio
- U.O. Cardiologia, Ospedale Santa Chiara, APSS Trento
| | - Claudio Bilato
- U.O.C. Cardiologia, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Vicenza
| | - Marco Corda
- S.C. Cardiologia, Azienda Ospedaliera G. Brotzu, Cagliari
| | - Leonardo De Luca
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | | | - Giovanna Geraci
- U.O. Cardiologia, P.O. Sant'Antonio Abate, ASP Trapani, Erice (TP)
| | - Attilio Iacovoni
- SSD Chirurgia dei Trapianti e del Trattamento Chirurgico dello Scompenso, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Massimo Milli
- Cardiologia Firenze 1 (Ospedali S. Maria Nuova e Nuovo San Giovanni di Dio), Azienda USL Toscana Centro, Firenze
| | - Alessandro Navazio
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | - Vittorio Pascale
- UTIC-Emodinamica e Cardiologia Interventistica, Ospedale Civile Pugliese, Catanzaro
| | - Carmine Riccio
- U.O.S.D. Follow-up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta
| | | | | | | | - Emanuele Tizzani
- Dipartimento di Cardiologia, Ospedale degli Infermi, Rivoli (TO)
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Massimo Grimaldi
- U.O.C. Cardiologia-UTIC, Ospedale Miulli, Acquaviva delle Fonti (BA)
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
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Imazio M, Milli M. [Focus on 2023 ESC guidelines for the management of infective endocarditis: in light of new evidence]. G Ital Cardiol (Rome) 2023; 24:941-944. [PMID: 38009343 DOI: 10.1714/4139.41337] [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)
- Massimo Imazio
- Cardiologia, Dipartimento Cardiotoracico, Ospedale Universitario S. Maria della Misericordia e Dipartimento di Medicina, Università degli Studi, Udine
| | - Massimo Milli
- Cardiologia Firenze 1 (Ospedali S. Maria Nuova e Nuovo San Giovanni di Dio), Azienda USL Toscana Centro, Firenze
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Beltrami M, Galluzzo A, Brocci RT, Paoletti Perini A, Pieragnoli P, Garofalo M, Halasz G, Milli M, Barilli M, Palazzuoli A. The role of fibrosis, inflammation, and congestion biomarkers for outcome prediction in candidates to cardiac resynchronization therapy: is "response" the right answer? Front Cardiovasc Med 2023; 10:1180960. [PMID: 37378403 PMCID: PMC10291081 DOI: 10.3389/fcvm.2023.1180960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Background Cardiac resynchronization therapy (CRT) is an established treatment in selected patients suffering from heart failure with reduced ejection fraction (HFrEF). It has been proposed that myocardial fibrosis and inflammation could influence CRT "response" and outcome. Our study investigated the long-term prognostic significance of cardiac biomarkers in HFrEF patients with an indication for CRT. Methods Consecutive patients referred for CRT implantation were retrospectively evaluated. The soluble suppression of tumorigenicity 2 (sST2), galectin-3 (Gal-3), N-terminal portion of the B-type natriuretic peptide (NT-proBNP), and estimated glomerular filtration rate (eGFR) were measured at baseline and after 1 year of follow-up. Multivariate analyses were performed to evaluate their correlation with the primary composite outcome of cardiovascular mortality and heart failure hospitalizations at a mean follow-up of 9 ± 2 years. Results Among the 86 patients enrolled, 44% experienced the primary outcome. In this group, the mean baseline values of NT-proBNP, Gal-3, and sST2 were significantly higher compared with the patients without cardiovascular events. At the multivariate analyses, baseline Gal-3 [cut-off: 16.6 ng/ml, AUC: 0.91, p < 0.001, HR 8.33 (1.88-33.33), p = 0.005] and sST2 [cut-off: 35.6 ng/ml AUC: 0.91, p < 0.001, HR 333 (250-1,000), p = 0.003] significantly correlated with the composite outcome in the prediction models with high likelihood. Among the parameters evaluated at 1-year follow-up, sST2, eGFR, and the variation from baseline to 1-year of Gal-3 levels showed a strong association with the primary outcome [HR 1.15 (1.08-1.22), p < 0.001; HR: 0.84 (0.74-0.91), p = 0.04; HR: 1.26 (1.10-1.43), p ≤ 0.001, respectively]. Conversely, the echocardiographic definition of CRT response did not correlate with any outcome. Conclusion In HFrEF patients with CRT, sST2, Gal-3, and renal function were associated with the combined endpoint of cardiovascular death and HF hospitalizations at long-term follow-up, while the echocardiographic CRT response did not seem to influence the outcome of the patients.
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Affiliation(s)
- Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, Azienda USL Toscana Centro, Florence, Italy
| | | | | | - Alessandro Paoletti Perini
- Department of Internal Medicine, Cardiology and Electrophysiology Unit, Azienda USL Toscana Centro, Florence, Italy
| | - Paolo Pieragnoli
- Arrhythmia and Electrophysiology Unit, Careggi University Hospital, Florence, Italy
| | - Manuel Garofalo
- Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Geza Halasz
- Department of Cardiosciences, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Massimo Milli
- Cardiology Unit, San Giovanni di Dio Hospital, Azienda USL Toscana Centro, Florence, Italy
| | - Maria Barilli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Le Scotte Hospital, Siena, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, Le Scotte Hospital, University of Siena, Siena, Italy
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11
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Pisani E, Bartolini S, Sani F, Signorini U, Milli M, Beltrami M. 889 ATRIOVENTRICULAR BLOCK, AN UNUSUAL CLINICAL PRESENTATION OF CALCIFIED BICUSPID AORTIC VALVE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.741] [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
Bicuspid aortic valve (BAV) is the most frequent congenital valve disease in adults. It is often associated with other congenital cardiac defects. Sometimes it is associated with aortic dilatation. BAV is an heterogeneous disease with varying valve morphology (asymmetrical cusp size and rafe), annulus geometry and size, asymmetrical calcification of the aortic valve and left ventricular outflow tract.
