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Piccirillo G, Moscucci F, Mezzadri M, Caltabiano C, Cisaria G, Vizza G, De Santis V, Giuffrè M, Stefano S, Scinicariello C, Carnovale M, Corrao A, Lospinuso I, Sciomer S, Rossi P. Artificial Intelligence Applied to Electrical and Non-Invasive Hemodynamic Markers in Elderly Decompensated Chronic Heart Failure Patients. Biomedicines 2024; 12:716. [PMID: 38672072 PMCID: PMC11048014 DOI: 10.3390/biomedicines12040716] [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: 02/04/2024] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES The first aim of this study was to assess the predictive power of Tend interval (Te) and non-invasive hemodynamic markers, based on bioimpedance in decompensated chronic heart failure (CHF). The second one was to verify the possible differences in repolarization and hemodynamic data between CHF patients grouped by level of left ventricular ejection fraction (LVEF). Finally, we wanted to check if repolarization and hemodynamic data changed with clinical improvement or worsening in CHF patients. METHODS Two hundred and forty-three decompensated CHF patients were studied by 5 min ECG recordings to determine the mean and standard deviation (TeSD) of Te (first study). In a subgroup of 129 patients (second study), non-invasive hemodynamic and repolarization data were recorded for further evaluation. RESULTS Total in-hospital and cardiovascular mortality rates were respectively 19 and 9%. Te was higher in the deceased than in surviving subjects (Te: 120 ± 28 vs. 100 ± 25 ms) and multivariable logistic regression analysis reported that Te was related to an increase of total (χ2: 35.45, odds ratio: 1.03, 95% confidence limit: 1.02-1.05, p < 0.001) and cardiovascular mortality (χ2: 32.58, odds ratio: 1.04, 95% confidence limit: 1.02-1.06, p < 0.001). Subjects with heart failure with reduced ejection fraction (HFrEF) reported higher levels of repolarization and lower non-invasive systolic hemodynamic data in comparison to those with preserved ejection fraction (HFpEF). In the subgroup, patients with the NT-proBNP reduction after therapy showed a lower rate of Te, heart rate, blood pressures, contractility index, and left ventricular ejection time in comparison with the patients without NT-proBNP reduction. CONCLUSION Electrical signals from ECG and bioimpedance were capable of monitoring the patients with advanced decompensated CHF. These simple, inexpensive, non-invasive, easily repeatable, and transmissible markers could represent a tool to remotely monitor and to intercept the possible worsening of these patients early by machine learning and artificial intelligence tools.
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Affiliation(s)
- Gianfranco Piccirillo
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy;
| | - Martina Mezzadri
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Cristina Caltabiano
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Giovanni Cisaria
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Guendalina Vizza
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Valerio De Santis
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Marco Giuffrè
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Sara Stefano
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Claudia Scinicariello
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Myriam Carnovale
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Andrea Corrao
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Ilaria Lospinuso
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy;
| | - Susanna Sciomer
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Pietro Rossi
- Arrhythmology Unit, Fatebenefratelli Hospital, Isola Tiberina-Gemelli Isola, 00186 Rome, Italy;
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Rossi P, Cauti FM, Polselli M, Magnocavallo M, Niscola M, Fanti V, Limite LR, Evangelista A, Bellisario A, De Paolis R, Facchetti S, Quaglione R, Piccirillo G, Bianchi S. Ablation of persistent atrial fibrillation based on atrial electrogram duration map: methodology and clinical outcomes from the AEDUM pilot study. J Interv Card Electrophysiol 2024:10.1007/s10840-023-01721-7. [PMID: 38206451 DOI: 10.1007/s10840-023-01721-7] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Catheter ablation of persistent atrial fibrillation (PsAF) represents a challenge for the electrophysiologist and there are still divergences regarding the best ablative approach to adopt. Create a new map of the duration of atrial bipolar electrograms (Atrial Electrogram DUration Map, AEDUM) to recognize a functional substrate during sinus rhythm and guide a patient-tailored ablative strategy for PsAF. METHODS Forty PsAF subjects were assigned in a 1:1 ratio to either for PVI alone (Group B1) or PVI+AEDUM areas ablation (Group B2). A cohort of 15 patients without AF history undergoing left-sided accessory pathway ablation was used as a control group (Group A). In all patients, voltage and AEDUM maps were created during sinus rhythm. The minimum follow-up was 12 months, with rhythm monitoring via 48-h ECG Holter or by implantable cardiac device. RESULTS Electrogram (EGM) duration was higher in Group B than in Group A (49±16.2ms vs 34.2±3.8ms; p-value<0.001). In Group B the mean cumulative AEDUM area was 21.8±8.2cm2; no difference between the two subgroups was observed (22.3±9.1cm2 vs 21.2±7.2cm2; p-value=0.45). The overall bipolar voltage recorded inside the AEDUM areas was lower than in the remaining atrial areas [median: 1.30mV (IQR: 0.71-2.38mV) vs 1.54mV (IQR: 0.79-2.97mV); p-value: <0.001)]. Low voltage areas (<0.5mV) were recorded in three (7.5%) patients in Group B. During the follow-up [median 511 days (376-845days)] patients who underwent PVI-only experienced more AF recurrence than those receiving a tailored approach (65% vs 35%; p-value= 0.04). CONCLUSIONS All PsAF patients exhibited AEDUM areas. An ablation approach targeting these areas resulted in a more effective strategy compared with PVI only.
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Affiliation(s)
- Pietro Rossi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy.
| | - Filippo Maria Cauti
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - Marco Polselli
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - Michele Magnocavallo
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - Marta Niscola
- Abbott Medical, Via Paracelso 20, 20864, Agrate Brianza, Italy
| | - Veronica Fanti
- Abbott Medical, Via Paracelso 20, 20864, Agrate Brianza, Italy
| | | | - Antonietta Evangelista
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
| | | | | | | | - Raffaele Quaglione
- Department of Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185, Rome, Italy
| | - Gianfranco Piccirillo
- Department of Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185, Rome, Italy
| | - Stefano Bianchi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Via Ponte Quattro Capi, 39, 00186, Rome, Italy
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Rossi P, Cauti FM, Niscola M, Magnocavallo M, Polselli M, Capone S, Della Rocca DG, Rodriguez-Garrido J, Piccirillo G, Anguera I, Dallaglio P, Bianchi S. Ventricular Electrograms Duration Map to Detect Ventricular Arrhythmia Substrate: the VEDUM Project Study. Circ Arrhythm Electrophysiol 2023; 16:447-455. [PMID: 37485678 PMCID: PMC10786440 DOI: 10.1161/circep.122.011729] [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: 11/22/2022] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The analysis of the wave-front activation patterns is crucial for the comprehension and treatment of ventricular tachycardia (VT). The ventricular electrograms duration map (VEDUM) is a potential method to identify areas (VEDUM area) with slow and inhomogeneous activation. There is no available data on the characteristics and the arrhythmogenic role of VEDUM areas identified during sinus/paced rhythm. METHODS Patients referred for VT ablation were enrolled at 3 different centers. VEDUM maps during sinus/paced rhythm as well as substrate and functional maps were created; activation mapping was performed for all hemodynamically tolerated VT. RESULTS Thirty-two patients (mean age:70.1±9.4 years; males 93.8%) were enrolled. The VEDUM approach was achieved in all patients and the mean size of the VEDUM area was 12.1±6.9 cm2 (interquartile range, 7.8-14.9 cm2). A significative difference was observed between the electrogram duration in the VEDUM area and the normal tissue (163.7 ms [interquartile range, 142.3-199.2 ms]; versus 65.5 ms [interquartile range, 59.5-76.2 ms]; P<0.001). The VEDUM area was visualized in a dense scar (<0.5 mV) in 19 (59.4%) patients. A deceleration zone and late potentials were recorded inside the VEDUM area in 56.3% and 81.3%, respectively. When a complete VT activation mapping was available, the isthmus projected in the VEDUM area in 93.5% of patients; 8 of them had multiple VTs mapped and in the 87.5% all VT isthmuses were included in the VEDUM area. CONCLUSIONS VEDUM maps allow the identification of discrete areas of inhomogeneous and slow conduction. They represent a potential target for VT ablation, including patients with multiple morphologies.
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Affiliation(s)
- Pietro Rossi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Filippo Maria Cauti
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Marta Niscola
- Abbott Medical Italy, Sesto San Giovanni, Milan, Italy (M.N.)
| | - Michele Magnocavallo
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Marco Polselli
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Silvia Capone
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R.)
| | | | - Gianfranco Piccirillo
- University of Rome “Sapienza,” Department of Science of Internal Clinics, Anestesiologists & Cardiovasculars, Policlinico Umberto I, Rome, Italy (G.P.)
| | - Ignasi Anguera
- Arrhythmias Unit, Cardiology Department, Bellvitge University Hospital & Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Unstitute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain (I.A., P.D.)
| | - Paolo Dallaglio
- Arrhythmias Unit, Cardiology Department, Bellvitge University Hospital & Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Unstitute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain (I.A., P.D.)
| | - Stefano Bianchi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
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Moscucci F, Sciomer S, Maffei S, Meloni A, Lospinuso I, Carnovale M, Corrao A, Di Diego I, Caltabiano C, Mezzadri M, Mattioli AV, Gallina S, Rossi P, Magrì D, Piccirillo G. Sex Differences in Repolarization Markers: Telemonitoring for Chronic Heart Failure Patients. J Clin Med 2023; 12:4714. [PMID: 37510828 PMCID: PMC10381165 DOI: 10.3390/jcm12144714] [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: 06/15/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Aging and chronic heart failure (CHF) are responsible for the temporal inhomogeneity of the electrocardiogram (ECG) repolarization phase. Recently, some short period repolarization-dispersion parameters have been proposed as markers of acute decompensation and of mortality risk in CHF patients. Some important differences in repolarization between sexes are known, but their impact on ECG markers remains unstudied. The aim of this study was to evaluate possible differences between men and women in ECG repolarization markers for the telemonitoring of CHF patients. METHOD 5 min ECG recordings were collected to assess the mean and standard deviation (SD) of the following variables: QT end (QTe), QT peak (QTp), and T peak to T end (Te) in 215 decompensated CHF (age range: from 49 to 103 years). Thirty-day mortality and high levels of NT-pro BNP (<75 percentile) were considered markers of decompensated CHF. RESULTS A total of 34 patients (16%) died during the 30-day follow-up, without differences between sexes. Women showed a more preserved ejection fraction and higher LDL and total cholesterol levels. Among female patients, implantable cardioverter devices, statins, and antiplatelet agents were less used. Data for Te mean showed increased values among deceased men and women compared to survival, but TeSD was shown to be the most reliable marker for CHF reacutization in both sexes. CONCLUSION TeSD could be considered a risk factor for CHF worsening and complications for female and male patients, but different cut offs should be taken into account. (ClinicalTrials.gov number, NCT04127162.).
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Affiliation(s)
- Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Viale del Policlinico n. 155, 00161 Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche, Cardiovascolari, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Silvia Maffei
- Endocrinologia Cardiovascolare Ginecologica ed Osteoporosi, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Antonella Meloni
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Ilaria Lospinuso
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche, Cardiovascolari, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Myriam Carnovale
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche, Cardiovascolari, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Andrea Corrao
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche, Cardiovascolari, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Ilaria Di Diego
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche, Cardiovascolari, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Cristina Caltabiano
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche, Cardiovascolari, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Martina Mezzadri
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche, Cardiovascolari, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Anna Vittoria Mattioli
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 42121 Modena, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, "G. D'Annunzio" University, 66100 Chieti, Italy
| | - Pietro Rossi
- Arrhythmology Unit, Fatebenefratelli Hospital Isola Tiberina-Gemelli Isola, 00186 Rome, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Gianfranco Piccirillo
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche, Cardiovascolari, "Sapienza" University of Rome, 00185 Rome, Italy
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Piccirillo G, Moscucci F, Di Diego I, Mezzadri M, Caltabiano C, Carnovale M, Corrao A, Lospinuso I, Stefano S, Scinicariello C, Giuffrè M, De Santis V, Sciomer S, Rossi P, Fiori E, Magrì D. Effect of Head-Up/-Down Tilt on ECG Segments and Myocardial Temporal Dispersion in Healthy Subjects. Biology (Basel) 2023; 12:960. [PMID: 37508390 PMCID: PMC10376208 DOI: 10.3390/biology12070960] [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] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023]
Abstract
The head-up/-down tilt test acutely modifies the autonomic nervous system balance throughout a deactivation of the cardiopulmonary reflexes. The present study examines the influence of head-up/-down tilt on a number of ECG segments. A total of 20 healthy subjects underwent a 5 min ECG and noninvasive hemodynamic bio-impedance recording, during free and controlled breathing, lying at (a) 0°; (b) -45°, tilting up at 45°, and tilting up at 90°. Heart rate variability power spectral analysis was obtained throughout some ECG intervals: P-P (P), P-Q (PQ), PeQ (from the end of P to Q wave), Q-R peak (QR intervals), Q-R-S (QRS), Q-T peak (QTp), Q-T end (QTe), STp, STe, T peak-T end (Te), and, eventually, the TeP segments (from the end of T to the next P waves). Results: In all study conditions, the Low Frequency/High FrequencyPP and LFPP normalized units (nu) were significantly lower than the LF/HFRR and LFRRnu, respectively. Conversely, the HFPP and HFPPnu were significantly higher in all study conditions. STe, QTp, and QTe were significantly related to the PP and RR intervals, whereas the T wave amplitude was inversely related to the standard deviations of all the myocardial repolarization variables and to the left ventricular end-systolic volume (LVEDV). The T wave amplitude diminished during head-up tilt and significantly correlated with the LVEDV.
