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Derchi CC, Mikulan E, Mazza A, Casarotto S, Comanducci A, Fecchio M, Navarro J, Devalle G, Massimini M, Sinigaglia C. Distinguishing intentional from nonintentional actions through eeg and kinematic markers. Sci Rep 2023; 13:8496. [PMID: 37231006 DOI: 10.1038/s41598-023-34604-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
How can an intentional movement be distinguished from the same movement done nonintentionally? How can this distinction be drawn without asking the subject, or in patients who are unable to communicate? Here we address these questions, by focusing on blinking. This is one of the most frequent spontaneous actions in our daily life, but it can also be done intentionally. Furthermore, blinking is often spared in patients with severe brain injuries, and for some, it is the only way to report complex meanings. Using kinematic and EEG-based measures, we found that intentional and spontaneous blinking are preceded by different brain activities, even when they are indistinguishable. Unlike spontaneous ones, intentional blinks are characterized by a slow negative EEG drift, resembling the classic readiness potential. We investigated the theoretical implication of this finding in stochastic decision models as well as the practical significance of using brain-based signals to improve the discrimination between intentional and nonintentional actions. As proof of principle, we considered three brain-injured patients with rare neurological syndromes characterized by motor and communicative impairments. Although further research is needed, our results indicate that brain-based signals can offer a feasible way to infer intentionality even in absence of overt communication.
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Affiliation(s)
- C C Derchi
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
| | - E Mikulan
- Department of Health Sciences, Università Degli Studi di Milano, Via di Rudinì 8, 20146, Milan, Italy
| | - A Mazza
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
| | - S Casarotto
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
- Department of Biomedical and Clinical Sciences, Università Degli Studi Di Milano, Via G. B. Grassi 75, 20157, Milan, Italy
| | - A Comanducci
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
| | - M Fecchio
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - J Navarro
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
| | - G Devalle
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
| | - M Massimini
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy.
- Department of Biomedical and Clinical Sciences, Università Degli Studi Di Milano, Via G. B. Grassi 75, 20157, Milan, Italy.
| | - C Sinigaglia
- Department of Philosophy, Università Degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
- Cognition in Action (CIA) Unit, PHILAB, 20122, Milan, Italy.
- Department of Philosophy, Stanford University, Stanford, CA, USA.
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Boriani G, Guerra F, De Ponti R, D'Onofrio A, Accogli M, Bertini M, Bisignani G, Forleo GB, Landolina M, Lavalle C, Notarstefano P, Ricci RP, Zanotto G, Palmisano P, De Bonis S, Pangallo A, Talarico A, Maglia G, Aspromonte V, Nigro G, Bianchi V, Rapacciuolo A, Ammendola E, Solimene F, Stabile G, Biffi M, Ziacchi M, Malpighi PSO, Saporito D, Casali E, Turco V, Malavasi VL, Vitolo M, Imberti JF, Bertini M, Anna AS, Zardini M, Placci A, Quartieri F, Bottoni N, Carinci V, Barbato G, De Maria E, Borghi A, Ramazzini OB, Bronzetti G, Tomasi C, Boggian G, Virzì S, Sassone B, Corzani A, Sabbatani P, Pastori P, Ciccaglioni A, Adamo F, Scaccia A, Spampinato A, Patruno N, Biscione F, Cinti C, Pignalberi C, Calò L, Tancredi M, Di Belardino N, Ricciardi D, Cauti F, Rossi P, Cardinale M, Ansalone G, Narducci ML, Pelargonio G, Silvetti M, Drago F, Santini L, Pentimalli F, Pepi P, Caravati F, Taravelli E, Belotti G, Rordorf R, Mazzone P, Bella PD, Rossi S, Canevese LF, Cilloni S, Doni LA, Vergara P, Baroni M, Perna E, Gardini A, Negro R, Perego GB, Curnis A, Arabia G, Russo AD, Marchese P, Dell’Era G, Occhetta E, Pizzetti F, Amellone C, Giammaria M, Devecchi C, Coppolino A, Tommasi S, Anselmino M, Coluccia G, Guido A, Rillo M, Palamà Z, Luzzi G, Pellegrino PL, Grimaldi M, Grandinetti G, Vilei E, Potenza D, Scicchitano P, Favale S, Santobuono VE, Sai R, Melissano D, Candida TR, Bonfantino VM, Di Canda D, Gianfrancesco D, Carretta D, Pisanò ECL, Medico A, Giaccari R, Aste R, Murgia C, Nissardi V, Sanna GD, Firetto G, Crea P, Ciotta E, Sgarito G, Caramanno G, Ciaramitaro G, Faraci A, Fasheri A, Di Gregorio L, Campsi G, Muscio G, Giannola G, Padeletti M, Del Rosso A, Notarstefano P, Nesti M, Miracapillo G, Giovannini T, Pieragnoli P, Rauhe W, Marini M, Guarracini F, Ridarelli M, Fedeli F, Mazza A, Zingarini G, Andreoli C, Carreras G, Zorzi A, Zanotto G, Rossillo A, Ignatuk B, Zerbo F, Molon G, Fantinel M, Zanon F, Marcantoni L, Zadro M, Bevilacqua M. Five waves of COVID-19 pandemic in Italy: results of a national survey evaluating the impact on activities related to arrhythmias, pacing, and electrophysiology promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing). Intern Emerg Med 2023; 18:137-149. [PMID: 36352300 PMCID: PMC9646282 DOI: 10.1007/s11739-022-03140-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The subsequent waves of the COVID-19 pandemic in Italy had a major impact on cardiac care. METHODS A survey to evaluate the dynamic changes in arrhythmia care during the first five waves of COVID-19 in Italy (first: March-May 2020; second: October 2020-January 2021; third: February-May 2021; fourth: June-October 2021; fifth: November 2021-February 2022) was launched. RESULTS A total of 127 physicians from arrhythmia centers (34% of Italian centers) took part in the survey. As compared to 2019, a reduction in 40% of elective pacemaker (PM), defibrillators (ICD), and cardiac resynchronization devices (CRT) implantations, with a 70% reduction for ablations, was reported during the first wave, with a progressive and gradual return to pre-pandemic volumes, generally during the third-fourth waves, slower for ablations. For emergency procedures (PM, ICD, CRT, and ablations), recovery from the initial 10% decline occurred in most cases during the second wave, with some variability. However, acute care for atrial fibrillation, electrical cardioversions, and evaluations for syncope showed a prolonged reduction of activity. The number of patients with devices which started remote monitoring increased by 40% during the first wave, but then the adoption of remote monitoring declined. CONCLUSIONS The dramatic and profound derangement in arrhythmia management that characterized the first wave of the COVID-19 pandemic was followed by a progressive return to the volume of activities of the pre-pandemic periods, even if with different temporal dynamics and some heterogeneity. Remote monitoring was largely implemented during the first wave, but full implementation is needed.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41121, Modena, Italy.
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo-University of Insubria, Varese, Italy
| | - Antonio D'Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Naples, Italy
| | | | - Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara "Arcispedale S. Anna", Cona, Ferrara, Italy
| | - Giovanni Bisignani
- Cardiology Division, Castrovillari Hospital, ASP Cosenza, Castrovillari, Italy
| | | | | | - Carlo Lavalle
- Department of Cardiology, Policlinico Universitario Umberto I, Rome, Italy
| | | | | | - Gabriele Zanotto
- Department of Cardiology, Mater Salutis Hospital, Legnago, Verona, Italy
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Schillaci V, De Sanctis V, Mazza A, Zucchelli G, Notaristefano F, Gagliardi M, Meynet I, Mantica M, Solimene F, Anselmino M, Stabile G, Ottaviano L, Cavaiani M, Malacrida M, Varbella F. Influence of catheter orientation on local impedance parameters during radiofrequency delivery in AF ablation. Europace 2022. [DOI: 10.1093/europace/euac053.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Recently, a novel contact force (CF) sensing catheter able to measure local tissue impedance (LI) providing a measure of tissue characteristics has become available for clinical use.