Case Report
A 32 year-old male patient was diagnosed with bicuspid aortic valve after several cardiologic visits for eligibility to competitive sport. Since April 2021 he developed a progressive exertional dyspnea for strenuous efforts. In February 2022, he was referred to our department after a Holter ECG showed a bradyarrhythmia with complete atrioventricular block. The echocardiography evaluation demonstrated a preserved ejection fraction and a bicuspid aortic valve with a mild-moderate regurgitation. The coronary computed tomography showed a thick and calcified bicuspid aortic valve with a coarse calcification of the anterior cuspid that involve the pars membranacea of the interventricular septum. The ergometric exercise demonstrated chronotropy incompetence. The tomography confirmed the mildy aortic root dilatation. Therefore, an MRI was performed and reported a small laminar LGE on the infero-lateral wall of the left ventricle, of unclear significance. He underwent Dual-Chamber permanent pacemaker implantation. A conservative approach was preferred over valvular replacement, considering the mild aortic root dilatation on a background of mild-to- moderate aortic insufficiency.
Conclusion
Our case is unusual given the bicuspid aortic valve concomitant with atrioventricular block, which was connected with the location of the calcification. Thus, the aim of our case report is, to describe a complication to this condition which, although rare, represents a different clinical presentation of the pathology itself in a young adult.
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Beltrami M, Dei LL, Milli M. The Role of the Left Atrium: From Multimodality Imaging to Clinical Practice: A Review. Life (Basel) 2022; 12:life12081191. [PMID: 36013370 PMCID: PMC9410416 DOI: 10.3390/life12081191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/25/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022]
Abstract
In recent years, new interest is growing in the left atrium (LA). LA functional analysis and measurement have an essential role in cardiac function evaluation. Left atrial size and function are key elements during the noninvasive analysis of diastolic function in several heart diseases. The LA represents a “neuroendocrine organ” with high sensitivity to the nervous, endocrine, and immune systems. New insights highlight the importance of left atrial structural, contractile, and/or electrophysiological changes, introducing the concept of “atrial cardiomyopathy”, which is closely linked to underlying heart disease, arrhythmias, and conditions such as aging. The diagnostic algorithm for atrial cardiomyopathy should follow a stepwise approach, combining risk factors, clinical characteristics, and imaging. Constant advances in imaging techniques offer superb opportunities for a comprehensive evaluation of LA function, underlying specific mechanisms, and patterns of progression. In this literature review, we aim to suggest a practical, stepwise algorithm with integrative multimodality imaging and a clinical approach for LA geometry and functional analysis. This integrates diastolic flow analysis with LA remodelling by the application of traditional and new diagnostic imaging techniques in several clinical settings such as heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), and mitral regurgitation (MR).
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Affiliation(s)
- Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, 50142 Florence, Italy
- Correspondence: ; Tel.: +39-339-541-8158
| | - Lorenzo-Lupo Dei
- Cardiology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Massimo Milli
- Cardiology Unit, San Giovanni di Dio Hospital, 50142 Florence, Italy
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Beltrami M, Milli M, Dei LL, Palazzuoli A. The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines. J Clin Med 2022; 11:jcm11082243. [PMID: 35456336 PMCID: PMC9025648 DOI: 10.3390/jcm11082243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/13/2022] [Accepted: 04/15/2022] [Indexed: 02/01/2023] Open
Abstract
Patients with heart failure (HF) and associated chronic kidney disease (CKD) are a population less represented in clinical trials; additionally, subjects with more severe estimated glomerular filtration rate reduction are often excluded from large studies. In this setting, most of the data come from post hoc analyses and retrospective studies. Accordingly, in patients with advanced CKD, there are no specific studies evaluating the long-term effects of the traditional drugs commonly administered in HF. Current concerns may affect the practical approach to the traditional treatment, and in this setting, physicians are often reluctant to administer and titrate some agents acting on the renin angiotensin aldosterone system and the sympathetic activity. Therefore, the extensive application in different HF subtypes with wide associated conditions and different renal dysfunction etiologies remains a subject of debate. The role of novel drugs, such as angiotensin receptor blocker neprilysin inhibitors and sodium glucose linked transporters 2 inhibitors seems to offer a new perspective in patients with CKD. Due to its protective vascular and hormonal actions, the use of these agents may be safely extended to patients with renal dysfunction in the long term. In this review, we discussed the largest trials reporting data on subjects with HF and associated CKD, while suggesting a practical stepwise algorithm to avoid renal and cardiac complications.
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Affiliation(s)
- Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, Via Torregalli 3, 50142 Florence, Italy;
- Correspondence: ; Tel.: +39-3395418158
| | - Massimo Milli
- Cardiology Unit, San Giovanni di Dio Hospital, Via Torregalli 3, 50142 Florence, Italy;
| | - Lorenzo Lupo Dei
- Cardiology, Department of Life, Health and Enviromental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, Le Scotte Hospital, University of Siena, 53100 Siena, Italy;
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Beltrami M, Bartolini S, Milli M, Palazzuoli A. The relevance of specific heart failure outpatient programs in the COVID era: an appropriate model for every disease. Rev Cardiovasc Med 2021; 22:677-690. [PMID: 34565069 DOI: 10.31083/j.rcm2203077] [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: 05/31/2021] [Revised: 07/19/2021] [Accepted: 07/28/2021] [Indexed: 11/06/2022] Open
Abstract
Heart Failure (HF) is characterized by an elevated readmission rate, with almost 50% of events occurring after the first episode over the first 6 months of the post-discharge period. In this context, the vulnerable phase represents the period when patients elapse from a sub-acute to a more stabilized chronic phase. The lack of an accurate approach for each HF subtype is probably the main cause of the inconclusive data in reducing the trend of recurrent hospitalizations. Most care programs are based on the main diagnosis and the HF stages, but a model focused on the specific HF etiology is lacking. The HF clinic route based on the HF etiology and the underlying diseases responsible for HF could become an interesting approach, compared with the traditional programs, mainly based on non-specific HF subtypes and New York Heart Association class, rather than on detailed etiologic and epidemiological data. This type of care may reduce the 30-day readmission rates for HF, increase the use of evidence-based therapies, prevent the exacerbation of each comorbidity, improve patient compliance, and decrease the use of resources. For all these reasons, we propose a dedicated outpatient HF program with a daily practice scenario that could improve the early identification of symptom progression and the quality-of-life evaluation, facilitate the access to diagnostic and laboratory tools and improve the utilization of financial resources, together with optimal medical titration and management.