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Affiliation(s)
- Gianfranco Piccirillo
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy
| | - Ilaria Di Diego
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Martina Mezzadri
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Cristina Caltabiano
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Myriam Carnovale
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Andrea Corrao
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Ilaria Lospinuso
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Sara Stefano
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Claudia Scinicariello
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Marco Giuffrè
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Valerio De Santis
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Pietro Rossi
- Arrhythmology Unit, Fatebenefratelli Hospital Isola Tiberina-Gemelli Isola, 00186 Rome, Italy
| | - Emiliano Fiori
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, "Sapienza" University of Rome, 00198 Rome, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, "Sapienza" University of Rome, 00198 Rome, Italy
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Piccirillo G, Moscucci F, Mezzadri M, Caltabiano C, Di Diego I, Carnovale M, Corrao A, Stefano S, Scinicariello C, Giuffrè M, De Santis V, Sciomer S, Rossi P, Magrì D. Electrocardiographic and other Noninvasive Hemodynamic Markers in Decompensated CHF Patients. J Cardiovasc Dev Dis 2023; 10:125. [PMID: 36975889 PMCID: PMC10058439 DOI: 10.3390/jcdd10030125] [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: 01/04/2023] [Revised: 02/14/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Acutely decompensated chronic heart failure (adCHF) is among the most important causes of in-hospital mortality. R-wave peak time (RpT) or delayed intrinsicoid deflection was proposed as a risk marker of sudden cardiac death and heart failure decompensation. Authors want to verify if QR interval or RpT, obtained from 12-lead standard ECG and during 5-min ECG recordings (II lead), could be useful to identify adCHF. At hospital admission, patients underwent 5-min ECG recordings, obtaining mean and standard deviation (SD) of the following ECG intervals: QR, QRS, QT, JT, and T peak-T end (Te). The RpT from a standard ECG was calculated. Patients were grouped by the age-stratified Januzzi NT-proBNP cut-off. A total of 140 patients with suspected adCHF were enrolled: 87 (mean age 83 ± 10, M/F 38/49) with and 53 (mean age: 83 ± 9, M/F: 23/30) without adCHF. V5-, V6- (p < 0.05) RpT, and QRSD, QRSSD, QTSD, JTSD, and TeSDp < 0.001 were significantly higher in the adCHF group. Multivariable logistic regression analysis demonstrated that the mean of QT (p < 0.05) and Te (p < 0.05) were the most reliable markers of in-hospital mortality. V6 RpT was directly related to NT-proBNP (r: 0.26, p < 0.001) and inversely related to a left ventricular ejection fraction (r: 0.38, p < 0.001). The intrinsicoid deflection time (obtained from V5-6 and QRSD) could be used as a possible marker of adCHF.
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Affiliation(s)
- Gianfranco Piccirillo
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Martina Mezzadri
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Cristina Caltabiano
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Ilaria Di Diego
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Myriam Carnovale
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Andrea Corrao
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Sara Stefano
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Claudia Scinicariello
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Marco Giuffrè
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Valerio De Santis
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Pietro Rossi
- Cardiology Division, Arrhytmology Unit, S. Giovanni Calibita Hospital, 00186 Rome, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, 00185 Rome, Italy
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Piccirillo G, Moscucci F, Corrao A, Carnovale M, Di Diego I, Lospinuso I, Caltabiano C, Mezzadri M, Magrì D. Time and Frequency Repolarization Domains in Elderly Candidates to Transcatheter Aortic Valve Replacement. Clin Ter 2023; 174:139-145. [PMID: 36920130 DOI: 10.7417/ct.2023.2510] [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] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Background and aim Aortic valve stenosis (AVS) is a well-known risk factor for sudden cardiac death. Therefore, some non-invasive, electrocardiographic markers are capable to stratify the risk of sudden death at rest and during light mental challenge [mini-mental state examination (MMSE) administration]. Method We compared short period RR, QT and Te intervals variability in 42 candidates to and 12 age-matched hypertensive control patients at rest and during mental challenge. Results At rest, AVS patients showed a higher QT standard deviation (sd), QT low frequency power (LF), QT High Frequency (HF), Tpeak-Tend intervals sd (Te sd) and Te HF than the control group. During mental challenge AVS group showed a decrease of RR mean and RR HF, expressed in normalized units (NU), and an increase of RR total power (TP), RR LF, RR LF NU, RR LF, HF ratio (LF/HF). During this same mental test, QT sd, QT LF, QT HF, Te sd, Te LF, Te HF, QT variability index (VI), TeVI, QT normalized variance (VN) were higher in AVS patients than the control group. During mental challenge Te LF (r:0.825, p<0.05) was significantly associated to: serum albumin (β:-0.473, p<0.001), MMSE (β:-0.267, p:0.038), diastolic blood pressure (β:-0.443, p:0.03) and cardiac index (β:-0.303, p:0.029). Conclusion AVS patients showed temporal dispersion of ventricular repolarization phase, useful maker to individuate high risk patients. MMSE administration induced a sympathetic sinus activation and vagal deactivation in AVS subjects. Frailty and mental function influenced Te HF and Te LF.
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Affiliation(s)
- G Piccirillo
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - F Moscucci
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - A Corrao
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - M Carnovale
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - I Di Diego
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - I Lospinuso
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - C Caltabiano
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - M Mezzadri
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - D Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Piccirillo G, Moscucci F, Carnovale M, Bertani G, Lospinuso I, Di Diego I, Corrao A, Sabatino T, Zaccagnini G, Crapanzano D, Rossi P, Magrì D. QT and Tpeak-Tend interval variability: Predictive electrical markers of hospital stay length and mortality in acute decompensated heart failure. Preliminary data. Clin Cardiol 2022; 45:1192-1198. [PMID: 36082998 DOI: 10.1002/clc.23888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/21/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As previously reported, an increased repolarization temporal imbalance induces a higher risk of total/cardiovascular mortality. HYPOTHESIS The aim of this study was to assess if the electrocardiographic short period markers of repolarization temporal dispersion could be predictive of the hospital stay length and mortality in patients with acutely decompensated chronic heart failure (CHF). METHOD Mean, standard deviation (SD), and normalized variance (VN) of QT (QT) and Tpeak-Tend (Te) were obtained on 5-min ECG recording in 139 patients hospitalized for acutely decompensated CHF, subgrouping the patients for hospital length of stay (LoS): less or equal 1 week (≤1 W) and those with more than 1 week (>1 W). RESULTS We observed an increase of short-period repolarization variables (TeSD and TeVN, p < .05), a decrease of blood pressure (p < .05), lower ejection fraction (p < .05), and higher plasma level of biomarkers (NT-proBNP, p < .001; Troponin, p < .05) in >1 W LoS subjects. 30-day deceased subjects reported significantly higher levels of QTSD (p < .05), Te mean (p < .001), TeSD (p < .05), QTVN (p < .05) in comparison to the survivors. Multivariable Cox regression analysis reported that TeVN was a risk factor for longer hospital stay (hazard ratio: 1.04, 95% confidence limit: 1.01-1.08, p < .05); whereas, a longer Te mean was associated with higher mortality risk (hazard ratio: 1.02, 95% confidence limit: 1.01-1.03, p < .05). CONCLUSION A longer hospital stay is considered a clinical surrogate of CHF severity, we confirmed this finding. Therefore, these electrical and simple parameters could be used as noninvasive, transmissible, inexpensive markers of CHF severity and mortality.
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Affiliation(s)
- Gianfranco Piccirillo
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Federica Moscucci
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Myriam Carnovale
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Gaetano Bertani
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Ilaria Lospinuso
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Ilaria Di Diego
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Corrao
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Teresa Sabatino
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Giulia Zaccagnini
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Davide Crapanzano
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Pietro Rossi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita, Isola Tiberina, Rome, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Piccirillo G, Moscucci F, Corrao A, Carnovale M, Di Diego I, Lospinuso I, Caltabiano C, Mezzadri M, Rossi P, Magrì D. Noninvasive Hemodynamic Monitoring in Advanced Heart Failure Patients: New Approach for Target Treatments. Biomedicines 2022; 10:biomedicines10102407. [PMID: 36289669 PMCID: PMC9599112 DOI: 10.3390/biomedicines10102407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/24/2022] Open
Abstract
Using bio-impedance to deduce some hemodynamic parameters combined with some short-term ECG temporal dispersion intervals, and measuring myocardial depolarization, intraventricular conduction, and repolarization. A total of 65 in-hospital patients (M/F:35/30) were enrolled, 39 with HFrEF and 26 HFpEF, in New York Heart Association (NYHA) class IV. Stroke volume (SVI), cardiac indexes (CI), left ventricular ejection fraction (LVEFBIO), end diastolic volume (LV-EDV), and other systolic and diastolic parameters were noninvasively obtained at enrollment and at hospital discharge. At the same time, QR, QRS, QT, ST, Tpeak-Tend (Te) interval mean, and standard deviation (SD) from 5 min ECG recordings were obtained. At baseline, HFrEF patients reported significantly lower SVI (p < 0.05), CI (p < 0.05), and LVEF (p < 0.001) than HFpEF patients; moreover, HFrEF patients also showed increased LV-EDV (p < 0.05), QR, QRS, QT, ST, and Te means (p < 0.05) and standard deviations (p < 0.05) in comparison to HFpEF subjects. Multivariable logistic regression analysis reported a significant correlation between hospital mortality and Te mean (odds ratio: 1.03, 95% confidence limit: 1.01−1.06, p: 0.01). Fifty-seven percent of patients were considered responders to optimal medical therapy and, at discharge, they had significantly reduced NT-proBNP, (p < 0.001), heart rate (p < 0.05), and TeSD (p < 0.001). LVEF, obtained by transthoracic echocardiography, and LVEFBIO were significantly related (r: 0.781, p < 0.001), but these two parameters showed a low agreement limit. Noninvasive hemodynamic and ECG-derived parameters were useful to highlight the difference between HFrEF and HFpEF and between responders and nonresponders to the optimal medical therapy. Short-period bioimpedance and electrocardiographic data should be deeply evaluated to determine possible advantages in the therapeutic and prognostic approach in severe CHF.