Purpose
We sought to evaluate the influence of catheter contact angle on LI and CF parameters in consecutive atrial fibrillation ablation cases.
Methods
Consecutive pts undergoing radiofrequency catheter (RFC) ablation of AF from the CHARISMA registry were included. A novel ablation catheter (IntellaNav Stablepoint catheter) with dedicated algorithm (DirectSense) was used to measure LI at the distal electrode of this catheter. Each targeted spot was characterized in terms of RF delivery time, catheter contact angle, baseline LI and subsequent LI drop during ablation at different levels of CF (<5g, 5-19g and ≥20g). RFC ablations were performed at ≥45 watts. Data are reported as mean±SD.
Results
A total of 4193 point ablations performed around PVs from 54 cases of AF ablation were analyzed (57% paroxysmal, 85% de novo). The LI was 157±17Ω prior to ablation and 137±14Ω after ablation (p<0.0001, absolute LI drop of 22±8Ω). The CF was 12.5±8g and the RFC delivery time was 8.8±4s. The LI drop increased as CF increased (ranging from 18.9±7Ω for CF<5g to 24.8±7Ω for CF≥20g, p<0.0001) as well as RFC delivery time decreased (ranging from 12.7±4s for CF<5g to 6.6±4s for CF≥20g, p<0.0001). The LI drop at perpendicular orientations was significantly lower than at parallel orientations (19.5±8Ω vs 23.4±8Ω, p<0.0001) and RFC delivery time was higher (9.6±5s vs 8.4±4s, p<0.0001). This trend was confirmed among different level of CF both for LI drop and RFC delivery time. Figure
Conclusions
In this experience, the magnitude of the LI drop at perpendicular orientation were significantly lower than at parallel orientation and RFC delivery time was greater in parallel instances than in perpendicular instances. Thus, perpendicular RF ablations required longer RF applications and produced weaker LI decreases that parallel lesions, suggesting that catheter orientation may have critical role in RF delivery for ablation.
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Affiliation(s)
| | | | - A Mazza
- Infermi Hospital, Rivoli, Italy
| | | | | | | | | | - M Mantica
- Clinical Institute Saint Ambrogio, Milan, Italy
| | | | - M Anselmino
- Hospital Molinette of the University Hospital S. Giovanni Battista, Turin, Italy
| | - G Stabile
- Montevergine Clinic, Mercogliano, Italy
| | - L Ottaviano
- Clinical Institute Saint Ambrogio, Milan, Italy
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Mazza A, Bendini M, Bianchi V, Esposito C, Calo’ L, Andreoli C, Santobuono V, Dello Russo A, Chianese R, La Greca C, Santoro A, Giubilato G, Strisciuglio T, Valsecchi S, Boriani G. Device-detected sleep-disordered breathing predicts implantable defibrillator therapy in patients with heart failure. Europace 2022. [DOI: 10.1093/europace/euac053.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Sleep-disordered breathing is highly prevalent in heart failure (HF) and it has been suggested as a risk factor for malignant ventricular arrhythmias. The Respiratory Disturbance Index (RDI) algorithm computed by select implantable cardioverter defibrillators (ICDs) can identify severe sleep apnea (SA).
Purpose
In the present analysis we evaluated the association between ICD-detected SA and the incidence of appropriate ICD therapy in patients with HF.
Methods
We enrolled 411 HF patients (age 69±10years, 77% male, ejection fraction 32±8%), implanted with an ICD endowed with an algorithm (ApneaScan, Boston Scientific) that calculates the RDI each night. In this analysis the weekly mean RDI value was considered. The endpoint was the first appropriate ICD shock. The median follow-up was 26 months [25th–75th percentile: 16-35].
Results
During follow-up, one or more ICD shocks were documented in 58 (14%) patients.
Patients with shocks were younger (66±13years versus 70±10years, p=0.038), and more frequently implanted for secondary prevention (21% versus 10%, p=0.026). The maximum RDI value calculated during the entire follow-up period did not differ between patients with and without shocks (55±15episodes/h versus 54±14episodes/h, p=0.539). However, the ICD-detected RDI showed a considerable variability during follow-up. The overall median of the weekly RDI was 33episodes/h [25th–75th percentile: 24-45]. Using a time-dependent Cox regression model, the continuously measured weekly mean RDI≥45episodes/h was independently associated with shock occurrence (HR:4.63, 95%CI:2.54-8.43, p<0.001), after correction for baseline confounders (age, secondary prevention).
Conclusions
In HF patients, patients were more likely to receive appropriate ICD shocks during periods of time when they exhibited more sleep-disordered breathing.
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Affiliation(s)
- A Mazza
- Hospital Santa Maria della Stella, Orvieto, Italy
| | - M Bendini
- Hospital Santa Maria della Stella, Orvieto, Italy
| | - V Bianchi
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - C Esposito
- San Giovanni di Dio and Ruggi d’Aragona University Hospital, Salerno, Italy
| | - L Calo’
- Polyclinic Casilino, Rome, Italy
| | - C Andreoli
- San Giovanni Battista Hospital, Foligno, Italy
| | | | | | - R Chianese
- Hospital Sant’anna E San Sebastiano, Caserta, Italy
| | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - A Santoro
- Senese University Hospital, Siena, Italy
| | - G Giubilato
- Presidio Ospedaliero di Frosinone, Frosinone, Italy
| | | | | | - G Boriani
- University-Hospital Polyclinic of Modena, Modena, Italy
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Segreti L, Maggio R, De Sanctis V, Stabile G, Battaglia A, Zingarini G, Mantica M, Agresta A, Mazza A, Pandozi C, Dello Russo A, Ottaviano L, Cavaiani M, Malacrida M, Solimene F. A novel local impedance algorithm to guide effective pulmonary vein isolation in AF patients: preliminary experience among different voltages of atrial substrate. Europace 2022. [DOI: 10.1093/europace/euac053.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Recently, a novel technology able to measure local tissue impedance (LI) and contact force (CF) aimed at validating ablation endpoints has become available for clinical use.
Purpose
This analysis explores the relationship between LI parameters, substrate characteristics and AF type during ablation in AF patients.
Methods
A novel ablation catheter with dedicated algorithm was used to measure LI at the distal electrode. Each ablation point was characterized in terms of RF delivery time, baseline LI and LI drop during ablation according to different voltages (above or below 0.5 mV) of the atrial substrate. Ablation endpoint was PVI as assessed by entrance and exit block with local capture. Data are reported as mean±SD.
Results
A total of 2032 RFC deliveries from 34 consecutive patients were analyzed (71% paroxysmal AF, 29% persistent AF). All PVs were successfully isolated with an overall procedure time of 128±33min (fluoroscopy time=15.6±9min, RF delivery time=9.6±4s, CF=11.1±7g). The baseline LI was 155±17Ω prior to ablation and 136±14Ω after ablation (p<0.0001, absolute LI drop of 21.0±8Ω) with a LI drop rate equal to 2.8±2Ω/s. Ablation spots were more frequently deployed in high-voltage areas (>0.5mv, n=1240, 61%). Baseline LI and LI drops were both higher when underlying atrial voltages were >0.5mV than when <0.5mV (156±18Ω vs 153.6±16Ω for starting LI, p=0.0032; 22.2±8Ω vs 19.1±8Ω for LI drop, p<0.0001, respectively). No differences were found in terms of both CF and LI after ablation between >0.5mV and <0.5mV (11.0±7g vs 11.2±7g for CF, p=0.3435; 136.4±13Ω vs 135.3±15Ω for ablated tissue LI, p=0.1521, respectively). Low-voltage areas were more frequently detected at ablated spots in persistent AF cases (n=288, 51.9%) than in paroxysmal AF cases (n=504, 35.1%, p<0.0001), however, no differences were found in terms of both baseline LI and LI drop between persistent and paroxysmal AF cases (156.3±17Ω vs 154.6±17Ω for starting LI, p=0.135; 20.7±8Ω vs 21.1±9Ω for LI drop, p=0.1722, respectively).