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Affiliation(s)
- Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, 50142 Florence, Italy
| | - Simone Bartolini
- Cardiology Unit, San Giovanni di Dio Hospital, 50142 Florence, Italy
| | - Massimo Milli
- Cardiology Unit, San Giovanni di Dio Hospital, 50142 Florence, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Internal Medicine, Le Scotte Hospital, University of Siena, 53100 Siena, Italy
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15
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Beltrami M, Fumagalli C, Milli M. Frailty, sarcopenia and cachexia in heart failure patients: Different clinical entities of the same painting. World J Cardiol 2021; 13:1-10. [PMID: 33552398 PMCID: PMC7821009 DOI: 10.4330/wjc.v13.i1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/25/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023] Open
Abstract
Heart Failure (HF) in elderly patients is a systemic syndrome where advanced age, comorbidities with organ system deterioration, frailty and impaired cognition significantly impact outcome. Cardiac cachexia, sarcopenia and frailty despite overlap in definitions are different clinical entities that frequently coexist in HF patients. However, these co-factors often remain unaddressed, resulting in poor quality-of-life, prolonged physical disability and exercise intolerance and finally with higher rehospitalization rates and mortality. Strategy aim to increase muscle mass and muscle strength and delay the occurrence of frailty state appear essential in this regard. Common HF drugs therapy (b-blockers, angiotensin-converting enzyme inhibitors) and prescription of physical exercise program remain the cornerstone of therapeutic approach in HF patients with new promising data regarding nutritional supplementation. However, the treatment of all these conditions still remain debated and only a profound knowledge of the specific mechanisms and patterns of disease progression will allow to use the appropriate therapy in a given clinical setting. For all these reasons we briefly review current knowledge on frailty, sarcopenia and cachexia in HF patients with the attempt to define clinically significant degrees of multiorgan dysfunction, specific "red alert" thresholds in clinical practice and therapeutic approach.
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Affiliation(s)
- Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, Florence 50142, Italy
| | - Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence 50139, Italy
| | - Massimo Milli
- Cardiology Unit, San Giovanni di Dio Hospital, Florence 50142, Italy
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Testa M, Cappuccio A, Latella M, Napolitano S, Milli M, Volpe M, Marini MG. The emotional and social burden of heart failure: integrating physicians', patients', and caregivers' perspectives through narrative medicine. BMC Cardiovasc Disord 2020; 20:522. [PMID: 33308152 PMCID: PMC7733244 DOI: 10.1186/s12872-020-01809-2] [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] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022] Open
Abstract
Background The The Roadmap Using Story Telling project used a narrative medicine (NM) framework to assess the perspectives of people with heart failure (HF), their informal caregivers and HF specialists of the impact of HF on the daily life of patients and their carers. Methods Italian HF specialists participated on a voluntary basis, completing their own narratives, and inviting patients and their caregivers to write anonymously about their experiences, all on a dedicated online platform. The narratives were analyzed according to standard NM methodology. Results 82 narratives were collected from patients, 61 from caregivers, and 104 from HF specialists. Analysis of the three points of view revealed the extent of the burden of illness on the entire family, particularly that of the caregiver. The impact was mainly experienced as emotional and social limitations in patients’ and their caregivers’ daily lives. The analysis of all three points of view highlighted a strong difference between how HF is perceived by patients, caregivers, and HF specialists. Conclusions This NM project illustrates the complex issues of living with HF and gave insights to integrate three different perspectives into the HF pathway of care.
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Affiliation(s)
- Marco Testa
- Cardiology Unit, Sant'Andrea Hospital, Rome, Italy
| | - Antonietta Cappuccio
- Area Sanità e Salute di Fondazione ISTUD, via Paolo Lomazzo 19, 20124, Milan, Italy.
| | | | - Silvia Napolitano
- Area Sanità e Salute di Fondazione ISTUD, via Paolo Lomazzo 19, 20124, Milan, Italy
| | - Massimo Milli
- Cardiology Unit, Santa Maria Nuova Firenze Hospital, Florence, Italy
| | - Massimo Volpe
- School of Medicine and Psychology, University of Rome "Sapienza", Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Maria Giulia Marini
- Area Sanità e Salute di Fondazione ISTUD, via Paolo Lomazzo 19, 20124, Milan, Italy
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Susi F, Mascia G, Milli M, Di Mario C, Giaccardi M. Esophageal visualization changes atrial fibrillation ablation strategy: from encircling to segmental approach. J Interv Card Electrophysiol 2020; 59:617-618. [PMID: 32494895 DOI: 10.1007/s10840-020-00774-2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Filippo Susi
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy.