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Affiliation(s)
- Gianfranco Piccirillo
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy
| | - Federica Moscucci
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy
- Correspondence: ; Tel.: +39-06-4997-0118
| | - Andrea Corrao
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy
| | - Myriam Carnovale
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy
| | - Ilaria Di Diego
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy
| | - Ilaria Lospinuso
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy
| | - Cristina Caltabiano
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy
| | - Martina Mezzadri
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy
| | - Pietro Rossi
- Arrhytmology Unit, Cardiology Division, S. Giovanni Calibita, Isola Tiberina, 00186 Rome, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, S. Andrea Hospital, “Sapienza” University of Rome, 00186 Rome, Italy
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Piccirillo G, Moscucci F, Carnovale M, Corrao A, Di Diego I, Lospinuso I, Caltabiano C, Mezzadri M, Rossi P, Magrì D. Short-Period Temporal Dispersion Repolarization Markers in Elderly Patients with Decompensated Heart Failure. Clin Ter 2022; 173:356-361. [PMID: 35857054 DOI: 10.7417/ct.2022.2446] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Aging and chronic heart failure (CHF) are responsible for the temporal inhomogeneity of electrocardiogram (ECG) repolarization phase. In the past, short period repolarization-dispersion parameters were used as makers of mortality risk in different heart diseases, yet. Aim of this work was to evaluate risk of mortality or worsening condition in CHF elderly subjects by mean of these repo-larization variables. METHOD An observational, prospective cohort study was performed, collecting 5 minutes ECG recordings to assess the mean and standard deviation (SD) of the following variables: QT end (QTe), QT peak (QTp) and T peak to T end (Te) in 117 decompensated CHF (age range: from 49 to 103 years). 30-day mortality and high levels of NT-pro BNP (<75 percentile) were considered markers of decompensated CHF. RESULTS A total of 27 patients (23%) died during the 30-day follow-up (overall mortality rate 23%). Te mean (odd ratio (OR): 1.04, 95% confidence limit (Cl 7u): 1.02-1.09, p<0.01), NT-pro BNP (OR: 1.00, 95% cl: 1.00-1.00, p<0.01) and LVMI (OR : 0.98, 95% cl: 0.96-0.10, p<0.05) were associated to risk of mortality at the multivariable logistic analysis. On the contrary, the same statistical analysis selected TeSD (OR: 1.36, 95% cl: 1.16-1.59, p<0.001) and LVEF (OR: 0.91, 95% cl: 0.87-0.95, p<0.001) as marker of decompensated CHF. CONCLUSION In decompensated CHF elderly subjects, Te mean seem be associated to mortality and TeSD could be considered a risk factor for CHF worsening and complications. These evidences could provide useful tools for telemonitoring CHF elderly patients, amelio-rating treatments and outcomes.
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Affiliation(s)
- G Piccirillo
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - F Moscucci
- Policlinico Umberto I, DAI Internal Medicine and Medical Specialties, Rome, Italy
| | - M Carnovale
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - A Corrao
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - I Di Diego
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - I Lospinuso
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - C Caltabiano
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - M Mezzadri
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - P Rossi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita, Isola Tiberina, Rome, Italy
| | - D Magrì
- Department of Clinical and Molecular Medicine, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Piccirillo G, Moscucci F, Bertani G, Lospinuso I, Sabatino T, Zaccagnini G, Crapanzano D, Diego ID, Corrao A, Rossi P, Magrì D. Short-period temporal repolarization dispersion in subjects with atrial fibrillation and decompensated heart failure. Pacing Clin Electrophysiol 2021; 44:327-333. [PMID: 33382121 DOI: 10.1111/pace.14158] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/13/2020] [Accepted: 12/27/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES The association between chronic heart failure (CHF) and permanent atrial fibrillation is very frequent. The repolarization duration was already found predictive for atrial fibrillation. Aim of this study was to evaluate the influence of atrial fibrillation on short period repolarization variables in decompensated CHF patients. METHOD We used 5 min ECG recordings to assess the mean, standard deviation (SD), and normalized variance (NV) of the following variables: QT end (QTe), QT peak (QTp), and T peak to T end (Te) in 121 decompensated CHF, of whom 40 had permanent atrial fibrillation, too. We reported also the 30-day mortality. RESULTS QTpSD (p < .01), TeSD (p < .01), QTpVN (p < .01), and TeVN (p < .01) were higher in the atrial fibrillation than among sinus rhythm CHF subjects. Multivariable logistic analysis selected only TeSD (odd ratio, o.r.: 1.32, 95% confidence interval, c.i.: 1.06-1.65, p: .015) associated with atrial fibrillation. A total of 27 patients died during the 30-days follow-up (overall mortality rate 22%), 7 (18%), and 20 (25%) respectively in the atrial fibrillation and sinus rhythm patients. Furthermore, the following variables were associated to the morality risk: NT-pro Brain Natriuretic Peptide (o.r.: 1.00, 95% c.i.: 1.00-1.00, p: .041), left ventricular end diastolic diameter (o.r.: 0.81, 95% c.i.: 0.67-0.96, p: .010), and Te mean (o.r.: 1.04, 95% c.i.: 1.02-1.09, p: .012). CONCLUSION In decompensated CHF subjects, Te mean seems be associated to mortality and TeSD to the permanent atrial fibrillation. We could hypothesize that, during severe CHF, the multi-level ionic CHF channel derangement could be critical in influencing these non-invasive markers. (ClinicalTrials.gov number, NCT04127162).
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Federica Moscucci
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Gaetano Bertani
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Ilaria Lospinuso
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Teresa Sabatino
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Giulia Zaccagnini
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Davide Crapanzano
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Ilaria Di Diego
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Andrea Corrao
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Pietro Rossi
- Cardiology Division, Arrhytmology Unit, S. Giovanni Calibita, Isola Tiberina, Rome, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Piccirillo G, Moscucci F, Iorio CD, Fabietti M, Mastropietri F, Crapanzano D, Bertani G, Sabatino T, Zaccagnini G, Lospinuso I, Magrì D. Time- and frequency-domain analysis of repolarization phase during recovery from exercise in healthy subjects. Pacing Clin Electrophysiol 2020; 43:1096-1103. [PMID: 32789871 DOI: 10.1111/pace.14038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/28/2020] [Accepted: 08/09/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND/AIM Recently, data from temporal dispersion of myocardial repolarization analysis have gained a capital role in the sudden cardiac death risk stratification. Aim of this study was to evaluate the influence of heart rate, autonomic nervous system, and controlled breathing on different myocardial repolarization markers in healthy subjects. METHOD Myocardial repolarization dispersion markers from short-period (5 minutes) electrocardiogram (ECG) analysis (time and frequency domain) have been obtained in 21 healthy volunteers during the following conditions: free breathing (rest); controlled breathing (resp); the first 5 minutes of postexercise recovery phases (exercisePeak ), maximum sympathetic activation; and during the second 5 minutes of postexercise recovery phases (exerciseRecovery ), intermediate sympathetic activation. Finally, we analyzed the whole repolarization (QTe), the QT peak (QTp), and T peak - T end intervals (Te). RESULTS During the exercisePeak , major part of repolarization variables changed in comparison to the rest and resp conditions. Particularly, QTe, QTp, and Te standard deviations (QTeSD , QTpSD , and TeSD ); variability indexes (QTeVI and QTpVI), normalized variances (QTeVN, QTpVN, and TeVN); and the ratio between short-term QTe, QTp, and Te variability RR (STVQTe/RR , STVQTp/RR, and STVTe/RR ) increased. During exerciseRecovery , QTpSD (P < .05), QTpVI (P < .05), QTeVN (P < .05), QTpVN (P < .001), TeVN (P < .05), STVQTe/RR (P < .05), STVQTp/RR (P < .001), and STVTe/RR (P < .001) were significantly higher in comparison to the rest. The slope between QTe (0.24 ± 0.06) or QTp (0.17 ± 0.06) and RR were significantly higher than Te (0.07 ± 0.06, P < .001). CONCLUSION Heart rate and sympathetic activity, obtained during exercise, seem able to influence the time domain markers of myocardial repolarization dispersion in healthy subjects, whereas they do not alter any spectral components.
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federica Moscucci
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Claudia Di Iorio
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Marcella Fabietti
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Fabiola Mastropietri
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Davide Crapanzano
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gaetano Bertani
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Teresa Sabatino
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giulia Zaccagnini
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Ilaria Lospinuso
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Piccirillo G, Moscucci F, Mariani MV, Di Iorio C, Fabietti M, Mastropietri F, Crapanzano D, Bertani G, Sabatino T, Zaccagnini G, Lospinuso I, Rossi P, Magrì D. Hospital mortality in decompensated heart failure. A pilot study. J Electrocardiol 2020; 61:147-152. [PMID: 32629315 DOI: 10.1016/j.jelectrocard.2020.05.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/29/2020] [Accepted: 05/09/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND/AIM Heart failure is a leading cause of morbidity and mortality worldwide and it is a major cause of emergency department access for cardiovascular disease patients. Aim of this study was to identify the electrocardiographic (ECG) markers, based on short-term temporal repolarization dispersion, capable to individuate decompensated chronic heart failure (CHF) patients at high mortality risk. METHODS We obtained the following variables from an ECG recording, monitored via mobile phone, during 5-minute recordings in decompensated CHF patients: RR, QT end (QTe), QT peak (QTp) and T peak to T end (Te) and we calculated mean, standard deviation (SD) and normalized index (N). RESULTS In-hospital mortality occurred for 25 subjects on 101 studied (25%). Deceased patients showed higher QTeSD (p < 0.01), Te mean (p < 0.01), TeSD (p < 0.05), QTeVN (p < 0.05) than the surviving group. Logistic multivariable analysis evidenced that Te mean was a significant predictor of in-hospital mortality (odd ratio: 0.09, 95% confidence limit: 0.02-0.35, p: 0.001). At multiple regression analysis, TeSD was significantly and positively related only to the NT-pro BNP levels (r: 0.540; p < 0.001). The Te mean (AUC: 0.677 p < 0.01) and TeSD (AUC: 0.647, p: 0.05) showed significant sensitivity/specificity for the event. CONCLUSIONS The Te mean and TeSD seem to be a promising noninvasive clinical marker able to identify patients with decompensated CHF at high risk of in-hospital mortality.
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Federica Moscucci
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy.
| | - Marco Valerio Mariani
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Claudia Di Iorio
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Marcella Fabietti
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Fabiola Mastropietri
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Davide Crapanzano
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Gaetano Bertani
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Teresa Sabatino
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Giulia Zaccagnini
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Ilaria Lospinuso
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Pietro Rossi
- Division of Cardiology, S. Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina, Piazza Ponte dei Quattro Capi, 39 186 Roma, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035/1039, k00189 Rome, Italy
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Piccirillo G, Moscucci F, Bertani G, Lospinuso I, Mastropietri F, Fabietti M, Sabatino T, Zaccagnini G, Crapanzano D, Di Diego I, Corrao A, Rossi P, Magrì D. Short-Period Temporal Dispersion Repolarization Markers Predict 30-Days Mortality in Decompensated Heart Failure. J Clin Med 2020; 9:jcm9061879. [PMID: 32560151 PMCID: PMC7356287 DOI: 10.3390/jcm9061879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/29/2020] [Accepted: 06/11/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Electrocardiographic (ECG) markers of the temporal dispersion of the myocardial repolarization phase have been shown able to identify chronic heart failure (CHF) patients at high mortality risk. The present prospective single-center study sought to investigate in a well-characterized cohort of decompensated heart failure (HF) patients the ability of short-term myocardial temporal dispersion ECG variables in predicting the 30-day mortality, as well as their relationship with N-terminal Pro Brain Natriuretic Peptide (NT-proBNP) plasmatic values. METHOD One hundred and thirteen subjects (male: 59, 67.8%) with decompensated CHF underwent 5 min of ECG recording, via a mobile phone. We obtained QT end (QTe), QT peak (QTp) and T peak to T end (Te) and calculated the mean, standard deviation (SD), and normalized index (VN). RESULTS Death occurred for 27 subjects (24%) within 30 days after admission. Most of the repolarization indexes (QTe mean (p < 0.05), QTeSD (p < 0.01), QTpSD (p < 0.05), mean Te (p < 0.05), TeSD (p < 0.001) QTeVN (p < 0.05) and TeVN (p < 0.01)) were significantly higher in those CHF patients with the highest NT-proBNP (>75th percentile). In all the ECG data, only TeSD was significantly and positively related to the NT-proBNP levels (r: 0.471; p < 0.001). In the receiver operating characteristic (ROC) analysis, the highest accuracy for 30-day mortality was found for QTeSD (area under curve, AUC: 0.705, p < 0.01) and mean Te (AUC: 0.680, p < 0.01), whereas for the NT-proBNP values higher than the 75th percentile, the highest accuracy was found for TeSD (AUC: 0.736, p < 0.001) and QTeSD (AUC: 0.696, p < 0.01). CONCLUSION Both mean Te and TeSD could be considered as reliable markers of worsening HF and of 30-day mortality. Although larger and possibly interventional studies are needed to confirm our preliminary finding, these non-invasive and transmissible ECG parameters could be helpful in the remote monitoring of advanced HF patients and, possibly, in their clinical management. (ClinicalTrials.gov number, NCT04127162).