Conclusions
LI measurements well distinguished contact with high-voltage areas from low-voltage areas and were able to detect significant differences in LI drop during ablation according to the voltage level.
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Affiliation(s)
- L Segreti
- University Hospital of Pisa, Pisa, Italy
| | | | | | - G Stabile
- Montevergine Clinic, Mercogliano, Italy
| | | | - G Zingarini
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - M Mantica
- Clinical Institute Saint Ambrogio, Milan, Italy
| | - A Agresta
- Montevergine Clinic, Mercogliano, Italy
| | - A Mazza
- Infermi Hospital, Rivoli, Italy
| | - C Pandozi
- San Filippo Neri Hospital, Rome, Italy
| | | | - L Ottaviano
- Clinical Institute Saint Ambrogio, Milan, Italy
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Corrado L, Sena L, Russo M, Colangelo G, Mazza A, Riccio G. P22 USE OF THE LIFE–VEST IN PATIENTS WITH HIGH ARRHYTHMIC RISK: EXPERIENCE OF A SPOKE CENTER IN THE COVID–19 PERIOD. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Patients with newly found dilated heart disease have a high risk of sudden death. During the COVID period, the follow–up of these patients was difficult due to the limitation of access to the hospital and the impossibility of performing tests with high decision–making power (cardiac MRI) at third–level hospitals.
Purpose
To evaluate the use of the Life–Vest in patients with newly found dilated heart disease as a protection system for early discharge and the related cost/benefit ratio in relation to an early ICD implant.
Methods
In the COVID period, a Life–Vest was applied to 18 patients with newly found dilated heart disease (4 post ischemic and 16 without coronary artery disease), to monitoring ventricular arrhythmias and to protect them against any life–threatening ventricular tachycardias. These patients showed an high arrhythmic risk for ventricular tachycardias, (VT found on monitoring) and an unfavorable echocardiographic aspect. Each week, the patient‘s telemetry was remotely viewed and a telephone assessment was performed for clinical conditions. A control echocardiogram was performed at 30 days to evaluate the FE and the possible continuation of monitoring.
Results
Of the 18 patients (mean age 59 years) analyzed, 5 (28%) underwent ICD implantation for persistent severe reduction in FE during 3 months after diagnosis and 13 (72%) normalized FE (duration average follow–up 50 days); there are no significant differences between the postischemic and non–postischemic DCM groups. The cost of renting the Life–Vest is about 4000 euros for 40 days and the average cost for an ICD implant, considering the device and the costs related to the days of hospitalization and use of human resources/advanced technological support, amounts to about 20700 euros. Considering these data, we observed a saving of approximately 261900 euros for 18 observed patients. To this saving must be added the costs related to the reduction of the days of hospitalization (average 5 days) and the costs to any future replacement of the ICD.
Conclusion
In patients with newly found dilated heart disease at high arrhythmic risk, the use of the Life–Vest reduces the days of hospitalization, allows patients to be discharged safely and generates substantial savings for the National Health System.
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Affiliation(s)
| | - L Sena
- PO VILLA MALTA – ASL SALERNO, SARNO
| | - M Russo
- PO VILLA MALTA – ASL SALERNO, SARNO
| | | | - A Mazza
- PO VILLA MALTA – ASL SALERNO, SARNO
| | - G Riccio
- PO VILLA MALTA – ASL SALERNO, SARNO
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7
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Meynet I, Tricomi L, Ferraro A, Maggio R, Mazza A, Ceci R, Minniti D, Varbella F. P14 PROCEDURAL SAFETY, SHORT AND LONG–TERM FOLLOW UP AFTER PACEMAKER IMPLANTATION IN NONAGENARIANS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Permanent cardiac stimulation is increasingly necessary in very old patients, due to the augmented life expectancy. This raise concerns in physicians, patients and caregivers, because pacemaker (PM) implantation can be perceived as too invasive for frail patients with significant comorbidities. The aim of the present study is to provide data about peri–operative complications, short and long–term survival and their predictors in this specific setting.
Materials and Methods
All consecutive patients aged ≥ 90 years undergoing pacemaker implantation in our Centre from 2008 to 2020 were enrolled in the registry. Their baseline and follow up data were recorded in a specific database.
Results
Among the 2437 patients undergoing PM implantation in a 13–year period, 153 were nonagenarians (6.3%). Mean age was 92.7 ± 2.3 years. Most of the patients (66.7%) received a ventricular single chamber PM. High–degree atrio–ventricular block was the first indication for implant (59.5%), followed by sick sinus syndrome or atrial fibrillation with slow ventricular response (30.1%). 15.7% patients needed temporary pacing at presentation. 4 patients (2.6%) experienced acute complications: 3 pneumothorax, 1 ventricular lead displacement with need of repositioning. Mean follow up duration was 2.5 ± 2.0 years. 117 patients (78.5%) died during the follow up. Death occurred after a mean of 2.47 years after pacemaker implantation (range 1 – 3272 days). Survival rates were 70.0%, 35.3% and 10.0% at 1, 3 and 5 years respectively. No pacemaker–related long–term complication was recorded during the follow up. 2 patients underwent generator replacement due to battery end of life. Chronic kidney insufficiency (p = 0.030) and congestive heart failure (p = 0.021) but not age were predictors of precocious mortality (within 1 month). Age at implant and longer length of hospital stay before PM implantation were predictors of long–term death (p = 0.001 and p = 0.043 respectively).
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Affiliation(s)
- I Meynet
- S.C. CARDIOLOGIA, OSPEDALE DI RIVOLI, RIVOLI; S.C. DIREZIONE SANITARIA, OSPEDALE DI RIVOLI, RIVOLI
| | - L Tricomi
- S.C. CARDIOLOGIA, OSPEDALE DI RIVOLI, RIVOLI; S.C. DIREZIONE SANITARIA, OSPEDALE DI RIVOLI, RIVOLI
| | - A Ferraro
- S.C. CARDIOLOGIA, OSPEDALE DI RIVOLI, RIVOLI; S.C. DIREZIONE SANITARIA, OSPEDALE DI RIVOLI, RIVOLI
| | - R Maggio
- S.C. CARDIOLOGIA, OSPEDALE DI RIVOLI, RIVOLI; S.C. DIREZIONE SANITARIA, OSPEDALE DI RIVOLI, RIVOLI
| | - A Mazza
- S.C. CARDIOLOGIA, OSPEDALE DI RIVOLI, RIVOLI; S.C. DIREZIONE SANITARIA, OSPEDALE DI RIVOLI, RIVOLI
| | - R Ceci
- S.C. CARDIOLOGIA, OSPEDALE DI RIVOLI, RIVOLI; S.C. DIREZIONE SANITARIA, OSPEDALE DI RIVOLI, RIVOLI
| | - D Minniti
- S.C. CARDIOLOGIA, OSPEDALE DI RIVOLI, RIVOLI; S.C. DIREZIONE SANITARIA, OSPEDALE DI RIVOLI, RIVOLI
| | - F Varbella
- S.C. CARDIOLOGIA, OSPEDALE DI RIVOLI, RIVOLI; S.C. DIREZIONE SANITARIA, OSPEDALE DI RIVOLI, RIVOLI
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8
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Leggio M, Fusco A, Coraci D, Villano A, Filardo G, Mazza A, Loreti C, Serafini E, Biscotti L, Bernabei R, Padua L, Giovannini S. Exercise training and atrial fibrillation: a systematic review and literature analysis. Eur Rev Med Pharmacol Sci 2021; 25:5163-5175. [PMID: 34486691 DOI: 10.26355/eurrev_202108_26530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE There are concerns in maintaining adequate levels of physical activity in patients with atrial fibrillation (AF). This could be related to the type of exercise delivered, different among studies, as the words used to describe it as treatment. We have analysed the state-of-art of the role of the exercise in AF by a mathematical analysis. This analysis documented the connections between topics and updated the available evidence through a systematic review of the current literature. MATERIALS AND METHODS A literature search was conducted using specific terms for studies published between 2000 and 2019. For the descriptive analysis of the current literature, we used the LExical Network analysed by the Graph THeory (LENGTH) method, while to perform our review we followed the PRISMA statement. Downs and Black Quality Index was also used to assess the quality of studies. The LENGTH approach indicated nonspecific terms as "exercise", "physical" and "activity" as more representative than "rehabilitation" to describe the intervention. RESULTS The systematic review identified nine studies on 882 patients of moderate (n=4) to good (n=5) quality. Training consisted of a combination of supervised ambulatory and home-based outpatient programs, focused on aerobic elements (endurance and resistance training, walking, treadmill and bicycle ergometer). Significant improvements in 6-minute walking test distance and peak oxygen uptake and in quality of life were obtained, with high adherence to training and no serious/significant adverse events. Only one trial was based on cardiac rehabilitation principles. CONCLUSIONS Adequate exercise training can get a favourable cardiovascular outcome in patients with AF.
