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Maiolino G, Boni A, Del Zingaro M, Russo M, Mearini E. Acute uropathogen-related cowperitis with sepsis: case report and literature review. Urol Case Rep 2023; 51:102566. [PMID: 38024513 PMCID: PMC10652140 DOI: 10.1016/j.eucr.2023.102566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/12/2023] [Indexed: 12/01/2023] Open
Abstract
Acute cowperitis, which was previously known as a common complication of sexually transmitted infections (STIs), is now commonly associated with bacterial urinary tract infections, particularly Escherichia coli. Patients often have a history of STIs, and the symptoms resemble other male accessory gland infections (MAGIs). Recent cases associated with sepsis have been managed with percutaneous drainage and/or surgery. We present a case of acute cowperitis with sepsis and an abscess in the right small gland. The diagnosis was made using transperineal ultrasound, and the patient was successfully treated only with a long-term antibiotic therapy.
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Affiliation(s)
- Giuseppe Maiolino
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Andrea Boni
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Miriam Russo
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
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Maiolino G, Fernández-Pascual E, Ochoa Arvizo MA, Vishwakarma R, Martínez-Salamanca JI. Male Infertility and the Risk of Developing Testicular Cancer: A Critical Contemporary Literature Review. Medicina (Kaunas) 2023; 59:1305. [PMID: 37512119 PMCID: PMC10383207 DOI: 10.3390/medicina59071305] [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: 05/31/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: The relationship between male infertility (MI) and testicular cancer (TC) is bilateral. On one hand, it is well-established that patients diagnosed with TC have a high risk of pre- and post-treatment infertility. On the other hand, the risk of developing TC in male infertile patients is not clearly defined. The objective of this review is to analyze the histopathological, etiological, and epidemiological associations between MI and the risk of developing testicular cancer. This review aims to provide further insights and offer a guide for assessing the risk factors for TC in infertile men. Materials and Methods: A comprehensive literature search was conducted to identify relevant studies discussing the relationship between MI and the risk of developing TC. Results: The incidence rates of germ cell neoplasia in situ (GCNIS) appear to be high in infertile men, particularly in those with low sperm counts. Most epidemiological studies have found a statistically significant risk of developing TC among infertile men compared to the general or fertile male populations. The concept of Testicular Dysgenesis Syndrome provides an explanatory model for the common etiology of MI, TC, cryptorchidism, and hypospadias. Clinical findings such as a history of cryptorchidism could increase the risk of developing TC in infertile men. Scrotal ultrasound evaluation for testis lesions and microlithiasis is important in infertile men. Sperm analysis parameters can be useful in assessing the risk of TC among infertile men. In the future, sperm and serum microRNAs (miRNAs) may be utilized for the non-invasive early diagnosis of TC and GCNIS in infertile men. Conclusions: MI is indeed a risk factor for developing testicular cancer, as demonstrated by various studies. All infertile men should undergo a risk assessment using clinical examination, ultrasound, and semen parameters to evaluate their risk of TC.
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Affiliation(s)
- Giuseppe Maiolino
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129 Perugia, Italy
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Esaú Fernández-Pascual
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
- Department of Urology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Mario Alberto Ochoa Arvizo
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, 28222 Madrid, Spain
| | - Ranjit Vishwakarma
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Juan Ignacio Martínez-Salamanca
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, 28222 Madrid, Spain
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Maiolino G, Bisogni V, Maggi M, Carlucci S, Federici G, Soranna D, Zambon A, Pengo MF, Lombardi C, Busetto L, Vettor R, Parati G. Nocturnal hypoxia indexes are associated with left ventricular remodeling and diastolic dysfunction in obstructive sleep apnea patients. Sleep Med 2023; 103:180-186. [PMID: 36812862 DOI: 10.1016/j.sleep.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/22/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Obstructive sleep apnea (OSA) is associated with heart derangements detected at echocardiography as higher left ventricular mass index (LVMI), higher left ventricular end-diastolic diameter, lower left ventricular ejection fraction (LVEF), and impaired diastolic function. However, the currently used parameter to define OSA diagnosis and severity, the apnea/hypopnea index (AHI), poorly predicts cardiovascular damage, cardiovascular events, and mortality. Our study aimed to assess if other polygraphic indices of OSA presence and severity, in addition to AHI, might better predict echocardiographic cardiac remodeling. METHODS AND RESULTS We enrolled two cohorts of individuals referred for suspected OSA to the outpatient facilities of the IRCCS Istituto Auxologico Italiano, Milano, and of the Clinica Medica 3, Padova. All patients underwent home sleep apnea testing and echocardiography. Based on the AHI the cohort was divided into no-OSA (AHI<15 events/hour) and moderate-severe OSA (AHI≥15 events/hour). We recruited 162 patients and found that compared to patients with no-OSA, those with moderate-severe OSA showed higher LV remodeling [left ventricular end-diastolic volume (LVEDV) 48.4 ± 11.5 ml/m2 vs. 54.1 ± 14.0 ml/m2, respectively, p = 0.005] and lower LVEF (65.3 ± 5.8% vs. 61.6 ± 7.8%, respectively, p = 0.002), whereas we could not find any difference in LVMI and early and late ventricular filling velocity ratio (E/A). At multivariate linear regression analysis two polygraphic hypoxic burden-related markers were independent predictors of LVEDV and E/A, i.e., the percentage of time with O2 saturation below 90% (β = 0.222) and ODI (β = -0.422), respectively. CONCLUSIONS Our study shows that nocturnal hypoxia-related indexes were associated with left ventricular remodeling and diastolic dysfunction in OSA patients.
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Affiliation(s)
- Giuseppe Maiolino
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Italy
| | | | - Michael Maggi
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Italy
| | - Silvia Carlucci
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Italy
| | - Giacomo Federici
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Italy
| | - Davide Soranna
- IRCCS Istituto Auxologico Italiano, Biostatistic Unit, Milan, Italy
| | - Antonella Zambon
- IRCCS Istituto Auxologico Italiano, Biostatistic Unit, Milan, Italy; Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Martino F Pengo
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Carolina Lombardi
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Luca Busetto
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Italy
| | - Gianfranco Parati
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Boni A, Gervasoni F, Lomauro A, Del Zingaro M, Maiolino G, Galletti C, Ricci V, Mearini E. Urologic latency time during uroflow stop test with electromyography: an incontinence detector in rehabilitation after robotic radical prostatectomy. Eur J Phys Rehabil Med 2023; 59:94-102. [PMID: 36305651 PMCID: PMC10035442 DOI: 10.23736/s1973-9087.22.07365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Stress urinary incontinence (UI) is the most common presentation following robot-assisted radical prostatectomy (RARP), but a postoperative non-invasive and objective test is still lacking. To assess pelvic floor integrity after RARP, we recently proposed Uroflow Stop Test (UST) with surface electromyography (EMG). AIM Here we provide two new clinical parameters: the neurologic latency time (NLT) and the urologic latency time (ULT) derived from UST-EMG Test. Principal outcome was to evaluate their variation during one year follow-up and ULT ability to predict post-RARP UI. DESIGN Observational and longitudinal study. SETTING Interdivisional Urology Clinic (Perugia-Terni, Italy). POPULATION Patients with prostate cancer treated with a full nerve-sparing RARP who underwent postoperative pelvic floor muscles training (PFMT): a diurnal functional home program and a weekly hospital program with the use of biofeedback, between 1 and 3 months postoperatively. METHODS All patients consecutively performed a UST-EMG test at one, three, six, and twelve months after surgery. At each follow-up visit we collected NLT values, ULT values, 5-item 26-Expanded Prostate Cancer Index (EPIC), Incontinence Developed on Incontinence Questionnaire (ICIQ-UI) Short Form and International Prostate Symptom Score (IPSS). We analysed statistically significant differences in NLT and ULT between continent and incontinent patients and we evaluate the diagnostic ability of 1-month post-surgery ULT value to diagnose the presence of postoperative UI. RESULTS Sixty patients were enrolled. The mean time to PFMT was 31.08 (range: 30-35) days. Overall IPSS, NLT and ULT had similar trends: progressive decrease until the six months after surgery (1-month vs. 3 months vs. 6 months, P<0.05) to plateau thereafter. When considering the two group of patients, IPSS and NLT were significantly higher in the incontinent group only one month after surgery, while ULT became similar between the two groups at 6 months after surgery. The best cut-off of 1-month ULT values that maximized the Youden function at 12-months resulted 3.13 second. CONCLUSIONS NLT and ULT may respectively account for the nerve and the urethral closure system integrity post-RARP. In the first month after RARP, both NLT and ULT differs between incontinent vs. continent patients. NLT become similar between two group after one month, confirming the recovery from neuropraxia, but ULT remains statistically significant different until 3 months postoperatively. The value of 1-month ULT resulted a valid tool to predict incontinence status at 12 months. CLINICAL REHABILITATION IMPACT ULT and NLT may be also useful tools to monitor the continence progressive recovery after RARP and they may help rehabilitation specialists to evaluate the ongoing results during postoperative follow-up.
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Affiliation(s)
- Andrea Boni
- Department of Surgical and Biomedical Sciences, Interdivisional Urology Clinic (Perugia-Terni), University Hospital of Perugia, Perugia, Italy
| | - Fabrizio Gervasoni
- Unit of Rehabilitation, Luigi Sacco University Hospital, A.S.S.T. Fatebenefratelli-Sacco, Milan, Italy
| | - Antonella Lomauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy -
| | - Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, Interdivisional Urology Clinic (Perugia-Terni), University Hospital of Perugia, Perugia, Italy
| | - Giuseppe Maiolino
- Department of Surgical and Biomedical Sciences, Interdivisional Urology Clinic (Perugia-Terni), University Hospital of Perugia, Perugia, Italy
| | - Chiara Galletti
- Department of Psychiatry, Santa Maria University Hospital, Terni, Italy
| | - Vincenzo Ricci
- Unit of Rehabilitation, Luigi Sacco University Hospital, A.S.S.T. Fatebenefratelli-Sacco, Milan, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Interdivisional Urology Clinic (Perugia-Terni), University Hospital of Perugia, Perugia, Italy
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Naruse M, Murakami M, Katabami T, Kocjan T, Parasiliti-Caprino M, Quinkler M, St-Jean M, O'Toole S, Ceccato F, Kraljevic I, Kastelan D, Tsuiki M, Deinum J, Torre EM, Puar T, Markou A, Piaditis G, Laycock K, Wada N, Grytaas MA, Kobayashi H, Tanabe A, Tong CV, Gallego NV, Gruber S, Beuschlein F, Kürzinger L, Sukor N, Azizan EABA, Ragnarsson O, Nijhoff MF, Maiolino G, Dalmazi GD, Kalugina V, Lacroix A, Furnica RM, Suzuki T. International multicenter survey on screening and confirmatory testing in primary aldosteronism. Eur J Endocrinol 2023; 188:6986591. [PMID: 36726325 DOI: 10.1093/ejendo/lvac002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/31/2022] [Accepted: 11/16/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Primary aldosteronism (PA) is one of the most frequent causes of secondary hypertension. Although clinical practice guidelines recommend a diagnostic process, details of the steps remain incompletely standardized. DESIGN In the present SCOT-PA survey, we have investigated the diversity of approaches utilized for each diagnostic step in different expert centers through a survey using Google questionnaires. A total of 33 centers from 3 continents participated. RESULTS We demonstrated a prominent diversity in the conditions of blood sampling, assay methods for aldosterone and renin, and the methods and diagnostic cutoff for screening and confirmatory tests. The most standard measures were modification of antihypertensive medication and sitting posture for blood sampling, measurement of plasma aldosterone concentration (PAC) and active renin concentration by chemiluminescence enzyme immunoassay, a combination of aldosterone-to-renin ratio with PAC as an index for screening, and saline infusion test in a seated position for confirmatory testing. The cutoff values for screening and confirmatory testing showed significant variation among centers. CONCLUSIONS Diversity of the diagnostic steps may lead to an inconsistent diagnosis of PA among centers and limit comparison of evidence for PA between different centers. We expect the impact of this diversity to be most prominent in patients with mild PA. The survey raises 2 issues: the need for standardization of the diagnostic process and revisiting the concept of mild PA. Further standardization of the diagnostic process/criteria will improve the quality of evidence and management of patients with PA.