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Affiliation(s)
- Gianfranco Piccirillo
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Federica Moscucci
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
- Correspondence: ; Tel.: +39-06-4997-0118
| | - Gaetano Bertani
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Ilaria Lospinuso
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Fabiola Mastropietri
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Marcella Fabietti
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Teresa Sabatino
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Giulia Zaccagnini
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Davide Crapanzano
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Ilaria Di Diego
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Andrea Corrao
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Pietro Rossi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita, Isola Tiberina, 00186 Rome, Italy;
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy;
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Sciomer S, Moscucci F, Magrì D, Badagliacca R, Piccirillo G, Agostoni P. SARS-CoV-2 spread in Northern Italy: what about the pollution role? Environ Monit Assess 2020; 192:325. [PMID: 32363409 PMCID: PMC7196178 DOI: 10.1007/s10661-020-08317-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/21/2020] [Indexed: 05/20/2023]
Abstract
The recent epidemic of the new SARS-CoV-2 in the northern regions of Italy is putting the organization of the Italian health system under serious attack. The current emergency requires all possible efforts to stem the spread of the virus. In this context, it is clear that we have the urgent need to rely upon etiopathogenetic data, in order to do all possible efforts to block the epidemic. However, observing the trend of the infections in China and the geographic areas of the main outbreaks, it could be hypothesized that air pollution plays a role. In particular, it has been previously demonstrated, in specific populations, a role of particulate matter in worsening clinical presentation of virus infection in airways. Without prejudice to the ascertained virus spread by air droplets or contaminated surfaces, the factors that could have favored its spread remain to be investigated. Moreover, if these observations were to be confirmed, when the health emergency is resolved, it will be mandatory to redesign an economic-productive model in balance with the environment.
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Affiliation(s)
- Susanna Sciomer
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Policlinico Umberto I Hospital, University of Rome "Sapienza", Viale del Policlinico n.155, 00186, Rome, Italy
| | - Federica Moscucci
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Policlinico Umberto I Hospital, University of Rome "Sapienza", Viale del Policlinico n.155, 00186, Rome, Italy.
| | - Damiano Magrì
- Department of Clinical and Experimental Medicine, "Sapienza", Sant'Andrea Hospital, University of Rome, Via di Grottarossa 1035-1029, 00189, Rome, Italy
| | - Roberto Badagliacca
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Policlinico Umberto I Hospital, University of Rome "Sapienza", Viale del Policlinico n.155, 00186, Rome, Italy
| | - Gianfranco Piccirillo
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Policlinico Umberto I Hospital, University of Rome "Sapienza", Viale del Policlinico n.155, 00186, Rome, Italy
| | - Piergiuseppe Agostoni
- Monzino Cardiology Center, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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Rossi P, Cauti FM, Limite LR, Iaia L, Allegretti G, Di Renzi P, Longa GD, Quaglione R, Piccirillo G, Bianchi S. Interatrial conduction times in paroxysmal atrial fibrillation patients with normal atrial volume and their correlation with areas of local prolonged bipolar electrograms. J Electrocardiol 2019; 58:19-26. [PMID: 31678717 DOI: 10.1016/j.jelectrocard.2019.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 07/04/2019] [Revised: 08/27/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent evidence has shown that the presence of abnormal substrate can be demonstrated also among patients with "lone" AF. OBJECTIVES Interatrial conduction slowing is likely to characterize patients with paroxysmal atrial fibrillation (AF) and it could be correlated to the left atrium area of prolonged local bipolar endocardial electrograms. METHODS P-wave duration (PWD), amplified PWD and endocavitary interatrial conduction time (IACT), were analyzed in 60 patients; 30 undergoing de novo ablation for paroxysmal AF with normal atrial volumes and without any other cardiac disease and 30 of similar age undergoing electrophysiological study for atrioventricular nodal reentrant tachycardia or atrioventricular re- entrant tachycardia. In patients with AF, voltage maps and local bipolar electrograms (LBE) duration map were evaluated. RESULTS Although PWD was <120 ms in 28 patients with AF and in 29 controls, patients with AF exhibited longer PWD, amplified-PWD and IACT. Although low-voltage areas (<0.5 mV) were not found in the study population, 28 of them demonstrated areas with LBE longer than 60 ms. These LBE were found mainly in the roof of the left atrium and their extension was correlated to IACT (R = 0.51, p = 0.004). IACT >135.5 ms identified the subjects who experienced AF with 90% sensitivity and 97% specificity. CONCLUSION A subclinical interatrial conduction disturbance is demonstrable in subjects with paroxysmal AF and normal left atrial volume. IACT has a good correlation to the areas of abnormal LBE in the left atrium. IACT >135 ms identified subjects who have experienced AF.
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Affiliation(s)
- Pietro Rossi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy.
| | - Filippo Maria Cauti
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Luca Rosario Limite
- Department of Molecular and Clinical Medicine, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Luigi Iaia
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | | | - Paolo Di Renzi
- Radiology Division, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Giulia Della Longa
- Radiology Division, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Raffaele Quaglione
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic and Geriatric Sciences, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Gianfranco Piccirillo
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic and Geriatric Sciences, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Stefano Bianchi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
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Piccirillo G, Moscucci F, Pofi R, D'Alessandro G, Minnetti M, Isidori AM, Francomano D, Lenzi A, Puddu PE, Alexandre J, Magrì D, Aversa A. Changes in left ventricular repolarization after short-term testosterone replacement therapy in hypogonadal males. J Endocrinol Invest 2019; 42:1051-1065. [PMID: 30838540 PMCID: PMC6692303 DOI: 10.1007/s40618-019-01026-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 02/14/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Evidences suggest that androgen deficiency is associated with sudden cardiac death (SCD). Our purpose was to analyse some electrocardiographic (ECG) markers of repolarization phase in hypogonadal patients either at baseline or after testosterone replacement therapy (TRT). PATIENTS AND METHODS Baseline and after 6 months of testosterone replacement therapy, 14 hypogonadal patients and 10 age-matched controls underwent a short-term ECG recordings at rest and immediately after a maximal exercise test. The following ECG parameters have been collected: QTe (the interval between the q wave the end of T wave), QTp (the interval between the q wave and the peak of T wave), and Te (the interval between the peak and the end of T wave). RESULTS At baseline, in the hypogonadal patients, corrected QTe and QTp values were longer at rest than in the controls at rest (p < 0.05), whereas, during the recovery phase, only the QTp remained significantly longer (p < 0.05). After TRT, hypogonadal patients showed an improvement only in Te (p < 0.05). Conversely, any difference between hypogonadal patients and control subjects was found with respect to the markers of temporal dispersion of repolarization phases, except for a worse QTp → Te coherence (p = 0.001) obtained during the recovery phase. CONCLUSIONS In conclusion, at rest, hypogonadal patients suffer from a stable increase in the myocardial repolarization phase without an increase in its temporal dispersion and, hence, the SCD risk seems to be low.
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Affiliation(s)
- G Piccirillo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico, 00185, Rome, Italy
| | - F Moscucci
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico, 00185, Rome, Italy.
| | - R Pofi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - G D'Alessandro
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico, 00185, Rome, Italy
| | - M Minnetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - D Francomano
- Division of Internal Medicine and Endocrinology, Madonna delle Grazie Hospital, Velletri, Rome, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - P E Puddu
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico, 00185, Rome, Italy
- EA 4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie reperfusion myocardique, Université de Caen, Normandie, France
| | - J Alexandre
- EA 4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie reperfusion myocardique, Université de Caen, Normandie, France
- Department of Pharmacology, CHU Caen, Caen, France
| | - D Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - A Aversa
- Department of Experimental and Clinical Medicine, University of Catanzaro « Magna Grecia », Catanzaro, Italy
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Piccirillo G, Moscucci F, Fabietti M, Parrotta I, Mastropietri F, Di Iorio C, Sabatino T, Crapanzano D, Vespignani G, Mariani MV, Salvi N, Magrì D. Arrhythmic Risk in Elderly Patients Candidates to Transcatheter Aortic Valve Replacement: Predictive Role of Repolarization Temporal Dispersion. Front Physiol 2019; 10:991. [PMID: 31447689 PMCID: PMC6691061 DOI: 10.3389/fphys.2019.00991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/18/2019] [Indexed: 12/30/2022] Open
Abstract
Background/Aim Degenerative aortic valve stenosis (AS) is associated to ventricular arrhythmias and sudden cardiac death, as well as mental stress in specific patients. In such a context, substrate, autonomic imbalance as well as repolarization dispersion abnormalities play an undoubted role. Aim of the study was to evaluate the increase of premature ventricular contractions (PVC) and complex ventricular arrhythmias during mental stress in elderly patients candidate to the transcatheter aortic valve replacement (TAVR). Methods In eighty-one elderly patients with AS we calculated several short-period RR- and QT-derived variables at rest, during controlled breathing and during mild mental stress, the latter being represented by a mini-mental state evaluation (MMSE). Results All the myocardial repolarization dispersion markers worsened during mental stress (p < 0.05). Furthermore, during MMSE, low frequency component of the RR variability increased significantly both as absolute power (LFRR) and normalized units (LFRRN U) (p < 0.05) as well as the low-high frequency ratio (LFRR/HFRR) (p < 0.05). Eventually, twenty-four (30%) and twelve (15%) patients increased significantly PVC and, respectively, complex ventricular arrhythmias during the MMSE administration. At multivariate logistic regression analysis, the standard deviation of QTend (QTesd), obtained at rest, was predictive of increased PVC (odd ratio: 1.54, 95% CI 1.14-2.08; p = 0.005) and complex ventricular arrhythmias (odd ratio: 2.31, 95% CI 1.40-3.83; p = 0.001) during MMSE. The QTesd showed the widest sensitive-specificity area under the curve for the increase of PVC (AUC: 0.699, 95% CI: 0.576-0.822, p < 0.05) and complex ventricular arrhythmias (AUC: 0.801, 95% CI: 0.648-0.954, p < 0.05). Conclusion In elderly with AS ventricular arrhythmias worsened during a simple cognitive assessment, this events being a possible further burden on the outcome of TAVR. QTesd might be useful to identify those patients with the highest risk of ventricular arrhythmias. Whether the TAVR could led to a QTesd reduction and, hence, to a reduction of the arrhythmic burden in this setting of patients is worthy to be investigated.
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Federica Moscucci
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Marcella Fabietti
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Ilaria Parrotta
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Fabiola Mastropietri
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Claudia Di Iorio
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Teresa Sabatino
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Davide Crapanzano
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Giulia Vespignani
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Marco Valerio Mariani
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Nicolò Salvi
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Piccirillo G, Carvajal Berrio DA, Laurita A, Pepe A, Bochicchio B, Schenke-Layland K, Hinderer S. Controlled and tuneable drug release from electrospun fibers and a non-invasive approach for cytotoxicity testing. Sci Rep 2019; 9:3446. [PMID: 30837604 PMCID: PMC6401126 DOI: 10.1038/s41598-019-40079-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/08/2019] [Indexed: 01/10/2023] Open
Abstract
Electrospinning is an attractive method to generate drug releasing systems. In this work, we encapsulated the cell death-inducing drug Diclofenac (DCF) in an electrospun poly-L-lactide (PLA) scaffold. The scaffold offers a system for a sustained and controlled delivery of the cytotoxic DCF over time making it clinically favourable by achieving a prolonged therapeutic effect. We exposed human dermal fibroblasts (HDFs) to the drug-eluting scaffold and employed multiphoton microscopy and fluorescence lifetime imaging microscopy. These methods were suitable for non-invasive and marker-independent assessment of the cytotoxic effects. Released DCF induced changes in cell morphology and glycolytic activity. Furthermore, we showed that drug release can be influenced by adding dimethyl sulfoxide as a co-solvent for electrospinning. Interestingly, without affecting the drug diffusion mechanism, the resulting PLA scaffolds showed altered fibre morphology and enhanced initial DCF burst release. The here described model could represent an interesting way to control the diffusion of encapsulated bio-active molecules and test them using a marker-independent, non-invasive approach.
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Affiliation(s)
- G Piccirillo
- Department of Science, University of Basilicata, 85100, Potenza, Italy
- Department of Women's Health, Research Institute for Women's Health, Eberhard-Karls-University Tübingen, 72076, Tübingen, Germany
| | - D A Carvajal Berrio
- Department of Women's Health, Research Institute for Women's Health, Eberhard-Karls-University Tübingen, 72076, Tübingen, Germany
| | - A Laurita
- Department of Science, University of Basilicata, 85100, Potenza, Italy
| | - A Pepe
- Department of Science, University of Basilicata, 85100, Potenza, Italy
| | - B Bochicchio
- Department of Science, University of Basilicata, 85100, Potenza, Italy
| | - K Schenke-Layland
- Department of Women's Health, Research Institute for Women's Health, Eberhard-Karls-University Tübingen, 72076, Tübingen, Germany
- Department of Biophysical Chemistry, Natural and Medical Sciences Institute (NMI) at the University of Tübingen, 72770, Reutlingen, Germany
- Department of Medicine/Cardiology, Cardiovascular Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - S Hinderer
- Department of Women's Health, Research Institute for Women's Health, Eberhard-Karls-University Tübingen, 72076, Tübingen, Germany.