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Affiliation(s)
- M Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital, Rome, Italy.
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Leggio M, Villano A, Fusco A, Mazza A. Hyperlipidemia management during the COVID-19 pandemic: PCSK9 inhibitors to enhance the antiviral action of interferon. Eur Rev Med Pharmacol Sci 2021; 25:2166-2167. [PMID: 33755951 DOI: 10.26355/eurrev_202103_25205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- M Leggio
- Clinical and Rehabilitative Cardiology Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy.
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10
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Maloberti A, Giannattasio C, Bombelli M, Desideri G, Cicero AFG, Muiesan ML, Rosei EA, Salvetti M, Ungar A, Rivasi G, Pontremoli R, Viazzi F, Facchetti R, Ferri C, Bernardino B, Galletti F, D'Elia L, Palatini P, Casiglia E, Tikhonoff V, Barbagallo CM, Verdecchia P, Masi S, Mallamaci F, Cirillo M, Rattazzi M, Pauletto P, Cirillo P, Gesualdo L, Mazza A, Volpe M, Tocci G, Iaccarino G, Nazzaro P, Lippa L, Parati G, Dell'Oro R, Quarti-Trevano F, Grassi G, Virdis A, Borghi C. Hyperuricemia and Risk of Cardiovascular Outcomes: The Experience of the URRAH (Uric Acid Right for Heart Health) Project. High Blood Press Cardiovasc Prev 2020; 27:121-128. [PMID: 32157643 DOI: 10.1007/s40292-020-00368-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/04/2020] [Indexed: 12/17/2022] Open
Abstract
The latest European Guidelines of Arterial Hypertension have officially introduced uric acid evaluation among the cardiovascular risk factors that should be evaluated in order to stratify patient's risk. In fact, it has been extensively evaluated and demonstrated to be an independent predictor not only of all-cause and cardiovascular mortality, but also of myocardial infraction, stroke and heart failure. Despite the large number of studies on this topic, an important open question that still need to be answered is the identification of a cardiovascular uric acid cut-off value. The actual hyperuricemia cut-off (> 6 mg/dL in women and 7 mg/dL in men) is principally based on the saturation point of uric acid but previous evidence suggests that the negative impact of cardiovascular system could occur also at lower levels. In this context, the Working Group on uric acid and CV risk of the Italian Society of Hypertension has designed the Uric acid Right for heArt Health project. The primary objective of this project is to define the level of uricemia above which the independent risk of CV disease may increase in a significantly manner. In this review we will summarize the first results obtained and describe the further planned analysis.
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Affiliation(s)
- Alessandro Maloberti
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy. .,Health Science Department, Milano-Bicocca University, Milan, Italy.
| | - C Giannattasio
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.,Health Science Department, Milano-Bicocca University, Milan, Italy
| | - M Bombelli
- Health Science Department, Milano-Bicocca University, Milan, Italy.,Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - G Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - A F G Cicero
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - M L Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - E A Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - M Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - A Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - G Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - R Pontremoli
- Department of Internal Medicine, University of Genoa and Policlinico SanMartino, Genoa, Italy
| | - F Viazzi
- Department of Internal Medicine, University of Genoa and Policlinico SanMartino, Genoa, Italy
| | - R Facchetti
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | - C Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - B Bernardino
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - F Galletti
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples, Italy
| | - L D'Elia
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples, Italy
| | - P Palatini
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
| | - E Casiglia
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
| | - V Tikhonoff
- Department of Medicine, University of Padua, Padua, Italy
| | - C M Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
| | - P Verdecchia
- Hospital S. Maria della Misericordia, Perugia, Italy
| | - S Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F Mallamaci
- Reggio Cal Unit, CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - M Cirillo
- Department of Public Health, "Federico II" University of Naples, Naples, Italy
| | - M Rattazzi
- Department of Medicine, University of Padua, Padua, Italy.,Medicina Interna I, Ca' Foncello University Hospital, Treviso, Italy
| | - P Pauletto
- Medicina Interna I, Ca' Foncello University Hospital, Treviso, Italy
| | - P Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, "Aldo Moro" University of Bari, Bari, Italy
| | - L Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, "Aldo Moro" University of Bari, Bari, Italy
| | - A Mazza
- Department of Internal Medicine, Santa Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy
| | - M Volpe
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - G Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - G Iaccarino
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Naples, Italy
| | - P Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
| | - L Lippa
- Italian Society of General Medicine (SIMG), Avezzano, L'Aquila, Italy
| | - G Parati
- Health Science Department, Milano-Bicocca University, Milan, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - R Dell'Oro
- Health Science Department, Milano-Bicocca University, Milan, Italy.,Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - F Quarti-Trevano
- Health Science Department, Milano-Bicocca University, Milan, Italy.,Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - G Grassi
- Health Science Department, Milano-Bicocca University, Milan, Italy.,Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - A Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Borghi
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Affiliation(s)
- M Leggio
- Cardiology Operative Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - C Tiberti
- AXA Insurance Company, Passo Corese, Italy
| | - M Armeni
- Istituto di Alta Formazione, Rome, Italy
| | - G Limongelli
- Cardiology Operative Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - A Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
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Leggio M, Fusco A, Villano A, Limongelli G, Mazza A. Anti-inflammatory diet to reduce mortality: is it time for a precision medicine approach? J Intern Med 2019; 285:469-471. [PMID: 30450654 DOI: 10.1111/joim.12851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- M Leggio
- Cardiology Operative Unit, San Filippo Neri Hospital, Rome, Italy
| | - A Fusco
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - A Villano
- Institute of Cardiology, Catholic University of the Sacred Heart, University Hospital Policlinic A. Gemelli Foundation, Rome, Italy
| | - G Limongelli
- Cardiology Operative Unit, San Filippo Neri Hospital, Rome, Italy
| | - A Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
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13
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Leggio M, Fusco A, D'Emidio S, Severi P, Lombardi M, Caldarone E, Armeni M, Mereu D, Bendini MG, Mazza A. Management of oral anticoagulation in patients with atrial fibrillation: newer agents, newer conundrums? J Intern Med 2018; 284:697-699. [PMID: 29658167 DOI: 10.1111/joim.12755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Rome, Italy
| | - A Fusco
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - S D'Emidio
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - P Severi
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Rome, Italy.,Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - M Lombardi