| | - Giuseppe Mascia
- Cardiology and Electrophysiology Unit, Department of Internal Medicine, Azienda USL Toscana Centro, Florence, Italy
| | - Massimo Milli
- Cardiology and Electrophysiology Unit, Department of Internal Medicine, Azienda USL Toscana Centro, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Marzia Giaccardi
- Cardiology and Electrophysiology Unit, Department of Internal Medicine, Azienda USL Toscana Centro, Florence, Italy
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Abraham WT, Sievert H, Perl L, Erdheim D, Soifer E, Milli M, Mario CD. V-LAP Left Atrial Monitoring systEm for Patients with Chronic sysTOlic and Diastolic Congestive Heart FailuRe First-in-Human. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.211] [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: 10/26/2022]
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19
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Fornaro A, Olivotto I, Rigacci L, Ciaccheri M, Tomberli B, Ferrantini C, Coppini R, Girolami F, Mazzarotto F, Chiostri M, Milli M, Marchionni N, Castelli G. Comparison of long-term outcome in anthracycline-related versus idiopathic dilated cardiomyopathy: a single centre experience. Eur J Heart Fail 2017; 20:898-906. [PMID: 29148208 DOI: 10.1002/ejhf.1049] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 05/30/2017] [Revised: 09/18/2017] [Accepted: 09/26/2017] [Indexed: 01/08/2023] Open
Abstract
AIMS Cardiac dysfunction is a severe complication of anthracycline-containing anticancer therapy. The outcome of anthracycline-induced cardiomyopathy (AICM) compared with other non-ischaemic causes of heart failure (HF), such as idiopathic dilated cardiomyopathy (IDCM), is unresolved. The aim of this study was to compare the survival of AICM patients with an IDCM cohort followed at our centre from 1990 to 2016. METHODS AND RESULTS We included 67 patients (67% female, 50 ± 15 years) with AICM, defined as onset of otherwise unexplained left ventricular ejection fraction (LVEF) ≤50% following anthracycline therapy, and 488 IDCM patients (28% female, 55 ± 12 years). Patients were followed with constantly optimized HF therapy, for 7.6 ± 5.5 and 8.1 ± 5.5 years, respectively. In both cohorts, 25% of patients reached the combined endpoint of death/heart transplantation. Overall survival rates at 5 and 10 years were similar (AICM: 86% and 61%, IDCM: 88% and 75%; P = 0.61), and so was cardiovascular survival (AICM: 91% and 76%, IDCM: 91% and 80%; P = 0.373), also after 1:1 propensity matching (P = 0.27) and adjusting for age, LVEF and left ventricular size. A trend toward higher all-cause mortality was present in AICM patients [hazard ratio (HR) 1.67, 95% confidence interval (CI) 0.95-2.92, P = 0.076]. No differences were observed between AICM and IDCM with regard to pharmacological HF therapy, but AICM patients were less likely to receive devices (13% vs. 41.8% in IDCM, P < 0.001). CONCLUSION Cardiovascular mortality in patients with AICM did not differ from that of a matched IDCM cohort, despite cancer-related morbidity and less prevalent use of devices. These data suggest that patients with AICM should be treated with appropriate guideline-directed medical therapies similar to other non-ischaemic dilated cardiomyopathies.
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Affiliation(s)
- Alessandra Fornaro
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.,Cardiology Unit, S. Maria Nuova Hospital, Florence, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Luigi Rigacci
- Hematology Unit, Careggi University Hospital, Florence, Italy
| | - Mauro Ciaccheri
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | | | - Cecilia Ferrantini
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence, Italy
| | | | | | - Francesco Mazzarotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence, Italy.,Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Marco Chiostri
- Intensive Cardiac Care Unit, Heart and Vessel Department, Careggi University Hospital, Florence, Italy
| | - Massimo Milli
- Cardiology Unit, S. Maria Nuova Hospital, Florence, Italy
| | - Niccolò Marchionni
- Department of Clinical and Experimental Medicine, University of Florence, Italy.,Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
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20
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Giaccardi M, Mascia G, Giomi A, Fratoni L, Binazzi B, Gigliotti F, Nesti M, Milli M. Severe obstructive sleep apnea: first screening with an implanted pacemaker. Clin Case Rep 2017; 5:1465-1467. [PMID: 28878905 PMCID: PMC5582239 DOI: 10.1002/ccr3.877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 12/11/2016] [Accepted: 01/24/2017] [Indexed: 11/09/2022] Open
Abstract
Sleep apnea syndrome (SAS) is a chronic condition associated with cardiovascular disease. In some pacemakers, an advanced algorithm using transthoracic impedance may be used to identify SAS. This algorithm may be also a useful tool for a long-term monitoring helping physicians to optimize therapy, reducing risk factors, and improving therapeutic compliance.