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Affiliation(s)
- Mitsuhide Naruse
- Endocrine Center and Clinical Research Center, Ijinkai Takeda General Hospital, Kyoto, 601-1495, Japan
| | - Masanori Murakami
- Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
| | - Takuyuki Katabami
- Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University Yokohama City Seibu Hospital, Yokohama, 241-0811, Japan
| | - Tomaz Kocjan
- Department of Endocrinology, Diabetes, and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, 1000, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, 1000, Slovenia
| | - Mirko Parasiliti-Caprino
- Endocrinology, Diabetes, and Metabolism; Department of Medical Sciences; University of Turin, Turin, 10126, Italy
| | | | - Matthieu St-Jean
- Division of Endocrinology, Department of Medicine, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada
| | - Sam O'Toole
- Department of Endocrinology, The Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Filippo Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Padova, 35128, Italy
| | - Ivana Kraljevic
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, 10 000, Croatia
| | - Darko Kastelan
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, 10 000, Croatia
| | - Mika Tsuiki
- Department of Endocrinology and Metabolism, NHO Kyoto Medical Center, Kyoto, 612-8555, Japan
| | - Jaap Deinum
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, 6525 GA, Netherlands
| | - Edelmiro Menéndez Torre
- Servicio de Endocrinología, Hospital Universitario Central de Asturias, Oviedo, 33011, Spain
| | - Troy Puar
- Department of Endocrinology, Changi General Hospital, Singapore, 529889, Singapore
| | - Athina Markou
- Endocrinology Department and Diabetes Center, 'G. Gennimatas' General Hospital of Athens, Athens, 115 28, Greece
| | - George Piaditis
- Endocrinology Department and Diabetes Center, 'G. Gennimatas' General Hospital of Athens, Athens, 115 28, Greece
| | - Kate Laycock
- Department of Diabetes & Metabolism, Barts Health NHS Trust, St Bartholomew's and Royal London Hospital, London, E1 1BB, UK
| | - Norio Wada
- Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, 060-8604, Japan
| | | | - Hiroki Kobayashi
- Division of Nephrology, Hypertension, and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Akiyo Tanabe
- Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, 162-8655, Japan
| | - Chin Voon Tong
- Department of Medicine, Hospital Melaka, Melaka, 75400, Malaysia
| | - Nuria Valdés Gallego
- Department of Internal Medicine, Section of Endocrinology and Nutrition, Hospital Universitario de Cabueñes, Gijón, 33394, Spain
| | - Sven Gruber
- Department of Endocrinology, Diabetology and Clinical Nutrition, Clinic for Endocrinology and Diabetology, University Hospital Zurich, CH-8091, Switzerland
| | - Felix Beuschlein
- Department of Endocrinology, Diabetology and Clinical Nutrition, Clinic for Endocrinology and Diabetology, University Hospital Zurich, CH-8091, Switzerland
| | - Lydia Kürzinger
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, 97082, Germany
| | - Norlela Sukor
- Department of Medicine, The National University of Malaysia (UKM) Medical Centre, Kuala Lumpur, 59200, Malaysia
| | - Elena A B Aisha Azizan
- Department of Medicine, The National University of Malaysia (UKM) Medical Centre, Kuala Lumpur, 59200, Malaysia
| | - Oskar Ragnarsson
- Department of Endocrinology, Sahlgrenska University Hospital, Göteborg,413 45, Sweden
| | - Michiel F Nijhoff
- Department of Internal Medicine, Division of Endocrinology and Diabetes, Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
| | - Giuseppe Maiolino
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Padova, 35126, Italy
| | - Guido Di Dalmazi
- Unit of Endocrinology and Diabetes Prevention and Care, University of Bologna, Bologna, 40126, Italy
| | - Valentina Kalugina
- Endocrinology Department, North-Western State Medical University named after I.I. Mechnikov, St Petersburg, 191015, Russia
| | - André Lacroix
- Endocrine Division, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, H2X 3E4, Canada
| | - Raluca Maria Furnica
- Department of Endocrinologie, Cliniques Universitaires Saint Luc, Bruxelles, 1200, Belgium
| | - Tomoko Suzuki
- Department of Public Health, International University of Health and Welfare School of Medicine, Chiba, 286-8686, Japan
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Bisogni V, Maiolino G, Pengo MF. Editorial: Sleep disorders, hypertension and cardiovascular diseases. Front Cardiovasc Med 2022; 9:1110487. [PMID: 36601068 PMCID: PMC9806424 DOI: 10.3389/fcvm.2022.1110487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Valeria Bisogni
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy,*Correspondence: Valeria Bisogni ✉
| | - Giuseppe Maiolino
- Clinica Medica 3, Department of Medicine – DIMED, University of Padua, Padua, Italy
| | - Martino F. Pengo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Maiolino G, Del Zingaro M, Manfredini G, Graziano F, Tancredi A, Boni A, Mearini E. Peak systolic velocity at basal penile ultrasound and individual 10-year risk of cardiovascular disease. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01026-6] [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: 11/07/2022] Open
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Maiolino G, Ciarletti S, Manfredini G, Paladini A, Mearini E. Acceleration parameters at uroflowmetry to predict urodynamic study findings. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01076-x] [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: 11/07/2022] Open
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9
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Tancredi A, Cochetti G, Maiolino G, Manfredini G, Vitale A, Guadagni L, Marsico M, Paladini A, Del Zingaro M, Mearini E. Evaluation of peri-operative and functional outcomes of cap holep technique. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01163-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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10
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Barbiero G, Maiolino G, Argiolas A, Testolin L, De Conti G. Intra-atrial course of right coronary artery: A case report. World J Cardiol 2022; 14:514-521. [PMID: 36187427 PMCID: PMC9523268 DOI: 10.4330/wjc.v14.i9.514] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/11/2022] [Accepted: 08/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intra-atrial right coronary artery (RCA) is a rare and generally asymptomatic anomaly of development of the coronary arteries. This malformation could potentially expose the patient to a catastrophic outcome in the case of injury during interventional or surgical procedures. Currently, only a few case reports and no systematic reviews are available in the literature.
CASE SUMMARY We report the case of a 54-year-old man with atypical chest pain who underwent multi-detector computed tomography angiography (MDCTA). The exam revealed no significant coronary artery stenoses; however, an intra-atrial course of mid RCA was evident. Medical therapy was administered, and the patient was discharged to home without undergoing a conventional angiography. Previously reported autoptic and clinical cases were retrieved from the PubMed literature database to compare the clinicopathological features of this case.
CONCLUSION MDCTA depicted the abnormal course of the coronary artery in this patient as an intra-atrial course of the mid RCA. Finding this abnormality was crucial to avoid an inadvertent injury during interventional or surgical procedures.
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Affiliation(s)
- Giulio Barbiero
- Department of Integrated Diagnostic Services, DIDAS, Radiology Unit, University Hospital of Padua, Padua 35128, Italy
| | - Giuseppe Maiolino
- Department of Medicine, Medical Clinic 3, University Hospital of Padua, Padua 35128, Italy
| | - Anna Argiolas
- Department of Integrated Diagnostic Services, DIDAS, Radiology Unit, University Hospital of Padua, Padua 35128, Italy
| | - Luca Testolin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiac Surgery, University Hospital of Padua, Padua 35128, Italy
| | - Giorgio De Conti
- Department of Integrated Diagnostic Services, DIDAS, Radiology Unit, University Hospital of Padua, Padua 35128, Italy
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Del Zingaro M, Maiolino G, Ceccarelli S, Branca A, Rosati F, Cochetti G, Mearini E. Post‐void residual volume after uroflowmetry measured using both ultrasound and bladder scanner by urologic nurses. Int J of Uro Nursing 2022. [DOI: 10.1111/ijun.12286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Giuseppe Maiolino
- Medicine and Surgery, Urology Clinic University of Perugia Perugia Italy
| | - Silvia Ceccarelli
- Medicine and Surgery, Urology Clinic University of Perugia Perugia Italy
| | - Angela Branca
- Medicine and Surgery, Urology Clinic University of Perugia Perugia Italy
| | - Francesca Rosati
- Nursing Degree Course of Foligno University of Perugia Foligno Italy
| | - Giovanni Cochetti
- Medicine and Surgery, Urology Clinic University of Perugia Perugia Italy
| | - Ettore Mearini
- Medicine and Surgery, Urology Clinic University of Perugia Perugia Italy
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12
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Del Zingaro M, Cochetti G, Zucchi A, Paladini A, Rossi De Vermandois JA, Ciarletti S, Felici G, Maiolino G, Renzetti R, Gaudio G, Mearini E. Holmium:YAG Laser for the Treatment of Genital and urethral Warts: Multicentre Prospective Evaluation of Safety and Efficacy. J Lasers Med Sci 2021; 12:e34. [PMID: 34733757 DOI: 10.34172/jlms.2021.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/06/2021] [Indexed: 01/30/2023]
Abstract
Introduction: Genital condylomatosis is a highly contagious disease caused by the human papilloma virus (HPV). The aim of this prospective multicentre study was to evaluate the safety and efficacy of the Holmium:YAG (yttrium-aluminium-garnet) laser in the treatment of genital and intra-urethral warts; the secondary aim was to assess the patients' postoperative satisfaction and cosmetic results. Methods: From December 2016 to March 2019, patients with genital warts were prospectively enrolled in three hospitals. The inclusion criteria were male gender, age over 18 years-old and treatment-naïve. External and urethral genitalia warts were treated by the Holmium YAG laser. The follow-up analysis consisted of physical examination, flexible urethro-cystoscopy in case of meatal lesions, and administration of Dermatology Quality of Life Index (DLQI) and Patient Global Impression of Improvement (PGI-I) questionnaires at 1, 3, 6 and 12 months after surgery and subsequently yearly. Results: Sixty patients were enrolled. The single treatment was effective in 57/60 patients (95%). At a mean follow-up of 26 months, recurrences occurred in 8 patients (13.3%). No peri- or post-operative complication occurred. An improvement in pre-operative condition was highlighted with PGI-I and DLQI questionnaires. Conclusion: Our prospective multicentre study showed that holmium laser surgery seems to be a safe and effective treatment for external genital and urethral warts. Good dermatological outcomes aid to further improve patient satisfaction.
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Affiliation(s)
- Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, Italy
| | - Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, Italy
| | | | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, Italy
| | | | - Sara Ciarletti
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, Italy
| | - Graziano Felici
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, Italy
| | - Giuseppe Maiolino
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, Italy
| | - Roberto Renzetti
- Department of Surgeries, Urology, Presidio Ospedaliero Pescara, Pescara, Italy
| | - Gianluca Gaudio
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, Italy
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Mearini E, Del Zingaro M, Maiolino G, Manfredini G, Paladini A, Ciarletti S, Guiggi P, Cochetti G. Robotic tumor enucleation in high complexity cT2 renal mass with involvement of collecting system. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02293-x] [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: 10/19/2022] Open
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Cochetti G, Del Zingaro M, Panciarola M, Paladini A, Guiggi P, Ciarletti S, Nogara A, Turco M, Felici G, Maiolino G, Gaudio G, Mearini E. HoLEP Cap: step-by-step technique. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00713-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Soli I, Turco M, Guiggi P, Marsico M, Manfredini G, Maiolino G, de Vermandois JR, Cochetti G, Mearini E. Should we reconsider SWL for ureteral stones >10 mm? EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00740-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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16
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Del Zingaro M, Cochetti G, Maiolino G, Stivalini D, Manfredini G, Tancredi A, Felici G, Ciarletti S, Gaudio G, Rossi de Vermandois JA, Mearini E. Influence of COVID-19 pandemic on stress levels of urologic patients. Open Med (Wars) 2021; 16:1198-1205. [PMID: 34514166 PMCID: PMC8389503 DOI: 10.1515/med-2021-0289] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/22/2021] [Accepted: 04/12/2021] [Indexed: 01/23/2023] Open
Abstract
Introduction Several studies have shown the consequences of COVID-19 pandemic on perceived stress of different populations, but none of them analyzed urological patients who underwent elective surgery. Methods We enrolled prospectively patients who underwent elective surgery between March and October 2020. A survey on COVID-19 and the 4-item Perceived Stress Scale (PPS-4) questionnaire were administered at hospital admission. Demographic and medical history data were also collected. Uni- and multivariate analyses were performed to identify independent predictors of higher PSS-4 values (≥7). Results A total of 200 patients were enrolled. Mean PSS-4 value resulted 6.04. Patients with PSS-4 value ≥7 resulted 43.5% (87/200). In multivariate analysis, PSS-4 value ≥7 was independently associated (p < 0.05) with female gender (OR 6.42), oncological disease (OR 2.87), high (>5 in a range between 0 and 10) fear of intrahospital transmission of SARS-CoV-2 infection (OR 4.75), history of bladder instillation (OR 0.26), and current smokers (OR 0.27) Conclusion High PSS-4 values at hospital admission in urologic surgical patients are positively correlated with female gender, fear of intrahospital transmission of SARS-CoV-2 infection, and oncological disease. PSS-4 questionnaire could be useful to select patients for whom a preadmission counselling is necessary to improve the management of their high stress level.
