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Reid A, Klein A, Lin D, Abbate A, Luis SA, Petersen J, Portman M, Winnowski D, Malinowski A, Marden L, Paolini JF, Martin D. RESONANCE Registry: rationale and design of the retrospective and prospective longitudinal, observational registry in pediatric and adult patients with recurrent pericarditis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3173] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Annually in the United States (US), an estimated 80–90,000 patients are diagnosed with acute pericarditis and 15–30% experience recurrent pericarditis (RP), resulting in increased morbidity and reduced health-related quality of life (HRQoL). Treatment options include non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine. Corticosteroids (CS) are often added to the treatment plan in RP despite CS-associated adverse events and inherent potentiation of recurrence with long-term treatment. A recent Phase 3 clinical trial RHAPSODY (NCT03737110) demonstrated efficacy and safety of rilonacept, an interleukin-1 α and β cytokine trap, in patients with RP. RHAPSODY data helped support FDA approval of the first therapy for RP. With the emergence of this targeted therapy, there is increased interest to learn more about this disease with the goal to better inform treatment and management decisions and improve long-term outcomes.
Purpose
RESONANCE Registry aims to evaluate the natural history of RP by collecting retrospective and prospective, longitudinal physician- and patient-reported outcomes data in real-world clinical practice across the US.
Methods
RP patients with active disease (recurrence within 3 years) will have both retrospective and prospective data collected (Figure 1) for as long as their RP is managed up to 5 years. For patients with inactive disease (no recurrence within 3 years), data collection will be retrospective (Figure 2). Up to 500 patients in the US are planned for enrollment at pediatric and adult medical centers, with the potential for expansion to European sites. Additionally, patients will be recruited through a novel, internet-based technology platform and screened for eligibility at a “decentralized” trial site. The registry will include variables obtained from health records, including baseline characteristics and medical history, as well as patient reported outcome (PRO) measures collected every 3 months. The RESONANCE protocol is designed to include a broad population of pediatric and adult patients, regardless of etiology or treatment course, including patients treated with rilonacept. Data will be analyzed to understand disease heterogeneity, variability in treatment and management, and impact on HRQoL. The protocol and Case Report Forms (CRFs) were developed in collaboration with physicians, patients, and patient advocates.
Conclusions
Registries utilize real-world data to fill knowledge gaps in the management of less common diseases such as RP. The RESONANCE Registry is the first RP registry designed to collect data across a broad range of patients regardless of treatment. The registry will also serve as a connection point for physicians to further educate and empower patients with information about their disease. In addition, PRO data may enable greater insights into the understanding of the burden of RP from the patient's perspective.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Kiniksa Pharmaceuticals
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Affiliation(s)
- A Reid
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - A Klein
- Cleveland Clinic, Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Cleveland, United States of America
| | - D Lin
- Abbott Northwestern Hospital, Minneapolis Heart Institute, Minneapolis, United States of America
| | - A Abbate
- Virginia Commonwealth University, VCU Pauley Heart Center, Richmond, United States of America
| | - S A Luis
- Mayo Clinic, Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Rochester, United States of America
| | - J Petersen
- Swedish Medical Center, Seattle, United States of America
| | - M Portman
- Seattle Children's Hospital, Seattle, United States of America
| | - D Winnowski
- Pericarditis Alliance, Albany, United States of America
| | - A Malinowski
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - L Marden
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - J F Paolini
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - D Martin
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
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Samsonov M, Bogin V, Van Tassell BW, Abbate A. Interleukin-1 blockade with RPH-104 in patients with acute ST-elevation myocardial infarction: study design and rationale. J Transl Med 2021; 19:169. [PMID: 33902621 PMCID: PMC8074403 DOI: 10.1186/s12967-021-02828-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Myocardial injury of ST-segment elevation myocardial infarction (STEMI) initiates an intense inflammatory response that contributes to further damage and is a predictor of increased risk of death or heart failure (HF). Interleukin-1 (IL-1) is a key mediator of local and systemic inflammatory response to myocardial damage. We postulate that the use of the drug RPH-104, which selectively binds and inactivates both α and β isoforms of IL-1 will lead to a decrease in the severity of the inflammatory response which will be reflected by decrease in the concentration of hsCRP, as well as the rate of fatal outcomes, frequency of new cases of HF, changes in levels of brain natriuretic peptide (BNP) and changes in structural and functional echocardiographic parameters. Methods This is a double blind, randomized, placebo-controlled study in which 102 patients with STEMI will receive a single administration of RPH-104 80 mg, RPH-104 160 mg or placebo (1:1:1). The primary endpoint will be hsCRP area under curve (AUC) from day 1 until day 14. Secondary endpoints will include hsCRP AUC from day 1 until day 28, rate of fatal outcomes, hospitalizations due to HF and other cardiac and non-cardiac reasons during 12-month follow-up period, frequency of new cases of HF, changes in levels of brain natriuretic peptide (BNP, NT-pro-BNP), changes in structural and functional echocardiographic parameters during 12-month follow-up period compared to baseline. The study started in October 2020 and is anticipated to end in 2Q 2022. Trial registration: ClinicalTrials.gov, NCT04463251. Registered on July 9, 2020
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Affiliation(s)
| | - V Bogin
- Cromos Pharma, LLC, Portland, OR, USA
| | - B W Van Tassell
- School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - A Abbate
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
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Van Tassell B, Wohlford G, Ho A, Vecchie A, Garmendia C, Trankle C, Buckley L, Kadariya D, Canada J, Carbone S, Markley R, Turlington J, Appleton D, Lipinski M, Abbate A. Recombinant Interleukin-1 receptor antagonist for the treatment of ST-segment elevation acute myocardial infarction prevents future heart failure events: a pooled analysis of the VCUART program. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1728] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
ST segment elevation myocardial infarction (STEMI) is associated with an intense acute inflammatory response and an increased risk of death and heart failure (HF). We analyzed the effect of recombinant interleukin-1 receptor antagonist (anakinra) 100 mg subcutaneous injection given once or twice daily for 14 days on the occurrence of HF in a pooled analysis of 3 clinical trials.
Methods
Enrollment criteria and study procedures were the same across the three studies. High-sensitivity C-reactive protein (CRP) was measured at baseline, 72 hours, and 14 days to construct an area under the curve (AUC0–14). Clinical events up to 1 year were adjudicated by an independent committee blinded to treatment allocation. Data for anakinra once daily and anakinra twice daily were pooled into a single anakinra group. CRP data are presented as median and interquartile range to allow for deviation from Gaussian distribution and non-parametric tests were used to evaluate differences between groups. Kaplan-Meier survival analyses were conducted and the intervention groups were compared using a log-rank test.
Results
Between 2008 and 2017, 139 patients with STEMI were enrolled. 84 patients were randomized to anakinra and 55 patients were randomized to placebo. Anakinra significantly reduced the CRP AUC0–14 (76 [42–147] vs 222 [117–339] mg*day/L; P<0.001), the composite of death or HF hospitalization (Chi2=7.167; P=0.007), and the composite of death or new onset HF (Chi2=9.43; P=0.002) compared with placebo. Treatment with anakinra had no effect on ischemic events (composite of death, myocardial infarction, and unstable angina; (Chi2=0.574; P=0.45) or the composite of death, myocardial infarction and cerebrovascular accident (Chi2=0.065; P=0.80). Patients receiving anakinra had increased injection site reactions (20.2% vs 3.6%; P=0.005) but no change in infections (14.3% vs 9.1%, P=0.435) versus placebo.
Conclusions
Treatment with anakinra for 14 days following STEMI blunts the inflammatory response and appears to reduce the occurrence of HF events at 1 year. These results support the hypothesis that early and targeted modification of the inflammatory response in STEMI may be a viable strategy to improve patient outcomes.
Adjudicated events at 1 year
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Heart Lung and Blood Institute (USA), American Heart Association (USA)
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Affiliation(s)
- B Van Tassell
- Virginia Commonwealth University, Richmond, United States of America
| | - G.F Wohlford
- Virginia Commonwealth University, Richmond, United States of America
| | - A.C Ho
- Virginia Commonwealth University, Richmond, United States of America
| | - A Vecchie
- Virginia Commonwealth University, Richmond, United States of America
| | - C Garmendia
- Virginia Commonwealth University, Richmond, United States of America
| | - C.R Trankle
- Virginia Commonwealth University, Richmond, United States of America
| | - L.F Buckley
- Brigham and Women's Hospital, Boston, United States of America
| | - D Kadariya
- Virginia Commonwealth University, Richmond, United States of America
| | - J.M Canada
- Virginia Commonwealth University, Richmond, United States of America
| | - S Carbone
- Virginia Commonwealth University, Richmond, United States of America
| | - R Markley
- Virginia Commonwealth University, Richmond, United States of America
| | - J.S Turlington
- Virginia Commonwealth University, Richmond, United States of America
| | - D Appleton
- Virginia Cardiovascular Specialists, Richmond, United States of America
| | - M.J Lipinski
- Medstar Research Institute, Washington, DC, United States of America
| | - A Abbate
- Virginia Commonwealth University, Richmond, United States of America
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Ricco A, Kim A, Canada J, Grizzard J, Dana F, Rezai Gharai L, Abbate A, Weiss E. Extracellular Volume Fraction of Cardiac MRI in the Detection of Cardiac Toxicity from Radiotherapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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Van Tassell B, Lipinski MJ, Appleton D, Trankle CR, Kadariya D, Abouzaki NA, Canada JM, Carbone S, Buckley LF, Melchior R, Thomas C, Garnett J, Puckett L, Kontos MC, Abbate A. P6388Effects of Interleukin-1 blockade with anakinra in patients with ST-segment elevation acute myocardial infarction on recurrent ischemic events: results from the VCUART3 study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
ST-segment elevation myocardial infarction (STEMI) is associated with an intense acute inflammatory response and an increased risk of recurrent ischemic events. Prior studies of IL-1 blockade have shown conflicting results regarding the risk of future events.
Methods
We enrolled patients with STEMI within 12 hours of presentation at 3 sites in the United States of America. After revascularization, patients were randomly assigned to receive anakinra 100 mg twice daily, anakinra 100 mg once daily (standard dose) alternated with placebo once daily every 12 hours, or placebo every 12 hours for 14 days in 1:1:1 ratio. Prespecified exploratory endpoints for recurrent ischemic events, adjudicated by an independent committee, evaluated the composite risk of subsequent acute myocardial infarction (AMI, World Health Organization classification Type 1), unstable angina, or urgent revascularization. Data are expressed as median and interquartile range or number and percentage. Cox regression analysis was used to generate unadjusted hazard ratios and confidence intervals. (ClinicalTrials.gov number, NCT01950299)
Results
Of 311 patients screened, 99 subjects (81% males, 58% Caucasians, 55 [49–62] years of age) were randomly assigned to anakinra twice daily (N=31), anakinra once daily (N=33) or placebo (N=35). The cohort included patients with hypertension (57%), tobacco use (55%), diabetes mellitus (30%), and prior diagnosis of coronary artery disease (21%) without statistically significant imbalances in the demographic characteristics between groups (all P>0.05). Discharge medications for the index STEMI admission, in addition to the study medication, included aspirin (100%), statins (100%), P2Y12 inhibitors (100%), beta-blockers (90%), and angiotensin converting enzyme inhibitor/angiotensin receptor blocker (84%), without statistically significant imbalances between the 3 groups. Over the 1-year follow-up, recurrent ischemic events occurred in 5/35 (14.3%) patients treated with placebo and 6/64 (9.1%) patients treated with anakinra (hazard ratio = 0.68 [0.20–2.24], P=0.53). No differences were observed between high- and low-dose anakinra treatment groups.
Conclusions
A two week treatment with IL-1 receptor antagonist, anakinra, did not significantly decrease or increase recurrent ischemic events over the course of a 1-year follow-up in patients with STEMI.