- Department of Biophysical Chemistry, Natural and Medical Sciences Institute (NMI) at the University of Tübingen, 72770, Reutlingen, Germany.
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Piccirillo G, Nocco M, Moisè A, Lionetti M, Naso C, Carlo SD, Marigliano V. Response: Vitamin C in Heart Failure: Hope! Hypertension 2019. [DOI: 10.1161/01.hyp.0000112028.46741.a9] [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: 11/16/2022]
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Piccirillo G, Moscucci F, Mastropietri F, Di Iorio C, Mariani MV, Fabietti M, Stricchiola GM, Parrotta I, Sardella G, Mancone M, Magrì D. Possible predictive role of electrical risk score on transcatheter aortic valve replacement outcomes in older patients: preliminary data. Clin Interv Aging 2018; 13:1657-1667. [PMID: 30237702 PMCID: PMC6138964 DOI: 10.2147/cia.s170226] [Citation(s) in RCA: 5] [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] [Indexed: 12/02/2022] Open
Abstract
Objectives To evaluate the predicative power of the electrical risk score (ERS), a noninvasive and inexpensive test obtained by means of a standard 12-lead electrocardiogram (ECG), in a cohort of elderly patients who had undergone transcatheter aortic valve replacement (TAVR). Methods Survivors and non-survivors after TAVR at 1-year follow-up were compared in respect to the pre-procedural ERS as well as a number of other clinical and instrumental variables. ERS is composed of seven simple ECG markers: heart rate (>75 bpm); QRS duration (>110 ms); left ventricular hypertrophy (Sokolow–Lyon criteria); delayed QRS transition zone (≥ V4); frontal QRS-T angle (>90°); long QTBazett (>450 ms for men and >460 in women) or JTBazett (330 ms for men and >340 ms for women); and long Tpeak to Tend interval (Tp-e) (>89 ms). The trial was registered in ClinicalTrials.gov as NCT03145376. Results A total of 40 patients were evaluated. During the follow-up, the all-cause mortality rate was 25% (ten patients) with 15% of cardiovascular death (six patients). The ERS was the strongest predictor of all-cause (odds ratio 3.73, 95% CI: 1.44–9.66, P<0.05) or cardiovascular (odds ratio 3.95, 95% CI: 1.09–14.27, P<0.05) mortality. Receiver operating characteristic curves showed that ERS had the widest significant sensitivity-specificity area under the curve (AUC) predicting all-cause (AUC: 0.855, P<0.05) or cardiovascular mortality (AUC: 0.908, P<0.05). Conclusion ERS seems to be a useful noninvasive tool able to stratify the risk of mortality in 1-year follow-up of TAVR patients. These findings, however, require larger trials to be confirmed.
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Affiliation(s)
- Gianfranco Piccirillo
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy,
| | - Federica Moscucci
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy,
| | - Fabiola Mastropietri
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy,
| | - Claudia Di Iorio
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy,
| | - Marco Valerio Mariani
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy,
| | - Marcella Fabietti
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy,
| | - Gaetana M Stricchiola
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy,
| | - Ilaria Parrotta
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy,
| | - Gennaro Sardella
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy,
| | - Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy,
| | - Damiano Magrì
- Department of Molecular and Clinical Medicine, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Piccirillo G, Magrì D, D'Alessandro G, Fiorucci C, Moscucci F, Di Iorio C, Mastropietri F, Parrotta I, Ogawa M, Lin SF, Chen PS. Oscillatory behavior of P wave duration and PR interval in experimental congestive heart failure: a preliminary study. Physiol Meas 2018; 39:035010. [PMID: 29393857 DOI: 10.1088/1361-6579/aaacab] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The relationship between the autonomic nervous system (ANS) modulation of the sinus node and heart rate variability has been extensively investigated. The current study sought to evaluate, in an animal experimental model of pacing-induced tachycardia congestive heart failure (CHF), a possible ANS influence on the P wave duration and PR interval oscillations. APPROACH Short-term (5 min) time and frequency domain analysis has been obtained in six dogs for the following electrocardiographic intervals: P wave duration (P), from the onset to peak of P wave (P p), from the onset of P wave to the q onset (PR) and from the end of P wave to the onset of q wave (P e R). Direct vagal nerve activity (VNA), stellate ganglion nerve activity (SGNA) and electrocardiogram (ECG) intervals have been evaluated contextually by implantation of three bipolar recording leads. MAIN RESULTS At the baseline, multiple regression analysis pointed out that VNA was strongly positively associated with the standard deviation of PP and P e R intervals (r 2:0.997, p < 0.05). The same variable was also positively associated with high-frequency (HF) of P expressed in normalized units, of P p, and of P e R (b: 0.001) (r 2: 0.993; p < 0.05). During CHF, most of the time and frequency domain variability significantly decreased from 20% to 50% in comparison to the baseline values (p < 0.05) and SGNA correlated inversely with the low frequency (LF) obtained from P e R (p < 0.05) and PR (p < 0.05) (r 2:0.899, p < 0.05). LF components, expressed in absolute and normalized power, obtained from all studied intervals, were reduced significantly during CHF. Any difference between the RR and PP spectral components was observed. SIGNIFICANCE The data showed a significant relationship between ANS and atrial ECG variables, independent of the cycle duration. In particular, the oscillations were vagal mediated at the baseline, while sympathetic mediated during CHF. Whereas P wave variability might have a clinical utility in CHF management, it needs to be addressed in specific studies.
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, 'La Sapienza' University of Rome, Rome, Italy. Division of Cardiology, Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, United States of America
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Piccirillo G, Lama J, Marzio P, Morelli S, Monteleone G, Mollace V, Violi F, Fimognari F. Nocturnal rise of urinary thromboxane B2 in patients with coronary artery disease. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1616561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Magrì D, Santolamazza C, Limite L, Mastromarino V, Casenghi M, Orlando P, Pagannone E, Musumeci MB, Maruotti A, Ricotta A, Oliviero G, Piccirillo G, Volpe M, Autore C. QT spatial dispersion and sudden cardiac death in hypertrophic cardiomyopathy: Time for reappraisal. J Cardiol 2017; 70:310-315. [PMID: 28341542 DOI: 10.1016/j.jjcc.2017.01.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/17/2017] [Accepted: 01/27/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND The 12-lead surface electrocardiographic (ECG) analysis is able to provide independent predictors of prognosis in several cardiovascular settings, including hypertrophic cardiomyopathy (HCM). The present single-center study investigated the possible ability of several ECG-derived variables in stratifying sudden cardiac death (SCD) risk and, possibly, in improving the accuracy of the 2014 European Society of Cardiology guidelines. METHODS A total of 221 consecutive HCM outpatients were recruited and prospectively followed. All of them underwent a full clinical and instrumental examination, including a 12-lead surface ECG to calculate the dispersion for the following intervals: QRS, Q-Tend (QT), Q-Tpeak (QTp), Tpeak-Tend (TpTe), J-Tpeak (JTp), and J-Tend (JT). The study composite end-point was SCD, aborted SCD, and appropriate implantable cardioverter defibrillator (ICD) interventions. RESULTS During a median follow-up of 4.4 years (25th-75th interquartile range: 2.4-9.4 years), 23 patients reached the end-point at 5-years (3 SCD, 3 aborted SCD, 17 appropriate ICD interventions). At multivariate analysis, the spatial QT dispersion corrected according to Bazett's formula (QTcd) remains independently associated to the study endpoint over the HCM Risk-SCD score (C-index 0.737). A QTcd cut-off value of 93ms showed the best accuracy in predicting the SCD endpoint within the entire HCM study cohort (sensitivity 56%, specificity 75%, positive predictive value 22%, negative predictive value 97%). CONCLUSION Our data suggest that the QTcd might be helpful in SCD risk stratification, particularly in those HCM categories classified at low-intermediate SCD risk according to the contemporary guidelines.
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Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy.
| | | | - Luca Limite
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy
| | | | - Matteo Casenghi
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy
| | - Paola Orlando
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy
| | - Erika Pagannone
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy
| | | | - Antonello Maruotti
- Department of Scienze Economiche, Politiche e delle Lingue Moderne, Libera Università SS Maria Assunta, Rome, Italy; Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK
| | - Agnese Ricotta
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy
| | - Giada Oliviero
- Department of Cardiovascular Sciences, University of Insubria, Varese, Italy
| | - Gianfranco Piccirillo
- Department of Cardiovascular, Respiratory, Anesthesiological, Nephrologic and Geriatrics Sciences, "Sapienza" University, Rome, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy; IRCCS, Neuromed, Pozzilli (IS), Italy
| | - Camillo Autore
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy
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Piccirillo G, Ottaviani C, Fiorucci C, Petrocchi N, Moscucci F, Di Iorio C, Mastropietri F, Parrotta I, Pascucci M, Magrì D. Transcranial direct current stimulation improves the QT variability index and autonomic cardiac control in healthy subjects older than 60 years. Clin Interv Aging 2016; 11:1687-1695. [PMID: 27895475 PMCID: PMC5117948 DOI: 10.2147/cia.s116194] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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] [Indexed: 12/12/2022] Open
Abstract
Background Noninvasive brain stimulation technique is an interesting tool to investigate the causal relation between cortical functioning and autonomic nervous system (ANS) responses. Objective The objective of this report is to evaluate whether anodal transcranial direct current stimulation (tDCS) over the temporal cortex influences short-period temporal ventricular repolarization dispersion and cardiovascular ANS control in elderly subjects. Subjects and methods In 50 healthy subjects (29 subjects younger than 60 years and 21 subjects older than 60 years) matched for gender, short-period RR and systolic blood pressure spectral variability, QT variability index (QTVI), and noninvasive hemodynamic data were obtained during anodal tDCS or sham stimulation. Results In the older group, the QTVI, low-frequency (LF) power expressed in normalized units, the ratio between LF and high-frequency (HF) power, and systemic peripheral resistances decreased, whereas HF power expressed in normalized units and α HF power increased during the active compared to the sham condition (P<0.05). Conclusion In healthy subjects older than 60 years, tDCS elicits cardiovascular and autonomic changes. Particularly, it improves temporal ventricular repolarization dispersion, reduces sinus sympathetic activity and systemic peripheral resistance, and increases vagal sinus activity and baroreflex sensitivity.
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Affiliation(s)
- Gianfranco Piccirillo
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | | | - Claudia Fiorucci
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | | | - Federica Moscucci
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | - Claudia Di Iorio
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | - Fabiola Mastropietri
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | - Ilaria Parrotta
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | - Matteo Pascucci
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, University of Rome "Sapienza", Rome, Italy
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Piccirillo G, Moscucci F, Fiorucci C, Di Iorio C, Mastropietri F, Magrì D. Time- and frequency-domain analysis of beat to beat P-wave duration, PR interval and RR interval can predict asystole as form of syncope during head-up tilt. Physiol Meas 2016; 37:1910-1924. [PMID: 27681167 DOI: 10.1088/0967-3334/37/11/1910] [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: 12/18/2022]
Abstract
To seek possible differences in short-period temporal RR interval, P-wave and PR interval dispersion and spectral coherence in patients with a head-up tilt test positive for vasovagal syncope with or without prolonged asystole, severe symptoms and at high risk of trauma. We retrospectively reviewed 5 min ECG and blood pressure recordings obtained at baseline, at rest and during head-up tilt in 40 patients diagnosed as having recurrent vasovagal syncope confirmed at a head-up tilt test. We analysed autoregressive spectral power for all the ECG-derived variables, focusing on temporal P-wave and PR interval dispersion indexes as well as their spectral coherence calculated on the same 5 min recordings at rest and during tilt. ECG recordings obtained during tilt before syncope showed significantly lower P → PR spectral coherence and higher RR standard deviations in patients with tilt-induced asystole than in those without (0.567 ± 0.097 versus 0.670 ± 0.127, p: 0.010 and 84 ± 36 versus 46 ± 22 ms2, p < 0.0001). Differences in the RR standard deviations persisted also on the last hundred beats (-100) (113 ± 54 versus 34 ± 17 ms2, p < 0.0001). Multiple regression analysis identified a significantly negative association between the maximum RR intervals and P → PR coherence at rest (β: -0.3, p < 0.05) and positive association with RR-100 standard deviation during tilt-induced syncope (β: 0.621, p < 0.001). P → PR spectral coherence could be used to assess the risk of prolonged asystole in patients with tilt-induced vasovagal syncope as well as as a possible surrogate for tilt-testing during these patients' follow-up.