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - E Caldarone
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - M Armeni
- Department of Research, EDUCAM (C.R.O.M.O.N., S.Os.I, A.I.R.O.P.), Rome, Italy
| | - D Mereu
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - M G Bendini
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
| | - A Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
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Cammertoni F, Bruno P, Mazza A, Pavone N, Farina P, Perri G, Iafrancesco M, Nesta M, Chiariello G, Colizzi C, D’Errico D, Massetti M. RF30 INTEGRATED PERCUTANEOUS AND MINIMALLY INVASIVE APPROACH FOR HEART VALVE SURGERY. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549971.67787.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Chiariello G, Pasquini A, Bruno P, Colizzi C, Ruggio A, Nesta M, Mazza A, Iafrancesco M, Cammertoni F, Pavone N, Perri G, Massetti M. EP26 PRELIMINARY RESULTS OF LAST GENERATION SURGICAL BIOPROSTHESES IN SMALL AORTIC ANNULI. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549998.76303.f1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Leggio M, Bendini M, Caldarone E, Lombardi M, Severi P, D’Emidio S, Stavri D, Armeni M, Bravi V, Mazza A. Low-dose aspirin for primary prevention of cardiovascular events in patients with diabetes: Benefit or risk? Diabetes & Metabolism 2018; 44:217-225. [DOI: 10.1016/j.diabet.2017.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/05/2017] [Accepted: 11/05/2017] [Indexed: 01/13/2023]
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Mazza A, Bendini M, Valsecchi S, Lovecchio M, Leggio M, De Cristofaro R, Boriani G. P870Occurrence of atrial fibrillation in pacemaker patients and its association with sleep apnea and heart rate variability. Europace 2018. [DOI: 10.1093/europace/euy015.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Mazza
- Cardiology Department, Orvieto, Italy
| | - M Bendini
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
| | | | | | - M Leggio
- San Filippo Neri Hospital, Salus Infirmorum, Rome, Italy
| | - R De Cristofaro
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
| | - G Boriani
- Polyclinic Hospital of Modena, Modena, Italy
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Sumini M, Mostacci D, Tartari A, Mazza A, Cucchi G, Isolan L, Buontempo F, Zironi I, Castellani G. Dose-current discharge correlation analysis in a Mather type Plasma Focus device for medical applications. Radiat Phys Chem Oxf Engl 1993 2017. [DOI: 10.1016/j.radphyschem.2017.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ferraro A, Bertaglia E, Botto GL, Rapacciuolo A, Reggiani A, Marenna B, Marini M, Mazza A, Maglia G, Badolati S, Spotti A, Ricciardi G, Amadori F, Malacrida M, Stabile G. 184Adherence to ESC guidelines class I was associated to better prognosis, clinical response and LV reverse remodeling in a large real-world CRT population. Europace 2017. [DOI: 10.1093/ehjci/eux137.003] [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: 11/13/2022] Open
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Mazza A, Caico SI, D'onofrio A, Pepi P, De Simone A, Botto GL, Pecora D, Pieragnoli P, Ferraro A, Giovannini T, Magnano V, Mazzuero A, Menichelli M, Malacrida M, Stabile G. P1549The adherence to 2016 ESC guidelines for CRT is associated with an improved outcome, when compared with 2013 guidelines. Europace 2017. [DOI: 10.1093/ehjci/eux158.175] [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: 11/12/2022] Open
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21
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Mazza A, Lenti S, Schiavon L, Ramazzina E, Bernardini D, Casiglia E. [OP.4C.08] ROLE OF THE FIXED-DOSE TRIPLE COMBINATION THERAPY IN THE MANAGEMENT OF UNCONTROLLED HYPERTENSION. J Hypertens 2016. [DOI: 10.1097/01.hjh.0000491464.43110.79] [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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Andreula C, Carella A, Colombo M, De Blasi R, Klaveness A, Mazza A, Simionato F, Scotti G. Valutazione della sicurezza ed efficacia di iodixanolo 270 mgI/ml e 320mgI/ml a confronto con iopamidolo 300 mgI/ml nella TC cerebrale. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140099300600404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Scopo di questo studio doppio cieco, randomizzato, comparativo a tre gruppi paralleli, è stato il confronto della sicurezza tollerabilità ed efficacia della concentrazione più bassa (270 mgI/ml: 39 pazienti) e più alta (320 mgI/ml: 39 pazienti) di iodixanolo (Visipaque ®), un nuovo mezzo di contrasto iodato non-ionico dimero, con iopamidolo (300 mgI/ml: 40 pazienti) nell'esame di tomografia computerizzata della testa. Le caratteristiche generali dei pazienti risultarono simili nei 3 gruppi di trattamento. Nessuna differenza significativa (p > 0,05) fu riscontrata tra i 3 gruppi di trattamento nella informazione diagnostica, il principale parametro di efficacia (ottimale in 37, 36 e 39 pazienti del gruppo iodixanolo 270, iodixanolo 320 e iopamidolo 300 rispettivamente). I risultati riguardanti la sicurezza non mostrarono nessuna differenza significativa tra i 3 mezzi di contrasto considerati. Su 118 pazienti, 9 accusarono discomfort (7%, 5%, e 10% nel gruppo iodixanolo 270, iodixanolo 320 e iopamidolo 300 rispettivamente) e solo 1 pz. del gruppo iodixanolo 320 mgI/ml presentò un evento avverso diverso dal discomfort (transitoria e lieve nausea, tosse, e dispnea). Il test esatto di Fisher dette p = 0,50 nel confronto tra gruppo iodixanolo 320 e gruppo iopamidolo 300. In conclusione, iodixanolo 270 mgI/ml e 320 mgI/ml risultarono mezzi di contrasto sicuri ed efficaci nell'esame di tomografia computerizzata della testa, e non fu riscontrata nessuna differenza significativa nella sicurezza ed efficacia rispetto a iopamidolo 300 mgI/ml.
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Affiliation(s)
| | | | | | | | | | - A. Mazza
- Università di Milano, Ospedale S. Raffaele
| | | | - G. Scotti
- Università di Milano, Ospedale S. Raffaele
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Mazza A, Schiavon L, Zuin M, Lenti S, Ramazzina E, Rubello D, Casiglia E. Effects of the Antihypertensive Fixed-Dose Combinations on an Early Marker of Hypertensive Cardiac Damage in Subjects at Low Cardiovascular Risk. Am J Hypertens 2016; 29:969-75. [PMID: 27053407 DOI: 10.1093/ajh/hpw022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/12/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In hypertensive subjects (HTs), isolated left ventricular diastolic dysfunction (LVDD) is an early marker of cardiac damage and is associated with poor prognosis. However, few intervention trials investigated the effects of antihypertensive therapy on isolated LVDD regression. This study investigates the blood pressure (BP)-lowering efficacy and the effect on LVDD of antihypertensive drugs administered as fixed-dose combinations in untreated HTs with isolated LVDD. METHODS A total of 168 HTs (23% of them having impaired fasting glucose (IFG)) aged 48±4.2 years were randomized to receive open-label once-daily oral treatment of beta-blocker + diuretic, angiotensin-converting enzyme inhibitor (ACEI) + diuretic, angiotensin II receptor blocker (ARB) + diuretic, ARB + calcium channel blocker (CCB), or ACEI + CCB. Clinic and 24-hour ambulatory BP values were measured before randomization and at the follow-up. Regression of LVDD was defined as normalization of both the E/A (ratio of early-to-late ventricular filling wave velocity) and E/E' (mitral velocity to early diastolic velocity of the mitral annulus) ratios. Comparisons were made between categorical variables using the χ(2) test and between continuous variables by gender using analysis of variance for repeated measures. RESULTS BP reduction did not differ between groups. LVDD regression was significantly more prevalent in the ARB + CCB or ACEI + CCB groups than with other combinations; in HTs with IFG, it was most prevalent (46%) with ACEI + CCB. CONCLUSIONS Independently of BP reduction, the fixed-dose combinations ARB + CCB and ACEI + CCB led to regression of isolated LVDD. In those with an IFG, ACEI + CCB was most effective.