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Affiliation(s)
- Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Giuseppe Maiolino
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Piazzale Giorgio Menghini 1, Perugia, 06129, Italy
| | - Davide Stivalini
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Giulia Manfredini
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Angelica Tancredi
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Graziano Felici
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Sara Ciarletti
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Gianluca Gaudio
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | | | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
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Boni A, Maiolino G, Del Zingaro M, Cochetti G, Turco M, Paladini A, Mearini E. Positive uroflow stop test with EMG may predict potency recovery after RARP. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00860-5] [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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Maiolino G, Bisogni V, Soranna D, Pengo MF, Pucci G, Vettor R, Fava C, Colussi GL, Bilo G, Lombardi C, Parati G, Rossi GP, Silvani A. Effects of insomnia and restless legs syndrome on sleep arterial blood pressure: A systematic review and meta-analysis. Sleep Med Rev 2021; 59:101497. [PMID: 34044356 DOI: 10.1016/j.smrv.2021.101497] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022]
Abstract
Hypertension and blunted blood pressure (BP) dipping during nighttime sleep are associated with increased cardiovascular risk. Chronic insomnia and restless legs syndrome (RLS) may affect the 24-h BP profile. We systematically reviewed the association of insomnia and RLS with BP values during nighttime sleep and the relative BP dipping pattern. We searched relevant articles in any language with selection criteria including enrolment of subjects with insomnia or RLS and with obstructive sleep apnea comorbidity assessment. Of the 872 studies originally retrieved, seven were selected. Four studies enrolled subjects with insomnia. One study relied on sleep diaries to classify nighttime sleep BP, whereas three relied only on clock time. At meta-analysis, subjects with insomnia displayed an attenuated dipping of systolic BP (-2.00%; 95% confidence interval (CI): -3.61 - -0.39%) and diastolic BP (-1.58%; 95% CI: -2.66 ̶ -0.49%) during nighttime sleep compared to controls. Three studies enrolled subjects with RLS. One study relied on polysomnography to classify nighttime sleep BP, whereas two relied only on clock time. Subjects with RLS showed increases in nighttime sleep systolic BP (5.61 mm Hg, 95% CI 0.13̶-11.09 mm Hg) compared to controls. In conclusion, the limited available data suggest that insomnia and RLS are both associated with altered BP control during nighttime sleep. There is need for more clinical studies to confirm these findings, specifically focusing on measurements of BP during objectively defined sleep, on causal roles of leg movements during sleep and alterations in sleep architecture, and on implications for cardiovascular risk. PROSPERO ACKNOWLEDGEMENT OF NUMBER: CRD42020217947.
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Affiliation(s)
- Giuseppe Maiolino
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Italy
| | - Valeria Bisogni
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Davide Soranna
- IRCCS Istituto Auxologico Italiano, Biostatistic Unit, Milan, Italy
| | - Martino F Pengo
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy.
| | - Giacomo Pucci
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Italy
| | - Cristiano Fava
- Section of General Medicine and Hypertension, Dept of Medicine, University of Verona, Verona, Italy
| | | | - Grzegorz Bilo
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Carolina Lombardi
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianfranco Parati
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gian Paolo Rossi
- Hypertension Clinic, Department of Medicine - DIMED, University of Padova, Italy
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Rossitto G, Maiolino G, Lerco S, Ceolotto G, Blackburn G, Mary S, Antonelli G, Berton C, Bisogni V, Cesari M, Seccia TM, Lenzini L, Pinato A, Montezano A, Touyz RM, Petrie MC, Daly R, Welsh P, Plebani M, Rossi GP, Delles C. High sodium intake, glomerular hyperfiltration, and protein catabolism in patients with essential hypertension. Cardiovasc Res 2021; 117:1372-1381. [PMID: 33053160 PMCID: PMC8064429 DOI: 10.1093/cvr/cvaa205] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 03/03/2020] [Revised: 05/28/2020] [Accepted: 07/10/2020] [Indexed: 01/01/2023] Open
Abstract
AIMS A blood pressure (BP)-independent metabolic shift towards a catabolic state upon high sodium (Na+) diet, ultimately favouring body fluid preservation, has recently been described in pre-clinical controlled settings. We sought to investigate the real-life impact of high Na+ intake on measures of renal Na+/water handling and metabolic signatures, as surrogates for cardiovascular risk, in hypertensive patients. METHODS AND RESULTS We analysed clinical and biochemical data from 766 consecutive patients with essential hypertension, collected at the time of screening for secondary causes. The systematic screening protocol included 24 h urine (24 h-u-) collection on usual diet and avoidance of renin-angiotensin-aldosterone system-confounding medications. Urinary 24 h-Na+ excretion, used to define classes of Na+ intake (low ≤2.3 g/day; medium 2.3-5 g/day; high >5 g/day), was an independent predictor of glomerular filtration rate after correction for age, sex, BP, BMI, aldosterone, and potassium excretion [P = 0.001; low: 94.1 (69.9-118.8) vs. high: 127.5 (108.3-147.8) mL/min/1.73 m2]. Renal Na+ and water handling diverged, with higher fractional excretion of Na+ and lower fractional excretion of water in those with evidence of high Na+ intake [FENa: low 0.39% (0.30-0.47) vs. high 0.81% (0.73-0.98), P < 0.001; FEwater: low 1.13% (0.73-1.72) vs. high 0.89% (0.69-1.12), P = 0.015]. Despite higher FENa, these patients showed higher absolute 24 h Na+ reabsorption and higher associated tubular energy expenditure, estimated by tubular Na+/ATP stoichiometry, accordingly [Δhigh-low = 18 (12-24) kcal/day, P < 0.001]. At non-targeted liquid chromatography/mass spectrometry plasma metabolomics in an unselected subcohort (n = 67), metabolites which were more abundant in high versus low Na+ intake (P < 0.05) mostly entailed intermediates or end products of protein catabolism/urea cycle. CONCLUSION When exposed to high Na+ intake, kidneys dissociate Na+ and water handling. In hypertensive patients, this comes at the cost of higher glomerular filtration rate, increased tubular energy expenditure, and protein catabolism from endogenous (muscle) or excess exogenous (dietary) sources. Glomerular hyperfiltration and the metabolic shift may have broad implications on global cardiovascular risk independent of BP.
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Affiliation(s)
- Giacomo Rossitto
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Giuseppe Maiolino
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Silvia Lerco
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Giulio Ceolotto
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Gavin Blackburn
- Glasgow Polyomics, University of Glasgow, Wolfson Wohl Cancer Research Centre, Garscube Campus, Bearsden, Glasgow G61 1BD, UK
| | - Sheon Mary
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Giorgia Antonelli
- Laboratory Medicine, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Chiara Berton
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Valeria Bisogni
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Maurizio Cesari
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Teresa Maria Seccia
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Livia Lenzini
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Alessio Pinato
- Laboratory Medicine, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Augusto Montezano
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Ronan Daly
- Glasgow Polyomics, University of Glasgow, Wolfson Wohl Cancer Research Centre, Garscube Campus, Bearsden, Glasgow G61 1BD, UK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Mario Plebani
- Laboratory Medicine, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Gian Paolo Rossi
- Clinica dell’Ipertensione, DIMED, University of Padua, University Hospital, via Giustiniani 2, Padua 35126, Italy
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
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Rossi GP, Bisogni V, Rossitto G, Maiolino G, Cesari M, Zhu R, Seccia TM. Practice Recommendations for Diagnosis and Treatment of the Most Common Forms of Secondary Hypertension. High Blood Press Cardiovasc Prev 2020; 27:547-560. [PMID: 33159664 PMCID: PMC7661394 DOI: 10.1007/s40292-020-00415-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/10/2020] [Indexed: 12/14/2022] Open
Abstract
The vast majority of hypertensive patients are never sought for a cause of their high blood pressure, i.e. for a 'secondary' form of arterial hypertension. This under detection explains why only a tiny percentage of hypertensive patients are ultimately diagnosed with a secondary form of arterial hypertension. The prevalence of these forms is, therefore, markedly underestimated, although, they can involve as many as one-third of the cases among referred patients and up to half of those with difficult to treat hypertension. The early detection of a secondary form is crucial, because if diagnosed in a timely manner, these forms can be cured at long-term, and even when cure cannot be achieved, their diagnosis provides a better control of high blood pressure, and allows prevention of hypertension-mediated organ damage, and related cardiovascular complications. Enormous progress has been made in the understanding, diagnostic work-up, and management of secondary hypertension in the last decades. The aim of this minireview is, therefore, to provide updated concise information on the screening, diagnosis, and management of the most common forms, including primary aldosteronism, renovascular hypertension, pheochromocytoma and paraganglioma, Cushing's syndrome, and obstructive sleep apnea.
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Affiliation(s)
- Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, University Hospital, via Giustiniani, 2, 35126, Padova, Italy.
| | - Valeria Bisogni
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, University Hospital, via Giustiniani, 2, 35126, Padova, Italy
| | - Giacomo Rossitto
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, University Hospital, via Giustiniani, 2, 35126, Padova, Italy
| | - Giuseppe Maiolino
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, University Hospital, via Giustiniani, 2, 35126, Padova, Italy
| | - Maurizio Cesari
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, University Hospital, via Giustiniani, 2, 35126, Padova, Italy
| | - Rui Zhu
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, University Hospital, via Giustiniani, 2, 35126, Padova, Italy
| | - Teresa Maria Seccia
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, University Hospital, via Giustiniani, 2, 35126, Padova, Italy
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Maiolino G, Bisogni V, Silvani A, Pengo MF, Lombardi C, Parati G. Treating sleep disorders to improve blood pressure control and cardiovascular prevention: a dream come true?-a narrative review. J Thorac Dis 2020; 12:S225-S234. [PMID: 33214926 PMCID: PMC7642627 DOI: 10.21037/jtd-cus-2020-014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hypertension is one of the primary risk factors for heart disease and stroke, the leading causes of death worldwide. Current evidence supports the treatment of high blood pressure (BP) values in order to obtain a substantial reduction of cardiovascular burden. Sleep plays an important role in maintaining nocturnal BP control and nocturnal hypertension which, in turn, can be affected by the presence of sleep disorders. Whilst respiratory disturbances have been extensively studied and their causal role in the development of nocturnal hypertension has been demonstrated in both cross sectional and prospective studies, less is known about the impact of other sleep disorders such as insomnia. In this review, we aim to describe the role of sleep disorders in the development of nocturnal and diurnal hypertension. Furthermore, we aim to discuss the potential impact of the treatment of such sleep disorders on BP values as an adjunct treatment for patients with hypertension.
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Affiliation(s)
- Giuseppe Maiolino
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Valeria Bisogni
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Martino Francesco Pengo
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
| | - Carolina Lombardi
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy.,Faculty of Medicine, University of Milan-Bicocca, Milan, Italy
| | - Gianfranco Parati
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy.,Faculty of Medicine, University of Milan-Bicocca, Milan, Italy
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Rossi GP, Ceolotto G, Rossitto G, Maiolino G, Cesari M, Seccia TM. Effects of Mineralocorticoid and AT1 Receptor Antagonism on The Aldosterone-Renin Ratio In Primary Aldosteronism-the EMIRA Study. J Clin Endocrinol Metab 2020; 105:5739618. [PMID: 32067030 DOI: 10.1210/clinem/dgaa080] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 12/23/2019] [Accepted: 02/14/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT While current guidelines recommend the withdrawal of mineralocorticoid receptor antagonist (MRA) and renin-angiotensin system blockers for the screening and detection of primary aldosteronism (PA), this can worsen hypokalemia and control of high blood pressure (BP) values. OBJECTIVE To investigate whether aldosterone/renin ratio (ARR) values were affected by the MRA canrenone and/or by canrenone plus olmesartan treatment in patients with PA. DESIGN Within-patient study. SETTING The European Society of Hypertension center of excellence at the University of Padua. PATIENTS Consecutive patients with an unambiguous diagnosis of PA subtyped by adrenal vein sampling. INTERVENTIONS Patients were treated for 1 month with canrenone (50-100 mg orally), and for an additional month with canrenone plus olmesartan (10-20 mg orally). Canrenone and olmesartan were up-titrated over the first 2 weeks until BP values and hypokalemia were controlled. Patients with unilateral PA were adrenalectomized; those with bilateral PA were treated medically. MAIN OUTCOME MEASURES BP, plasma levels of sodium and potassium, renin and aldosterone. RESULTS Canrenone neither lowered plasma aldosterone nor increased renin; thus, the high ARR and true positive rate remained unaffected. Addition of the angiotensin type 1 receptor blocker raised renin and slightly lowered aldosterone, which reduced the ARR and increased the false negative rate. CONCLUSIONS At doses that effectively controlled serum potassium and BP values, canrenone did not preclude an accurate diagnosis in patients with PA. Addition of the angiotensin type 1 receptor blocker olmesartan slightly raised the false negative rate. Hence, MRA did not seem to endanger the accuracy of the diagnosis of PA.