Acknowledgement/Funding
Funded by NHLBI 1R34HL121402; Drug supply by Swedish Orphan Biovitrum
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Affiliation(s)
- B Van Tassell
- Virginia Commonwealth University, Richmond, United States of America
| | - M J Lipinski
- Medstar Research Institute, Washington, United States of America
| | - D Appleton
- Virginia Cardiovascular Specialists, Richmond, United States of America
| | - C R Trankle
- Virginia Commonwealth University, Richmond, United States of America
| | - D Kadariya
- Virginia Commonwealth University, Richmond, United States of America
| | - N A Abouzaki
- Virginia Commonwealth University, Richmond, United States of America
| | - J M Canada
- Virginia Commonwealth University, Richmond, United States of America
| | - S Carbone
- Virginia Commonwealth University, Richmond, United States of America
| | - L F Buckley
- Virginia Commonwealth University, Richmond, United States of America
| | - R Melchior
- Virginia Cardiovascular Specialists, Richmond, United States of America
| | - C Thomas
- Virginia Cardiovascular Specialists, Richmond, United States of America
| | - J Garnett
- Virginia Cardiovascular Specialists, Richmond, United States of America
| | - L Puckett
- Virginia Cardiovascular Specialists, Richmond, United States of America
| | - M C Kontos
- Virginia Commonwealth University, Richmond, United States of America
| | - A Abbate
- Virginia Commonwealth University, Richmond, United States of America
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6
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Chiabrando J, Lombardi M, Vescovo GM, Biondi Zoccai G, Abbate A, Wohlford G, Berrocal DH, Guzman L. P5752Which is the best stenting technique for coronary bifurcation lesions? Evidence from a network meta-analysis of randomized clinical trials. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0692] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Bifurcation lesions represent 20% of all coronary lesions treated by percutaneous coronary interventions (PCI). Although provisional technique with 1 stent in the main branch and balloon angioplasty of the side branch is considered the standard approach, the implantation of 2 stents is often being pursued with a wide variety of bifurcation stenting techniques. We thus conducted a systematic review and network meta-analysis of randomized clinical trials (RCTs) to compare clinical cardiovascular outcomes involving stenting techniques in coronary bifurcation lesions.
Methods
We searched on Pubmed, Google Scholar, Embase and Cochrane Library, up to October 2018 for published and unpublished RCTs that compared clinical cardiovascular outcomes in patients with bifurcation lesions treated with 7different techniques (crush [Cr]; culotte [Cu]; double kissing crush [DKCr], mini-crush [mCr], routine T-stenting [RTS], T-stenting and small protrusion [TAP], and provisional (1 stent technique)). We performed a frequentist fixed-effect network meta-analysis to estimate relative risks (RR) of major adverse cardiovascular events (“MACE”, typically defined as death, myocardial infarction and target vessel revascularization), target vessel revascularization (TVR), target lesion revascularization (TLR), and stent thrombosis (ST).
Results
We identified 14 studies, yielding data on 4285 patients. DKCr and mCr yielded significant reductions in MACE, TVR, and TLR when compared with the 1-stent technique (RR 0.31–0.55 [all P<0.01] and RR 0.42–0.45 [all P<0.02], respectively) and with the rest of the bifurcation techniques (RR 0.44–0.55 [all P<0.05] for DKCr and RR 0.37–0.45 [all P<0.05] for mCr). On the other hand, Cu and Cr were associated with an increased risk for ST compared to 1-stent technique (RR 3.25–4.27 [both P<0.05]) and to DKCr (RR 3.02–3.99 [both P<0.05]). We found no heterogeneity nor inconsistency between studies.
Conclusions
The various PCI bifurcation stenting techniques are associated with different cardiovascular outcomes, with double kissing crush and mini crush being more effective than others, including the 1-stent approach, whereas culotte and crush are associated with increased risk of stent thrombosis.
Acknowledgement/Funding
None
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Affiliation(s)
- J Chiabrando
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - M Lombardi
- VCU Pauley Heart Center, Clinical Research Unit, Richmond, United States of America
| | - G M Vescovo
- University of Padova, Dept. Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - G Biondi Zoccai
- Sapienza University of Rome, Department of Medical-Surgical Sciences and Biotechnologies, Rome, Italy
| | - A Abbate
- VCU Pauley Heart Center, Clinical Research Unit, Richmond, United States of America
| | - G Wohlford
- VCU Pauley Heart Center, Clinical Research Unit, Richmond, United States of America
| | - D H Berrocal
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - L Guzman
- VCU Pauley Heart Center, Clinical Research Unit, Richmond, United States of America
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7
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Abbate A, Trankle CR, Lipinski MJ, Kadariya D, Canada JM, Carbone S, Buckley LF, Appleton D, Wohlford GF, Medina De Chazal H, Chiabrando JG, Roberts C, Turlington JS, Abouzaki NA, Van Tassell B. 5233Interleukin-1 blockade with Anakinra in ST-segment elevation acute myocardial infarction: Results from the VCUART3 study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0079] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
ST-segment elevation myocardial infarction (STEMI) is associated with an intense inflammatory response that predicts an increased risk of death and heart failure (HF). In the current study we tested whether anakinra, a recombinant Interleukin-1 (IL-1) receptor antagonist, given once daily (standard dose) or twice daily reduced systemic inflammation in patients with STEMI.
Methods
We enrolled patients with STEMI within 12 hours of presentation at 3 sites. After revascularization, patients were randomly assigned to receive anakinra 100 mg twice daily, anakinra 100 mg once daily alternating with placebo once daily every 12 hours, or placebo twice daily, for 14 days in a 1:1:1 ratio. The primary efficacy outcome was the area under the curve for C-reactive protein levels (CRP-AUC) using a high-sensitivity assay at 14 days comparing anakinra (both arms) versus placebo followed by a comparison between each of the anakinra arms with placebo. Two pre-specified exploratory clinical efficacy endpoints, adjudicated by a blinded event committee, were assessed: a composite endpoint of all-cause death for any reason or incidence of HF (defined as new-onset HF requiring hospitalization or a new prescription of a loop diuretic, D+HF) and a composite endpoint of death and HF hospitalization (D+HHF) at 1 year. Data are expressed as median and interquartile range or number and percentage. Kaplan-Meyer survival curves were compared using Log-rank test (Mantel-Cox). (ClinicalTrials.gov number, NCT01950299)
Results
Of 311 patients screened, 99 subjects (80 [81%] males, 57 [58%] Caucasians, 55 [49–62] years of age) were randomly assigned to anakinra twice daily (N=31), anakinra once daily (N=33) or placebo (N=35). There were no significant imbalances in the demographic characteristics between groups (all P>0.05). The CRP-AUC was significantly lower in the anakinra group than in the placebo group (67 [39–120] versus 214 [131–394] mg/dl, P<0.001; and P<0.001 for each anakinra arm versus placebo separately, without significant differences between the two anakinra arms, P=0.41). Treatment with anakinra was associated with a significant reduction versus placebo in the incidence of D+HF (6/64 [9.4%] versus 9/35 [25.7%], P=0.046), and of D+HHF (0/64 [0] versus 4/35 [11.4%], P=0.011), without any significant difference between the two anakinra arms. Anakinra was not associated with any treatment-related serious adverse events, nor with excess infections compared with placebo (14.1% vs 14.3%, P=0.87).
Conclusions
Among patients with STEMI, IL-1 blockade significantly reduced the systemic inflammatory response compared with placebo, without any significant difference between standard or high dose regimens. Prespecified exploratory analyses on clinical endpoints demonstrate reduced incidence of HF and reduced HF hospitalizations, supporting the concept of beneficial effects with IL-1 blockade in patients with acute myocardial infarction.
Acknowledgement/Funding
Funded by NHLBI 1R34HL121402; Drug supply from Swedish Orphan Biovitrum
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Affiliation(s)
- A Abbate
- Virginia Commonwealth University, Richmond, United States of America
| | - C R Trankle
- Virginia Commonwealth University, Richmond, United States of America
| | - M J Lipinski
- Medstar Research Institute, Washington, United States of America
| | - D Kadariya
- Medstar Research Institute, Washington, United States of America
| | - J M Canada
- Medstar Research Institute, Washington, United States of America
| | - S Carbone
- Medstar Research Institute, Washington, United States of America
| | - L F Buckley
- Brigham and Womens Hospital, Boston, United States of America
| | - D Appleton
- Virginia Cardiovascular Specialists, Richmond, United States of America
| | - G F Wohlford
- Virginia Commonwealth University, Richmond, United States of America
| | | | - J G Chiabrando
- Virginia Commonwealth University, Richmond, United States of America
| | - C Roberts
- Virginia Commonwealth University, Richmond, United States of America
| | - J S Turlington
- Virginia Commonwealth University, Richmond, United States of America
| | - N A Abouzaki
- Virginia Commonwealth University, Richmond, United States of America
| | - B Van Tassell
- Virginia Commonwealth University, Richmond, United States of America
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8
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Imazio M, Klein A, Brucato A, Cremer P, Lewinter M, Abbate A, Lin D, Martini A, Beutler A, Chang S, Crugnale S, Fang F, Gervais A, Perrin R, Paolini JF. P3349RHAPSODY: a pivotal phase 3 trial to assess efficacy and safety of rilonacept, an interleukin 1 alpha and beta blocker, in patients with recurrent pericarditis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Recurrent pericarditis (RP) is managed with nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids (CS), and colchicine; up to 15% of pericarditis patients experience multiple recurrences. Interleukin 1 (IL-1) is an important cytokine in the pathophysiology of RP. Rilonacept (KPL-914) is a recombinant fusion protein which binds IL-1α and IL-1β. An ongoing Phase 2 study of rilonacept demonstrated improvements in RP symptoms and inflammation.
Purpose
To evaluate the efficacy and safety of subcutaneous (SC) rilonacept in patients with RP in a Phase 3, randomized, placebo-controlled trial.
Methods
RHAPSODY is a double-blind, placebo-controlled, randomized-withdrawal trial; ∼50 patients will be enrolled (Figure). Patients (≥12 y) must present with at least a third pericarditis episode (all etiologies except infectious and malignant) characterized by a pain score ≥4 on the 11-point Numeric Rating Scale (NRS) and C-reactive protein (CRP) ≥1 mg/dL at screening. Patients may be receiving stable doses of analgesics, NSAIDs, colchicine, and/or CS. After a loading dose (320 mg SC in adults and 4.4 mg/kg SC in children), all patients will receive weekly rilonacept (160 mg SC in adults and 2.2 mg/kg SC in children) during the run-in period. Patients able to taper and discontinue concomitant pericarditis medications and achieve clinical response (mean daily NRS score ≤2.0 during the 7 days before randomization and CRP level ≤0.5 mg/dL) will be randomized 1:1 in a blinded fashion to continued rilonacept or matching placebo weekly SC injections. Investigators may choose different treatments for pericarditis recurrences based on patient clinical status, including bailout rilonacept, while maintaining the blind to prior treatment assignment. The primary efficacy endpoint is time to pericarditis recurrence (adjudicated by an independent committee) in the randomized-withdrawal portion of the study. Secondary efficacy endpoints are the proportion of patients maintaining a clinical response, percentage of days with NRS pain score ≤1, and percentage of patients with no-to-minimal pericarditis symptoms based on patient global assessment. Safety evaluations include adverse events monitoring, physical examinations, and laboratory tests.
Figure 1
Conclusions
RHAPSODY is a pivotal Phase 3 trial evaluating the efficacy and safety of rilonacept in patients with RP using a double-blind, placebo-controlled, randomized-withdrawal design. The results of this study may inform the management of RP.
Acknowledgement/Funding
This study is sponsored by Kiniksa Pharmaceuticals, Ltd.
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Affiliation(s)
- M Imazio
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - A Klein
- Cleveland Clinic, Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland, United States of America
| | - A Brucato
- Ospedale Papa Giovanni XXIII, Internal Medicine Division, Bergamo, Italy
| | - P Cremer
- Cleveland Clinic, Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland, United States of America
| | - M Lewinter
- The University of Vermont Medical Center, The University of Vermont, Cardiology Unit, Burlington, United States of America
| | - A Abbate
- Virginia Commonwealth University, VCU Pauley Heart Center, Richmond, United States of America
| | - D Lin
- Abbott Northwestern Hospital, Minneapolis Heart Institute, Minneapolis, United States of America
| | - A Martini
- University of Genoa and G. Gaslini Institute, Genoa, United States of America
| | - A Beutler
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - S Chang
- NJS Associates, Bridgewater, United States of America
| | - S Crugnale
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - F Fang
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - A Gervais
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - R Perrin
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - J F Paolini
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
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9
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Abbate A, Kadariya D, Medina De Chazal H, Chiabrando JG, Trankle CR, Abraham Foscolo MM, Wohlford GF, Carbone S, Buckley LF, Lipinski MJ, Appleton D, Abouzaki NA, Turlington JS, Van Tassell BW. 253Effects of Interleukin-1 blockade with Anakinra on cardiac function in ST-segment elevation acute myocardial infarction: results from the VCUART3 echocardiography study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0069] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
ST-segment elevation myocardial infarction (STEMI) is associated with an intense acute inflammatory response further promoting cardiac dysfunction and heart failure (HF). Pilot proof-of-concept studies with anakinra, recombinant Interleukin-1 (IL-1) receptor antagonist, have shown feasibility and safety of IL-1 blockade in patients with STEMI. In the current study we analyzed the effects of anakinra on left ventricular (LV) dimensions and function in patients with STEMI.