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Affiliation(s)
- A Mazza
- Hypertension Centre certified by the Italian Society of Hypertension, Azienda ULSS 18 Rovigo, Rovigo, Italy;
| | - L Schiavon
- Hypertension Centre certified by the Italian Society of Hypertension, Azienda ULSS 18 Rovigo, Rovigo, Italy
| | - M Zuin
- Faculty of Medicine, University of Ferrara, Ferrara, Italy
| | - S Lenti
- Hypertension Centre, San Donato Hospital, USL 8 Arezzo, Arezzo, Italy
| | - E Ramazzina
- Department of Medicine, Azienda ULSS 18 Rovigo, Rovigo, Italy
| | - D Rubello
- Department of Nuclear Medicine, Azienda ULSS 18 Rovigo, Rovigo, Italy
| | - E Casiglia
- Department of Medicine, University of Padova, Padova, Italy
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Mazza A, Cicero AF, Ramazzina E, Lenti S, Schiavon L, Casiglia E, Gussoni G. Nutraceutical approaches to homocysteine lowering in hypertensive subjects at low cardiovascular risk: a multicenter, randomized clinical trial. J BIOL REG HOMEOS AG 2016; 30:921-927. [PMID: 27655522] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Although the role of homocysteine (HCys) in secondary cardiovascular prevention has been scaled down, hyper-homocysteinemia remains a risk factor for cerebrovascular events. The aim of this study was to investigate the efficacy of nutraceuticals in lowering HCys serum levels versus a conventional vitamin supplementation in hypertensive subjects at low cardiovascular risk. One-hundred and four patients (mean age 62.8±14.5 years, 63.5% males), 52 for each treatment group, were enrolled. The study recruited patients with stage 1 essential hypertension and hyper-homocysteinemia (HCys ≥15 μmol/L), without a history of cardiovascular and cerebrovascular disease. They were sequentially randomized to receive a combined nutraceutical containing 400 μg folate-6-5-methyltetrahydrofolate, 3 mg vitamin B6, 5 μg vitamin B12, 2.4 mg vitamin B2, 12.5 mg zinc and 250 mg betaine (Normocis400®) once daily for two months, or supplementation with highly dosed folic acid (5 mg/day) (control group). Differences in serum HCys values were compared by ANOVA for repeated measures. A significant HCys reduction in comparison to baseline was found in both groups at the end of the study treatment, from 21.5±8.7 to 10.0±1.7 μmol/L for Normocis400® subjects (p less than 0.0001), and from 22.6±6.2 to 14.3±2.8 μmol/L for controls (p less than 0.0001). HCys reduction was significantly higher among patients treated with Normocis400® (p less than 0.035). The ideal HCys level (i.e. less than 10 μmol/L) was reached in 55.8% of cases in theNormocis400® group, and it was significantly higher than in controls. No side effects were observed in either treatment group. Randomized clinical trials are ongoing to test the effect of folate, B6, and B12 supplementation in primary prevention of cardiovascular and cerebrovascular events. In the meantime, especially when the ideal HCys level is far from being reached, Normocis400® appears to be safe, well tolerated and effective in reducing HCys levels.
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Affiliation(s)
- A Mazza
- Department of Medicine, S. Maria della Misericordia Hospital, Rovigo, Italy
| | - A F Cicero
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - E Ramazzina
- Department of Medicine, S. Maria della Misericordia Hospital, Rovigo, Italy
| | - S Lenti
- Department of Internal Medicine and Geriatrics, San Donato Hospital, Arezzo, Italy
| | - L Schiavon
- Department of Medicine, S. Maria della Misericordia Hospital, Rovigo, Italy
| | - E Casiglia
- Department of Medicine, University of Padova, Padua, Italy
| | - G Gussoni
- Department of Clinical Research, FADOI Foundation, Milan, Italy
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Mazza A, Perrin D, Fontenot J. SU-F-T-271: Comparing IMRT QA Pass Rates Before and After MLC Calibration. Med Phys 2016. [DOI: 10.1118/1.4956411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Palumbo D, Mucci A, Piegari G, Chieffi M, Mazza A, Giugliano R, De Riso F, D’Alise V, Galderisi S. The social cognition individualized activities lab: Implementation of a new remediation intervention for social cognition. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.2102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IntroductionPeople with schizophrenia exhibit deficits in neurocognitive and social cognitive (SC) processes which limit their social reintegration. SC was found to mediate in part the impact of neurocognitive dysfunctions on real-life functioning.ObjectiveThe purpose of this study was to implement a new intervention for patients with schizophrenia, the Social Cognition Individualized Activities Lab (So.C.I.A.L.) which trains both social cognition and neurocognitive functions.AimsTo determine the efficacy of the So.C.I.A.L in improving SC by a comparison with a validated cognitive remediation (CR) intervention: the Social Skills And Neurocognitive Individualized Training (SSANIT).MethodsNine stabilized patients accepted to participate in this pilot study. Five were randomized to So.C.I.A.L. and 4 to SSANIT. The two programs were matched for the overall treatment duration (20 weeks), as well as frequency and duration of the sessions. Both interventions included individual sessions of neurocognitive individualized training; So.C.I.A.L included group sessions on Emotion Recognition and Theory of Mind, while SSANIT group sessions of Social Skills Individualized Training.ResultsNo group difference was found for changes in neurocognition, while a significant group effect was observed for changes in SC, due to improvement only in the So.C.I.A.L. group.ConclusionsThe study results showed a specific effect of the So.C.I.A.L. on SC, beyond the effect on neurocognition. Further studies are needed to assess the impact of So.C.I.A.L. on real-life functioning in a larger group of subjects.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Leone A, Gaudino M, Lupascu A, Mazza A, Flore R, Toesca A, Tondi P, Massetti M. 073-I * MORPHOLOGIC AND FUNCTIONAL CONSEQUENCES OF TRANSRADIAL CORONARY ANGIOGRAPHY ON THE RADIAL ARTERY: IMPLICATIONS FOR USE AS A BYPASS CONDUIT. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.73] [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: 11/15/2022] Open
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Mazza A, Montemurro D, Maffione AM, Vescovo G, Rampin L, Zuin M, Schiavon L, Camerotto A, Marzola MC, Fiorini F, Rubello D. (99m)Tc-DTPA scintigraphy assesses the absence of glomerular filtration rate impairment of Aliskiren in high-risk hypertensive subjects. A 12-month follow-up study. Minerva Cardioangiol 2014; 62:311-320. [PMID: 25012100] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Glomerular filtration rate (GFR) is commonly calculated using the modification of diet in renal disease (MDRD) and Cockroft-Gault (CG) formulas and recently by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) algorithm and not directly measured, so that the real impact of antihypertensive therapy on GFR could not be well defined. In this study, the effect of Aliskiren on the GFR measured by radionuclide clearance of 99mTc-diethylene triamine penta-acetic acid (DTPA) was investigated. METHODS In 106 hypertensive subjects (53% men) aged 61.9±12.7 years with uncontrolled blood pressure (BP) receiving at least 2 antihypertensive medications, Aliskiren was added once-daily at a dose of 150-300 mg for 12 months. Clinic BP measurements were taken at every follow-up visit (1st, 6th and 12th month), while 24-hours ambulatory BP and GFR (in mL/min/1.73 m2) were evaluated at baseline and at the end of the follow-up. Analysis of variance for repeated measures of BP, GFR and microalbuminuria was provided. RESULTS With the use of Aliskiren a significant reduction of BP and microalbuminuria was found (P<0.0001). Only in male population, a significant reduction in GFR calculated with CKD-EPI (82.4±15 vs. 78.6±18.2, P<0.01) and CG (81.6±29.5 vs. 74.2±28.4, P<0.0001) formulas was observed. This impairment of GFR was not found either with MDRD formula (70.5±19.6 vs. 68.3±23.4) or by radionuclide clearance (62.4±18.6 vs. 61.4±20.5). CONCLUSION This study seems to demonstrate that the efficacy on BP control of Aliskiren is not accompanied by an impairment of GFR. In order to evaluate the effect of Aliskiren on GFR scintigraphy technique or MDRD formula resulted to be the most accurate methods.