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Affiliation(s)
- Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy
| | - Giulio Ceolotto
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy
| | - Giacomo Rossitto
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Giuseppe Maiolino
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy
| | - Maurizio Cesari
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy
| | - Teresa Maria Seccia
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy
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Rossitto G, Amar L, Azizi M, Riester A, Reincke M, Degenhart C, Widimsky J, Naruse M, Deinum J, Schultzekool L, Kocjan T, Negro A, Rossi E, Kline G, Tanabe A, Satoh F, Rump LC, Vonend O, Willenberg HS, Fuller P, Yang J, Nian Chee NY, Magill SB, Shafigullina Z, Quinkler M, Oliveras A, Chang CC, Wu VC, Somloova Z, Maiolino G, Barbiero G, Battistel M, Lenzini L, Quaia E, Pessina AC, Rossi GP. Subtyping of Primary Aldosteronism in the AVIS-2 Study: Assessment of Selectivity and Lateralization. J Clin Endocrinol Metab 2020; 105:5571856. [PMID: 31536622 DOI: 10.1210/clinem/dgz017] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/18/2019] [Indexed: 01/21/2023]
Abstract
CONTEXT Adrenal venous sampling (AVS) is the key test for subtyping primary aldosteronism (PA), but its interpretation varies widely across referral centers and this can adversely affect the management of PA patients. OBJECTIVES To investigate in a real-life study the rate of bilateral success and identification of unilateral aldosteronism and their impact on blood pressure outcomes in PA subtyped by AVS. DESIGN AND SETTINGS In a retrospective analysis of the largest international registry of individual AVS data (AVIS-2 study), we investigated how different cut-off values of the selectivity index (SI) and lateralization index (LI) affected rate of bilateral success, identification of unilateral aldosteronism, and blood pressure outcomes. RESULTS AVIS-2 recruited 1625 individual AVS studies performed between 2000 and 2015 in 19 tertiary referral centers. Under unstimulated conditions, the rate of biochemically confirmed bilateral AVS success progressively decreased with increasing SI cut-offs; furthermore, with currently used LI cut-offs, the rate of identified unilateral PA leading to adrenalectomy was as low as <25%. A within-patient pairwise comparison of 402 AVS performed both under unstimulated and cosyntropin-stimulated conditions showed that cosyntropin increased the confirmed rate of bilateral selectivity for SI cut-offs ≥ 2.0, but reduced lateralization rates (P < 0.001). Post-adrenalectomy outcomes were not improved by use of cosyntropin or more restrictive diagnostic criteria. CONCLUSION Commonly used SI and LI cut-offs are associated with disappointingly low rates of biochemically defined AVS success and identified unilateral PA. Evidence-based protocols entailing less restrictive interpretative cut-offs might optimize the clinical use of this costly and invasive test. (J Clin Endocrinol Metab XX: 0-0, 2020).
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Affiliation(s)
- Giacomo Rossitto
- Department of Medicine-DIMED, University Hospital, Padova, Italy
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Laurence Amar
- Hypertension unit, Université de Paris, Inserm UMR970 and CIC1418, Hôpital Européen Georges Pompidou, Paris, France
| | - Michel Azizi
- Hypertension unit, Université de Paris, Inserm UMR970 and CIC1418, Hôpital Européen Georges Pompidou, Paris, France
| | - Anna Riester
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, München, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, München, Germany
| | - Christoph Degenhart
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, München, Germany
| | - Jiri Widimsky
- 3rd Department of Medicine, Charles University Prague, General Hospital, Prague, Czech Republic
| | - Mitsuhide Naruse
- Department of Endocrinology, Clinical Research Institute, NHO Kyoto Medical Center and Endocrine Center, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Jaap Deinum
- Departments of Internal Medicine and Radiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Leo Schultzekool
- Departments of Internal Medicine and Radiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Tomaz Kocjan
- Department of Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Aurelio Negro
- Department of Internal Medicine, Azienda Unità Sanitaria Locale, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Ermanno Rossi
- Department of Internal Medicine, Azienda Unità Sanitaria Locale, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Gregory Kline
- University of Calgary, Foothills Medical Centre, Calgary, Canada
| | - Akiyo Tanabe
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine (NCGHM), Tokyo, Japan
| | - Fumitoshi Satoh
- Department of Nephrology, Tohoku University Hospital, Endocrinology and Vascular Medicine, Sendai, Japan
| | - Lars Christian Rump
- Department of Nephrology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Oliver Vonend
- Department of Nephrology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Holger S Willenberg
- Division of Endocrinology and Metabolism, Rostock University Medical Center, Rostock, Germany
| | - Peter Fuller
- Department of Endocrinology, Monash Health, Clayton, Australia
| | - Jun Yang
- Department of Endocrinology, Monash Health, Clayton, Australia
| | | | - Steven B Magill
- Medical College of Wisconsin, Endocrinology Center, North Hills Health Center, Menomonee Falls, Wisconsin
| | - Zulfiya Shafigullina
- Department of Endocrinology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | | | - Anna Oliveras
- Nephrology Department, Hospital del Mar Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Chin-Chen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Vin Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Zusana Somloova
- 3rd Department of Medicine, Charles University Prague, General Hospital, Prague, Czech Republic
| | | | | | | | - Livia Lenzini
- Department of Medicine-DIMED, University Hospital, Padova, Italy
| | - Emilio Quaia
- Institute of Radiology, University of Padova, Padova, Italy
| | | | - Gian Paolo Rossi
- Department of Medicine-DIMED, University Hospital, Padova, Italy
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24
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Rossi GP, Bisogni V, Bacca AV, Belfiore A, Cesari M, Concistrè A, Del Pinto R, Fabris B, Fallo F, Fava C, Ferri C, Giacchetti G, Grassi G, Letizia C, Maccario M, Mallamaci F, Maiolino G, Manfellotto D, Minuz P, Monticone S, Morganti A, Muiesan ML, Mulatero P, Negro A, Parati G, Pengo MF, Petramala L, Pizzolo F, Rizzoni D, Rossitto G, Veglio F, Seccia TM. The 2020 Italian Society of Arterial Hypertension (SIIA) practical guidelines for the management of primary aldosteronism. Int J Cardiol Hypertens 2020; 5:100029. [PMID: 33447758 PMCID: PMC7803025 DOI: 10.1016/j.ijchy.2020.100029] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/07/2020] [Indexed: 02/06/2023]
Abstract
Background and aim Considering the amount of novel knowledge generated in the last five years, a team of experienced hypertensionlogists was assembled to furnish updated clinical practice guidelines for the management of primary aldosteronism. Methods To identify the most relevant studies, the authors utilized a systematic literature review in international databases by applying the PICO strategy, and then they were required to make use of only those meeting predefined quality criteria. For studies of diagnostic tests, only those that fulfilled the Standards for Reporting of Diagnostic Accuracy recommendations were considered. Results Each section was jointly prepared by at least two co-authors, who provided Class of Recommendation and Level of Evidence following the American Heart Association methodology. The guidelines were sponsored by the Italian Society of Arterial Hypertension and underwent two rounds of revision, eventually reexamined by an External Committee. They were presented and thoroughly discussed in two face-to-face meetings with all co-authors and then presented on occasion of the 36th Italian Society of Arterial Hypertension meeting in order to gather further feedbacks by all members. The text amended according to these feedbacks was subjected to a further peer review. Conclusions After this process, substantial updated information was generated, which could simplify the diagnosis of primary aldosteronism and assist practicing physicians in optimizing treatment and follow-up of patients with one of the most common curable causes of arterial hypertension.
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Affiliation(s)
- Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
- Corresponding author. DIMED –Clinica dell’Ipertensione Arteriosa, University Hospital, via Giustiniani, 2; 35126, Padova, Italy.
| | - Valeria Bisogni
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
| | | | - Anna Belfiore
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Maurizio Cesari
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
| | - Antonio Concistrè
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Italy
| | - Rita Del Pinto
- University of L'Aquila, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, L'Aquila, Italy
| | - Bruno Fabris
- Department of Medical Sciences, Università degli Studi di Trieste, Cattinara Teaching Hospital, Trieste, Italy
| | - Francesco Fallo
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Italy
| | - Cristiano Fava
- Department of Medicine, University of Verona, Policlinico "G.B. Rossi", Italy
| | - Claudio Ferri
- University of L'Aquila, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, L'Aquila, Italy
| | | | | | - Claudio Letizia
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Italy
| | - Mauro Maccario
- Endocrinology, Diabetology, and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesca Mallamaci
- CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Giuseppe Maiolino
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
| | - Dario Manfellotto
- UO Medicina Interna, Ospedale Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Pietro Minuz
- Department of Medicine, University of Verona, Policlinico "G.B. Rossi", Italy
| | - Silvia Monticone
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Alberto Morganti
- Centro Fisiologia Clinica e Ipertensione, Ospedale Policlinico, Università Milano, Milan, Italy
| | - Maria Lorenza Muiesan
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Paolo Mulatero
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Aurelio Negro
- Department of Medicine, Center for Hypertension, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Martino F. Pengo
- Department of Medicine and Surgery, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Luigi Petramala
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Italy
| | - Francesca Pizzolo
- Department of Medicine, University of Verona, Policlinico "G.B. Rossi", Italy
| | - Damiano Rizzoni
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Giacomo Rossitto
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Franco Veglio
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Teresa Maria Seccia
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
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25
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Abstract
Adrenal venous sampling is the gold standard test to identify surgically curable primary aldosteronism, but it is markedly underused in clinical practice being perceived as a technically challenging and invasive procedure and, moreover, as difficult to interpret. This review provides updated information on current indications to adrenal venous sampling and how to perform and interpret adrenal venous sampling.
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Affiliation(s)
- Gian Paolo Rossi
- Arterial Hypertension Unit, Clinica dell'Ipertensione Arteriosa, Department of Medicine, DIMED University Hospital, University of Padova, Via Giustiniani, 2, Padova 35126, Italy.
| | - Giuseppe Maiolino
- Clinica dell'Ipertensione Arteriosa, Department of Medicine, DIMED, University of Padova, Via Giustiniani, 2, Padova 35126, Italy
| | - Teresa M Seccia
- Clinica dell'Ipertensione Arteriosa, Department of Medicine, DIMED, University of Padova, Via Giustiniani, 2, Padova 35126, Italy
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26
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Abstract
PURPOSE Atrial fibrillation is the most common sustained arrhythmia, with a prevalence of 1-2% in the general population and over 15% in people older than 80 years. Due to aging of the population it imposes an increasing burden on the healthcare system because of the need for life-long pharmacological treatment and the associated increased risk of heart failure and hospitalization. Hence, identification of the factors that predispose to atrial fibrillation it is of utmost relevance. RECENT FINDINGS Several conditions exist that are characterized by inappropriately high levels of aldosterone, mostly primary aldosteronism and the severe or drug-resistant forms of arterial hypertension. In these forms, aldosterone can cause prominent target organ damage, mostly in the heart, vasculature, and kidney. This review examines the experimental data and clinical evidences that support a link between hyperaldosteronism and atrial fibrillation, and how this knowledge should lead to a change in our management of the hypertensive patients presenting with atrial fibrillation.
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Affiliation(s)
- Teresa M Seccia
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 35128, Padova, Italy
| | - Brasilina Caroccia
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 35128, Padova, Italy
| | - Giuseppe Maiolino
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 35128, Padova, Italy
| | - Maurizio Cesari
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 35128, Padova, Italy
| | - Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 35128, Padova, Italy.