Methods
We enrolled patients with STEMI within 12 hours of presentation at 3 sites in the United States of America. After revascularization, patients were randomly assigned to receive anakinra 100 mg twice daily, anakinra 100 mg once daily alternated with placebo once daily every 12 hours, or placebo twice daily, for 14 days in a 1:1:1 ratio. A transthoracic echocardiogram was completed within 24 hours of admission and at 1 year follow up to measure LV end-diastolic and end-systolic volumes (LVEDV and LVESV, respectively), stroke volume (SV) and ejection fraction (LVEF). (ClinicalTrials NCT01950299)
Results
Paired echocardiography studies (follow up study obtained 362 days [336–375] after the baseline study) were available in 63 of the 99 patients (63%): 23 of 35 patients in the placebo group (66%) and 40 of the 64 patients in the anakinra group (62%, P>0.05 for missing studies between the 2 groups; P>0.05 for duration of follow up). Baseline LVEDV, LVESV, SV and LVEF was not significantly different comparing placebo and anakinra (all P>0.05). Patients treated with anakinra had a significant improvement in LVEF from 49.8% (41.8–60.0%) to 54.0% (46.0–58.4%, P=0.028) and SV from 43.6 ml (37.6–52.1 ml) to 48.7 ml (40.9–62.5 ml, P=0.008), whereas no significant changes occurred within the placebo group (LVEF: from 51.7% [40.1–56.0%] to 53.5% [43.4–59.4%], P=0.25; SV: from 47.7 ml [40.1–56.8 ml], to 53.0 ml [44.9–57.4 ml], P=0.81). The between-groups differences, however, were not statistically significant. No significant changes were noted in LVEDV and LVESV in either group. The interval changes in CRP between admission and 72 hours, expression of the acute inflammatory response, inversely correlated with the LVEF at follow up (R=-0.30, P=0.026), with higher levels of CRP corresponding to lower LVEF values
Conclusions
A significant improvement in cardiac systolic function was seen in patients treated with IL-1 receptor antagonist, anakinra, following STEMI, and not in patients with placebo. Further studies are however required to determine whether the benefits of IL-1 blockade in the prevention and treatment of HF are mediated by the effects on cardiac function.
Acknowledgement/Funding
Funded by NHLBI 1R34HL121402; Drug supply from Swedish Orphan Biovitrum
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Affiliation(s)
- A Abbate
- Virginia Commonwealth University, Richmond, United States of America
| | - D Kadariya
- Virginia Commonwealth University, Richmond, United States of America
| | | | - J G Chiabrando
- Virginia Commonwealth University, Richmond, United States of America
| | - C R Trankle
- Virginia Commonwealth University, Richmond, United States of America
| | | | - G F Wohlford
- Virginia Commonwealth University, Richmond, United States of America
| | - S Carbone
- Virginia Commonwealth University, Richmond, United States of America
| | - L F Buckley
- Brigham and Womens Hospital, Boston, United States of America
| | - M J Lipinski
- Medstar Research Institute, Washington, United States of America
| | - D Appleton
- Virginia Cardiovascular Specialists, Richmond, United States of America
| | - N A Abouzaki
- Virginia Commonwealth University, Richmond, United States of America
| | - J S Turlington
- Virginia Commonwealth University, Richmond, United States of America
| | - B W Van Tassell
- Virginia Commonwealth University, Richmond, United States of America
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Westman P, Ravindra K, Chiabrando J, Kadariya D, Maehara G, Dell M, Van Wezenbeek J, Moeller G, Keyser-Marcus L, Gal TS, Ma L, Abbate A. P760Clinical profile of African-American and non-Hispanic caucasian patients with Takotsubo cardiomyopathy syndrome in a large urban hospital in the United States of America. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0360] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Takotsubo (stress) cardiomyopathy is an acute reversible heart failure syndrome initially described in Japanese patients, but now well characterized in Caucasians patients in Europe or of European descent. An initial observation has suggested a lower incidence of Takotsubo in non-Caucasian subjects, particularly in the African-American (AA) population in the United States of America. The purpose of this study was to assess whether epidemiologic and clinical differences were present in Takotsubo in a large urban hospital in Virginia, USA.
Methods
We used an informatics-based system to query electronic health records (TriNetX, Cambridge, MA, USA) to search for cases of Takotsubo between 2010 and 2018 and a corresponding cohort of patients with non-ST segment elevation acute myocardial infarction (NSTEMI). We then performed a chart-level review of 160 cases and obtained additional clinical information including symptoms, risk factors, co-morbidities, and in-hospital outcomes. This retrospective study was approved by the Institutional Review Board of our institution.
Results
We identified 260 cases of Takotsubo and 6,270 of NSTEMI in the same time period (1:24, 4.2%). Being AA was associated with an odds ratio of Takotsubo versus NSTEMI of 0.38 [0.29–0.50] (P=0.0001). With further evaluation of patients with Takotsubo (N=160), AA (N=44, 27.2%) and Non-Hispanic Caucasian (C) (N=110, 67.9%) had no differences in age and sex. AA patients with Takotsubo however were more likely than C patients to be affected by type II diabetes mellitus (38.6% versus 14.5%, P=0.002, OR 3.70 [1.65–8.28]), have history of drug abuse (27.3% versus 9.1%, P=0.009, OR 3.75 [1.48–9.49]) and of cocaine use in particular (9.1% versus 0.9%, P=0.024, OR 11.0 [1.19–101.4]). The pattern of wall motion abnormality was not different between the 2 groups. AA patients presented with a lower ratio of brain natriuretic peptide (BNP) to troponin I (41.9 [12.7–258] pg./ml versus 281 [42–890] pg/ml, P=0.022). There was no significant difference of in-hospital mortality between the AA and C groups (9.1% versus 25%, respectively, OR 0.40 [0.13–1.24], P=0.11).
Conclusions
The incidence and clinical characteristics of Takotsubo (stress) cardiomyopathy appear to be different between African-American and Non-Hispanic Caucasian patients. African-American patients are more likely to have diabetes and illicit drug usage, but have a lower BNP/troponin I ratio. Both AA and Non-Hispanic Caucasian patients have similar in-hospital mortality.
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Affiliation(s)
- P Westman
- VCU Pauley Heart Center, Clinical Research Unit, Richmond, United States of America
| | - K Ravindra
- VCU Pauley Heart Center, Clinical Research Unit, Richmond, United States of America
| | - J Chiabrando
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - D Kadariya
- VCU Pauley Heart Center, Clinical Research Unit, Richmond, United States of America
| | - G Maehara
- Virginia Commonwealth University, Department of Psychiatry, Richmond, United States of America
| | - M Dell
- VCU Pauley Heart Center, Clinical Research Unit, Richmond, United States of America
| | - J Van Wezenbeek
- VCU Pauley Heart Center, Clinical Research Unit, Richmond, United States of America
| | - G Moeller
- Virginia Commonwealth University, Department of Psychiatry, Richmond, United States of America
| | - L Keyser-Marcus
- Virginia Commonwealth University, Department of Psychiatry, Richmond, United States of America
| | - T S Gal
- Virginia Commonwealth University, Department of Biostatistics, Richmond, United States of America
| | - L Ma
- Virginia Commonwealth University, Department of Radiology, Richmond, United States of America
| | - A Abbate
- VCU Pauley Heart Center, Clinical Research Unit, Richmond, United States of America
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Van Tassell B, Trankle CR, Kadariya D, Canada JM, Carbone S, Buckley LF, Wohlford GF, Dixon DL, Christopher S, Vo C, Mankad P, Dell M, Shah KB, Kontos MC, Abbate A. 5947Predictive role of C-reactive protein levels in patients with ST-segment elevation acute myocardial infarction for heart failure related events. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0097] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
ST-segment elevation myocardial infarction (STEMI) is associated with an intense acute inflammatory response and an increased risk of death and heart failure (HF). C-reactive protein (CRP) is the inflammatory biomarker most commonly used for risk stratification in patients with cardiovascular diseases. CRP levels are known to rise and fall during STEMI in response to myocardial injury. In this study, we analyzed whether admission CRP or delayed CRP (measured at 72 hours after admission) held a greater predictive value for adverse HF events in patients with STEMI.
Methods
We analyzed data from the VCUART3 clinical trial enrolling 99 patients with STEMI within 12 hours of presentation at 3 sites in the United States of America treated with anakinra or placebo. CRP levels were measured with a high-sensitivity assay at time of admission and again at 72 hours later. A dedicated committee composed of individuals not involved in the conduct of the trial adjudicated HF events including a composite endpoint of death from any reason or incidence of HF defined as new-onset HF requiring hospital admission or a new prescription for a loop diuretic (D+HF) and a composite endpoint of death and HF hospitalization (D+HHF) at 1 year. We used a time-dependent Cox-regression analysis to determine the association of CRP at admission or at 72 hours with the outcomes of interest in univariate and multivariate analysis. Data are presented as median and interquartile range. (ClinicalTrials NCT01950299)
Results
CRP levels from admission and 72 hours were available in 90 and 87 subjects respectively and they increased from 4.6 [2.8–8.5] mg/L to 11.6 [4.6–24.5] mg/L (P<0.001). Both admission CRP (CRP0) and CRP at 72 hours (CRP72) were associated with the risk of D+HF (P=0.011 and <0.001, respectively) and of D+HHF (P=0.010 and P<0.001, respectively); however at multivariate analysis, only CRP72 remained significantly associated with the risk of D+HF (P=0.001) and D+HHF (P=0.004) while CRP0 was not. CRP72 significantly correlated with NTproBNP levels at 72 hours (NTproBNP72, Spearman rho R=+0.37, P=0.001). NTproBNP72 predicted D+HF (P=0.030) but not independently of CRP72 (P=0.096 for NTproBNP72 and P=0.007 for CRP72 at multivariate analysis including the 2 variables). NTproBNP72 did not predict D-HHF.
Conclusions
Among contemporary patients with STEMI, the levels of CRP at 72 hours after admission was superior to admission CRP levels for predicting the incidence of HF events, and independent of NTproBNP levels. Our results indicate the importance of the inflammatory response during STEMI, supporting the concept of inhibiting the inflammatory response as a therapeutic strategy.
Acknowledgement/Funding
Funded by NHLBI 1R34HL121402; Drug supply from Swedish Orphan Biovitrum
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Affiliation(s)
- B Van Tassell
- Virginia Commonwealth University, Richmond, United States of America
| | - C R Trankle
- Virginia Commonwealth University, Richmond, United States of America
| | - D Kadariya
- Virginia Commonwealth University, Richmond, United States of America
| | - J M Canada
- Virginia Commonwealth University, Richmond, United States of America
| | - S Carbone
- Virginia Commonwealth University, Richmond, United States of America
| | - L F Buckley
- Brigham and Womens Hospital, Boston, United States of America
| | - G F Wohlford
- Virginia Commonwealth University, Richmond, United States of America
| | - D L Dixon
- Virginia Commonwealth University, Richmond, United States of America
| | - S Christopher
- Virginia Commonwealth University, Richmond, United States of America
| | - C Vo
- Virginia Commonwealth University, Richmond, United States of America
| | - P Mankad
- Virginia Commonwealth University, Richmond, United States of America
| | - M Dell
- Virginia Commonwealth University, Richmond, United States of America
| | - K B Shah
- Virginia Commonwealth University, Richmond, United States of America
| | - M C Kontos
- Virginia Commonwealth University, Richmond, United States of America
| | - A Abbate
- Virginia Commonwealth University, Richmond, United States of America
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Ricco A, Slade A, Canada J, Grizzard J, Dana F, Gharai LR, Neiderer K, Vera A, Abbate A, Weiss E. T1 Mapping and Cardiac MRI in the Detection of Cardiac Toxicity from Radiotherapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Bonaventura A, Carbone S, Dixon DL, Abbate A, Montecucco F. Pharmacologic strategies to reduce cardiovascular disease in type 2 diabetes mellitus: focus on SGLT-2 inhibitors and GLP-1 receptor agonists. J Intern Med 2019; 286:16-31. [PMID: 30888088 DOI: 10.1111/joim.12890] [Citation(s) in RCA: 18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patients with type 2 diabetes mellitus (T2D) present an increased risk for cardiovascular (CV) complications. In addition to improvement in glycaemic control, glucose-lowering therapies, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-dependent glucose cotransporter (SGLT)-2 inhibitors, have been shown to significantly reduce CV events. In 2008, the US Food and Drug Administration mandated that all new glucose-lowering drugs undergo CV outcomes trials (CVOTs) to determine their CV safety. These trials have largely demonstrated no major CV safety concerns. Most notably, the GLP-1RAs and SGLT-2 inhibitors have been found to be not only safe, but also cardioprotective compared to placebo. The SGLT-2 inhibitors have opened a new perspective for clinicians treating patients with T2D and established CV disease in light of their 'pleiotropic' effects, specifically on heart failure, while GLP-1RAs seem to present more favourable effects on atherosclerotic events. In this review, we discuss the role of GLP-1RAs and SGLT-2 inhibitors to reduce CV risk in T2D patients and suggest an individualized therapeutic approach in this population based on the presence of metabolic and CV comorbidities.