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Affiliation(s)
- A Mazza
- Department of Internal Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy -
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Mazza A, Bendini MG, Leggio M, Riva U, Ciardiello C, Valsecchi S, De Cristofaro R, Giordano G. Author reply. Europace 2014; 16:617-8. [DOI: 10.1093/europace/eut389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Massavon W, Barlow-Mosha L, Mugenyi L, McFarland W, Gray G, Lundin R, Costenaro P, Nannyonga MM, Penazzato M, Bagenda D, Namisi CP, Wabwire D, Mubiru M, Kironde S, Bilardi D, Mazza A, Fowler MG, Musoke P, Giaquinto C. Factors Determining Survival and Retention among HIV-Infected Children and Adolescents in a Community Home-Based Care and a Facility-Based Family-Centred Approach in Kampala, Uganda: A Cohort Study. ISRN AIDS 2014; 2014:852489. [PMID: 25006529 PMCID: PMC4003865 DOI: 10.1155/2014/852489] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 04/01/2014] [Indexed: 12/28/2022]
Abstract
We describe factors determining retention and survival among HIV-infected children and adolescents engaged in two health care delivery models in Kampala, Uganda: one is a community home-based care (CHBC) and the other is a facility-based family-centred approach (FBFCA). This retrospective cohort study reviewed records from children aged from 0 to 18 years engaged in the two models from 2003 to 2010 focussing on retention/loss to follow-up, mortality, use of antiretroviral therapy (ART), and clinical characteristics. Kaplan Meier survival curves with log rank tests were used to describe and compare retention and survival. Overall, 1,623 children were included, 90.0% (1460/1623) from the CHBC. Children completed an average of 4.2 years of follow-up (maximum 7.7 years). Median age was 53 (IQR: 11-109) months at enrolment. In the CHBC, retention differed significantly between patients on ART and those not (log-rank test, adjusted, P < 0.001). Comparing ART patients in both models, there was no significant difference in long-term survival (log-rank test, P = 0.308, adjusted, P = 0.489), while retention was higher in the CHBC: 94.8% versus 84.7% in the FBFCA (log-rank test, P < 0.001, adjusted P = 0.006). Irrespective of model of care, children receiving ART had better retention in care and survival.
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Affiliation(s)
- W. Massavon
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
- St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
| | - L. Barlow-Mosha
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - L. Mugenyi
- Infectious Diseases Research Collaboration, Mulago Hospital Complex, Kampala, Uganda
| | - W. McFarland
- Department of Global Health Sciences, University of California San Francisco, 50 Beale Street, 12th Floor, San Francisco, CA 94105, USA
| | - G. Gray
- University of Witwatersrand, 1 Jan Smuts Avenue, Braamfontein 2000, Johannesburg, South Africa
| | - R. Lundin
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - P. Costenaro
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - M. M. Nannyonga
- St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
| | - M. Penazzato
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - D. Bagenda
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Global Heath and Population, Harvard University School of Public Health, Boston, MA, USA
| | - C. P. Namisi
- St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
| | - D. Wabwire
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - M. Mubiru
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - S. Kironde
- St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
| | - D. Bilardi
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - A. Mazza
- Santa Chiara Hospital, Via Largo Gold Medals 9, 38122 Trento, Italy
| | - M. G. Fowler
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Pathology, Johns Hopkins School of Medicine 600 N. Wolfe Street/Carnegie 43 Baltimore, MD 21287, USA
| | - P. Musoke
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - C. Giaquinto
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
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Petrara MR, Penazzato M, Massavon W, Nabachwa S, Nannyonga M, Mazza A, Gianesin K, Del Bianco P, Lundin R, Sumpter C, Zanchetta M, Giaquinto C, De Rossi A. Epstein-Barr Virus Load in Children Infected With Human Immunodeficiency Virus Type 1 in Uganda. J Infect Dis 2014; 210:392-9. [DOI: 10.1093/infdis/jiu099] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Mazza A, Fruci B, Guzzi P, D'Orrico B, Malaguarnera R, Veltri P, Fava A, Belfiore A. In PCOS patients the addition of low-dose spironolactone induces a more marked reduction of clinical and biochemical hyperandrogenism than metformin alone. Nutr Metab Cardiovasc Dis 2014; 24:132-139. [PMID: 23845740 DOI: 10.1016/j.numecd.2013.04.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 04/14/2013] [Accepted: 04/17/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND & AIMS Polycystic ovary syndrome (PCOS) is characterized by ovarian dysfunction and hyperandrogenism and by insulin resistance and related metabolic alterations. Both metformin and anti-androgens, such as spironolactone, are used to ameliorate the different aspects of this disorder. We investigated whether therapy with metformin plus low-dose spironolactone is more effective than metformin alone in PCOS patients. METHODS AND RESULTS Fifty-six PCOS patients were randomized in two groups: group A (28 patients) was treated with metformin (1700 mg/die) and group B (28 patients) was treated with metformin (1700 mg/die) plus low-dose spironolactone (25 mg/die). Anthropometric, hormonal and metabolic parameters were evaluated at baseline and after six months of treatment. After therapy regular menses were restored in approximately 82% of group A patients (P < 0.001) and in 68% of group B patients (P < 0.001). Circulating testosterone, Δ-4-androstenedione and Hirsutism Score (HS) significantly decreased in both groups. However, dehydro-epiandrosterone sulphate significantly decreased only in group B, and HS underwent a stronger reduction in group B (P < 0.001). At baseline, 39/56 (69.6%) patients met the diagnostic criteria for metabolic syndrome, but only one patient met these criteria after treatment. CONCLUSIONS This study confirms the beneficial effects of metformin in PCOS patients. It also indicates that the addition of low-dose spironolactone induces a more marked reduction of clinical and biochemical hyperandrogenism as compared to metformin alone.
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Affiliation(s)
- A Mazza
- Department of Health Sciences, Endocrinology, University Magna Graecia of Catanzaro, Campus Universitario, località Germaneto, 88100 Catanzaro, Italy
| | - B Fruci
- Department of Health Sciences, Endocrinology, University Magna Graecia of Catanzaro, Campus Universitario, località Germaneto, 88100 Catanzaro, Italy
| | - P Guzzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Campus Universitario, località Germaneto, 88100 Catanzaro, Italy
| | - B D'Orrico
- Department of Health Sciences, Endocrinology, University Magna Graecia of Catanzaro, Campus Universitario, località Germaneto, 88100 Catanzaro, Italy
| | - R Malaguarnera
- Department of Health Sciences, Endocrinology, University Magna Graecia of Catanzaro, Campus Universitario, località Germaneto, 88100 Catanzaro, Italy
| | - P Veltri
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Campus Universitario, località Germaneto, 88100 Catanzaro, Italy
| | - A Fava
- Department of Health Sciences, Endocrinology, University Magna Graecia of Catanzaro, Campus Universitario, località Germaneto, 88100 Catanzaro, Italy
| | - A Belfiore
- Department of Health Sciences, Endocrinology, University Magna Graecia of Catanzaro, Campus Universitario, località Germaneto, 88100 Catanzaro, Italy.
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Mazza A, Montemurro D, Zuin M, Schiavon L, Zorzan S, Chondrogiannis S, Ferretti A, Ramazzina E, Rubello D. Aliskiren improves blood pressure control and prevents cardiac damage in high-risk hypertensive subjects. Minerva Cardioangiol 2013; 61:461-469. [PMID: 23846012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM Longitudinal study aimed to evaluate the antihypertensive efficacy, safety and the effect on cardiac damage of Aliskiren, administered to a group of high-risk hypertensive patients with mild impairment of renal function and uncontrolled blood pressure (BP) despite a two-drug antihypertensive treatment. METHODS One hundred and six patients (56 men and 50 females) aged 61.9±12.7 years, were assigned to receive Aliskiren 150-300 mg once-daily for 12 months. Clinic BP measurements were taken at every follow-up visit (1st, 6th and 12th month), while biochemical tests, estimated glomerular filtration rate (eGFR), 24-hours ambulatory BP measurements (ABMP) and echocardiography were evaluated at baseline and at the end of follow-up. Analysis of variance for repeated measures compared BP, left ventricular mass index (LVMI) and eGFR values changes. RESULTS A significant reduction (all P<0.0001) of clinic systolic (-28.6 mmHg) and diastolic (-12.8 mmHg) BP values, mean 24h-systolic (-12.3 mmHg) and 24h-diastolic (-6.5 mmHg), day-time systolic (-11.5 mmHg) and diastolic (-6.4 mmHg), night-time systolic (-11.9 mmHg) and diastolic (-7 mmHg) ABPM values and in the use of antihypertensive drugs was observed (3.0±0.9 vs. 2.0±0.7, p=0.01). LVMI was significantly reduced (130.2±36.1 vs. 115.9±33.4 g/m2, P<0.0001); eGFR was steady (75.3±17.3 vs. 73.1±21.5 ml/min/1.73m2, P>0.05). Putative adverse events caused withdrawal of 7 subjects (6 for gastrointestinal disturbances, 1 for alopecia). CONCLUSION Aliskiren was effective in decreasing both clinical and ABPM values and in reducing LVMI in both genders without any influence on eGFR. The treatment resulted safe, even in combination with ACE-inhibitors and angiotensin II receptor blockers. A significant reduction in the use of concomitant antihypertensive drugs was observed.