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27
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Lenzini L, Prisco S, Vanderriele PE, Lerco S, Torresan F, Maiolino G, Seccia TM, Iacobone M, Rossi GP. PTH Modulation by Aldosterone and Angiotensin II is Blunted in Hyperaldosteronism and Rescued by Adrenalectomy. J Clin Endocrinol Metab 2019; 104:3726-3734. [PMID: 30865228 DOI: 10.1210/jc.2019-00143] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/07/2019] [Indexed: 12/13/2022]
Abstract
CONTEXT Accumulating evidence suggests a link between adrenocortical zona glomerulosa and parathyroid gland through mechanisms that remain unexplored. OBJECTIVES To test the hypothesis that in vivo angiotensin II blockade affects PTH secretion in patients with hypertension and that aldosterone and angiotensim II directly stimulate PTH secretion ex vivo. DESIGN AND SETTING We investigated the changes of serum PTH levels induced by oral captopril (50 mg) administration in patients with primary essential hypertension (EH) and with primary aldosteronism (PA) caused by bilateral adrenal hyperplasia (BAH) or aldosterone-producing adenoma (APA), the latter before and after adrenalectomy. We also exposed primary cultures of human parathyroid cells from patients with primary hyperparathyroidism to angiotensin II (10-7 M) and/or aldosterone (10-7 M). RESULTS Captopril lowered PTH levels (in nanograms per liter) both in patients with EH (n = 63; 25.9 ± 8.3 baseline vs 24.4 ± 8.0 postcaptopril, P < 0.0001) and in patients with APA after adrenalectomy (n = 27; 26.3 ± 11.6 vs 24.0 ± 9.7 P = 0.021). However, it was ineffective in patients with full-blown PA caused by APA and BAH. In primary culture of human parathyroid cells, both aldosterone (P < 0.001) and angiotensin II (P = 0.002) markedly increased PTH secretion from baseline, by acting through mineralocorticoid receptor and angiotensin type 1 receptor, as these effects were abolished by canrenone and irbesartan, respectively. CONCLUSION These results collectively suggest an implication of the renin-angiotensin-aldosterone system in PTH regulation in humans, at least in PTH-secreting cells obtained from parathyroid tumors. Moreover, they further support the concept that mild hyperparathyroidism is a feature of human PA that is correctable with adrenalectomy.
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Affiliation(s)
- Livia Lenzini
- Hypertension Unit, Department of Medicine-DIMED, University of Medicine of Padova, Padova, Italy
| | - Selene Prisco
- Hypertension Unit, Department of Medicine-DIMED, University of Medicine of Padova, Padova, Italy
| | | | - Silvia Lerco
- Hypertension Unit, Department of Medicine-DIMED, University of Medicine of Padova, Padova, Italy
| | - Francesca Torresan
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterolgy, University of Padua, Padova, Italy
| | - Giuseppe Maiolino
- Hypertension Unit, Department of Medicine-DIMED, University of Medicine of Padova, Padova, Italy
| | - Teresa Maria Seccia
- Hypertension Unit, Department of Medicine-DIMED, University of Medicine of Padova, Padova, Italy
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterolgy, University of Padua, Padova, Italy
| | - Gian Paolo Rossi
- Hypertension Unit, Department of Medicine-DIMED, University of Medicine of Padova, Padova, Italy
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28
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Rossitto G, Maiolino G, Lerco S, Ceolotto G, Blackburn G, Mary S, Antonelli G, Berton C, Bisogni V, Cesari M, Seccia TM, Lenzini L, Pinato A, Montezano A, Touyz RM, Petrie MC, Welsh P, Plebani M, Rossi GP, Delles C. Abstract 058: High Sodium Intake Induces a Catabolic State via Glomerular Hyperfiltration and Enhanced Glomerulotubular Balance in Essential Hypertension. Hypertension 2019. [DOI: 10.1161/hyp.74.suppl_1.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
A metabolic shift in energy expenditure toward a catabolic state upon high sodium (Na
+
) diet, ultimately favouring endogenous water accrual and body fluid preservation, has recently been described in a rodent model.
Objective:
To investigate the impact of high Na
+
intake on renal Na
+
/water handling and metabolic signatures in a large real-life cohort of patients.
Methods and Results:
We analysed biochemical data from 767 hypertensive patients (429 males, 55.9%; age 47 ± 13 years; BMI 25.6 [23.0-29.0] kg/m
2
) in washout from drugs affecting the renin-angiotensin-aldosterone system at the time of screening for secondary causes and with a conclusive diagnosis of essential hypertension (2012-2017). Classes of Na
+
intake (
L
ow ≤2.3g/d;
M
edium 2.3-5g/d;
H
igh >5g/d) were defined based on urinary 24h Na
+
excretion (uNaV). The fractional excretion (FE) of Na
+
increased with increasing Na
+
intake (L: 0.39% [0.30-0.47] vs H: 0.81% [0.73-0.98], p < 0.001), while FE of free water decreased (L: 1.13% [0.73-1.72] vs H: 0.89% [0.69-1.12], p = 0.015). uNaV was an independent predictor of glomerular filtration rate (GFR, estimated by creatinine clearance; H: 130 ± 33 vs M: 111 ± 52 and L: 96 ± 39 ml/min/1.73m
2
; p < 0.001 for comparisons) after correction for age, sex, BMI, renin, aldosterone and uKV (p = 0.001). This resulted in a marked increase in the 24h tubular Na
+
reabsorption and, accordingly, in the estimated energy expenditure (Δ H vs L= 18 [12-24] kcal/d, p < 0.001). At non-targeted LC/MS metabolomics (n = 67), metabolites increased (p < 0.05) in H vs L Na
+
intake mostly entailed intermediates or end products of the urea cycle and products of protein catabolism. Urinary 24h cortisol excretion, as a potential determinant of catabolism, increased with Na
+
intake (n = 137; L: 63 [36-72] nmol, M: 60 [47-86] nmol, H: 86 [75-139] nmol; p < 0.001), but its strongest predictor at multivariate regression analysis was GFR (p = 0.001).
Conclusions:
Kidneys can effectively dissociate Na
+
and water handling upon high Na
+
diet, at the cost of glomerular hyperfiltration, enhanced glomerulotubular balance, increased tubular energy expenditure and, ultimately, protein catabolism from endogenous or excess exogenous sources. This has broad implications on global cardiovascular risk.
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Affiliation(s)
| | | | | | | | | | - Sheon Mary
- Univ of Glasgow, Glasgow, United Kingdom
| | | | | | | | | | | | | | - Alessio Pinato
- Univ of Padua, Clinical Biochemistry, Padua, United Kingdom
| | | | | | | | - Paul Welsh
- Univ of Glasgow, Glasgow, United Kingdom
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29
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Bisogni V, Maiolino G, Ceolotto G, Pengo MF, Marchese Ragona R, Artusi C, Brugnolo L, Lerco S, Borsetto D, Gaudioso P, Martini A, Plebani M, Rossi GP. Design of a study to investigate the mechanisms of obstructive sleep apnoea by means of drug-induced sleep endoscopy. Clin Chem Lab Med 2019; 57:1406-1413. [PMID: 31112503 DOI: 10.1515/cclm-2019-0113] [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: 01/30/2019] [Accepted: 03/23/2019] [Indexed: 11/15/2022]
Abstract
Background Obstructive sleep apnoea (OSA) is an independent risk factor of hypertension and cardiovascular diseases. Recurrent episodes of upper airways collapse during sleep causing blood oxygen desaturation, hypercapnia, and micro-arousals, are known to activate the sympathetic nervous system (SNS). However, whether changes in the renin-angiotensin-aldosterone system and endothelial activation also occur remains contentious. Methods Based on routine use of drug-induced sleep endoscopy (DISE) for the work-up of OSA patients in our centre, we designed a prospective study to investigate the haemodynamic and humoral changes occurring during the apnoeic episodes reproduced in vivo in the course of DISE. Specifically, plasma aldosterone concentration and renin activity, C-terminal fragment of proendothelin-1, as a marker of endothelial damage, and free plasma catecholamines, will be measured at fixed times during DISE. The activity of catechol-O-methyltransferase (COMT), a key catecholamine-inactivating enzyme that has been scantly investigated thus far owing to the lack of commercially available kits, will be also determined by a newly developed high performance liquid chromatography method, which is herein described. Results and conclusions The aim of this study is to provide novel information on the haemodynamic, hormonal, and SNS changes, and also on COMT activity modification concomitantly occurring during apnoea, thus contributing substantively to the understanding of the pathophysiology of OSA.
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Affiliation(s)
- Valeria Bisogni
- Department of Medicine, Clinica dell'Ipertensione Arteriosa, DIMED - University Hospital of Padova, Padova, Italy
| | - Giuseppe Maiolino
- Department of Medicine, Clinica dell'Ipertensione Arteriosa, DIMED - University Hospital of Padova, Padova, Italy
| | - Giulio Ceolotto
- Department of Medicine, Clinica dell'Ipertensione Arteriosa, DIMED - University Hospital of Padova, Padova, Italy
| | - Martino F Pengo
- Sleep Disorder Centre, Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Rosario Marchese Ragona
- Institute of Otolaryngology, Department of Neurosciences, University Hospital of Padova, Padova, Italy
| | - Carlo Artusi
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Laura Brugnolo
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Silvia Lerco
- Department of Medicine, Clinica dell'Ipertensione Arteriosa, DIMED - University Hospital of Padova, Padova, Italy
| | - Daniele Borsetto
- Institute of Otolaryngology, Department of Neurosciences, University Hospital of Padova, Padova, Italy
| | - Piergiorgio Gaudioso
- Institute of Otolaryngology, Department of Neurosciences, University Hospital of Padova, Padova, Italy
| | - Alessandro Martini
- Institute of Otolaryngology, Department of Neurosciences, University Hospital of Padova, Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Gian Paolo Rossi
- Department of Medicine, Clinica dell'Ipertensione Arteriosa, DIMED - University Hospital of Padova, Padova, Italy
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30
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Affiliation(s)
- Gian Paolo Rossi
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine, DIMED, University of Padua, Italy
| | - Giuseppe Maiolino
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine, DIMED, University of Padua, Italy
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31
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Ravarotto V, Simioni F, Sabbadin C, Pagnin E, Maiolino G, Armanini D, Calò LA. Proinflammatory/profibrotic effects of aldosterone in Gitelman's syndrome, a human model opposite to hypertension. J Endocrinol Invest 2019; 42:521-526. [PMID: 30136149 DOI: 10.1007/s40618-018-0942-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/09/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Aldosterone proinflammatory/profibrotic effects are mediated by the induction of mononuclear leucocytes (MNL) to express oxidative stress (OxSt)-related proteins, such as p22phox, and by the activation of RhoA/Rho kinase pathway. Gitelman's syndrome (GS), an autosomal recessive tubulopathy, is an interesting opposite model to hypertension, being characterized by hypokalemia, activation of renin-angiotensin-aldosterone system yet normo/hypotension and lack of cardiovascular-renal remodeling. We aimed to evaluate the proinflammatory/profibrotic effect of aldosterone in MNL of 6 GS patients compared with 6 healthy subjects (HS). METHODS p22phox expression and MYPT-1 phosphorylation status, a marker of RhoA/Rho kinase pathway activation, were evaluated in MNL of GS patients and HS at baseline and after incubation with aldosterone (1 × 10-8 M) alone or with canrenone (1 × 10-6 M). RESULTS At basal condition, p22phox expression was significantly higher in HS than in GS patients (1.02 ± 0.05 densitometric unit (du) vs 0.40 ± 0.1 du, respectively). Aldosterone significantly increased p22phox expression in HS and this effect was reversed by coincubation with canrenone (1.4 ± 0.05 du and 1.09 ± 0.03 du, respectively). No significant change was reported in GS after incubation of MNL with aldosterone and/or canrenone compared with basaline. Even MYPT-1 phosphorylation was significantly higher in HS compared with GS patients at basal condition (1.16 ± 0.1 du vs 0.69 ± 0.07, respectively). Aldosterone significantly increased MYPT-1 phosphorylation only in HS (1.37 ± 0.1 du vs 0.83 ± 0.12 du in GS). CONCLUSIONS GS patients seem to be protected by the OxSt status induced by aldosterone and revealed in HS. This human model could provide additional clues to highlight the proinflammatory/cardiovascular remodeling effects of aldosterone.