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Affiliation(s)
- A Bonaventura
- the First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, Virginia, USA
| | - S Carbone
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, Virginia, USA
| | - D L Dixon
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - A Abbate
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, Virginia, USA
| | - F Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino -Italian Cardiovascular Network, Genoa, Italy
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14
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Van Tassell B, Viscusi M, Del Buono M, Canada J, Carbone S, Trankle C, Buckley L, Lesnefsky E, Arena R, Abbate A. Anakinra improves exercise peak aerobic capacity in patients with recently decompensated systolic heart failure. Vascul Pharmacol 2018. [DOI: 10.1016/j.vph.2017.12.002] [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: 10/17/2022]
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15
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Cimino G, Abbate A, Teresi G, Piraino D. And if the Ventricle was Innocent?: The Rare Case of the Guilty Atrium. Exp Clin Cardiol 2018. [DOI: 10.4172/2155-9880.1000577] [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: 11/09/2022]
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Carbone S, Lee PJH, Mauro AG, Mezzaroma E, Buzzetti R, Van Tassell B, Abbate A, Toldo S. Interleukin-18 mediates cardiac dysfunction induced by western diet independent of obesity and hyperglycemia in the mouse. Nutr Diabetes 2017; 7:e258. [PMID: 28394363 PMCID: PMC5436096 DOI: 10.1038/nutd.2017.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/12/2016] [Accepted: 12/22/2016] [Indexed: 12/27/2022] Open
Abstract
Obesity and diabetes are independent risk factors for heart failure and are associated with the consumption of diet rich in saturated fat and sugar, Western diet (WD), known to induce cardiac dysfunction in the mouse through incompletely characterized inflammatory mechanisms. We hypothesized that the detrimental cardiac effects of WD are mediated by interleukin-18 (IL-18), pro-inflammatory cytokine linked to cardiac dysfunction. C57BL/6J wild-type male mice and IL-18 knockout male mice were fed high-saturated fat and high-sugar diet for 8 weeks. We measured food intake, body weight and fasting glycemia. We assessed left ventricular (LV) systolic and diastolic function by Doppler echocardiography and cardiac catheterization. In wild-type mice, WD induced a significant increase in isovolumetric relaxation time, myocardial performance index and left ventricular end-diastolic pressure, reflecting an impairment in diastolic function, paired with a mild reduction in LV ejection fraction. IL-18 KO mice had higher food intake and greater increase in body weight without significant differences in hyperglycemia. Despite displaying greater obesity, IL-18 knockout mice fed with WD for 8 weeks had preserved cardiac diastolic function and higher left ventricular ejection fraction. IL-18 mediates diet-induced cardiac dysfunction, independent of food intake and obesity, thus highlighting a disconnect between the metabolic and cardiac effects of IL-18.
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Affiliation(s)
- S Carbone
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
- Victoria Johnson Research Laboratories, Virginia Commonwealth University, Richmond, VA, USA
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - P J H Lee
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
- Victoria Johnson Research Laboratories, Virginia Commonwealth University, Richmond, VA, USA
| | - A G Mauro
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
- Victoria Johnson Research Laboratories, Virginia Commonwealth University, Richmond, VA, USA
| | - E Mezzaroma
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
- Victoria Johnson Research Laboratories, Virginia Commonwealth University, Richmond, VA, USA
- School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - R Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - B Van Tassell
- Victoria Johnson Research Laboratories, Virginia Commonwealth University, Richmond, VA, USA
- School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - A Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
- Victoria Johnson Research Laboratories, Virginia Commonwealth University, Richmond, VA, USA
| | - S Toldo
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
- Victoria Johnson Research Laboratories, Virginia Commonwealth University, Richmond, VA, USA
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Lee P, Toldo S, Mauro A, Regan J, Kraskauskas D, Van Tassell B, Abbate A, Carbone S. INTERLEUKIN 18 ATTENUATES MYOCARDIAL DYSFUNCTION IN A MODEL OF OBESITY INDUCED BY WESTERN DIET. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.217] [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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Affiliation(s)
- S. Toldo
- VCU Pauley Heart Center; Virginia Commonwealth University; Richmond VA USA
- Victoria Johnson Research Laboratory; Virginia Commonwealth University; Richmond VA USA
| | - A. Abbate
- VCU Pauley Heart Center; Virginia Commonwealth University; Richmond VA USA
- Victoria Johnson Research Laboratory; Virginia Commonwealth University; Richmond VA USA
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20
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Biondi-Zoccai G, Abbate A, Landoni G, Zangrillo A, Vincent JL, D'Ascenzo F, Frati G. An updated systematic review and meta-analysis on impedance threshold devices in patients undergoing cardiopulmonary resuscitation. Heart Lung Vessel 2014; 6:105-113. [PMID: 25024992 PMCID: PMC4095837] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Uncertainty persists on the clinical impact of impedance threshold devices in out-of-hospital cardiac arrest. We conducted an updated systematic review on impedance threshold devices. METHODS Several databases were searched for studies testing the effectiveness of impedance threshold devices in patients with cardiac arrest. The primary endpoint was long-term survival. RESULTS Seven trials (11,254 patients) were included. In 4 studies (2,284 patients) impedance threshold devices were used with active compression-decompression-cardiopulmonary resuscitation, and in the others alone. Overall, impedance threshold devices did not impact on the rate of return of spontaneous circulation (odds ratio=1.17 [0.96-1.43], p=0.114), favorable neurologic outcome (odds ratio=1.56 [0.97-2.50], p=0.065), or long-term survival (odds ratio=1.22 [0.94-1.58], p=0.127). These analyses were fraught with heterogeneity (respectively, p=0.055, p=0.236, and p=0.011) and inconsistency (respectively, I-squared=51% , I-squared=27% , and I-squared=67%). Exploratory analysis showed that combined use of impedance threshold devices with active compression-decompression significantly increased the likelihood of return of spontaneous circulation (odds ratio=1.19 [1.00-1.40], p=0.045), favorable neurologic outcome (odds ratio=1.60 [1.14-2.25], p=0.006), and long-term survival (odds ratio=1.52 [1.11-2.08], p=0.009). The favorable impact of the interaction between impedance threshold devices and active compression-decompression was also confirmed at meta-regression analysis (respectively, b=0.195 [0.004-0.387], p=0.045, b=0.500 [0.079-0.841], p=0.018, b=0.413 [0.063-0.764], p=0.021). CONCLUSIONS The evidence base on impedance threshold devices is apparently inconclusive, with a neutral impact on clinically relevant outcomes. However, exploratory analysis focusing on the combined use of impedance threshold devices with active compression-decompression suggests that this combo treatment may be useful to improve patient prognosis.
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Affiliation(s)
- G Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - A Abbate
- VCU Pauley Heart Center, Richmond, VA, USA
| | - G Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - J L Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - F D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - G Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy ; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
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Biondi-Zoccai G, Peruzzi M, Abbate A, Gertz ZM, Benedetto U, Tonelli E, D'Ascenzo F, Giordano A, Agostoni P, Frati G. Network meta-analysis on the comparative effectiveness and safety of transcatheter aortic valve implantation with CoreValve or Sapien devices versus surgical replacement. Heart Lung Vessel 2014; 6:232-43. [PMID: 25436205 PMCID: PMC4246842] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Surgical replacement for aortic stenosis is fraught with complications in high-risk patients. Transcatheter techniques may offer a minimally invasive solution, but their comparative effectiveness and safety is uncertain. We performed a network meta-analysis on this topic. METHODS Randomized trials on transcatheter aortic valve replacement vs surgery were searched. The primary outcome was all cause death. Risk estimates were obtained with Bayesian network meta-analytic methods. RESULTS Four trials with 1,805 patients were included. After a median of 8 months, risk of death and myocardial infarction was not different when comparing surgery versus transcatheter procedures, irrespective of device or access. Conversely, surgery was associated with higher rates of major bleeding (odds ratio vs CoreValve=3.03 [95% credible interval: 2.23-4.17]; odds ratio vs transfemoral Sapien =1.82 [1.21-2.70]; odds ratio vs transapical Sapien =2.08 [1.20-3.70]), and acute kidney injury (odds ratio vs CoreValve =2.08 [1.33-3.32]; odds ratio vs transapical Sapien =2.78 [2.21-99.80]), but lower rates of pacemaker implantation (odds ratio vs CoreValve =0.41 [0.28-0.59]), and moderate or severe aortic regurgitation (odds ratio vs CoreValve =0.06 [0.02-0.27]; odds ratio vs Sapien=0.17 [0.02-0.76]). Strokes were less frequent with CoreValve than with transfemoral Sapien (odds ratio =0.32 [0.13-0.73]) or transapical Sapien (odds ratio =0.33 [0.10-0.93]), whereas pacemaker implantation was more common with CoreValve (odds ratio vs surgery =2.46 [1.69-3.61]; odds ratio vs transfemoral Sapien =2.22 [1.27-3.85]). CONCLUSIONS Survival after transcatheter or surgical aortic valve replacement is similar, but there might be differences in the individual safety and effectiveness profile between the treatment strategies and the individual devices used in transcatheter aortic valve implantation.