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
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Piccirillo G, Moscucci F, Fiorucci C, D'Alessandro G, Pascucci M, Magrì D. P wave analysis and left ventricular systolic function in chronic heart failure. Possible insights form the P wave - PP interval spectral coherence. Minerva Cardioangiol 2016; 64:525-533. [PMID: 25720448] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Chronic increase in left ventricular filling pressure represents one of the most important mechanism underlying the structural, as well as the electrical, atrial chamber remodeling leading to atrial fibrillation. The present pilot pathophysiological study sought to investigate possible relationship between short-period cross-spectral coherence of P-Q, R-R and P-P intervals and echocardiographic indices of left ventricular and atrial function. METHODS Electrocardiographic single lead short-term cross-spectral analysis on P-Q and P-P intervals was performed in 31 patients with chronic heart failure (CHF). Twenty age and therapy matched hypertensive patients acted as control group. The interval between the beginning of P wave and its peak (Ppeak) was also analyzed. RESULTS Patients with CHF showed a significant lower PQ → PP and Ppeak → PP coherence (P<0.001) than the counterpart. At multivariate analysis only Ppeak → PP was independently associated to LVEF (r2:0.312; b:60; β:0.559; P<0.0001) and atrial volume (r2:-0.160; b:-0.15; β:-0.400, P<0.05). CONCLUSIONS Ppeak → PP coherence might be a simple marker of left ventricular and atrial function. Whether this index could be a useful noninvasive marker of increased left ventricular filling pressure and, possibly, of atrial fibrillation risk or not, it needs to be tested in larger prospective studies.
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Affiliation(s)
- Gianfranco Piccirillo
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiology and Geriatric Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy -
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Baumert M, Porta A, Vos MA, Malik M, Couderc JP, Laguna P, Piccirillo G, Smith GL, Tereshchenko LG, Volders PGA. QT interval variability in body surface ECG: measurement, physiological basis, and clinical value: position statement and consensus guidance endorsed by the European Heart Rhythm Association jointly with the ESC Working Group on Cardiac Cellular Electrophysiology. Europace 2016; 18:925-44. [PMID: 26823389 PMCID: PMC4905605 DOI: 10.1093/europace/euv405] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 12/20/2022] Open
Abstract
This consensus guideline discusses the electrocardiographic phenomenon of beat-to-beat QT interval variability (QTV) on surface electrocardiograms. The text covers measurement principles, physiological basis, and clinical value of QTV. Technical considerations include QT interval measurement and the relation between QTV and heart rate variability. Research frontiers of QTV include understanding of QTV physiology, systematic evaluation of the link between QTV and direct measures of neural activity, modelling of the QTV dependence on the variability of other physiological variables, distinction between QTV and general T wave shape variability, and assessing of the QTV utility for guiding therapy. Increased QTV appears to be a risk marker of arrhythmic and cardiovascular death. It remains to be established whether it can guide therapy alone or in combination with other risk factors. QT interval variability has a possible role in non-invasive assessment of tonic sympathetic activity.
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Affiliation(s)
- Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Marc A Vos
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marek Malik
- St Paul's Cardiac Electrophysiology, University of London, and National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, UK
| | - Jean-Philippe Couderc
- Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Pablo Laguna
- Zaragoza University and CIBER-BBN, Zaragoza, Spain
| | - Gianfranco Piccirillo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Università 'La Sapienza' Rome, Rome, Italy
| | - Godfrey L Smith
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Larisa G Tereshchenko
- Oregon Health and Science University, Knight Cardiovascular Institute, Portland, OR, USA
| | - Paul G A Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
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Nguyen BL, Iuliano S, Persi A, Ammirati F, Ciccaglioni A, Alessandri N, Gaudio C, Piccirillo G. NON-INVASIVE MARKERS OF DISPERSION OF REPOLARIZATION, VENTRICULAR ARRHYTHMIAS AND ICD THERAPIES IN POST-MYOCARDIAL INFARCTION PATIENTS WITH RELATIVELY PRESERVED LEFT VENTRICULAR EJECTION FRACTION. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30873-7] [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: 11/29/2022]
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Nguyen BL, Iannetta L, Persi A, Piccirillo G, Ammirati F, Ciccaglioni A, Alessandri N, Gaudio C, Puddu PE. LEFT VENTRICULAR TRANSMURAL REPOLARIZATION GRADIENT IN HUMANS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30742-2] [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: 11/28/2022]
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Piccirillo G, Moscucci F, Magrì D. [Syncope: physiopathology, diagnosis and therapy]. Clin Ter 2015; 166:e216-33. [PMID: 26152635 DOI: 10.7417/ct.2015.1857] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nowadays, syncope still generates complicated challenges for clinicians for the alarm it arises in patients and, at the same time, for the multiple causes it has determined by. In almost one third of cases, syncope is neuromediated, in young subjects in vasovagal, whereas in elderly is often determinated by carotid sinus hypersensitivity. These two kinds of syncope have two completely different diagnostic approach. In some cases pace-maker implantation will be suggested to avoid new syncope episodes. In a 20% of cases, the underlying cause is arrhythmic, most of all bradiarrhythmia which is treated with pace-maker implantation. In a little number of cases, syncope is caused by ventricular arrhythmias, that require the implantation of a defibrillator device. In this review, we analyze in detail every cause of syncope with its diagnostic and therapeutic approach.
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Affiliation(s)
- G Piccirillo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - F Moscucci
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - D Magrì
- Dipartimento di Medicina Clinica e Molecolare - Azienda Ospedaliera Sant' Andrea, University of Rome, Italy
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Alexandre J, Milliez P, Rouet R, Manrique A, Allouche S, Piccirillo G, Schiariti M, Puddu PE. Aldosterone and testosterone: two steroid hormones structurally related but with opposite electrophysiological properties during myocardial ischemia-reperfusion. Fundam Clin Pharmacol 2015; 29:341-51. [DOI: 10.1111/fcp.12122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 03/18/2015] [Accepted: 04/02/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Joachim Alexandre
- Department of Pharmacology; CHU de Caen; Caen F-14000 France
- Université de Caen Basse-Normandie; EA 4650 Signalisation; électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique; Caen F-14000 France
- Medical School; Université de Caen Basse-Normandie; Caen F-14000 France
| | - Paul Milliez
- Université de Caen Basse-Normandie; EA 4650 Signalisation; électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique; Caen F-14000 France
- Medical School; Université de Caen Basse-Normandie; Caen F-14000 France
- Department of Cardiology; CHU de Caen; Caen F-14000 France
| | - René Rouet
- Université de Caen Basse-Normandie; EA 4650 Signalisation; électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique; Caen F-14000 France
- Medical School; Université de Caen Basse-Normandie; Caen F-14000 France
| | - Alain Manrique
- Université de Caen Basse-Normandie; EA 4650 Signalisation; électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique; Caen F-14000 France
- Medical School; Université de Caen Basse-Normandie; Caen F-14000 France
- Department of Nuclear Medicine; CHU de Caen; Caen F-14000 France
| | - Stéphane Allouche
- Université de Caen Basse-Normandie; EA 4650 Signalisation; électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique; Caen F-14000 France
- Medical School; Université de Caen Basse-Normandie; Caen F-14000 France
- Department of Biochemistry; CHU de Caen; Caen F-14000 France
| | | | - Michele Schiariti
- Department of Cardiovascular Sciences; Sapienza University; Rome Italy
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Magrì D, Piccirillo G, Ricotta A, De Cecco CN, Mastromarino V, Serdoz A, Muscogiuri G, Gregori M, Casenghi M, Cauti FM, Oliviero G, Musumeci MB, Maruotti A, Autore C. Spatial QT Dispersion Predicts Nonsustained Ventricular Tachycardia and Correlates with Confined Systodiastolic Dysfunction in Hypertrophic Cardiomyopathy. Cardiology 2015; 131:122-9. [DOI: 10.1159/000377622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/28/2015] [Indexed: 11/19/2022]
Abstract
Objectives: An increased dispersion of myocardial repolarization represents one of the mechanisms underlying the arrhythmic risk in hypertrophic cardiomyopathy (HCM). We investigated spatial myocardial repolarization dispersion indices in HCM patients with nonsustained ventricular tachycardia (NSVT) and, contextually, their main clinical determinants. Methods: Fifty-two well-matched HCM outpatients were categorized into two groups according to the presence or the absence of NSVT at 24-hour Holter electrocardiogram (ECG) monitoring. Each patient underwent a clinical examination, including Doppler echocardiogram integrated with tissue Doppler imaging, cardiac magnetic resonance, and 12-lead surface ECG to calculate the dispersion for the following intervals: QRS, Q-Tend (QTe), Q-Tpeak, Tpeak-Tend (TpTe), J-Tpeak, and J-Tend. Results: The NSVT group showed only QTe dispersion and TpTe dispersion values to be significantly higher than their counterparts. NSVT occurrence was independently predicted by late gadolinium enhancement presence (p = 0.021) and QTe Bazett dispersion (p = 0.030), the latter strongly associated with the myocardial performance index (MPI) obtained at the basal segment of the interventricular septum (p = 0.0004). Conclusion: Our data support QTe dispersion as an easy and noninvasive tool for identifying HCM patients with NSVT propensity. The strong relationship between QTe dispersion and MPI allows us to hypothesize an intriguing link between electrical instability and confined myocardial areas of systodiastolic dysfunction.
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Nguyen BL, Capotosto L, Persi A, Placanica A, Rafique A, Piccirillo G, Gaudio C, Gang ES, Siegel RJ, Vitarelli A. Global and regional left ventricular strain indices in post-myocardial infarction patients with ventricular arrhythmias and moderately abnormal ejection fraction. Ultrasound Med Biol 2015; 41:407-417. [PMID: 25542492 DOI: 10.1016/j.ultrasmedbio.2014.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 06/09/2014] [Revised: 09/15/2014] [Accepted: 09/19/2014] [Indexed: 06/04/2023]
Abstract
The aim of the study described here was to compare myocardial strains in ischemic heart patients with and without sustained ventricular tachycardia (VT) and moderately abnormal left ventricular ejection fraction (LVEF) to investigate which index could better predict VT on the basis of the analysis of global and regional left ventricular (LV) dysfunction. We studied 467 patients with previous myocardial infarction and LVEF >35%. Fifty-one patients had documented VT, and 416 patients presented with no VT. LV volumes and score index were obtained by 2-D echocardiography. Longitudinal, radial and circumferential strains were determined. Strains of the infarct, border and remote zones were also obtained. There were no differences in standard LV 2-D parameters between patients with and those without VT. Receiver operating characteristic values were -12.7% for global longitudinal strain (area under the curve [AUC] = 0.72), -4.8% for posterior-inferior wall circumferential strain (AUC = 0.80), 61 ms for LV mechanical dispersion (AUC = 0.84), -10.1% for longitudinal strain of the border zone (AUC = 0.86) and -9.2% for circumferential strain of the border zone (AUC = 0.89). In patients with previous myocardial infarction and moderately abnormal LVEF, peri-infarct circumferential strain was the strongest predictor of documented ventricular arrhythmias among all strain quantitative indices. Additionally, strain values from posterior-inferior wall infarctions had a higher association with arrhythmic events compared with global strain.