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Affiliation(s)
- V Ravarotto
- Department of Medicine-Nephrology, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - F Simioni
- Department of Medicine-Nephrology, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - C Sabbadin
- Department of Medicine-Endocrinology, University of Padova, Padua, Italy
| | - E Pagnin
- Department of Medicine-Nephrology, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - G Maiolino
- Department of Medicine-Hypertension, University of Padova, Padua, Italy
| | - D Armanini
- Department of Medicine-Endocrinology, University of Padova, Padua, Italy
| | - L A Calò
- Department of Medicine-Nephrology, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
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Affiliation(s)
- Giuseppe Maiolino
- From the Hypertension Unit, Department of Medicine (G.M., G.P.R.), University of Padua, Italy
| | - Peter W de Leeuw
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (P.W.d.L.).,Department of Internal Medicine, Zuyderland Medical Centre, Sittard/Heerlen, the Netherlands (P.W.d.L., D.J.L.v.T.)
| | - Daan J L van Twist
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard/Heerlen, the Netherlands (P.W.d.L., D.J.L.v.T.)
| | - Giulio Barbiero
- Department of Medicine, Institute of Radiology (G.B., M.B.), University of Padua, Italy
| | - Michele Battistel
- Department of Medicine, Institute of Radiology (G.B., M.B.), University of Padua, Italy
| | - Garry L R Jennings
- Sydney Health Partners, Sydney Medical School, University of Sydney, NSW, Australia (G.L.R.J.)
| | - Gian Paolo Rossi
- From the Hypertension Unit, Department of Medicine (G.M., G.P.R.), University of Padua, Italy
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Bisogni V, Pengo MF, Maiolino G, Cesari M, Lerco S, Rossitto G, Concistrè A, Petramala L, Letizia C, Seccia TM, Rossi GP. A sleep apnoea questionnaire predicts organ damage in hypertensive patients. Blood Press 2019; 28:173-183. [PMID: 30836778 DOI: 10.1080/08037051.2019.1586429] [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] [Indexed: 10/27/2022]
Abstract
BACKGROUND Arterial hypertension is associated with obstructive sleep apnoea, poor quality and duration of sleep, which might contribute to hypertension-mediated organ damage. METHODS We investigated the presence of insomnia, restless legs syndrome, and obstructive sleep apnoea using validated questionnaires (Insomnia Severity Index, Restless Legs Syndrome Rating Scale, and STOP-Bang), and their relationship with hypertension-mediated organ damage, in hypertensive patients. RESULTS In 159 consecutive consenting hypertensive patients [age 47(11) years, median and (interquartile range), body mass index 25.5(5.9) kg/m2, office systolic and diastolic blood pressure 144(23)/92(12) mmHg], the STOP-Bang, but not the other scores, predicted cardiac remodelling: compared to patients with a STOP-Bang score < 3, those at high risk of obstructive sleep apnoea showed higher left ventricular mass index [49.8(11.9) vs. 43.3(11.9) g/m2.7, p < 0.0001], left atrium volume [25.7(2.5) vs. 25.0(2.8) ml/m2, p = 0.003], and aortic root diameter [33.6(3.0) vs. 33.0(3.7) mm, p < 0.0001]. They did not differ for microalbuminuria and estimated glomerular filtration rate. At multivariate analysis, after adjustment for office systolic blood pressure values, the STOP-Bang score remained a predictor of left ventricular mass index; while the Insomnia Severity Index and restless legs syndrome risk score had no predictive value. However, a significant interaction between STOP-Bang and Restless Legs Syndrome Rating Scale scores in determining left ventricular remodelling was found. CONCLUSIONS In consecutive hypertensive stage I patients the STOP-Bang questionnaire allowed identification of a high-risk cohort featuring a more prominent cardiac damage. Hence, this inexpensive tool can be useful for risk stratification purposes in municipalities with limited access to health care resources.
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Affiliation(s)
- Valeria Bisogni
- a Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED , University of Padua , Italy.,b Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension , "Sapienza" University of Rome , Italy
| | - Martino F Pengo
- c Sleep Disorder Centre, Department of Cardiovascular, Neural and Metabolic Sciences , IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Giuseppe Maiolino
- a Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED , University of Padua , Italy
| | - Maurizio Cesari
- a Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED , University of Padua , Italy
| | - Silvia Lerco
- a Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED , University of Padua , Italy
| | - Giacomo Rossitto
- a Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED , University of Padua , Italy
| | - Antonio Concistrè
- b Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension , "Sapienza" University of Rome , Italy
| | - Luigi Petramala
- b Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension , "Sapienza" University of Rome , Italy
| | - Claudio Letizia
- b Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension , "Sapienza" University of Rome , Italy
| | - Teresa Maria Seccia
- a Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED , University of Padua , Italy
| | - Gian Paolo Rossi
- a Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED , University of Padua , Italy
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Rossitto G, Cesari M, Ceolotto G, Maiolino G, Seccia TM, Rossi GP. Effects of mineralocorticoid and AT-1 receptor antagonism on the aldosterone–renin ratio (ARR) in primary aldosteronism patients (EMIRA Study): rationale and design. J Hum Hypertens 2018; 33:167-171. [DOI: 10.1038/s41371-018-0139-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/29/2018] [Accepted: 11/15/2018] [Indexed: 11/09/2022]
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Ravarotto V, Carraro G, Pagnin E, Bertoldi G, Simioni F, Maiolino G, Martinato M, Landini L, Davis PA, Calò LA. Oxidative stress and the altered reaction to it in Fabry disease: A possible target for cardiovascular-renal remodeling? PLoS One 2018; 13:e0204618. [PMID: 30261035 PMCID: PMC6160124 DOI: 10.1371/journal.pone.0204618] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/11/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Fabry disease is characterized by deficient expression/activity of α-GalA with consequent lysosomal accumulation in various organs of its substrate Gb3. Despite enzyme replacement therapy, Fabry disease progresses with serious myocardial, cerebral and renal manifestations. Gb3 accumulation may induce oxidative stress (OxSt), production of inflammatory cytokines and reduction of nitric oxide, which may impact on Fabry disease's clinical manifestations. METHODS OxSt status was characterized in 10 patients compared with 10 healthy subjects via protein expression of p22phox, subunit of NADH/NADPH oxidase, (Western blot), Heme oxygenase (HO)-1 levels (ELISA), antioxidant/anti-inflammatory, lipid peroxidation as malondialdehyde (MDA) production (colorimetric assay), phosphorylation state of Extracellular Signal Regulated Kinase (ERK)1/2 and Myosin Phosphatase Target Protein (MYPT)-1 (Western blot), marker of Rho kinase activation, both involved in OxSt signaling. Cardiac left ventricular (LV) mass was also evaluated (M-mode echocardiography). RESULTS LV mass was higher in Fabry's males (123.72±2.03SEM g/m2) and females (132.09±6.72g/m2). p22phox expression was also higher in patients (1.04±0.09 d.u. vs 0.54±0.05 d.u. p<0.01) as well as MDA levels (54.51±3.97 vs 30.05±7.11 nmol/mL p = 0.01) while HO-1 was reduced (8.84±0.79 vs 14.03±1.23 ng/mL, p<0.02). MYPT-1's phosphorylation was increased in patients (0.52±0.11 d.u. vs 0.03±0.08 d.u., p<0.01) while phosphorylation of ERK1/2 was reduced (0.91±0.08 d.u. vs 1.53±0.17 d.u., p = 0.004). CONCLUSIONS This study documents OxSt activation and the altered reaction to it in Fabry patients. Cardiac remodeling, Rho kinase signaling activation and reduction of protective HO-1 might suggest that, in addition to enzyme replacement therapy, OxSt inhibition by either pharmacological or nutritional measures, is likely to prove useful for the prevention/treatment of Fabry patients' cardiovascular-renal remodeling.
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Affiliation(s)
| | - Gianni Carraro
- Department of Medicine, Nephrology, University of Padua, Padua Italy
| | - Elisa Pagnin
- Department of Medicine, Nephrology, University of Padua, Padua Italy
| | - Giovanni Bertoldi
- Department of Medicine, Nephrology, University of Padua, Padua Italy
| | - Francesca Simioni
- Department of Medicine, Nephrology, University of Padua, Padua Italy
| | - Giuseppe Maiolino
- Department of Medicine, Hypertension, University of Padua, Padua Italy
| | | | | | - Paul A Davis
- Department of Nutrition, University of California, Davis, United States of America
| | - Lorenzo A Calò
- Department of Medicine, Nephrology, University of Padua, Padua Italy
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Rossitto G, Maiolino G, Lerco S, Bisogni V, Cesari M, Ceolotto G, Touyz RM, Pinato A, Plebani M, Rossi GP, Delles C. Abstract P383: High Sodium Intake is Independently Associated with Subclinical Hypercortisolism in Hypertensive Patients. Hypertension 2018. [DOI: 10.1161/hyp.72.suppl_1.p383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The widely accepted notion of an increase in water intake to compensate for a similar increase in salt consumption has recently been challenged by evidence of long-term renal and metabolic mechanisms favouring endogenous water accrual and body fluid preservation. A glucocorticoid-driven catabolic state is instrumental to this aim and is prevented by increased food intake in rodents. Demonstration of these mechanisms in large human populations is lacking and their relevance for cardiovascular disease is therefore unknown. We explored the association between sodium intake (estimated by 24h urine sodium excretion; USE) and 24h urinary free cortisol (UFC) in 145 patients screened for secondary causes of hypertension in a tertiary referral centre, after washout from drugs affecting the renin-angiotensin-aldosterone system (63 males, 43.3%; age, 48 [38-56] years; BMI, 27.1 [24.3-31.0] kg/m
2
). USE was directly associated with UFC (Spearman’s rho=0.407, p<0.001), as well as male gender (r=0.381, p<0.001), BMI (r=0.243, p=0.006), creatinine clearance (r=0.637, p<0.001) and, borderline, to plasma glucose (r=0.268, p=0.065). Importantly, UFC increased across classes of sodium intake (Low < 2.3g/d, Medium 2.3-5g/d and High > 5g/d) in lean and overweight groups (n=41, ANOVA p = 0.005 and n= 49, ANOVA p < 0.001, respectively), but not in obese subjects (n=35; p = 0.083). Linear regression analysis showed that (square root-transformed) USE was the strongest explanatory variable for UFC after correction for age, gender, BMI, eGFR and aldosterone:renin ratio (β = 0.04, p < 0.0005). A regression model that also included (Log-transformed) BMI as a surrogate of excess food intake (β = -0.51, p = 0.042), explained 23% of UFC variability in the cohort. We conclude that sodium intake, as estimated by USE, is an independent predictor of subclinical hypercortisolism in lean and overweight but possibly not in obese subjects. These data, in a population at increased cardiovascular risk, suggest a link between sodium intake and subclinical metabolic derangement, which could further add to the overall risk profile.
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Maiolino G, Battistel M, Barbiero G, Bisogni V, Rossi GP. Cure With Cryoablation of Arterial Hypertension Due to a Renin-Producing Tumor. Am J Hypertens 2018. [PMID: 29522074 DOI: 10.1093/ajh/hpx213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We herein report on a 20 years old woman with stage I hypertension, who was found to carry a renin-producing tumor (RPT). METHODS Due to her young age, the patient underwent screening measurement of plasma renin and aldosterone, abdominal computed tomography (CT) angiography, and selective renal vein renin assessment to identify secondary hypertension. RESULTS The patient was screened for secondary causes of hypertension and was diagnosed with secondary aldosteronism. Therefore, she underwent an abdominal computed tomography (CT) angiography that was reported as unremarkable. Selective renal vein renin studies showed overproduction of renin in the right kidney and a re-evaluation of her CT allowed detection of an 8-mm mass in her right kidney, suggesting the presence of a RPT. Considering the technical difficulty of renal sparing surgery a CT-guided cryoablation was undertaken, which provided long-term cure of arterial hypertension and normalization of plasma active renin concentration. CONCLUSIONS RPTs usually present with a clinical phenotype featuring stage III and/or malignant hypertension and are held to be exceptionally rare. This case is unique in that it presented with stage I hypertension and a mild clinical phenotype. Moreover, to our knowledge this is the first case of RPTs shown to be safely treated with CT-guided cryoablation and found to be cured at long-term.
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Affiliation(s)
- Giuseppe Maiolino
- Clinica dell’Ipertensione Arteriosa, Department of Medicine – DIMED, University of Padua, Italy
| | - Michele Battistel
- Institute of Radiology, Department of Medicine – DIMED, University of Padua, Italy
| | - Giulio Barbiero
- Institute of Radiology, Department of Medicine – DIMED, University of Padua, Italy
| | - Valeria Bisogni
- Clinica dell’Ipertensione Arteriosa, Department of Medicine – DIMED, University of Padua, Italy
| | - Gian Paolo Rossi
- Clinica dell’Ipertensione Arteriosa, Department of Medicine – DIMED, University of Padua, Italy
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Pagnin E, Ravarotto V, Maiolino G, Naso E, Davis PA, Calò LA. Gαq/p63RhoGEF interaction in RhoA/Rho kinase signaling: investigation in Gitelman's syndrome and implications with hypertension. J Endocrinol Invest 2018; 41:351-356. [PMID: 28840514 DOI: 10.1007/s40618-017-0749-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/19/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE Gitelman's syndrome (GS) presents normo-hypotension and absence of cardiovascular-renal remodeling despite high angiotensin II (Ang II), activation of renin-angiotensin-aldosterone system and is a human model of endogenous antagonism of Ang II signaling, opposite to hypertension. GS's clinical presentation leads to questions regarding what features might be responsible. One area of investigation involves Ang II signaling. In hypertensive patients, RhoA/Rho kinase (RhoA/ROCK) pathway activation by Ang II is involved in hypertension development/maintenance and induction of long-term consequences (cardiovascular-renal remodeling), while GS has reduced p63RhoGEF gene and protein levels and ROCK activity. Ang II signaling is mediated by Gαq, which interacts with p63RhoGEF via the α6-αN linker connecting p63RhoGEF's DH and PH domains acting as a conformational switch to activate RhoA/ROCK signaling. METHODS We have investigated in GS patients, the presence of mutations in either p63RhoGEF's α6-αN linker domain and in Gαq's Ala253, Trp263, and Tyr356 residues, crucial for p63RhoGEF-Gαq interplay. RESULTS No mutations have been found in specific aminoacids of p63RhoGEF α6-αN linker and Gαq, key for p63RhoGEF/Gαq interplay. CONCLUSIONS Gitelman's syndrome normo/hypotension and lack of cardiovascular-renal remodeling are not due to mutations of p63RhoGEF α6-αN linker and Gαq interactions. This opens the way for investigations on different coding and no-coding regions (p63RhoGEF and Gαq promoters) and on altered transcriptional/post-transcriptional regulation. Clarification of how these biochemical/molecular mechanisms work/interact would provide insights into mechanisms involved in the GS's Ang II signaling fine tuning, in human physiology/pathophysiology in general and could also identify significant targets for intervention in the treatments of hypertension.