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Affiliation(s)
- G Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy,VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - M Peruzzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - A Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Z M Gertz
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - U Benedetto
- Department of Cardiac Surgery, Harefield Hospital, London, UK
| | - E Tonelli
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - F D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, University of Turin, Turin, Italy
| | - A Giordano
- Unità Operativa di Interventistica Cardiovascolare, Presidio Ospedaliero Pineta Grande, Castel Volturno, and Unità Operativa di Emodinamica, Casa di Salute Santa Lucia, San Giuseppe Vesuviano, both in Italy
| | - P Agostoni
- Division of Cardiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - G Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy,Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
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Abdovic E, Abdovic S, Hristova K, Hristova K, Katova T, Katova T, Gocheva N, Gocheva N, Pavlova M, Pavlova M, Gurzun MM, Ionescu A, Canpolat U, Yorgun H, Sunman H, Sahiner L, Kaya E, Ozer N, Tokgozoglu L, Kabakci G, Aytemir K, Oto A, Gonella A, D'ascenzo F, Casasso F, Conte E, Margaria F, Grosso Marra W, Frea S, Morello M, Bobbio M, Gaita F, Seo H, Lee S, Lee J, Yoon Y, Park E, Kim H, Park S, Lee H, Kim Y, Sohn D, Nemes A, Domsik P, Kalapos A, Orosz A, Lengyel C, Forster T, Enache R, Muraru D, Popescu B, Calin A, Nastase O, Botezatu D, Purcarea F, Rosca M, Beladan C, Ginghina C, Canpolat U, Aytemir K, Ozer N, Yorgun H, Sahiner L, Kaya E, Oto A, Muraru D, Piasentini E, Mihaila S, Padayattil Jose' S, Peluso D, Ucci L, Naso P, Puma L, Iliceto S, Badano L, Cikes M, Jakus N, Sutherland G, Haemers P, D'hooge J, Claus P, Yurdakul S, Oner F, Direskeneli H, Sahin T, Cengiz B, Ercan G, Bozkurt A, Aytekin S, Osa Saez AM, Rodriguez-Serrano M, Lopez-Vilella R, Buendia-Fuentes F, Domingo-Valero D, Quesada-Carmona A, Miro-Palau V, Arnau-Vives M, Palencia-Perez M, Rueda-Soriano J, Lipczynska M, Piotr Szymanski P, Anna Klisiewicz A, Lukasz Mazurkiewicz L, Piotr Hoffman P, Kim K, Cho S, Ahn Y, Jeong M, Cho J, Park J, Chinali M, Franceschini A, Matteucci M, Doyon A, Esposito C, Del Pasqua A, Rinelli G, Schaefer F, Kowalik E, Klisiewicz A, Rybicka J, Szymanski P, Biernacka E, Hoffman P, Lee S, Kim W, Yun H, Jung L, Kim E, Ko J, Ruddox V, Norum I, Edvardsen T, Baekkevar M, Otterstad J, Erdei T, Edwards J, Braim D, Yousef Z, Fraser A, Melcher A, Reiner B, Hansen A, Strandberg L, Caidahl K, Wellnhofer E, Kriatselis C, Gerd-Li H, Furundzija V, Thnabalasingam U, Fleck E, Graefe M, Park Y, Moon J, Ahn T, Baydar O, Kadriye Kilickesmez K, Ugur Coskun U, Polat Canbolat P, Veysel Oktay V, Umit Yasar Sinan U, Okay Abaci O, Cuneyt Kocas C, Sinan Uner S, Serdar Kucukoglu S, Ferferieva V, Claus P, Rademakers F, D'hooge J, Le TT, Wong P, Tee N, Huang F, Tan R, Altman M, Logeart D, Bergerot C, Gellen B, Pare C, Gerard S, Sirol M, Vicaut E, Mercadier J, Derumeaux GA, Park TH, Park JI, Shin SW, Yun SH, Lee JE, Makavos G, Kouris N, Keramida K, Dagre A, Ntarladimas I, Kostopoulos V, Damaskos D, Olympios C, Leong D, Piers S, Hoogslag G, Hoke U, Thijssen J, Ajmone Marsan N, Schalij M, Bax J, Zeppenfeld K, Delgado V, Rio P, Branco L, Galrinho A, Cacela D, Abreu J, Timoteo A, Teixeira P, Pereira-Da-Silva T, Selas M, Cruz Ferreira R, Popa BA, Zamfir L, Novelli E, Lanzillo G, Karazanishvili L, Musica G, Stelian E, Benea D, Diena M, Cerin G, Fusini L, Mirea O, Tamborini G, Muratori M, Gripari P, Ghulam Ali S, Cefalu' C, Maffessanti F, Andreini D, Pepi M, Mamdoo F, Goncalves A, Peters F, Matioda H, Govender S, Dos Santos C, Essop M, Kuznetsov VA, Yaroslavskaya EI, Pushkarev GS, Krinochkin DV, Kolunin GV, Bennadji A, Hascoet S, Dulac Y, Hadeed K, Peyre M, Ricco L, Clement L, Acar P, Ding W, Zhao Y, Lindqvist P, Nilson J, Winter R, Holmgren A, Ruck A, Henein M, Illatopa V, Cordova F, Espinoza D, Ortega J, Cavalcante J, Patel M, Katz W, Schindler J, Crock F, Khanna M, Khandhar S, Tsuruta H, Kohsaka S, Murata M, Yasuda R, Tokuda H, Kawamura A, Maekawa Y, Hayashida K, Fukuda K, Le Tourneau T, Kyndt F, Lecointe S, Duval D, Rimbert A, Merot J, Trochu J, Probst V, Le Marec H, Schott J, Veronesi F, Addetia K, Corsi C, Lamberti C, Lang R, Mor-Avi V, Gjerdalen GF, Hisdal J, Solberg E, Andersen T, Radunovic Z, Steine K, Maffessanti F, Gripari P, Tamborini G, Muratori M, Fusini L, Ferrari C, Caiani E, Alamanni F, Bartorelli A, Pepi M, D'ascenzi F, Cameli M, Iadanza A, Lisi M, Reccia R, Curci V, Sinicropi G, Henein M, Pierli C, Mondillo S, Rekhraj S, Hoole S, Mcnab D, Densem C, Boyd J, Parker K, Shapiro L, Rana B, Kotrc M, Vandendriessche T, Bartunek J, Claeys M, Vanderheyden M, Paelinck B, De Bock D, De Maeyer C, Vrints C, Penicka M, Silveira C, Albuquerque E, Lamprea D, Larangeiras V, Moreira C, Victor Filho M, Alencar B, Silveira A, Castillo J, Zambon E, Iorio A, Carriere C, Pantano A, Barbati G, Bobbo M, Abate E, Pinamonti B, Di Lenarda A, Sinagra G, Salemi VMC, Tavares L, Ferreira Filho J, Oliveira A, Pessoa F, Ramires F, Fernandes F, Mady C, Cavarretta E, Lotrionte M, Abbate A, Mezzaroma E, De Marco E, Peruzzi M, Loperfido F, Biondi-Zoccai G, Frati G, Palazzoni G, Park TH, Lee JE, Lee DH, Park JS, Park K, Kim MH, Kim YD, Van 'T Sant J, Gathier W, Leenders G, Meine M, Doevendans P, Cramer M, Poyhonen P, Kivisto S, Holmstrom M, Hanninen H, Schnell F, Betancur J, Daudin M, Simon A, Carre F, Tavard F, Hernandez A, Garreau M, Donal E, Calore C, Muraru D, Badano L, Melacini P, Mihaila S, Denas G, Naso P, Casablanca S, Santi F, Iliceto S, Aggeli C, Venieri E, Felekos I, Anastasakis A, Ritsatos K, Kakiouzi V, Kastellanos S, Cutajar I, Stefanadis C, Palecek T, Honzikova J, Poupetova H, Vlaskova H, Kuchynka P, Linhart A, Elmasry O, Mohamed M, Elguindy W, Bishara P, Garcia-Gonzalez P, Cozar-Santiago P, Bochard-Villanueva B, Fabregat-Andres O, Cubillos-Arango A, Valle-Munoz A, Ferrer-Rebolleda J, Paya-Serrano R, Estornell-Erill J, Ridocci-Soriano F, Jensen M, Havndrup O, Christiansen M, Andersen P, Axelsson A, Kober L, Bundgaard H, Karapinar H, Kaya A, Uysal E, Guven A, Kucukdurmaz Z, Oflaz M, Deveci K, Sancakdar E, Gul I, Yilmaz A, Tigen MK, Karaahmet T, Dundar C, Yalcinsoy M, Tasar O, Bulut M, Takir M, Akkaya E, Jedrzejewska I, Braksator W, Krol W, Swiatowiec A, Dluzniewski M, Lipari P, Bonapace S, Zenari L, Valbusa F, Rossi A, Lanzoni L, Molon G, Canali G, Campopiano E, Barbieri E, Rueda Calle E, Alfaro Rubio F, Gomez Gonzalez J, Gonzalez Santos P, Cameli M, Lisi M, Focardi M, D'ascenzi F, Solari M, Galderisi M, Mondillo S, Pratali L, Bruno RM, Corciu A, Comassi M, Passera M, Gastaldelli A, Mrakic-Sposta S, Vezzoli A, Picano E, Perry R, Penhall A, De Pasquale C, Selvanayagam J, Joseph M, Simova II, Katova TM, Kostova V, Hristova K, Lalov I, D'ascenzi F, Pelliccia A, Natali B, Cameli M, Alvino F, Zorzi A, Corrado D, Bonifazi M, Mondillo S, Rees E, Rakebrandt F, Rees D, Halcox J, Fraser A, O'driscoll J, Lau N, Perez-Lopez M, Sharma R, Lichodziejewska B, Goliszek S, Kurnicka K, Kostrubiec M, Dzikowska Diduch O, Krupa M, Grudzka K, Ciurzynski M, Palczewski P, Pruszczyk P, Gheorghe L, Castillo Ortiz J, Del Pozo Contreras R, Calle Perez G, Sancho Jaldon M, Cabeza Lainez P, Vazquez Garcia R, Fernandez Garcia P, Chueca Gonzalez E, Arana Granados R, Zhao X, Xu X, Bai Y, Qin Y, Leren I, Hasselberg N, Saberniak J, Leren T, Edvardsen T, Haugaa K, Daraban AM, Sutherland G, Claus P, Werner B, Gewillig M, Voigt J, Santoro A, Ierano P, De Stefano F, Esposito R, De Palma D, Ippolito R, Tufano A, Galderisi M, Costa R, Fischer C, Rodrigues A, Monaco C, Lira Filho E, Vieira M, Cordovil A, Oliveira E, Mohry S, Gaudron P, Niemann M, Herrmann S, Strotmann J, Beer M, Hu K, Bijnens B, Ertl G, Weidemann F, Baktir A, Sarli B, Cicek M, Karakas M, Saglam H, Arinc H, Akil M, Kaya H, Ertas F, Bilik M, Yildiz A, Oylumlu M, Acet H, Aydin M, Yuksel M, Alan S, O'driscoll J, Gravina A, Di Fino S, Thompson M, Karthigelasingham A, Ray K, Sharma R, De Chiara B, Russo C, Alloni M, Belli O, Spano' F, Botta L, Palmieri B, Martinelli L, Giannattasio C, Moreo A, Mateescu A, La Carrubba S, Vriz O, Di Bello V, Carerj S, Zito C, Ginghina C, Popescu B, Nicolosi G, Antonini-Canterin F, Malev E, Omelchenko M, Vasina L, Luneva E, Zemtsovsky E, Cikes M, Velagic V, Gasparovic H, Kopjar T, Colak Z, Hlupic L, Biocina B, Milicic D, Tomaszewski A, Kutarski A, Poterala M, Tomaszewski M, Brzozowski W, Kijima Y, Akagi T, Nakagawa K, Ikeda M, Watanabe N, Ueoka A, Takaya Y, Oe H, Toh N, Ito H, Bochard Villanueva B, Paya-Serrano R, Fabregat-Andres O, Garcia-Gonzalez P, Perez-Bosca J, Cubillos-Arango A, Chacon-Hernandez N, Higueras-Ortega L, De La Espriella-Juan R, Ridocci-Soriano F, Noack T, Mukherjee C, Ionasec R, Voigt I, Kiefer P, Hoebartner M, Misfeld M, Mohr FW, Seeburger J, Daraban AM, Baltussen L, Amzulescu M, Bogaert J, Jassens S, Voigt J, Duchateau N, Giraldeau G, Gabrielli L, Penela D, Evertz R, Mont L, Brugada J, Berruezo A, Bijnens B, Sitges M, Yoshikawa H, Suzuki M, Hashimoto G, Kusunose Y, Otsuka T, Nakamura M, Sugi K, Ruiz Ortiz M, Mesa D, Romo E, Delgado M, Seoane T, Martin M, Carrasco F, Lopez Granados A, Arizon J, Suarez De Lezo J, Magalhaes A, Cortez-Dias N, Silva D, Menezes M, Saraiva M, Santos L, Costa A, Costa L, Nunes Diogo A, Fiuza M, Ren B, De Groot-De Laat L, Mcghie J, Vletter W, Geleijnse M, Toda H, Oe H, Osawa K, Miyoshi T, Ugawa S, Toh N, Nakamura K, Kohno K, Morita H, Ito H, El Ghannudi S, Germain P, Samet H, Jeung M, Roy C, Gangi A, Orii M, Hirata K, Yamano T, Tanimoto T, Ino Y, Yamaguchi T, Kubo T, Imanishi T, Akasaka T, Sunbul M, Kivrak T, Oguz M, Ozguven S, Gungor S, Dede F, Turoglu H, Yildizeli B, Mutlu B, Mihaila S, Muraru D, Piasentini E, Peluso D, Cucchini U, Casablanca S, Naso P, Iliceto S, Vinereanu D, Badano L, Rodriguez Munoz D, Moya Mur J, Becker Filho D, Gonzalez A, Casas Rojo E, Garcia Martin A, Recio Vazquez M, Rincon L, Fernandez Golfin C, Zamorano Gomez J, Ledakowicz-Polak A, Polak L, Zielinska M, Kamiyama T, Nakade T, Nakamura Y, Ando T, Kirimura M, Inoue Y, Sasaki O, Nishioka T, Farouk H, Sakr B, Elchilali K, Said K, Sorour K, Salah H, Mahmoud G, Casanova Rodriguez C, Cano Carrizal R, Iglesias Del Valle D, Martin Penato Molina A, Garcia Garcia A, Prieto Moriche E, Alvarez Rubio J, De Juan Bagua J, Tejero Romero C, Plaza Perez I, Korlou P, Stefanidis A, Mpikakis N, Ikonomidis I, Anastasiadis S, Komninos K, Nikoloudi P, Margos P, Pentzeridis P. Poster session Thursday 12 December - AM: 12/12/2013, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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D'Ascenzo F, Cerrato E, Moretti C, Abbate A, Kastrati A, Capodanno D, Carrie D, Escaned J, Biondi-Zoccai G, Gaita F. CD4+ lymphocyte count predicts recurrent thrombotic events in HIV-infected patients with acute coronary syndromes. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Quadri G, D'Ascenzo F, Cerrato E, Omede' P, Calcagno A, Bonora S, Abbate A, Biondi Zoccai G, Moretti C, Gaita F. Incidence and clinical features of stroke in HIV patients in HAART era: a meta-analysis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Biondi-Zoccai G, Malavasi V, D'Ascenzo F, Abbate A, Agostoni P, Lotrionte M, Castagno D, Van Tassell B, Casali E, Marietta M, Modena MG, Ellenbogen KA, Frati G. Comparative effectiveness of novel oral anticoagulants for atrial fibrillation: evidence from pair-wise and warfarin-controlled network meta-analyses. HSR Proc Intensive Care Cardiovasc Anesth 2013; 5:40-54. [PMID: 23734288 PMCID: PMC3670724] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Novel oral anticoagulants have been tested against warfarin for atrial fibrillation, yet no direct comparison is available. We thus aimed to perform pair-wise (direct) and warfarin-adjusted network (i.e. indirect) meta-analyses of novel oral anticoagulants for atrial fibrillation. METHODS Databases were searched for randomized warfarin-controlled trials of novel anticoagulants for non-valvular atrial fibrillation. The primary end-point was long-term stroke/systemic embolism. Odds ratios (95% intervals) were computed with RevMan and WinBUGS. RESULTS Seven trials (52701 patients) were included, focusing on apixaban, dabigatran, edoxaban and rivaroxaban. Pair-wise meta-analysis showed that after a weighted average of 23 months these novel anticoagulants lead to significant reductions in the risk of stroke/systemic embolism (odds ratio=0.81 [0.71-0.92], I2=23%) and all cause death (odds ratio=0.88 [0.82-0.95], I2=0%) in comparison to warfarin. Network meta-analysis showed that apixaban and dabigatran proved similarly superior to warfarin in preventing stroke/systemic embolism (odds ratio=0.78 [0.62-0.96] for apixaban vs warfarin; odds ratio=0.66 [0.52-0.84] for high-dose dabigatran vs warfarin; odds ratio for apixaban vs high-dose dabigatran=1.17 [0.85-1.63]), but apixaban was associated with fewer major bleedings (odds ratio=0.73 [0.57-0.93]) and drug discontinuations (odds ratio=0.64 [0.52-0.78]) than dabigatran. Rivaroxaban did not reduce stroke/systemic embolism (odds ratio=0.87 [0.71-1.07]) or major bleedings in comparison to warfarin (odds ratio=0.87 [0.71-1.07]) and was associated with more major bleedings in comparison to apixaban (odds ratio=1.52 [1.19-1.92]). Data for edoxaban were inconclusive. CONCLUSIONS Novel oral anticoagulants appear as a very promising treatment option for atrial fibrillation.