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Affiliation(s)
| | | | | | | | - Asim Rafique
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Eli S Gang
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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Piccirillo G, Moscucci F, Pascucci M, Di Barba D, Montesanti D, Magrì D. Effects of weather on neurally mediated syncope tests. Int J Cardiol 2014; 176:1411-3. [PMID: 25129308 DOI: 10.1016/j.ijcard.2014.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 07/29/2014] [Accepted: 08/02/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
| | - Federica Moscucci
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Matteo Pascucci
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Daniele Di Barba
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Dalma Montesanti
- Dipartimento di Medicina Clinica e Molecolare - Azienda Ospedaliera Sant' Andrea, University of Rome, Rome, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare - Azienda Ospedaliera Sant' Andrea, University of Rome, Rome, Italy
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Piccirillo G, Moscucci F, Magrì D. [QT Variability Index as a tool for risk stratification of sudden cardiac death]. Recenti Prog Med 2014; 105:385-391. [PMID: 25282351 DOI: 10.1701/1626.17672] [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: 06/03/2023]
Abstract
Sudden cardiac death is the leading cause of mortality in patients with chronic heart failure (CHF) and history of myocardial infarction. Selection of patients at risk of sudden cardiac death is dramatically important to choose the correct therapeutic approach. The QT Variability Index (QTVI) is a non-invasive measure of repolarization lability that has been applied to a wide variety of subjects with cardiovascular disease. It is a ratio of normalized QT variability to normalized heart rate variability, and therefore includes an assessment of the autonomic nervous system tone. As opposed to T wave alternans, QTVI assesses variance in repolarization at all frequencies. Recent studies suggest that QTVI may help clinicians choosing the appropriate implantable cardiovester defibrillator timing implantation, in patients with dilated or hypertrophic cardiomyopathy or CHF because of its efficacy in patient evaluation and follow-up.
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Magrì D, De Cecco CN, Piccirillo G, Mastromarino V, Serdoz A, Muscogiuri G, Ricotta A, Gregori M, Marino L, Cauti FM, Pagannone E, Musumeci MB, Maruotti A, Autore C. Myocardial Repolarization Dispersion and Late Gadolinium Enhancement in Patients With Hypertrophic Cardiomyopathy. Circ J 2014; 78:1216-23. [DOI: 10.1253/circj.cj-13-1423] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 11/09/2022]
Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine, Sapienza University
| | - Carlo Nicola De Cecco
- Department of Radiological Sciences, Sapienza University
- Department of Radiology and Radiological Sciences, Medical University of South Carolina
| | - Gianfranco Piccirillo
- Department of Cardiovascular, Respiratory, Anesthesiological, Nephrologic and Geriatrics Sciences, Sapienza University
| | | | - Andrea Serdoz
- Department of Clinical and Molecular Medicine, Sapienza University
| | | | - Agnese Ricotta
- Department of Clinical and Molecular Medicine, Sapienza University
| | - Mario Gregori
- Department of Clinical and Molecular Medicine, Sapienza University
| | - Laura Marino
- Department of Clinical and Molecular Medicine, Sapienza University
| | | | - Erika Pagannone
- Department of Clinical and Molecular Medicine, Sapienza University
| | | | - Antonello Maruotti
- Department of Political Sciences, University Roma Tre
- Southampton Statistical Sciences Research Institute and School of Mathematics, University of Southampton
| | - Camillo Autore
- Department of Clinical and Molecular Medicine, Sapienza University
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Caiazzo G, Corbo D, Trojsi F, Piccirillo G, Cirillo M, Monsurrò MR, Esposito F, Tedeschi G. Distributed corpus callosum involvement in amyotrophic lateral sclerosis: a deterministic tractography study using q-ball imaging. J Neurol 2013; 261:27-36. [DOI: 10.1007/s00415-013-7144-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 10/01/2013] [Accepted: 10/04/2013] [Indexed: 12/14/2022]
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Piccirillo G, Lavorgna L, Tessitore A, Bonavita S, Cirillo M, Tortora F, Monsurrò M, Tedeschi G. Primary central nervous system lymphoma or vanishing tumor in a patient presenting a Parinaud's syndrome. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.2044] [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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Piccirillo G, Moscucci F, Pascucci M, Pappadà MA, D'Alessandro G, Rossi P, Quaglione R, Di Barba D, Barillà F, Magrì D. Influence of aging and chronic heart failure on temporal dispersion of myocardial repolarization. Clin Interv Aging 2013; 8:293-300. [PMID: 23662051 PMCID: PMC3646393 DOI: 10.2147/cia.s41879] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Indexed: 01/01/2023] Open
Abstract
Background and purpose: QT and Tpeak-Tend (Te) intervals are associated with sudden cardiac death
in patients with chronic heart failure (CHF). We studied age-dependent influence on short-term
temporal dispersion of these two variables in patients with postischemic CHF. Method: We grouped 75 CHF and 53 healthy control subjects into three age subsets: ≤50 years,
>50 years and ≤65 years, and >65 years. We then calculated the following
indices: QT and Te variability index (QTVI and TeVI), the ratio between the short-term variability
(STV) of QT or Te, and the STV of resting rate (RR) (QT/RR STV and Te/RR STV). Results: In all different age subgroups, patients with CHF showed a higher level of QTVI than age-matched
control subjects (≤50 years: P < 0.0001; >50 years and
≤65 years: P < 0.05; >65 years: P
< 0.05). Patients with CHF < 50 years old also had all repolarization variability
indices higher than normal age-matched controls (TeVI, P < 0.05; QT/RR STV,
P < 0.05; Te/RR STV, P < 0.05), whereas we did not
find any difference between the two older classes of subjects. Both QTVI
(r2: 0.178, P < 0.05) and TeVI
(r2: 0.433, P < 0.001) were positively related
to age in normal subjects, even if the first correlation was weaker than the second one. Conclusion: Our data showed that QTVI could be used in all ages to evaluate repolarization temporal
liability, whereas the other indices are deeply influenced by age. Probably, the age-dependent
increase in QTVI was more influenced by a reduction of RR variability reported in older normal
subjects.
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Affiliation(s)
- Gianfranco Piccirillo
- Department of Cardiovascular, Respiratory, Nephrological and Geriatric Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
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Piccirillo G, Rossi P, Mitra M, Quaglione R, Dell'Armi A, Di Barba D, Maisto D, Lizio A, Barillà F, Magrì D. Indexes of temporal myocardial repolarization dispersion and sudden cardiac death in heart failure: any difference? Ann Noninvasive Electrocardiol 2012; 18:130-9. [PMID: 23530483 DOI: 10.1111/anec.12005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The QT variability index, calculated between Q- and the T-wave end (QTend VI), is an index of temporal myocardial repolarization lability associated with sudden cardiac death (SCD) in chronic heart failure (CHF). Little is known about temporal variability in the other two temporal myocardial repolarization descriptors obtained from Q-Tpeak and Tpeak -Tend intervals. We therefore investigated differences between these indexes in patients with CHF who died suddenly and in those who survived with a left ventricular ejection fraction (LVEF) ≤35% or >35%. METHODS AND RESULTS We selected 127 ECG and systolic blood pressure (SPB) recordings from outpatients with CHF all of whom had been followed up for 30 months. We calculated RR and SPB variability by power spectral analysis and QTend VI, QTpeak VI, Tpeak Tend VI. We then subdivided data patients into three groups SCD, LVEF ≤ 35%, and LVEF > 35%. The LVEF was higher in the SCD than in the LVEF ≤ 35% group, whereas no difference was found between the SCD and LVEF > 35% groups. QTend VI, QTpeak VI, and Tpeak Tend VI were higher in the SCD and LVEF ≤ 35% groups than in the LVEF > 35% group. Multivariate analysis detected a negative relationship between all repolarization variability indexes, low frequency obtained from RR intervals and LVEF. CONCLUSIONS Our data show that variability in the first (QTpeak VI) and second halves of the QT interval (Tpeak -Tend VI) significantly contributes to the QTend VI in patients with CHF. Further studies should investigate whether these indexes might help stratify the risk of SCD in patients with a moderately depressed LVEF.
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Affiliation(s)
- Gianfranco Piccirillo
- Department of Cardiovascular, Respiratory, Nephrologic, and Geriatric Sciences, Sapienza University of Rome, 00185 Rome, Italy.
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Piccirillo G, Magrì D, Pappadà MA, Maruotti A, Ogawa M, Han S, Joung B, Rossi P, Nguyen BL, Lin SF, Chen PS. Autonomic nerve activity and the short-term variability of the Tpeak-Tend interval in dogs with pacing-induced heart failure. Heart Rhythm 2012; 9:2044-50. [PMID: 23063868 DOI: 10.1016/j.hrthm.2012.08.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Indexed: 01/27/2023]
Abstract
BACKGROUND In congestive heart failure (CHF), autonomic nervous system (ANS) activity is known to modulate arrhythmic risk through its effects on myocardial repolarization. An increased interval between the peak and the end of the T wave (T(peak)-T(end)) has been reported to increase the incidence of sudden cardiac death. However, the ANS influence on the T(peak)-T(end) interval remains unclear. OBJECTIVE We directly measured ANS nerve activity in ambulatory dogs with pacing-induced CHF to test the hypothesis that ANS activity modulates the T(peak)-T(end) variability index (T(peak)-T(end)VI), the short-term variability of the T(peak)-T(end) interval obtained on 30 beats (T(peak)-T(end)STV(30)), and the short-term variability of the T(peak)-T(end) interval obtained on 5-minute ECG recording (T(peak)-T(end)STV(T)). METHODS By using data previously recorded in 6 ambulatory dogs before and after pacing-induced CHF, we assessed ANS activity recorded with an implanted radiotransmitter that monitored integrated left stellate ganglion nervous activity (iSGNA), integrated vagus nerve activity (iVNA), and electrocardiogram (ECG). We selected for analysis 36 segments recorded at baseline and 36 after pacing-induced CHF with similar iSGNA. RESULTS During CHF, T(peak)-T(end)STV(30) (P<.001) and T(peak)-T(end)STV(T) (P<.05) were significantly higher than those at baseline. The multiple linear mixed regression analysis disclosed a significant positive correlation between iSGNA and T(peak)-T(end)STV(T) (baseline: β 2.92, P<.001; CHF: β 1.13, P<.001) and a significant negative correlation between iVNA and T(peak)-T(end)STV(T) (baseline: β-6.74, P<.001; CHF: β-1.42, P< .001). CONCLUSIONS In a canine model of pacing-induced CHF, iSGNA correlates positively while iVNA correlates negatively with T(peak)-T(end)STV(T). These findings suggest that SGNA increases while VNA decreases the dispersion of ventricular repolarization in ambulatory dogs with CHF.
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Anestesiologiche, Nefrologiche e Geriatriche, Policlinico Umberto I, Università degli Studi di Roma La Sapienza, Rome, Italy.
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Magrì D, Piccirillo G, Quaglione R, Dell'armi A, Mitra M, Velitti S, Di Barba D, Lizio A, Maisto D, Barillà F. Effect of Acute Mental Stress on Heart Rate and QT Variability in Postmyocardial Infarction Patients. ISRN Cardiol 2012; 2012:912672. [PMID: 22844616 PMCID: PMC3403409 DOI: 10.5402/2012/912672] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 05/16/2012] [Indexed: 01/08/2023]
Abstract
Emotionally charged events are associated with an increased risk of sudden cardiac death (SCD). In this study we assessed RR and QT variability index (QTVI) at baseline during anger recall test (AR). We calculated QTVI from a 5-min ECG recording and from a 10-beats segment around the presumed maximum sympathetic activation in thirty post-myocardial infarction patients under β-blocker therapy and 10 controls underwent. In all groups, the low-frequency component of RR and SBP increased during AR. In all recordings, the QTVI calculated on a 5-min ECG recording and the QTVI10 beats were higher in patients than in controls (P < 0.05). The QTVI during AR remained unchanged from baseline within each group. Conversely, during AR, the QTVI10 beats in controls diminished significantly (P < 0.05) from baseline whereas in patients remained unchanged. The inability to buffer an acute stress-induced increase in sympathetic activity could explain why events charged with acute stress are associated with an increased risk of ventricular arrhythmias in this setting of patients and support the role of cognitive behavior stress management strategies.