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Affiliation(s)
- Marzia Giaccardi
- Cardiology and Electrophysiology Unit Department of Internal Medicine Santa Maria Nuova Hospital Florence Italy
| | - Giuseppe Mascia
- Cardiology and Electrophysiology Unit Department of Internal Medicine Santa Maria Nuova Hospital Florence Italy
| | - Andrea Giomi
- Cardiology and Electrophysiology Unit Department of Internal Medicine Santa Maria Nuova Hospital Florence Italy
| | - Lanfranco Fratoni
- Cardiology and Electrophysiology Unit Department of Internal Medicine Santa Maria Nuova Hospital Florence Italy
| | - Barbara Binazzi
- Rehabilitative Pneumology IRCCS Fondazione Don Gnocchi Hospital Florence Italy
| | - Francesco Gigliotti
- Rehabilitative Pneumology IRCCS Fondazione Don Gnocchi Hospital Florence Italy
| | - Martina Nesti
- Cardiology Unit Department of Internal Medicine San Giovanni di Dio Hospital Florence Italy
| | - Massimo Milli
- Cardiology and Electrophysiology Unit Department of Internal Medicine Santa Maria Nuova Hospital Florence Italy
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21
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Majani G, Di Tano G, Giardini A, De Maria R, Russo G, Maestri R, Marini M, Milli M, Aspromonte N. Prevalence of job-related distress and satisfaction in a nationwide cardiology setting: The IANUS - itAliaN cardiologists' Undetected distress Study. J Cardiovasc Med (Hagerstown) 2016; 17:587-94. [PMID: 26895400 DOI: 10.2459/jcm.0000000000000370] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION AND OBJECTIVES Cardiologists' work distress has been seldom studied. The ItAliaN cardiologists' Undetected distress Study survey was designed to assess prevalence of work distress and satisfaction, and to gain insight into associations among these constructs and socio-demographics and job description. METHODS We invited members of our national cardiological society (Associazione Nazionale Medici Cardiologi Ospedalieri) to participate in an anonymous, self-report, exclusively web-based survey, posted on the Associazione Nazionale Medici Cardiologi Ospedalieri website. ItAliaN cardiologists' Undetected distress Study included socio-demographics, job description and a 15-item questionnaire on job-related distress and work satisfaction. RESULTS Of 7393 invited cardiologists, 1064 completed the survey. Organizational problems and worries about medico-legal controversies were reported by 71% and 49% of participants, respectively; over one-third reported loss of enthusiasm, helplessness, work-life imbalance and lack of control over work. Conversely, 86% felt competent at work, 67% rewarded by the moral/human meaning of their work and 52% satisfied with their professional fulfilment. Factor analysis revealed a meaningful underlying structure including four factors: job strain, positive meaning, emotional fatigue and relational difficulties. Relational difficulties were more frequent in cardiologists working in primary-level than in secondary and tertiary care hospitals (P = 0.017 and P = 0.013, respectively). Interventional cardiologists reported higher positive meaning than those in the clinical inpatients area and outpatient diagnostic settings (P = 0.007 and P = 0.025, respectively) and lower emotional fatigue than subjects in the clinical inpatients area (P = 0.0005). CONCLUSION Cardiologists' work distress should be interpreted integrating job-related negative aspects with a reappraisal of protective personal and relational resources, which should be fostered to promote physicians' wellbeing at the individual, collective and organizational levels.
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Affiliation(s)
- Giuseppina Majani
- aPsychology Unit, Salvatore Maugeri Foundation IRCSS, Scientific Institute of Montescano (PV) bCardiology Department, Istituti Ospitalieri, ASST Cremona cCNR Clinical Phsyiology Institute, CardioThoracic and Vascular Department, ASST Great Metropolitan Hospital Niguarda, Milan dCardiovascular Center, AAS 1 Triestina, Trieste eDepartment of Biomedical Engineering, Salvatore Maugeri Foundation IRCSS, Scientific Institute of Montescano (PV) fCardiovascular Sciences Department, Cardiology-ICU Umberto I°, Lancisi-Salesi Hospital, Ancona gCardiology Department, Santa Maria Nuova Hospital, Florence hCardiology, - San Filippo Neri Hospital ASL RM1, Rome, Italy
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22
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Di Tano G, De Maria R, Gonzini L, Aspromonte N, Di Lenarda A, Feola M, Marini M, Milli M, Misuraca G, Mortara A, Oliva F, Pulignano G, Russo G, Senni M, Tavazzi L. The 30-day metric in acute heart failure revisited: data from IN-HF Outcome, an Italian nationwide cardiology registry. Eur J Heart Fail 2015; 17:1032-41. [PMID: 26018852 DOI: 10.1002/ejhf.290] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 12/29/2014] [Revised: 04/17/2015] [Accepted: 04/27/2015] [Indexed: 11/11/2022] Open
Abstract
AIMS Unplanned readmissions early after a discharge from acute heart failure hospitalization are common and have become a reimbursement benchmark and marker of hospital quality. However, the competing risk of short-term post-discharge mortality is substantial. METHODS AND RESULTS Using data from the prospective, nationwide Registry IN-HF Outcome, we analysed the incidence and predictors of 30-day mortality or readmissions and associated days-alive-out-of-hospital (DAOH) in 1520 patients discharged alive after admission for acute heart failure. Within 30 days after discharge, 94 patients (6.2%) were readmitted (91% for cardiovascular causes; 60% recurrent heart failure) and 42 (2.8%) died, 10 of which occurred during readmission. Overall, 126 patients (8.3%) met the combined endpoint. By multivariable logistic regression, worsening chronic heart failure as clinical presentation [odds ratio (OR) 1.83, 95% confidence interval (CI) 1.21-2.77, P = 0.005), inotropes during admission (OR 2.19, 95% CI 1.40-3.43, P = 0.0006), length of stay (OR 1.02, 95% CI 1.01-1.04, P = 0.002) and renin-angiotensin system inhibitors at discharge (OR 0.52, 95%CI 0.35-0.77, P = 0.001) independently predicted 30-day all-cause mortality and/or readmission (c-statistic = 0.695). Per cent 30-day DAOH was lower in patients with in-hospital inotrope use, no renin-angiotensin system inhibitors prescription at discharge, New York Heart Association III-IV class at discharge, and correlated inversely with length of stay and age. CONCLUSION A clinical and biohumoral profile consistent with chronic advanced heart failure and end-organ damage identifies acute heart failure patients discharged home from cardiology units, who are at highest risk of early death and/or readmission. These findings have practical implications for tailoring specific follow-up.