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Affiliation(s)
- E Pagnin
- Department of Medicine (DIMED), Nephrology, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - V Ravarotto
- Department of Medicine (DIMED), Nephrology, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - G Maiolino
- Hypertension, University of Padova, Padua, Italy
| | - E Naso
- Department of Medicine (DIMED), Nephrology, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - P A Davis
- Department of Nutrition, University of California, Davis, USA
| | - L A Calò
- Department of Medicine (DIMED), Nephrology, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
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Rossi GP, Maiolino G, Flego A, Belfiore A, Bernini G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Muiesan ML, Mannelli M, Negro A, Palumbo G, Parenti G, Rossi E, Mantero F. Adrenalectomy Lowers Incident Atrial Fibrillation in Primary Aldosteronism Patients at Long Term. Hypertension 2018; 71:585-591. [PMID: 29483224 DOI: 10.1161/hypertensionaha.117.10596] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 11/20/2017] [Accepted: 12/28/2017] [Indexed: 01/30/2023]
Abstract
Primary aldosteronism (PA) causes cardiovascular damage in excess to the blood pressure elevation, but there are no prospective studies proving a worse long-term prognosis in adrenalectomized and medically treated patients. We have, therefore, assessed the outcome of PA patients according to treatment mode in the PAPY study (Primary Aldosteronism Prevalence in Hypertension) patients, 88.8% of whom were optimally treated patients with primary (essential) hypertension (PH), and the rest had PA and were assigned to medical therapy (6.4%) or adrenalectomy (4.8%). Total mortality was the primary end point; secondary end points were cardiovascular death, major adverse cardiovascular events, including atrial fibrillation, and total cardiovascular events. Kaplan-Meier and Cox analysis were used to compare survival between PA and its subtypes and PH patients. After a median of 11.8 years, complete follow-up data were obtained in 89% of the 1125 patients in the original cohort. Only a trend (P=0.07) toward a worse death-free survival in PA than in PH patients was observed. However, at both univariate (90.0% versus 97.8%; P=0.002) and multivariate analyses (hazard ratio, 1.82; 95% confidence interval, 1.08-3.08; P=0.025), medically treated PA patients showed a lower atrial fibrillation-free survival than PH patients. By showing that during a long-term follow-up adrenalectomized aldosterone-producing adenoma patients have a similar long-term outcome of optimally treated PH patients, whereas, at variance, medically treated PA patients remain at a higher risk of atrial fibrillation, this large prospective study emphasizes the importance of an early identification of PA patients who need adrenalectomy as a key measure to prevent incident atrial fibrillation.
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Affiliation(s)
- Gian Paolo Rossi
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy.
| | - Giuseppe Maiolino
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Alberto Flego
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Anna Belfiore
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Giampaolo Bernini
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Bruno Fabris
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Claudio Ferri
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Gilberta Giacchetti
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Claudio Letizia
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Mauro Maccario
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Francesca Mallamaci
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Maria Lorenza Muiesan
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Massimo Mannelli
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Aurelio Negro
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Gaetana Palumbo
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Gabriele Parenti
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Ermanno Rossi
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
| | - Franco Mantero
- From the Clinica dell'Ipertensione Arteriosa Department of Medicine - DIMED, University of Padua, Italy
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Maiolino G, Ceolotto G, Battistel M, Barbiero G, Cesari M, Amar L, Caroccia B, Padrini R, Azizi M, Rossi GP. Macrolides for KCNJ5-mutated aldosterone-producing adenoma (MAPA): design of a study for personalized diagnosis of primary aldosteronism. Blood Press 2018; 27:200-205. [PMID: 29409357 DOI: 10.1080/08037051.2018.1436961] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Aldosterone-producing adenoma (APA) is the main curable cause of endocrine hypertension cause of primary aldosteronism (PA) and it is in up to 66% of all cases investigated with adrenal vein sampling (AVS). Mutations in the KCNJ5 potassium channel involve up to 70% of APA and cause the most florid PA phenotypes. The recent finding that macrolide antibiotics specifically inhibit in vitro the altered function of mutated KCNJ5 channels has opened new horizons for the diagnosis and treatment of APA with KCNJ5 mutations in that it can allow identification and target treatment of PA patients harbouring a mutated APA. Thus, we aimed at investigating if clarithromycin and roxithromycin, two macrolides that potently blunt mutated Kir3.4 channel function in vitro, affect plasma aldosterone concentration in adrenal vein blood during AVS and in peripheral blood, respectively, in PA patients with a mutated APA. METHODS AND DESIGN We designed two proof of concept studies. In study A: consecutive patients with an unambiguous biochemical evidence of PA will be exposed to a single dose of 250 mg clarithromycin during AVS, to assess its effect on the relative aldosterone secretion index in adrenal vein blood from the gland with and without APA. In study B: consecutive hypertensive patients submitted to the work-up for hypertension will receive a single oral dose of 150 mg roxithromycin. The experimental endpoints will be the change induced by roxithromycin of plasma aldosterone concentration and other steroids, direct active renin concentration, serum K+, systolic and diastolic blood pressure. DISCUSSION We expect to prove that: (i) clarithromycin allows identification of mutated APA before adrenalectomy and sequencing of tumour DNA; (ii) the acute changes of plasma aldosterone concentration, direct active renin concentration, and blood pressure in peripheral venous blood after roxithromycin can be a proxy for the presence of an APA with somatic mutations.
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Affiliation(s)
- Giuseppe Maiolino
- a Department of Medicine-DIMED, Clinica dell'Ipertensione Arteriosa , University of Padova , Padova , Italy
| | - Giulio Ceolotto
- a Department of Medicine-DIMED, Clinica dell'Ipertensione Arteriosa , University of Padova , Padova , Italy
| | - Michele Battistel
- b Department of Medicine-DIMED, Institute of Radiology , University of Padova , Padova , Italy
| | - Giulio Barbiero
- b Department of Medicine-DIMED, Institute of Radiology , University of Padova , Padova , Italy
| | - Maurizio Cesari
- a Department of Medicine-DIMED, Clinica dell'Ipertensione Arteriosa , University of Padova , Padova , Italy
| | - Laurence Amar
- c Department of Medicine-DIMED, Clinical Pharmacology , University of Padova , Padova , Italy
| | - Brasilina Caroccia
- a Department of Medicine-DIMED, Clinica dell'Ipertensione Arteriosa , University of Padova , Padova , Italy
| | - Roberto Padrini
- d APHP , Georges Pompidou European Hospital and Paris Descartes University , Paris , France
| | - Michel Azizi
- c Department of Medicine-DIMED, Clinical Pharmacology , University of Padova , Padova , Italy
| | - Gian Paolo Rossi
- a Department of Medicine-DIMED, Clinica dell'Ipertensione Arteriosa , University of Padova , Padova , Italy
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Seccia TM, Caroccia B, Adler GK, Maiolino G, Cesari M, Rossi GP. Arterial Hypertension, Atrial Fibrillation, and Hyperaldosteronism: The Triple Trouble. Hypertension 2018; 69:545-550. [PMID: 28264920 DOI: 10.1161/hypertensionaha.116.08956] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Teresa M Seccia
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.)
| | - Brasilina Caroccia
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.)
| | - Gail K Adler
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.)
| | - Giuseppe Maiolino
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.)
| | - Maurizio Cesari
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.)
| | - Gian Paolo Rossi
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.).
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Bisogni V, Pengo MF, Drakatos P, Maiolino G, Kent B, Rossitto G, Steier J, Rossi GP. Excessive daytime sleepiness, sympathetic nervous system activation and arterial stiffening in patients with mild-to-moderate obstructive sleep apnoea. Reply. Int J Cardiol 2017; 249:415-416. [DOI: 10.1016/j.ijcard.2017.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/15/2017] [Indexed: 10/18/2022]
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Pengo M, Ioratti D, Bisogni V, Ravarotto V, Rossi B, Bonfante L, Simioni F, Nalesso F, Maiolino G, Calò L. In Patients with Chronic Kidney Disease Short Term Blood Pressure Variability is Associated with the Presence and Severity of Sleep Disorders. Kidney Blood Press Res 2017; 42:804-815. [DOI: 10.1159/000484357] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/14/2017] [Indexed: 11/19/2022] Open
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Caroccia B, Prisco S, Seccia TM, Piazza M, Maiolino G, Rossi GP. Macrolides Blunt Aldosterone Biosynthesis: A Proof-of-Concept Study in KCNJ5 Mutated Adenoma Cells Ex Vivo. Hypertension 2017; 70:1238-1242. [PMID: 28993452 DOI: 10.1161/hypertensionaha.117.10226] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 08/23/2017] [Revised: 08/29/2017] [Accepted: 09/17/2017] [Indexed: 11/16/2022]
Abstract
Aldosterone-producing adenoma (APA), a major subtype of primary hyperaldosteronism, the main curable cause of human endocrine hypertension, involves somatic mutations in the potassium channel Kir3.4 (KCNJ5) in 30% to 70% of cases, typically the more florid phenotypes. Because KCNJ5 mutated channels were reported to be specifically sensitive to inhibition by macrolide antibiotics, which concentration dependently blunts aldosterone production in HAC15 transfected with the G151R and L168R mutated channel, we herein tested the effect of clarithromycin on aldosterone synthesis and secretion in a pure population of aldosterone-secreting cells obtained by immunoseparation (CD56+ cells) from APA tissues with/without the 2 most common KCNJ5 mutations. From a large cohort of patients with an unambiguous APA diagnosis, we recruited those who were wild type (n=3) or had G151R (n=2) and L168R (n=2) mutations. We found that clarithromycin concentration dependently lowered CYP11B2 gene expression (by 60%) and aldosterone secretion (by 70%; P<0.001 for both) in CD56+ cells isolated ex vivo from KCNJ5 mutated APAs, although it was ineffective in CD56+ cells from wild-type APAs. By proving the principle that the oversecretion of aldosterone can be specifically blunted in APA cells ex vivo with G151R and L168R mutations, these results provide compelling evidence of the possibility of specifically correcting aldosterone excess in patients with APA carrying the 2 most common KCNJ5 somatic mutations.
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Affiliation(s)
- Brasilina Caroccia
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine, University of Padua, Italy
| | - Selene Prisco
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine, University of Padua, Italy
| | - Teresa Maria Seccia
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine, University of Padua, Italy
| | - Maria Piazza
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine, University of Padua, Italy
| | - Giuseppe Maiolino
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine, University of Padua, Italy
| | - Gian Paolo Rossi
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine, University of Padua, Italy.
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Bisogni V, Pengo MF, De Vito A, Maiolino G, Rossi GP, Moxham J, Steier J. Electrical stimulation for the treatment of obstructive sleep apnoea: a review of the evidence. Expert Rev Respir Med 2017; 11:711-720. [PMID: 28730908 DOI: 10.1080/17476348.2017.1358619] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Obstructive sleep apnoea is an increasingly prevalent clinical condition with significant impact on individuals and public health. Continuous positive airway pressure therapy is the standard treatment, but adherence is limited and alternative treatments are needed. In this context, non-invasive and invasive methods for the electrical stimulation of upper airway dilator muscles have been demonstrated to be effective in selected patients. Areas covered: This review will cover investigations on the clinical effects, safety, and tolerability of non-invasive and invasive electrical stimulation of the upper airway for the management of obstructive sleep apnoea. Following a search of the relevant literature published on PubMed this review is focused mainly on data obtained from randomized clinical trials and clinical studies. Expert commentary: The available evidence provides a rationale to consider upper airway electrical stimulation as treatment for selected patients with obstructive sleep apnoea, who have poor adherence or experience difficulties with continuous positive airway pressure therapy. Non-invasive stimulation using transcutaneous electrodes and implantable hypoglossal nerve stimulator technologies may provide an alternative to continuous positive airway pressure for the treatment of obstructive sleep apnoea via restoration of neuromuscular tone and improved upper airway patency.