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Affiliation(s)
- Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, Azienda Ospedaliera S. Andrea, "Sapienza" Università degli Studi di Roma, 00185 Rome, Italy
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Cirillo M, Esposito F, Tedeschi G, Caiazzo G, Sagnelli A, Piccirillo G, Conforti R, Tortora F, Monsurrò MR, Cirillo S, Trojsi F. Widespread microstructural white matter involvement in amyotrophic lateral sclerosis: a whole-brain DTI study. AJNR Am J Neuroradiol 2012; 33:1102-8. [PMID: 22300932 PMCID: PMC8013257 DOI: 10.3174/ajnr.a2918] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 09/23/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The extensive application of advanced MR imaging techniques to the study of ALS has undoubtedly improved our knowledge of disease pathophysiology, even if the actual spread of the neurodegenerative process throughout the central nervous system is not fully understood. The present study aimed to detect WM patterns of microstructural abnormalities to better investigate the pathologic process in ALS, within but also beyond CSTs, in a whole-brain analysis. MATERIALS AND METHODS DTI was performed in 19 patients with ALS and 20 matched healthy controls, by using whole-brain TBSS and VOI analyses. RESULTS We observed a significant decrease of FA in the body of CC of the ALS group (P < .05). At the VOI level, both FA decrease and RD increase in the body of CC significantly correlated with the UMN score (P = .003 and P = .02). Additionally, significant voxelwise positive correlations between FA and the ALSFRS-R were detected in the WM tracts underneath the left premotor cortex (P < .05). CONCLUSIONS The correlations between reduction of FA and increase of RD in the body of CC with the UMN score indicate that the WM degeneration in the CC is strictly related to the ALS pyramidal impairment, while the correlation between FA and ALSFRS-R in the associative tracts underneath the left premotor cortex might reflect the progressive spread of the disease from the motor toward the extramotor areas.
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Affiliation(s)
- M Cirillo
- Department of Neurological Sciences, Second University of Naples, Naples, Italy
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Han S, Kobayashi K, Joung B, Piccirillo G, Maruyama M, Vinters HV, March K, Lin SF, Shen C, Fishbein MC, Chen PS, Chen LS. Electroanatomic remodeling of the left stellate ganglion after myocardial infarction. J Am Coll Cardiol 2012; 59:954-61. [PMID: 22381432 DOI: 10.1016/j.jacc.2011.11.030] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 10/18/2011] [Accepted: 11/07/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the changes of left stellate ganglionic nerve activity (SGNA) and left thoracic vagal nerve activity (VNA) after acute myocardial infarction (MI). BACKGROUND Whether MI results in remodeling of extracardiac nerve activity remains unclear. METHODS We implanted radiotransmitters to record the SGNA, VNA, and electrocardiogram in 9 ambulatory dogs. After baseline monitoring, MI was created by 1-h balloon occlusion of the coronary arteries. The dogs were then continuously monitored for 2 months. Both stellate ganglia were stained for growth-associated protein 43 and synaptophysin. The stellate ganglia from 5 normal dogs were used as control. RESULTS MI increased 24-h integrated SGNA from 7.44 ± 7.19 Ln(Vs)/day at baseline to 8.09 ± 7.75 Ln(Vs)/day after the MI (p < 0.05). The 24-h integrated VNA before and after the MI was 5.29 ± 5.04 Ln(Vs)/day and 5.58 ± 5.15 Ln(Vs)/day, respectively (p < 0.05). A significant 24-h circadian variation was noted for the SGNA (p < 0.05) but not the VNA. The SGNA/VNA ratio also showed significant circadian variation. The nerve densities from the left SG were 63,218 ± 34,719 μm(2)/mm(2) and 20,623 ± 4,926 μm(2)/mm(2) for growth-associated protein 43 (p < 0.05) and were 32,116 ± 8,190 μm(2)/mm(2)and 16,326 ± 4,679 μm(2)/mm(2) for synaptophysin (p < 0.05) in MI and control groups, respectively. The right SG also showed increased nerve density after MI (p < 0.05). CONCLUSIONS MI results in persistent increase in the synaptic density of bilateral stellate ganglia and is associated with increased SGNA and VNA. There is a circadian variation of the SGNA/VNA ratio. These data indicate significant remodeling of the extracardiac autonomic nerve activity and structures after MI.
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Affiliation(s)
- Seongwook Han
- Krannert Institute of Cardiology, Division of Cardiology, Department of Medicine, Indiana University, School of Medicine, Indianapolis, Indiana, USA
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Piccirillo G, Rossi P, Magrì D. The QT variability index: a multidimensional approach to understanding cardiovascular disease. Cardiology 2011; 118:42-4. [PMID: 21411996 DOI: 10.1159/000324476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 01/16/2011] [Indexed: 11/19/2022]
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Joung B, Park HW, Maruyama M, Tang L, Song J, Han S, Piccirillo G, Weiss JN, Lin SF, Chen PS. Intracellular calcium and the mechanism of anodal supernormal excitability in langendorff perfused rabbit ventricles. Circ J 2011; 75:834-43. [PMID: 21301131 DOI: 10.1253/circj.cj-10-1014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anodal stimulation hyperpolarizes the cell membrane and increases the intracellular Ca(2+) (Ca(i)) transient. This study tested the hypothesis that the maximum slope of the Ca(i) decline (-(dCa(i)/dt)(max)) corresponds to the timing of anodal dip on the strength-interval curve and the initiation of repetitive responses and ventricular fibrillation (VF) after a premature stimulus (S(2)). METHODS AND RESULTS We simultaneously mapped the membrane potential (V(m)) and Ca(i) in 23 rabbit ventricles. A dip in the anodal strength-interval curve was observed. During the anodal dip, ventricles were captured by anodal break excitation directly under the S(2) electrode. The Ca(i) following anodal stimuli is larger than that following cathodal stimuli. The S(1)-S(2) intervals of the anodal dip (203±10 ms) coincided with the -(dCa(i)/dt)(max) (199±10 ms, P=NS). BAPTA-AM (n=3), inhibition of the electrogenic Na(+)-Ca(2+) exchanger current (I(NCX)) by low extracellular Na(+) (n=3), and combined ryanodine and thapsigargin infusion (n=2) eliminated the anodal supernormality. Strong S(2) during the relative refractory period (n=5) induced 29 repetitive responses and 10 VF episodes. The interval between S(2) and the first non-driven beat was coincidental with the time of -(dCa(i)/dt)(max). CONCLUSIONS Larger Ca(i) transient and I(NCX) activation induced by anodal stimulation produces anodal supernormality. The time of maximum I(NCX) activation is coincidental to the induction of non-driven beats from the Ca(i) sinkhole after a strong premature stimulation.
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Affiliation(s)
- Boyoung Joung
- Krannert Institute of Cardiology and the Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Magrì D, Piccirillo G, Bucci E, Pignatelli G, Cauti FM, Morino S, Latino P, Santini D, Marrara F, Volpe M, Antonini G, Testa M. Increased temporal dispersion of myocardial repolarization in myotonic dystrophy type 1: beyond the cardiac conduction system. Int J Cardiol 2010; 156:259-64. [PMID: 21112106 DOI: 10.1016/j.ijcard.2010.10.132] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 10/04/2010] [Accepted: 10/31/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVES The most frequently mechanism underlying sudden cardiac death in myotonic dystrophy type 1 (DM1) is bradyarrhythmias due to cardiac conduction abnormalities. However the risk of ventricular tachyarrhythmias remains a concern in clinical management as well as in its determinant. We therefore assessed autonomic nervous system activity aiming to disclose differences in the QT variability index (QTVI)-a marker of temporal myocardial repolarization lability-between DM1 patients and healthy controls. We also investigated the possible differences within DM1 patients by subdividing them according either to the presence of first degree atrioventricular block (1st AVB) or to the cytosine-thymine-guanine (CTG) repeat expansion size. METHODS Sixty-two DM1 patients and 20 healthy subjects underwent neurological and cardiological examinations, the latter including ECG, echocardiography and 24-hour Holter monitoring. All underwent a 5-minute ECG recording to assess heart rate variability power spectral components, and the QTVI values. RESULTS Power spectral data, namely total power, low frequency power and high frequency power, were lower, whereas QTVI values were higher in DM1 patients than in controls (p<.0001). Higher QTVI values were found in DM1 subgroups with 1st AVB (p=.009) and more than 500 CTG repeat (p=.014) with respect to DM1 patients without 1st AVB and CTG<500. Spectral data did not significantly differ. At multivariable analysis, QTVI and age were independently associated with PR interval and CTG repeat. CONCLUSIONS The increased values of QTVI argue in favour of an important heart involvement extending beyond the conduction system. Whether QTVI could be useful in predicting clinical course of DM1 clearly requires larger prospective studies.
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Affiliation(s)
- Damiano Magrì
- Cardiology Department, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
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Rossi P, Bianchi S, Valsecchi S, Porcelli D, Sgreccia F, Lucifiero A, Canonaco S, Campoli M, Malavasi M, Piccirillo G, Quaglione R, Azzolini P. Endocardial vagal atrioventricular node stimulation in humans: reproducibility on 18-month follow-up. Europace 2010; 12:1719-24. [PMID: 20876272 DOI: 10.1093/europace/euq343] [Citation(s) in RCA: 6] [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: 11/14/2022] Open
Abstract
AIMS Control of atrioventricular (AV) node conduction by means of high-frequency stimulation (HFS) of efferent AV node vagal stimulation (AVNS) fibres enables the ventricular rate (VR) to be modulated during atrial fibrillation (AF). The aims of this study were to verify, on 18-month follow-up, the reproducibility of the dromotropic effect obtained on implantation and the long-term reliability of the system in patients who received an implantable cardioverter-defibrillator (ICD) with a standard atrial lead positioned at a location suitable for AVNS. METHODS AND RESULTS We enrolled 12 patients with paroxysmal or persistent AF who were candidates for ICD. The right atrium was mapped to locate the pacing site, and a transvenous screw-in lead was implanted in that region. The voltages required for VR modulation (25% VR reduction) and complete AV block at different pulse durations (from 0.1 to 0.5 ms) were recorded. Eleven out of 12 patients underwent 18-month follow-up examination. Atrial pacing parameters were adequate and did not differ from the baseline values (all P > 0.05): pacing threshold 0.9 ± 0.5 V (0.5 ms pulse duration) and impedance 556 ± 121 Ω, with P-wave amplitude of 1.6 ± 0.7 mV. High-frequency stimulation induced VR modulation in nine patients and complete AV block in eight patients at pulse durations ≥0.3 ms. No differences were observed in the voltages for VR modulation and complete AV block between implantation and 18-month examination (all P > 0.100). CONCLUSION Ventricular rate control during AF was obtained under HFS 18 months after implantation in patients with the atrial lead positioned at a location suitable for AVNS. The pacing outputs needed to achieve the dromotropic effect were comparable to those measured on implantation.
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Affiliation(s)
- Pietro Rossi
- Department of Medicine, Electrophysiology and Pacing Unit, Belcolle Hospital, Viterbo, Italy
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Joung B, Shinohara T, Zhang H, Kim D, Choi EK, On YK, Piccirillo G, Chen PS, Lin SF. Tachybradycardia in the isolated canine right atrium induced by chronic sympathetic stimulation and pacemaker current inhibition. Am J Physiol Heart Circ Physiol 2010; 299:H634-42. [PMID: 20601460 DOI: 10.1152/ajpheart.00347.2010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The mechanisms of sinoatrial node (SAN) dysfunction in patients with chronically elevated sympathetic tone and reduced pacemaker current (I(f); such as heart failure) are poorly understood. We simultaneously mapped membrane potential and intracellular Ca(2+) in the Langendorff-perfused canine right atrium (RA). Blockade of either I(f) (ZD-7288) or sarcoplasmic reticulum Ca(2+) release (ryanodine) alone decreased heart rate by 8% (n = 3) and 16% (n = 3), respectively. Combined treatment of ZD-7288 and ryanodine consistently resulted in prolonged (> or =3 s) sinus pauses (PSPs) (n = 4). However, the middle SAN remained as the leading pacemaking site after these treatments. Prolonged exposure with isoproterenol (0.01 micromol/l) followed by ZD-7288 completely suppressed SAN but triggered recurrent ectopic atrial tachycardia. Cessation of tachycardia was followed by PSPs in five of eight RAs. Isoproterenol initially increased heart rate by 75% from baseline with late diastolic intracellular Ca(2+) elevation (LDCAE) from the superior SAN. However, after a prolonged isoproterenol infusion, LDCAE disappeared in the superior SAN, the leading pacemaker shifted to the inferior SAN, and the rate reduced to 52% above baseline. Caffeine (2 ml, 20 mmol/l) injection after a prolonged isoproterenol infusion produced LDCAE in the SAN and accelerated the SAN rate, ruling out sarcoplasmic reticulum Ca(2+) depletion as a cause of Ca(2+) clock malfunction. We conclude that in an isolated canine RA preparation, chronically elevated sympathetic tone results in abnormal pacemaking hierarchy in the RA, including suppression of the superior SAN and enhanced pacemaking from ectopic sites. Combined malfunction of both membrane and Ca(2+) clocks underlies the mechanisms of PSPs.
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Affiliation(s)
- Boyoung Joung
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University Schoolof Medicine, Indianapolis, Indiana 46202, USA
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