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Affiliation(s)
| | - Renata De Maria
- CNR Clinical Physiology Institute, Cardiothoracic and Vascular Department, Azienda Ospedaliera Niguarda Ca' Granda, Milan, Italy
| | | | | | - Andrea Di Lenarda
- Cardiovascular Center, Health Authority n. 1 and University of Trieste, Trieste, Italy
| | - Mauro Feola
- Cardiovascular Rehabilitation, Heart Failure Unit, Ospedale Maggiore SS, Trinità, Fossano, Italy
| | - Marco Marini
- Cardiology Department, Ospedali Riuniti, Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Massimo Milli
- Cardiology, Ospedale Santa Maria Nuova, Florence, Italy
| | | | - Andrea Mortara
- Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Fabrizio Oliva
- Cardiologia 2 Heart Failure and Heart Transplant Programme, 'A. De Gasperis' Cardiothoracic and Vascular Department, Azienda Ospedaliera Niguarda Ca' Granda, Milan, Italy
| | - Giovanni Pulignano
- Heart Failure Clinic, 1st Cardiology/CCU Unit, Cardiovascular Department, San Camillo Hospital, Rome, Italy
| | - Giulia Russo
- Cardiovascular Center, Health Authority n. 1 and University of Trieste, Trieste, Italy
| | - Michele Senni
- Cardiovascular Department, Cardiology 1, Papa Giovanni XXIII Hospital, Bergamo
| | - Luigi Tavazzi
- Maria Cecilia Hospital-GVM Care&Research-E.S. Health Science Foundation, Cotignola, Italy
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23
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Marini M, Pini D, Russo G, Milli M, De Maria R, Di Tano G, Aspromonte N. [Clinical competence certification for advanced heart failure: an emerging need also in Italy?]. G Ital Cardiol (Rome) 2015; 16:77-82. [PMID: 25805090 DOI: 10.1714/1798.19576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Advanced heart failure (HF) is a deadly condition. Fortunately, an increasing array of effective (but often expensive) therapies has become available. The management of patients with advanced HF is complex and requires a high level of expertise. The American Board of Internal Medicine was the first regulatory board to recognize the need for a subspecialty in Advanced HF and Transplant Cardiology. More recently, the HF Association of the European Society of Cardiology has proposed a curriculum for HF specialists that includes the optional module of advanced HF therapy. However, the successful completion of such a curriculum does not result in a European Certification in Heart Failure, because no European Board of Medicine does exist. While in some European countries the secondary specialty of HF has been implemented, no country has a subspecialty in advanced HF. The ANMCO HF Area has proposed a survey to 25 Italian centers with accredited programs for heart transplant or ventricular assist device implant as destination therapy with the aim to assess the actual need of a certification of clinical competence in advanced HF and a certification of institutional competence for the centers with the highest expertise in advanced HF management. The survey indicated that there is a perceived need. A first step towards education of advanced HF specialists could be the implementation of CME courses by Scientific Societies. As regards certification of institutional competence for the centers with the highest expertise in advanced HF management, the government appears to be the only entity that can grant it.
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Perna ER, Aspromonte N, Cimbaro Canella JP, Di Tano G, Macin SM, Feola M, Coronel ML, Milani L, Parras JI, Milli M, García EH, Valle R. Minor Myocardial Damage is a Prevalent Condition in Patients With Acute Heart Failure Syndromes and Preserved Systolic Function With Long-Term Prognostic Implications. A Report From the CIAST-HF (Collaborative Italo-Argentinean Study on Cardiac Troponin T in Heart Failure) Study. J Card Fail 2012; 18:822-30. [DOI: 10.1016/j.cardfail.2012.10.008] [Citation(s) in RCA: 24] [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: 05/18/2012] [Revised: 09/30/2012] [Accepted: 10/02/2012] [Indexed: 11/26/2022]
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25
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Perna E, Valle R, Cimbaro Canella JP, Di Tano G, Macin S, Milani L, Coronel ML, Milli M, Aspromonte N. THE RELEVANCE OF TROPONIN AND NATRIURETIC PEPTIDES AS PROGNOSTIC MARKERS IN PATIENTS WITH ACUTE PULMONARY EDEMA AND PRESERVED LEFT VENTRICULAR SYSTOLIC FUNCTION: A REPORT FROM CIAST-HF STUDY. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)60367-7] [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] [Indexed: 10/18/2022]
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26
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Passino C, Giannoni A, Milli M, Polettii R, Emdin M. [Recent knowledges on chemosensitivity to hypoxia and hypercapnia in cardiovascular disease]. Recenti Prog Med 2010; 101:308-313. [PMID: 20842961] [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: 05/29/2023]
Abstract
The pathophysiologic role of enhanced chemosensitivity to carbon dioxide and/or hypoxia has been underscored in several cardiovascular diseases, including heart failure. In the early stages of this syndrome, the chemoreflex acts as a compensatory mechanism. Later on, however, it contributes to sustain the sympathetic activation, with detrimental effects on cardiovascular function and prognosis.
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Affiliation(s)
- Claudio Passino
- UO Medicina Cardiovascolare, Fondazione Gabriele Monasterio, Pisa.
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27
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De Maria R, Misuraca G, Milli M, Filippi A. [Role of outpatient heart failure clinics and primary care physicians in the tailored follow-up of heart failure patients]. G Ital Cardiol (Rome) 2010; 11:38S-44S. [PMID: 20873467] [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: 05/29/2023]
Abstract
Continuity of care is pivotal to appropriately manage patients affected by heart failure (HF). HF is a chronic disease with frequent exacerbations that requires long-term care at different complexity levels. The lack of adequate communication between hospital cardiologists and primary care physicians (PCPs) is the main pitfall in continuity of care for HF patients. To overcome this problem, all dedicated outpatient HF clinics should organize together with PCPs in the community educational and auditing initiatives, based on locally derived performance measures to assess the appropriateness and effectiveness of integrated care pathways. The primary task of PCPs is to follow up stable HF patients and focus assessment on patient empowerment, adjustment of drug therapy, assessment of clinical stability and the early identification of worsening signs and symptoms. The progress of information technology should help in achieving adequate communication between hospital professionals and PCPs; outpatient clinical records should in any case comply with qualitative standards of discharge summaries for all patients taken in charge by PCPs. Systematic assessment of shared care between hospital cardiologists and PCPs will be a main objective of the outpatient HF clinic network in the near future.