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Affiliation(s)
- G Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - V Malavasi
- Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy
| | - F D'Ascenzo
- Division of Cardiology, University of Turin, Turin, Italy
| | - A Abbate
- VCU Pauley Heart Center, Richmo-nd, VA, USA
| | - P Agostoni
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Lotrionte
- Division of Cardiology, Catholic University, Rome, Italy
| | - D Castagno
- Division of Cardiology, University of Turin, Turin, Italy
| | | | - E Casali
- Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy
| | - M Marietta
- Hemostasis/Thrombosis Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - M G Modena
- Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - G Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy,Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
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Varma A, Appleton DL, Nusca A, Lipinski MJ, Goudreau E, Cowley MJ, Wittkamp M, Vetrovec GW, Abbate A. Iron deficiency anemia and cardiac mortality in patients with left ventricular systolic dysfunction undergoing coronary stenting. Minerva Cardioangiol 2010; 58:1-10. [PMID: 20145590] [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: 05/28/2023]
Abstract
AIM The aim of this study was to assess cardiac mortality in patients with reduced ejection fraction (EF< or =45%) and anemia (Hb< or =12 g/dL) undergoing coronary stenting and to investigate whether iron-deficiency anemia influenced outcome when compared to non-anemic patients or patients with other types of anemia. METHODS One hundred twenty consecutive patients undergoing percutaneous coronary intervention (PCI) between April 2003 and December 2005 were identified and followed for a median of 30 months. Patients were divided into 2 groups, anemic (Hb< or =12 g/dL) and non-anemic. Anemic patients were then divided into 3 sub-groups based on laboratory analysis and anemia work-up: iron-deficiency, malignancy-associated, and anemia of chronic disease (including chronic kidney disease). Mortality rates and cause of death were retrieved using both the Social Security database and the hospital records. RESULTS Thirty-one percent of patients had iron deficiency, 24% had a malignancy-associated anemia and 45% had anemia of chronic disease. Overall mortality was 12% of which 29% was cardiac death. All-cause and cardiac mortality were significantly higher in anemic vs. non-anemic patients, (31% vs. 6%, P<0.001, and 10% vs. 1%, P=0.016, respectively). Iron-deficiency anemia strongly predicted cardiac mortality (33% vs. 1% in non-anemic patients, P<0.001), while malignancy-associated anemia was the strongest predictor of non-cardiac death (57% vs. 4% in non-anemic patients, P<0.001). Anemia of chronic disease neither predicted cardiac nor non-cardiac death. CONCLUSIONS To the authors' knowledge, this is the first study to show that iron-deficiency anemia is a strong predictor of cardiac death when compared to patients with other types of anemia or to non-anemic patients.
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Affiliation(s)
- A Varma
- Virginia Commonwealth University, Department of Internal Medicine, Richmond, VA, USA
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Valgimigli M, Biondi-Zoccai GG, Malagutti P, Leone AM, Abbate A. Autologous bone marrow stem cell mobilization induced by granulocyte colony-stimulating factor after myocardial infarction. Eur Heart J Suppl 2008. [DOI: 10.1093/eurheartj/sun051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Testa L, Van Gaal WJ, Bhindi R, Biondi-Zoccai GGL, Abbate A, Agostoni P, Porto I, Andreotti F, Crea F, Banning AP. Pexelizumab in ischemic heart disease: A systematic review and meta-analysis on 15,196 patients. J Thorac Cardiovasc Surg 2008; 136:884-93. [PMID: 18954626 DOI: 10.1016/j.jtcvs.2007.12.062] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 12/14/2007] [Indexed: 02/05/2023]
Affiliation(s)
- L Testa
- Institute of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom.
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Abbate A, Bussani R, Liuzzo G, Biondi-Zoccai GGL, Barresi E, Mellone P, Sinagra G, Dobrina A, De Giorgio F, Sharma R, Bassan F, Severino A, Baldi F, Biasucci LM, Pandolfi F, Silvestri F, Vetrovec GW, Baldi A, Crea F. Sudden coronary death, fatal acute myocardial infarction and widespread coronary and myocardial inflammation. Heart 2008; 94:737-42. [PMID: 17698556 DOI: 10.1136/hrt.2007.115329] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND T-lymphocyte activation within atherosclerotic plaque, and widespread to the myocardium, has been shown in patients with acute coronary syndromes. OBJECTIVE To investigate the presence of T-lymphocyte infiltrate at different stages of acute coronary syndromes by studying patients with sudden coronary death, acute myocardial infarction (AMI) and healed infarction, in comparison with patients with myocarditis and patients with non-ischaemic heart failure. METHODS 72 cases were studied at autopsy: 12 dying of sudden coronary death (group 1), 12 dying <4 weeks (group 2) and 12 dying >4 months after AMI (group 3), 12 with active lymphocytic myocarditis (group 4), 12 with hypertensive heart disease (group 5), and 12 control subjects (group 6). Light microscopy was performed to measure the number of activated T-lymphocytes (CD3+/DR+) in the myocardium and coronary artery wall, and intercellular adhesion molecule-1 (ICAM-1) expression in the myocardium. RESULTS Activated T-lymphocyte infiltrates and ICAM-1 myocardial expression in both remote and peri-infarction regions and activated T-lymphocytes within the epicardial coronary artery wall of both the infarct- and non-infarct-related arteries were found in groups 1, 2 and 3, whereas myocardial, but not coronary, infiltrates were found in groups 4 (p<0.001 vs groups 1, 2 and 3 for coronary infiltrates). Groups 5 and 6 had no evidence of myocardial or coronary inflammation (p<0.001 vs groups 1, 2 and 3). CONCLUSIONS The study shows the presence of a lymphocytic infiltrate in both coronary arteries and myocardium and a proinflammatory phenotype shift in the myocardium associated with acute coronary thrombosis in patients dying suddenly, shortly, or even late after coronary thrombosis.
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Affiliation(s)
- A Abbate
- Virginia Commonwealth University, VCU Pauley Heart Center, 1200 E Broad Street, Box 980281, Richmond, VA 23298, USA.
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Testa L, van Gaal WJ, Biondi-Zoccai GGL, Abbate A, Agostoni P, Bhindi R, Banning AP. Repeat thrombolysis or conservative therapy vs. rescue percutaneous coronary intervention for failed thrombolysis: systematic review and meta-analysis. QJM 2008; 101:387-95. [PMID: 18287111 DOI: 10.1093/qjmed/hcn018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Despite proven advantages of primary percutaneous coronary intervention (PCI), thrombolysis remains the first line treatment for ST-elevation myocardial infarction (STEMI) worldwide. Management of patients with failed thrombolysis is still debated, and data from existing randomized controlled trials are conflicting. AIM To compare the risk/benefit profile of repeat thrombolysis (RT) vs. rescue PCI in patients with failed thrombolysis. METHODS Search of BioMedCentral, CENTRAL, mRCT and PubMed for randomized controlled trials comparing rescue PCI vs. conservative therapy and/or RT vs. conservative therapy. Outcomes of interest assessed by adjusted indirect meta-analysis: major adverse events (MAE, defined as the composite of overall mortality and re-infarction), stroke, congestive heart failure (CHF), major bleeds (MB), and minor bleeds. Overall mortality and re-infarction have been also analysed individually. RESULTS Eight trials were included (1318 patients). Follow-up ranged from 'in-hospital' to 6 months. No significant difference was found for the risk of MAE [OR 0.93(0.26-3.35), P = 0.4], overall mortality [OR 1.01(0.52-1.95), P = 0.15], stroke [OR 5.03(0.64-39.1), P = 0.58] and CHF [OR 0.74(0.28-1.96), P = 0.6]. Compared with conservative therapy, rescue PCI was associated with a 70% reduction in the risk of re-infarction [OR 0.32(0.14-0.74), P = 0.008], number needed to treat 17. No difference in terms of MB was found [OR 0.5(0.1-2.5), P = 0.09], while a greater risk of minor bleeds was observed with rescue PCI [OR 2.48(1.08-5.7), P = 0.04], number needed to harm 50. CONCLUSION Although the observed benefit is modest, these data support the use of PCI after failed thrombolysis.
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Affiliation(s)
- L Testa
- Institute of Cardiology, John Radcliffe Hospital, Oxford, UK.