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Affiliation(s)
- Valeria Bisogni
- a Clinica dell'Ipertensione Arteriosa, Department of Internal Medicine - DIMED , University of Padova , Padua , Italy
| | - Martino F Pengo
- b Hypertension Unit, Ospedale S. Bortolo , University of Padova , Vicenza , Italy
| | - Andrea De Vito
- c Special Surgery Department, Head and Neck Department , Ear-Nose-Throat Unit, Morgagni-Pierantoni Hospital , Forlì , Italy
| | - Giuseppe Maiolino
- a Clinica dell'Ipertensione Arteriosa, Department of Internal Medicine - DIMED , University of Padova , Padua , Italy
| | - Gian Paolo Rossi
- a Clinica dell'Ipertensione Arteriosa, Department of Internal Medicine - DIMED , University of Padova , Padua , Italy
| | - John Moxham
- d King's College London , Faculty of Life Sciences and Medicine , London , UK
| | - Joerg Steier
- d King's College London , Faculty of Life Sciences and Medicine , London , UK.,e Guy's and St Thomas' NHS Foundation Trust , Lane Fox Respiratory Unit/Sleep Disorders Centre , London , UK
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Ceolotto G, Antonelli G, Maiolino G, Cesari M, Rossitto G, Bisogni V, Plebani M, Rossi GP. Androstenedione and 17-α-Hydroxyprogesterone Are Better Indicators of Adrenal Vein Sampling Selectivity Than Cortisol. Hypertension 2017; 70:342-346. [PMID: 28584010 DOI: 10.1161/hypertensionaha.117.09415] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 03/21/2017] [Revised: 04/07/2017] [Accepted: 05/05/2017] [Indexed: 11/16/2022]
Abstract
For identification of potentially surgically curable primary aldosteronism, guidelines recommend use of adrenal vein sampling (AVS) that requires selective catheterization of both adrenal veins as verified by using the cortisol-derived selectivity index. Unfortunately, bilaterally selective studies are not obtained under unstimulated conditions in a proportion of the cases ranging between 15% and 50% depending on the cutoff used. We therefore investigated whether 17-α-hydroxyprogesterone and androstenedione, which showed a higher step-up between adrenal vein and inferior vena cava blood than cortisol, can ascertain selectivity when cortisol failed to do so. We prospectively recruited 32 hypertensive patients with confirmed primary aldosteronism, who underwent bilaterally simultaneous sampling without cosyntropin stimulation and with the same predefined AVS protocol. All were consecutively selected because of a cortisol-based selectivity index <2.00 in at least one of the paired adrenal vein blood samples collected as per protocol. Results showed that the values of the selectivity index based on 17-α-hydroxyprogesterone and androstenedione were higher (P<0.01) on average by 1.6- and 12-fold, respectively, than those based on cortisol. With use of these steroids, we rescued 43% and 73% of the AVS, respectively, from being judged nonselective. Thus, in challenging patients with primary aldosteronism submitted to AVS use of 17-α-hydroxyprogesterone, and even more so of androstenedione, for ascertaining selectivity allows demonstration of correct catheter placement in a proportion of AVS studies better than cortisol. Thus, replacing cortisol measurement with these steroids, and particularly androstenedione, can improve the diagnostic yield of AVS.
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Affiliation(s)
- Giulio Ceolotto
- From the Clinica dell'Ipertensione Arteriosa (G.C., G.M., M.C., G.R., V.B., G.P.R.) and Laboratory Medicine (G.A., M.P.), Department of Medicine, DIMED-University of Padua, Italy
| | - Giorgia Antonelli
- From the Clinica dell'Ipertensione Arteriosa (G.C., G.M., M.C., G.R., V.B., G.P.R.) and Laboratory Medicine (G.A., M.P.), Department of Medicine, DIMED-University of Padua, Italy
| | - Giuseppe Maiolino
- From the Clinica dell'Ipertensione Arteriosa (G.C., G.M., M.C., G.R., V.B., G.P.R.) and Laboratory Medicine (G.A., M.P.), Department of Medicine, DIMED-University of Padua, Italy
| | - Maurizio Cesari
- From the Clinica dell'Ipertensione Arteriosa (G.C., G.M., M.C., G.R., V.B., G.P.R.) and Laboratory Medicine (G.A., M.P.), Department of Medicine, DIMED-University of Padua, Italy
| | - Giacomo Rossitto
- From the Clinica dell'Ipertensione Arteriosa (G.C., G.M., M.C., G.R., V.B., G.P.R.) and Laboratory Medicine (G.A., M.P.), Department of Medicine, DIMED-University of Padua, Italy
| | - Valeria Bisogni
- From the Clinica dell'Ipertensione Arteriosa (G.C., G.M., M.C., G.R., V.B., G.P.R.) and Laboratory Medicine (G.A., M.P.), Department of Medicine, DIMED-University of Padua, Italy
| | - Mario Plebani
- From the Clinica dell'Ipertensione Arteriosa (G.C., G.M., M.C., G.R., V.B., G.P.R.) and Laboratory Medicine (G.A., M.P.), Department of Medicine, DIMED-University of Padua, Italy
| | - Gian Paolo Rossi
- From the Clinica dell'Ipertensione Arteriosa (G.C., G.M., M.C., G.R., V.B., G.P.R.) and Laboratory Medicine (G.A., M.P.), Department of Medicine, DIMED-University of Padua, Italy.
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Maiolino G, Rossitto G, Bisogni V, Cesari M, Seccia TM, Plebani M, Rossi GP. Quantitative Value of Aldosterone-Renin Ratio for Detection of Aldosterone-Producing Adenoma: The Aldosterone-Renin Ratio for Primary Aldosteronism (AQUARR) Study. J Am Heart Assoc 2017; 6:JAHA.117.005574. [PMID: 28529209 PMCID: PMC5524101 DOI: 10.1161/jaha.117.005574] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Current guidelines recommend use of the aldosterone‐renin ratio (ARR) for the case detection of primary aldosteronism followed by confirmatory tests to exclude false‐positive results from further diagnostic workup. We investigated the hypothesis that this could be unnecessary in patients with a high ARR value if the quantitative information carried by the ARR is taken into due consideration. Methods and Results We interrogated 2 large data sets of prospectively collected patients studied with the same predefined protocol, which included the captopril challenge test. We used an unambiguous diagnosis of aldosterone‐producing adenoma as reference index. We also assessed whether the post‐captopril ARR and plasma aldosterone concentration fall furnished a diagnostic gain over baseline ARR values. We found that the false‐positive rate fell exponentially, and, conversely, the specificity increased with rising ARR values. At receiver operating characteristics curves and diagnostic odds ratio analysis, the high baseline ARR values implied very high positive likelihood ratio and diagnostic odds ratio values. The baseline and post‐captopril ARR showed similar diagnostic accuracy (area under the receiver operating characteristics curve) in both the exploratory and validation cohorts, indicating lack of diagnostic gain with this confirmatory test (between‐area under the curve difference, 0.005; 95% CI, −0.031 to 0.040; P=0.7 for comparison, and 0.05; 95% CI, −0.061 to 0.064; P=0.051 for comparison, respectively). Conclusions These results indicate that the ARR conveys key quantitative information that, if properly used, can simplify the diagnostic workup, resulting in saving of money and resources. This can offer the chance of diagnosis and ensuing adrenalectomy to a larger number of hypertensive patients, ultimately resulting in better control of blood pressure.
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Affiliation(s)
- Giuseppe Maiolino
- Clinica dell'Ipertensione Arteriosa, and Laboratory Medicine, University of Padua, Italy
| | - Giacomo Rossitto
- Clinica dell'Ipertensione Arteriosa, and Laboratory Medicine, University of Padua, Italy
| | - Valeria Bisogni
- Clinica dell'Ipertensione Arteriosa, and Laboratory Medicine, University of Padua, Italy
| | - Maurizio Cesari
- Clinica dell'Ipertensione Arteriosa, and Laboratory Medicine, University of Padua, Italy
| | - Teresa Maria Seccia
- Clinica dell'Ipertensione Arteriosa, and Laboratory Medicine, University of Padua, Italy
| | - Mario Plebani
- Department of Medicine - DIMED, University of Padua, Italy
| | - Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, and Laboratory Medicine, University of Padua, Italy
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Cesari M, Ceolotto G, Rossitto G, Maiolino G, Seccia TM, Rossi GP. The Intra-Procedural Cortisol Assay During Adrenal Vein Sampling: Rationale and Design of a Randomized Study (I-Padua). High Blood Press Cardiovasc Prev 2017; 24:167-170. [DOI: 10.1007/s40292-017-0192-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/09/2017] [Indexed: 11/29/2022] Open
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Rossi GP, Ceolotto G, Rossitto G, Seccia TM, Maiolino G, Berton C, Basso D, Plebani M. Prospective validation of an automated chemiluminescence-based assay of renin and aldosterone for the work-up of arterial hypertension. Clin Chem Lab Med 2017; 54:1441-50. [PMID: 26824982 DOI: 10.1515/cclm-2015-1094] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/14/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND The availability of simple and accurate assays of plasma active renin (DRC) and aldosterone concentration (PAC) can improve the detection of secondary forms of arterial hypertension. Thus, we investigated the performance of an automated chemiluminescent assay for DRC and PAC in referred hypertensive patients. METHODS We prospectively recruited 260 consecutive hypertensive patients referred to an ESH Center for Hypertension. After exclusion of six protocol violations, 254 patients were analyzed: 67.3% had primary hypertension, 17.3% an aldosterone producing adenoma (APA), 11.4% idiopathic hyperaldosteronism (IHA), 2.4% renovascular hypertension (RVH), 0.8% familial hyperaldosteronism type 1 (FH-1), 0.4% apparent mineralocorticoid excess (AME), 0.4% a renin-producing tumor, and 3.9% were adrenalectomized APA patients. Bland-Altman plots and Deming regression were used to analyze results. The diagnostic accuracy (area under the curve, AUC of the ROC) of the DRC-based aldosterone-renin ratio (ARRCL) was compared with that of the PRA-based ARR (ARRRIA) using as reference the conclusive diagnosis of APA. RESULTS At Bland-Altman plot, the DRC and PAC assay showed no bias as compared to the PRA and PAC assay. A tight relation was found between the DRC and the PRA values (concordance correlation coefficient=0.92, p<0.0001) and the PAC values measured with radioimmunoassay and chemiluminescence (concordance correlation coefficient=0.93, p<0.001). For APA identification the AUC of the ARRCL was higher than that of the ARRRIA [0.974 (95% CI 0.940-0.991) vs. 0.894 (95% CI 0.841-0.933), p=0.02]. CONCLUSIONS This rapid automated chemiluminescent DRC/PAC assay performed better than validated PRA/PAC radioimmunoassays for the identification of APA in referred hypertensive patients.
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Vianello A, Bisogni V, Rinaldo C, Gallan F, Maiolino G, Braccioni F, Guarda-Nardini L, Molena B, Rossi GP, Marchese-Ragona R. Recent advances in the diagnosis and management of obstructive sleep apnea. Minerva Med 2016; 107:437-451. [PMID: 27625198] [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: 06/06/2023]
Abstract
Affecting a large number of middle-aged, frequently overweight subjects, obstructive sleep apnea (OSA) is the most common sleep related breathing disorder. Partial or complete upper airway (UA) collapse during sleep causing repeated apneic episodes, which is the leading pathophysiological mechanism underlying the disorder, results in arterial oxygen desaturation and recurrent arousals from sleep to re-establish airway patency. Untreated OSA is commonly associated with a range of adverse consequences, including cardiovascular complications, such as arterial and/or pulmonary hypertension, arrhythmias, stroke, as well as diabetes mellitus and metabolic syndrome, and motor vehicle accidents. Evidence-based guidelines are presently available for the diagnosis and management of OSA, and a variety of updated testing and treatment procedures and devices including some that are able to identify the site and degree of airway obstruction are becoming increasingly available. As the "one size fits all" approach falls to the wayside, a tailored personal therapeutic strategy is becoming increasingly popular in the field of sleep medicine. The aim of this review is to provide an overview for practicing clinicians on recent advances in the evaluation and management of obstructive sleep apnea in adults.
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Affiliation(s)
- Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiac, Thoracic and Vascular Sciences, University-City Hospital of Padua, Padua, Italy -
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