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Affiliation(s)
- Renata De Maria
- Istituto di Fisiologia Clinica del CNR, Dipartimento Cardiologica, A.O. Niguarda Ca' Granda, Milano.
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28
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Perna ER, Valle R, Cimbaro Canella JP, Di Tano G, Macin SM, Milani L, Coronel ML, Milli M, Moreno JP, Aspromonte N. Myocardial Damage Is a Prevalent Condition with Long-Term Prognostic Implications in Patients with Acute Heart Failure Syndromes and Preserved Systolic Function. A Report from the CIAST-HF (Collaborative Italo-Argentinean Study on Cardiac Troponin-T in Heart Failure) Study. J Card Fail 2009. [DOI: 10.1016/j.cardfail.2009.06.101] [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: 11/25/2022]
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29
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Valle R, Aspromonte N, Giovinazzo P, Carbonieri E, Chiatto M, di Tano G, Feola M, Milli M, Fontebasso A, Barro S, Bardellotto S, Milani L. B-Type Natriuretic Peptide–Guided Treatment for Predicting Outcome in Patients Hospitalized in Sub–Intensive Care Unit With Acute Heart Failure. J Card Fail 2008; 14:219-24. [PMID: 18381185 DOI: 10.1016/j.cardfail.2007.10.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2007] [Revised: 09/30/2007] [Accepted: 10/10/2007] [Indexed: 10/22/2022]
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30
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Perna ER, Aspromonte N, Canella JPC, Di Tano G, Macin SM, Milani L, Coronel ML, Milli M, Moreno JP, Valle R. Independent and Additive Prognostic Role of Natriuretic Peptides and Cardiac Troponin T for Long-Term Risk-Stratification in Decompensated Heart Failure. A Report of the CIAST-HF (Collaborative Italo-Argentinean Study on Troponin-T in Heart Failure) Study. J Card Fail 2007. [DOI: 10.1016/j.cardfail.2007.06.589] [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: 11/28/2022]
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31
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Gori F, Pasqualucci A, Corradetti F, Milli M, Peduto VA. Maternal and neonatal outcome after cesarean section: the impact of anesthesia. J Matern Fetal Neonatal Med 2007; 20:53-7. [PMID: 17437200 DOI: 10.1080/14767050601134645] [Citation(s) in RCA: 12] [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: 10/23/2022]
Abstract
BACKGROUND Among the anesthetic technologies used, regional anesthesia is becoming the most common in cesarean section (CS) deliveries. Aim. This retrospective survey examined the variables taken into account when selecting the anesthetic technique to be used, and how this choice affects the outcome for the mother and the newborn. METHODS One thousand eight hundred and seventy elective and emergency CS were evaluated for anesthetic technique used, indications, and maternal and neonatal outcome. RESULTS Of the 611 elective CS (32.6%), 206 (33.8%) were performed under general anesthesia and 405 (66.2%) under regional anesthesia. Of the 1259 emergency CS performed (67.4%), 525 (41.9%) were under general anesthesia and 734 (58.1%) under regional anesthesia. Conditions associated with a newborn 1-minute Apgar score of <7 were general anesthesia and multiple pregnancy (p<0.01); a 5-minute Apgar score of <7 was only associated with multiple pregnancy. The most important factor for very low Apgar scores was the presence of fetal malformations. Whatever the chosen technique, neither maternal deaths directly or indirectly due to the anesthesia nor major maternal and perinatal complications were found. CONCLUSIONS This survey confirms the preference for regional anesthesia during elective cesarean sections and for general anesthesia in emergency situations. Moreover, newborn outcome was found not to be influenced either by the technique used or by the character of the procedure.
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Affiliation(s)
- F Gori
- Department of Clinical and Experimental Medicine, Section of Anaesthesiology, Analgesia and Intensive Care, University of Perugia School of Medicine, Perugia, Italy.
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32
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Aspromonte N, Feola M, Milli M, Scardovi AB, Coletta C, Carbonieri E, Giovinazzo P, Di Giacomo T, Barro S, Rosso GL, Ceci V, Milani L, Valle R. Prognostic role of B-type natriuretic peptide in patients with diabetes and acute decompensated heart failure. Diabet Med 2007; 24:124-30. [PMID: 17257273 DOI: 10.1111/j.1464-5491.2007.02070.x] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several studies have reported the prognostic value of natriuretic peptides, but their predictive value in patients with diabetes mellitus is unknown. The aim of the study was to test the hypothesis that measurement of brain natriuretic peptide (BNP) levels in ambulatory patients with congestive heart failure (CHF) and diabetes can predict the occurrence of cardiovascular events at 6-month follow-up. METHODS We enrolled 145 consecutive patient with diabetes [age 72 +/- 9 years, hypertension (21%), ischaemic heart disease (52%), atrial fibrillation (22%), preserved left ventricular function (29%)] seen in the outpatient heart failure clinic after an acute episode of cardiac failure. RESULTS The median (25th/75th interquartile range) BNP concentrations at discharge were 186 (75-348) pg/ml. At 6-month clinical follow-up 10/145 (7%) subjects had died and 31/145 (21%) had been readmitted because of cardiac decompensation. BNP values of 200 and 500 pg/ml were found to have the best compromise between sensitivity (88 and 46%, respectively) and specificity (71 and 89%, respectively) for predicting events at 6 months. Multivariate Cox regression analysis identified only two parameters as predictors of events: serum creatinine [hazard ratio (HR) = 3.3; P = 0.02], and BNP plasma level BNP cut-off values (HR = 3.8; P = 0.03 for 201-499 pg/ml and HR = 7.7; P = 0.001 for > or = 500 pg/ml). CONCLUSION These results suggest that BNP and serum creatinine are strong predictors of clinical events in patients with diabetes and CHF. In these patients, clinical outcome might be stratified by plasma BNP levels.