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Delcrè S, Anselmino M, Moretti C, Biondi-Zoccai G, Abbate A, Sheiban I. Clinical and pharmaceutical management of a high-risk diabetic population undergoing percutaneous coronary interventions. Cardiovascular Revascularization Medicine 2008. [DOI: 10.1016/j.carrev.2008.02.009] [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: 11/17/2022]
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33
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Lotrionte M, Palazzoni G, Natali R, Comerci G, Abbate A, Loperfido F, Biondi-Zoccai G. Assessment of left ventricular systolic dysfunction by tissue Doppler imaging to detect subclinical cardiomyopathy early after anthracycline therapy. Minerva Cardioangiol 2007; 55:711-20. [PMID: 18091640 DOI: pmid/18091640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Anthracycline (ANT) chemotherapy for breast cancer, while associated with high response rates, is fraught by risks of irreversible cardiotoxicity. Unfortunately means to detect such cardiotoxicity early on and at a sublinical stage are lacking. We evaluated the role of systolic tissue Doppler imaging (TDI) in appraising postchemotherapy left ventricular (LV) remodelling. METHODS Patients undergoing ANT-chemotherapy for breast cancer were enrolled, and underwent baseline and >6-months echocardiography (standard and TDI). According to the pattern of LV-TDI systolic remodelling from baseline to follow-up, patients were stratified in: group 1 (no LV-TDI worsening), group 2 (minor LV-TDI worsening), and group 3 (major LV-TDI worsening). Fifty-six patients were included (follow-up 9+/-6 months). RESULTS At baseline, no patient had abnormal LV ejection fraction (LVEF), LV-TDI systolic dysfunction or New York Heart Association (NYHA) >1. Follow-up overall analysis showed significant deterioration in LVEF, end-diastolic diameter (EDD) end-systolic diameter (ESD), and TDI-systolic parameters (all P<0.05). Specifically, 29 (51.8%) patients showed no adverse LV-TDI systolic remodelling, while 17 (30.4%) were in group 2, and 10 (17.9%) in group 3. All groups shared similar conditions at baseline. Patients with adverse LV-TDI remodelling had significant increases in EDD and ESD, as well as a significantly decreased LVEF (all P<0.05). No patient in group 1 had abnormal LVEF at follow-up, while 1 patient in group 2 and 2 patients in group 3 had abnormal LVEF (P<0.05). CONCLUSION Subclinical systolic dysfunction occurs in almost 50% of patients early after chemotherapy for breast cancer, with a more adverse by LV-TDI remodelling implying a more pronounced deterioration of standard echocardiographic parameters.
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Affiliation(s)
- M Lotrionte
- Division of Heart Failure and Cardiac Rehabilitation, Cardiovascular Department, Catholic University of the Sacred Heart Rome, Italy
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34
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Abbate A, Limana F, Capogrossi MC, Santini D, Biondi-Zoccai GGL, Scarpa S, Germani A, Straino S, Severino A, Vasaturo F, Campioni M, Liuzzo G, Crea F, Vetrovec GW, Biasucci LM, Baldi A. Cyclo-oxygenase-2 (COX-2) inhibition reduces apoptosis in acute myocardial infarction. Apoptosis 2007; 11:1061-3. [PMID: 16544098 DOI: 10.1007/s10495-006-6306-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- A Abbate
- Department of Medicine, Virginia Commonwealth University, Richmond, VA 23233, USA.
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Biondi-Zoccai GG, Abbate A, Agostoni P, Lipinski MJ, Vetrovec GW. Recurrent angina and the problem of inadequate/inappropriate revascularization: reply. Eur Heart J 2007. [DOI: 10.1093/eurheartj/ehm463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Abbate A, Saffioti G, Malara G, Licordari P, Carrello S, De Pasquale D, Giorgianni C. [Whole-body vibration risk among operators in railway engines shunting ]. G Ital Med Lav Ergon 2007; 29:568-569. [PMID: 18409836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Purpose of the present note is to assess the risk from Whole-body vibration (WBV) in operators employed in the shunting of engines within the railway stations. The study has been conducted in the cockpits of the shunting engines used within the railway station of Villa S. Giovanni (RC). The measures have been taken through accelerometer IHVM 100 Larson-Davis, placed on the seat of each locomotives for a recording time of around 15 minutes. A standard measure has been effected besides, positioning the sensor on the floor of the same locomotives. The measurements indicate that the risk to these workers is negligible because in any case the value is exceeded action daily 0.5 m/s2, having recorded values range from 0.1 to 0.2 m / s2. In conclusion it holds him necessary, to the preventive goals, in respect to how much anticipated from the D.L.gs 187/05 the necessary technical, organizational and formative measures to the containment of the risk.
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Affiliation(s)
- A Abbate
- Dipartimento di Medicina Sociale del Teritorio Sezione di Medicina del Lavoro Università degli Studi di Messina
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Venuti V, De Pasquale D, Abbate A, Brecciaroli R, Giorgianni C. [Malignant pleuric mesothelioma in Sicily. Epidemiologic observations during the time 1998-2005]. G Ital Med Lav Ergon 2007; 29:639-640. [PMID: 18409881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Pleural malign mesothelioma is the only one to which we can straight attribute to an exposition, in professional and ambient ambit, to a good identified agent and, precisely, to the fibres of asbestos. Objective of our work has been to verify the incidence of the pleural malign mesothelioma in Sicily and in particular in the Messina's area, during the period 1988-2005. We have examined the epidemiologic data of the period 1988-1997 and 1998-2005 through the consultation of the Mesothelioma Sicilian Register; Mesothelioma Italian Register and of the available documentation in the Health Superior Institute. The study showed that the pleural malign mesothelioma in sicily and in Messina's area is reduced for the elimination of the asbestos and for the low use of asbestos in the sicilian industry.
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Affiliation(s)
- V Venuti
- Dipartimento di Medicina Sociale del Teritorio, Sez. di Medicina del Lavoro, Università di Messina.
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38
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Muraca G, Martino LB, Abbate A, De Pasquale D, Barbuzza O, Brecciaroli R. [The risk of manual handling loads in the hotel sector]. G Ital Med Lav Ergon 2007; 29:569-570. [PMID: 18409837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The aim of our study is to evaluate the manual handling risk and the incidence of muscle-skeletal pathologies in the hotel compartment. Our study is conducted on 264 workers of the hotel compartment. The sample is divided on the base of the working turn in the following groups: porter (both to the plans and in the kitchen); waiters to the plans; services (gardeners and workers). The duties have been valued according to the method NIOSH. The presence of muscle-skeletal pathologies has been verified on the base to the accused symptomology, and on the presence of clinical objectivity and to the reports of checks. The data has been compared to a control group. The application of the NIOSH method has showed for each working profile an elevated synthetic index, > 3, and for porter the index is 5. The clinical data has shown an elevated incidence of pathologies of the spine, especially lumbar spine, with a high prevalence in the group of male porters. In conclusion we believe that the manual handling represents a particularly remarkable risk for the workers in the hotel compartment.
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Affiliation(s)
- G Muraca
- Università degli Studi di Messina, Dipartimento di Medicina Sociale del Territorio, Sezione di Medicina del Lavoro
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39
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Biondi-Zoccai G, Abbate A, Moretti C, Agostoni P, Valgimigli M, Sangiorgi G, Trevi G, Sheiban I. Benefits of clopidogrel in patients undergoing coronary stenting significantly depends on loading dose: evidence from a meta-regression. Cardiovascular Revascularization Medicine 2007. [DOI: 10.1016/j.carrev.2007.03.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Tumours metastatic to the heart (cardiac metastases) are among the least known and highly debated issues in oncology, and few systematic studies are devoted to this topic. Although primary cardiac tumours are extremely uncommon (various postmortem studies report rates between 0.001% and 0.28%), secondary tumours are not, and at least in theory, the heart can be metastasised by any malignant neoplasm able to spread to distant sites. In general, cardiac metastases are considered to be rare; however, when sought for, the incidence seems to be not as low as expected, ranging from 2.3% and 18.3%. Although no malignant tumours are known that diffuse preferentially to the heart, some do involve the heart more often than others--for example, melanoma and mediastinal primary tumours. This paper attempts to review the pathophysiology of cardiac metastatic disease, epidemiology and clinical presentation of cardiac metastases, and pathological characterisation of the lesions.
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Affiliation(s)
- R Bussani
- Department of Pathologic Anatomy, University of Trieste, Trieste, Italy.
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41
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Galiuto L, Lotrionte M, Crea F, Anselmi A, Biondi-Zoccai GGL, De Giorgio F, Baldi A, Baldi F, Possati G, Gaudino M, Vetrovec GW, Abbate A. Impaired coronary and myocardial flow in severe aortic stenosis is associated with increased apoptosis: a transthoracic Doppler and myocardial contrast echocardiography study. Heart 2005; 92:208-12. [PMID: 15908482 PMCID: PMC1860772 DOI: 10.1136/hrt.2005.062422] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To test the hypothesis that impaired coronary and myocardial blood flow are linked with increased myocyte apoptosis, thus establishing a link between pressure overload and left ventricular (LV) remodelling. METHODS AND RESULTS Peak diastolic coronary blood flow velocity (CBFV) was evaluated at transthoracic Doppler echocardiography, and signal intensity (SI) and the rate of SI rise (beta) were measured at myocardial contrast echocardiography in 11 patients with severe aortic stenosis and LV hypertrophy. In the same patients, biopsies were obtained from the anterolateral LV free wall during surgery and analysed for cardiomyocyte apoptosis. LV mass corrected CBFV (CBFVI) was significantly lower in patients than in controls (median 0.100 cm.g/s (interquartile range 0.07-0.115) v 0.130 cm.g/s (0.130-0.160), p = 0.002). Similarly, SI*beta was significantly lower in patients than in controls (11 1/s (8-66) v 83 1/s (73-95), p = 0.001). Apoptotic rate was increased in aortic stenosis more than 100-fold versus controls (1.2% (0.8-1.4) v 0.01% (0.01-0.01), p < 0.001) and inversely correlated with lower CBFVI and SI*beta (r = -0.77, p = 0.001 for both). CONCLUSIONS Patients with severe aortic stenosis and LV hypertrophy have impaired myocardial perfusion, which is associated with enhanced cardiomyocyte apoptosis. Impaired myocardial perfusion and the ensuing oxygen demand-supply imbalance may, at least partially, be responsible for increased apoptosis and possible transition to heart failure, thus establishing a link between pressure overload, LV remodelling, and heart failure.
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Affiliation(s)
- L Galiuto
- Institute of Cardiology, Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
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42
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Santini D, Abbate A, Scarpa S, Vasaturo F, Biondi-Zoccai GG, Bussani R, De Giorgio F, Bassan F, Camilot D, Di Marino MP, Feroce F, Baldi F, Silvestri F, Crea F, Baldi A. Surviving acute myocardial infarction: survivin expression in viable cardiomyocytes after infarction. J Clin Pathol 2005; 57:1321-4. [PMID: 15563676 PMCID: PMC1770501 DOI: 10.1136/jcp.2004.018986] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Apoptosis is a key feature in postinfarction remodelling leading to progressive myocyte loss. Both proapoptotic and antiapoptotic factors contribute to the delicate balance between death and survival. The survivin pathway has emerged as essential in the control of apoptosis, although its role in heart disease is unknown. AIM To evaluate survivin expression after acute myocardial infarction (AMI). METHODS Survivin expression was assessed immunohistochemically in the peri-infarct and remote viable myocardium in 17 consecutive patients who died 1-30 weeks after AMI and in four control hearts. RESULTS Survivin was expressed by myocytes in the peri-infarct area in eight patients and in the remote region in 13 patients. The rate of survivin expression after AMI was significantly higher in the remote versus peri-infarct regions and compared with control hearts. Its expression was inversely associated with the presence of dilated cardiopathy and of apoptosis, independently from the gross pathology infarct size. CONCLUSIONS Survivin myocardial expression after AMI may be associated with the survival of at risk myocardium and may be indicative of more favourable remodelling after AMI. These findings identify a potential new target for the treatment of postinfarction remodelling.
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Affiliation(s)
- D Santini
- Department of Oncology, University Campus Bio-Medico, Rome, 00100 Italy
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Biondi-Zoccai GGL, Agostoni P, Testa L, Abbate A, Parisi Q, Burzotta F, Trani C, Mongiardo R, Vassanelli C, Biasucci LM. Increased mortality after coronary stenting in patients treated with clopidogrel without loading dose. Evidence from a meta-analysis. Minerva Cardioangiol 2004; 52:195-208. [PMID: 15194981 DOI: pmid/15194981] [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: 02/08/2023]
Abstract
AIM Clopidogrel is an established alternative to ticlopidine in addition to aspirin after coronary stenting because of its hematologic safety, but its efficacy in comparison to ticlopidine is debated. We thus systematically reviewed randomized trials comparing clopidogrel vs ticlopidine after coronary stenting. METHODS Medline (1/1986-10/2003), BioMed Central, Central, Current Contents, LILACS and mRCT were searched. Fixed-effect relative risks (RR [95% CI]) were computed, and the primary end-point was death. Heterogeneity tests and subgroup analyses were performed according to loading vs non-loading clopidogrel scheme. RESULTS Five trials were retrieved (2 962 patients, average follow-up 7.4 months). In 3 studies both clopidogrel and ticlopidine were started with a loading dose, in 1 trial clopidogrel was administered without loading, and in 1 trial clopidogrel could be administered with or without loading. Overall analysis (p for heterogeneity=0.12) showed a non-significant trend toward increased mortality in patients treated with clopidogrel (38/1 649 [2.3%]) vs ticlopidine (22/1 313 [1.7%], RR=1.64 [0.94-2.86], p=0.080). After stratification, clopidogrel with loading was associated with non-significantly lower mortality rates than ticlopidine (9/959 [0.9%] vs 13/798 [1.6%], RR=0.68 [0.29-1.63], p=0.39). Instead, clopidogrel without any loading yielded a highly significantly 3-fold increased risk of death than ticlopidine (29/690 [4.2%] vs 9/515 [1.7%], RR=2.9 [1.45-6.1], p=0.0029). Similar results were obtained for the rate of death or non-fatal myocardial infarction. CONCLUSION This meta-analysis suggests that clopidogrel treatment including a loading regimen is equivalent or may even be superior to ticlopidine after coronary stenting. However, current evidence shows conversely that clopidogrel therapy in the absence of a loading dose is associated with a significantly higher risk of death or myocardial infarction.
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Abbate A, Santini D, Biondi-Zoccai GGL, Scarpa S, Vasaturo F, Liuzzo G, Bussani R, Silvestri F, Baldi F, Crea F, Biasucci LM, Baldi A. Cyclo-oxygenase-2 (COX-2) expression at the site of recent myocardial infarction: friend or foe? Heart 2004; 90:440-3. [PMID: 15020525 PMCID: PMC1768143 DOI: 10.1136/hrt.2003.010280] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cyclo-oxygenase-2 (COX-2) is induced in cardiomyocytes only in response to stress, such as ischaemia. OBJECTIVE To assess COX-2 expression at the site of recent myocardial infarction. METHODS COX-2 expression was evaluated by specific immunostaining in cardiomyocytes from 23 subjects who died 10-60 days after acute myocardial infarction. The relation between COX-2 myocardial expression and apoptotic rate was investigated. Cardiomyocyte apoptotic rate was defined as the number of cells co-expressing in situ end labelling of DNA fragmentation (TUNEL) and immunostaining for activated caspase-3. RESULTS COX-2 expression was found in cardiomyocytes at the site of infarction in nine of 23 cases (39%). It was associated with fivefold higher apoptotic rates (median 17.9% (interquartile range 11.0-25.4%) v 3.7% (0.6-12.8%); p = 0.016), and apoptotic rate increased progressively from mild to intense COX-2 staining (p for trend 0.009). COX-2 expression co-localised with TUNEL nuclear staining in myocytes, and there was a high concordance between COX-2 and hypoxia induced factor 1-alpha staining (78%, p = 0.021) and between COX-2 and bax (83%, p = 0.014). Subjects showing myocardial COX-2 expression were more likely to have enlarged hearts (p = 0.050), and intense COX-2 staining was strictly associated with symptomatic heart failure (p = 0.035). CONCLUSIONS COX-2 is expressed in cardiomyocytes in nearly 40% of cases at the site of recent acute myocardial infarction, even late after the index event. Its expression was associated with extremely high apoptotic rates. These findings suggest a potential cause-effect link between COX-2 expression and enhanced myocardial apoptosis in ischaemic cardiomyopathy.
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Affiliation(s)
- A Abbate
- Institute of Cardiology, Catholic University, Rome, Italy.
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45
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Bussani R, Abbate A, Biondi-Zoccai GGL, Dobrina A, Leone AM, Camilot D, Di Marino MP, Baldi F, Silvestri F, Biasucci LM, Baldi A. Right ventricular dilatation after left ventricular acute myocardial infarction is predictive of extremely high peri-infarctual apoptosis at postmortem examination in humans. J Clin Pathol 2003; 56:672-6. [PMID: 12944550 PMCID: PMC1770058 DOI: 10.1136/jcp.56.9.672] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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] [Accepted: 04/26/2003] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cardiac remodelling after acute myocardial infarction (AMI) is characterised by molecular and cellular mechanisms involving both left and right ventricles, and biventricular failure identifies patients with an extremely unfavourable prognosis. AIMS To assess whether a link exists between increased myocardial apoptotic rates (AR) at sites of recent infarction and patterns of unfavourable cardiac remodelling, such as biventricular enlargement after left ventricular (LV) infarction. METHODS Twelve patients with recent AMI involving the LV and not the right ventricle (RV) and with permanent infarct related artery occlusion were selected at necropsy. Gross pathological characteristics, such as LV and RV dilatation, and AR at site of infarction were assessed. Potential false positive results (DNA synthesis and RNA splicing) were excluded from the cell count. RESULTS RV enlargement, defined as a tricuspidal ring greater than 120 mm, was found in five cases and was associated with LV dilatation. These patients showed significantly higher AR than the others. When the subjects were divided into three groups according to progressive cardiac remodelling (absence of cardiac dilatation, isolated LV dilatation, and biventricular enlargement), the last group had significantly higher ARs than the other two groups, showing that myocardiocyte apoptosis is increased in more unfavourable forms of cardiac remodelling. CONCLUSION Patients with severely unfavourable cardiac remodelling, such as biventricular enlargement, have extremely high myocardiocyte apoptosis at necropsy, even late after LV myocardial infarction, supporting the role of myocardiocyte loss in determining post-infarction adverse remodelling.
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Affiliation(s)
- R Bussani
- Department of Pathological Anatomy, University of Trieste, Trieste 34125, Italy
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46
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Abbate A, Biondi-Zoccai GGL, Bussani R, Camilot D, Dobrina A, Leone AM, Baldi F, Silvestri F, Biasucci LM, Baldi A. High-risk clinical features predict increased post-infarction myocardial apoptosis and the benefits as a result of an open infarct-related artery. Eur J Clin Invest 2003; 33:662-8. [PMID: 12864776 DOI: 10.1046/j.1365-2362.2003.01198.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Infarct-related artery (IRA) patency after acute myocardial infarction (AMI) is associated with a more favourable clinical course, in particular in patients with high-risk features. As it has been recently reported that IRA patency is associated with a reduced postinfarction apoptotic rate (AR), the aim of our study was to assess whether IRA status late after AMI had a different impact on AR in high- vs. low-risk patients. METHODS AND RESULTS Co-localization of TUNEL and caspase-3 was used to calculate the AR at the site of infarction at the time of death in 30 subjects. The Norris coronary prognostic index (NI) was calculated (computing age, presence of pulmonary congestion, heart size and history of previous additional AMI) in order to define the patients' individual risk at the time of hospitalization. According to the NI (< or =7 vs. >7), subjects were divided into low and high risk, as NI >7 carries an approximate threefold higher risk of death. The NI was significantly correlated with the AR at the time of death both in infarct and remote areas. Twenty subjects had IRA occlusion at the time of death, and in these patients AR was significantly higher both in infarct and remote areas (P<0.001 and P=0.009 vs. the others, respectively). However the impact of IRA occlusion on AR was significantly different comparing high- vs. low-risk subjects. In particular, AR at the infarct site was 10-fold higher in the high-risk subjects with IRA occlusion (26.1%[20.4-28.7%]) vs. those with open IRA (2.3%[0.6-3.5%]; P=0.002) and was nonsignificantly different in the low-risk subjects vs. those without IRA occlusion (8.2%[2.5-17.5%] vs. 5.4%[1.5-7.9%]; P=0.48). Similarly, in the high-risk subjects, AR in remote areas was significantly greater in cases with occluded vs. open IRA (0.7%[0.4-0.9%] vs. 0.3%[0.3-0.32%]; P=0.009). CONCLUSION A significantly higher AR is associated with IRA occlusion late post AMI in subjects with high-risk clinical features, and not in low-risk patients. The diverse impact of IRA occlusion on AR in subjects with different risk profiles may explain the greater benefit associated with coronary reperfusion in high-risk subjects. The overall lower AR in low-risk subjects, independently from the IRA status, may be correlated with the better long-term prognosis after AMI in this case.
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Affiliation(s)
- A Abbate
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
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Zamperetti N, Carraro R, Marafon S, Abbate A, Lieta E, Piccinni P, Dan M. Principles, protocols and patients: the practical management of a limit in ICU. Minerva Anestesiol 2002; 68:214-8. [PMID: 12024085] [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: 02/25/2023]
Abstract
The definition and management of a limit is a common but sometimes extremely complex problem in the Intensive Care Unit (ICU). Guidelines and consensus documents have been published in order to help clinicians. Yet, many controversial issues are brought into question. Legal rules are sometimes vague and derive more from the interpretation of various and unrelated principles (which vary from country to country) than from a clear ad hoc law. In this sense, the practical management of a limit in ICU is usually run by a dual normativity: an external one, which derives from the cultural, moral and legal values of the society, and an internal one, which depends on the particular clinical and human situation, namely the values of everybody involved in (the patient, his/her relatives, the health staff) and the relationships among these people. The considerable freedom left for the decision by an open communication is a great and favourable potential which must be used in the interest of the patient's and of his/her family.
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Affiliation(s)
- N Zamperetti
- Department of Anesthesia and Intensive Care Medicine, San Bortolo Hospital, Vicenza, Italy.
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Abbate A, Viaggio MB, Piras D, López L, Hubscher O, Nogués M. [Acute bilateral sensorineural hearing loss caused by immuno-mediated inner ear disease]. Medicina (B Aires) 2002; 61:860-2. [PMID: 11808429] [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: 02/23/2023] Open
Abstract
The audiovestibular system can be affected by an immunologic etiology. The immune-mediated inner ear disease (IMIED) is a syndrome that includes rapidly progressive sensorineural hearing loss, vertigo and tinnitus, which occurs as a primary disorder or complicates certain autoimmune systemic conditions. However, if treated promptly with immunosuppression, the audiological sequel of IMIED may be avoided. We present a 28 year old female patient, who after rhinitis and mioarthralgias developed a vestibular syndrome. A week later she experienced bilateral hearing loss that progressed to deafness in 72 hours. The examination revealed horizontal and torsional nystagmus, a disrupted vestibulo-ocular reflex and vertigo with the positional changes. Laboratory data were normal except for eritrosedimentation rate (75 mm/1 hour). The autoantibodies usually present in rheumatologic autoimmune systemic diseases were negative. The antibodies to the 68-kD antigen found in the inner ear were positive. The chest x-ray and sinus x-ray were normal. The head magnetic resonance imaging with gadolinium and ear computed tomography were normal. Cerebrospinal fluid studies showed normal findings. With the possible diagnosis of IMIED we started early treatment with corticosteroids, with improvement in auditory and vestibular function thereafter. We highlight the early recognition of IMIED as a differential diagnosis in patients with acute bilateral hearing loss, because prompt treatment with immunosuppression might have a positive effect on auditory function recovery.
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Affiliation(s)
- A Abbate
- Sección Clínica Médica, Hospital Ramos Mejía, Buenos Aires, Argentina.
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Manzoli A, Patti G, D'Ambrosio A, Montesanti R, Calabrese V, Abbate A, Gioia G, Di Sciascio G. [Statins: from hypocholesteremic drugs to antiatherogenic agents]. Clin Ter 2001; 152:307-13. [PMID: 11794851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Statins (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors) are widely used for the treatment of hypercholesterolemia. They reduce LDL levels more than other lipid-lowering drugs. Moreover, they are effective in raising HDL and even in reducing triglyceride levels. Statins have an excellent tolerability and safety. Clinical trials in patients with and without ischemic heart disease and with and without high cholesterol levels have demonstrated that statins significantly reduce the relative risk of major coronary events and of total mortality. Other mechanisms independent of LDL lowering may play an important role in the clinical benefits conferred by these drugs and may broaden their therapeutic indications from lipid-lowering to antiatherogenic agents.
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Affiliation(s)
- A Manzoli
- Dipartimento di Scienze Cardiovascolari, Università Campus Bio-Medico, Roma, Italia.
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