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Affiliation(s)
- N Aspromonte
- Heart Failure Unit, Department of Cardiology, Ospedale S Croce-Carle, Cuneo, Italy.
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33
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Valle R, Aspromonte N, Feola M, Milli M, Canali C, Giovinazzo P, Carbonieri E, Ceci V, Cerisano S, Barro S, Milani L. B-Type Natriuretic Peptide Can Predict the Medium-Term Risk in Patients With Acute Heart Failure and Preserved Systolic Function. J Card Fail 2005; 11:498-503. [PMID: 16198244 DOI: 10.1016/j.cardfail.2005.05.002] [Citation(s) in RCA: 43] [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] [Received: 03/24/2005] [Revised: 03/24/2005] [Accepted: 05/09/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Half of patients with heart failure (HF) have preserved left ventricular ejection fraction (LVEF). Neurohormonal activation characterizes the disease and measurement of plasma B-type natriuretic peptide (BNP) indicates the severity of left ventricular dysfunction. The purpose of this study was to test the hypothesis that measurement of BNP levels in ambulatory patients with HF and preserved LVEF can predict the occurrence of cardiovascular events in the next 6 months. METHODS AND RESULTS We enrolled 233 consecutive patients admitted to the Outpatient Heart Failure Clinic (OHFC), on stabilization after an episode of acute HF, with a LVEF > 50%. Standard echocardiography was performed and left ventricular systolic/diastolic function was assessed. Plasma BNP levels were measured on admission to OHFC. Patients were followed for 6 months; the main endpoint combined cardiovascular death or readmission for HF. Among the 233 patients discharged, 48 endpoints occurred (death: n = 15; readmission: n = 33). Receiver operated curve analysis shows that BNP levels are strong predictors of subsequent events (area under the curve = 0.84; CI = 0.78-0.88). Multivariate Cox regression showed that the cutoff values identified by receiver operated curve analysis (200-500 pg/mL) of the neurohormone are the most accurate predictors of events: HR = 2.2 (P < .04) and HR = 5.8 (P < .001), respectively, for 201-499 pg/mL and > or = 500 pg/mL ranges. CONCLUSION BNP level is a strong predictor for cardiovascular mortality and early readmission in patients with diastolic HF. The results suggest that BNP levels might be used successfully to guide the intensity of follow-up after a decompensation, because increased BNP levels were associated with a progressively bad prognosis.
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Affiliation(s)
- Roberto Valle
- Heart Failure Unit, Department of Cardiology, Ospedale Civile, San Donà di Piave, Italy
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34
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Vannucchi PL, Polignano R, Becucci P, Milli M. [Shunt effect in iloprost treatment of obliterative arteriopathy]. Minerva Cardioangiol 1999; 47:654-5. [PMID: 10670247] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- P L Vannucchi
- Servizio di Angiologia, U.O. Medicina Interna II U.O. Cardiologia, Firenze
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Milli M, Marchi F. [The phenomenon of ischemic preconditioning]. G Ital Cardiol 1994; 24:445-50. [PMID: 8056221] [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: 01/28/2023]
Affiliation(s)
- M Milli
- Unità Coronarica, Ospedale di Santa Maria Nuova, Firenze
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Monaldi ML, Milli M, Lagi A. [Pulmonary embolism. A case report of right atrial thromboembolism treated by thrombolysis]. Recenti Prog Med 1992; 83:685-7. [PMID: 1494707] [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: 12/27/2022]
Abstract
This case report describes a 40-years-old man affected by fracture of leg and pulmonary embolism. Two-dimensional echocardiography showed a large right atrial migrant thromboembolus prolapsing into tricuspid valve during diastole. The patient was treated with rt-PA through right atrial venous catheter and underwent to serial echocardiographic examinations. The rt-PA determined the dissolution of the thrombo-embolus at the 2nd hour of infusion. It is concluded that early two-dimensional echocardiography might be a very helpful technique to diagnose and follow-up therapy of pulmonary embolism.
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Affiliation(s)
- M L Monaldi
- U.O. di Medicina interna I, Ospedale di Santa Maria Nuova, USL 10/A, Firenze
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Parigi L, Battelli P, Cerisano S, Milli M, Tarlini M, Zambaldi G, Marchi F. [Myocardial ischemia induced by exercise. Analysis of the recovery phase. Behavior of the rate-pressure normalization product in patients with fixed ischemic threshold and patients with variable ischemic threshold]. G Ital Cardiol 1990; 20:511-5. [PMID: 2227219] [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: 12/30/2022]
Abstract
Traditionally, in patients with exercise-induced myocardial ischemia we analyze the stress-test by studying the behaviour of double product at ischemia. We recognize the presence of a functional component in the reduction of coronary-flow reserve if the double product at ischemia (DPI) varies in 3 stress-tests i.e. more than 20% or more than 3200 mmHg b m'-1. Any analysis that relies exclusively on double product at ischemia is, of necessity, limited to the beginning of the ischemic phenomenon. To better understand the development of the whole event, we also considered the double product calculated when the ischemic electrocardiographic signal regressed (double product of normalization: DPN). More specifically, we set out to determine whether or not double product at ischemia behaviour in patients with variable ischemic threshold (i.e. double product at ischemia variation greater than 3200 mmHg b m'-1) differs from that of patients with fixed ischemic threshold (i.e. double product at ischemia variation less than b m'-1). We performed four multistage bicycle ergometer tests, without drugs, on 19 patients with chronic exertional anginal and exercise-induced ST depression. Patients were tested at the same time of day, within a 10 day period. In the second, third and fourth stress test double product at ischemia was calculated. On the basis of double product at ischemia values in three stress-tests, we distinguished two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L Parigi
- Unità di Terapia Intensiva Cardiaca dell'Ospedale di S. Maria Nuova di Firenze
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