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Affiliation(s)
- A Mazza
- Department of Internal Medicine, Santa Maria della Misericordia Hospital Rovigo, Italy -
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Mazza A, Armigliato M, Ferretti A, Schiavon L, Zorzan S, Casiglia E, Marzola M, Tadayyon S, Chondrogiannis S, Rubello D. Gestational diastolic hypertension with gene mutation-related pheochromocytoma positive at 18F-DOPA PET/CT: Diagnostic and therapeutic implications. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mazza A, Bendini MG, Leggio M, Riva U, Ciardiello C, Valsecchi S, De Cristofaro R, Giordano G. Incidence and predictors of heart failure hospitalization and death in permanent pacemaker patients: a single-centre experience over medium-term follow-up. Europace 2013; 15:1267-72. [DOI: 10.1093/europace/eut041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mazza A, Montemurro D, Zuin M, Schiavon L, Zorzan S, Chondrogiannis S, Ferretti A, Ramazzina E, Rubello D. Aliskiren improves blood pressure control and prevents cardiac damage in high-risk hypertensive subjects. Minerva Cardioangiol 2013:R05133342. [PMID: 23370164] [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: 06/01/2023]
Abstract
Aim: Longitudinal study aimed to evaluate the antihypertensive efficacy, safety and the effect on cardiac damage of Aliskiren, administered to a group of high-risk hypertensive patients with mild impairment of renal function and uncontrolled blood pressure (BP) despite a two-drug antihypertensive treatment. Methods: One hundred and six patients (56 men and 50 females) aged 61.9±12.7 years, were assigned to receive Aliskiren 150-300 mg once-daily for 12 months. Clinic BP measurements were taken at every follow-up visit (1st, 6th and 12th month), while biochemical tests, estimated glomerular filtration rate (eGFR), 24-hours ambulatory BP measurements (ABMP) and echocardiography were evaluated at baseline and at the end of follow-up. Analysis of variance for repeated measures compared BP, left ventricular mass index (LVMI) and eGFR values changes. Results: A significant reduction (all P<0.0001) of clinic systolic (-28.6 mmHg) and diastolic (-12.8 mmHg) BP values, mean 24h-systolic (-12.3 mmHg) and 24h-diastolic (-6.5 mmHg), day-time systolic (-11.5 mmHg) and diastolic (-6.4 mmHg), night-time systolic (-11.9 mmHg) and diastolic (-7 mmHg) ABPM values and in the use of antihypertensive drugs was observed (3.0±0.9 vs. 2.0±0.7, p=0.01). LVMI was significantly reduced (130.2±36.1 vs. 115.9±33.4 g/m2, P<0.0001); eGFR was steady (75.3±17.3 vs. 73.1±21.5 ml/min/1.73m2, P>0.05). Putative adverse events caused withdrawal of 7 subjects (6 for gastrointestinal disturbances, 1 for alopecia). Conclusion: Aliskiren was effective in decreasing both clinical and ABPM values and in reducing LVMI in both genders without any influence on eGFR. The treatment resulted safe, even in combination with ACE-inhibitors and angiotensin II receptor blockers. A significant reduction in the use of concomitant antihypertensive drugs was observed.
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Affiliation(s)
- A Mazza
- Department of Internal Medicine, Santa Maria della Misericordia Hospital Rovigo, Italy -
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Mazza A, Armigliato M, Ferretti A, Schiavon L, Zorzan S, Casiglia E, Marzola MC, Tadayyon S, Chondrogiannis S, Rubello D. Gestational diastolic hypertension with gene mutation-related pheochromocytoma positive at ¹⁸F-DOPA PET/CT: diagnostic and therapeutic implications. Rev Esp Med Nucl Imagen Mol 2012; 32:111-2. [PMID: 23153989 DOI: 10.1016/j.remn.2012.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 09/25/2012] [Accepted: 09/27/2012] [Indexed: 11/29/2022]
Affiliation(s)
- A Mazza
- Department of Internal Medicine, Santa Maria della Misericodia Hospital, Rovigo, Italy
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Casiglia E, Tikhonoff V, Boschetti G, Bascelli A, Saugo M, Guglielmi G, Caffi S, Rigoni G, Giordano N, Grasselli C, Martini B, Mazza A, Lazzari FD, Palatini P. The C825T GNB3 polymorphism, independent of blood pressure, predicts cerebrovascular risk at a population level. Am J Hypertens 2012; 25:451-7. [PMID: 22258330 DOI: 10.1038/ajh.2011.257] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The role of C825T polymorphism of the candidate GNB3 gene in predicting cerebrovascular outcome has been poorly explored in longitudinal setting at a population level. METHODS In an epidemiological setting, 1,678 men and women from general population were genotyped for C825T polymorphism of GNB3 gene and follow-up for 10 years to detect nonfatal and fatal cerebrovascular events (CE). Established cerebrovascular risk factors were used to adjust the multivariate Cox analysis for confounders. RESULTS Seventy-three nonfatal and 30 fatal CE were recorded. Incidence of CE was higher in TT than in C-carriers (fatal: 2.6 vs. 1.7%, P < 0.03; nonfatal: 7.8 vs. 3.9%, P < 0.03; fatal recurrences: 1.6 vs. 0.6%, P < 0.03). In Cox analysis, the TT genotype predicted nonfatal (hazard ratio 1.99, 95% confidence interval 1.05-3.79, P = 0.03), fatal (2.91, 1.05-8.12, P = 0.04), and fatal recurrent CE (6.82, 1.50-31.1, P = 0.02) also after adjustment for age, gender, systolic and diastolic blood pressure, body adiposity, atherogenetic blood lipids, serum uric acid, diabetes, calories, caffeine and ethanol intake, and coronary events at baseline. Further adjustment for historical CE made the association between TT genotype and incident fatal CE nonsignificant (hazard ratio 2.72, 95% confidence interval 0.96-7.22, P = 0.06). CONCLUSIONS The TT genotype of GNB3 gene predicts incident CE independent of blood pressure and other established risk factors at a population level. Further studies are needed to clarify the nature and pathways of this association.
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Mazza A, Rigatelli G, Piva M, Rampin L, Cardaioli P, Giordan M, Roncon L, Zattoni L, Zuin M, Al-Nahhas A, Rubello D, Ramazzina E, Ravenni R, Casiglia E. In high risk hypertensive subjects with incidental and unilateral renal artery stenosis percutaneous revascularization with stent improves blood pressure control but not glomerular filtration rate. Minerva Cardioangiol 2011; 59:533-542. [PMID: 22134468] [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: 05/31/2023]
Abstract
AIM In high-risk hypertensive subjects (HTs) with incidental unilateral renal artery stenosis (RAS), the effectiveness of percutaneous revascularization with stent (PR-STENT) on blood pressure (BP) and glomerular filtration rate (GFR) is not established. METHODS Eighteen HTs aged 65.7 ± 9.2 years with angiographically diagnosed unilateral RAS (≥ 60%) were randomized to receive PR-STENT (N=9) or to NO-STENT (N=9). BP (mercury sphygmomanometer) and GFR (99mTc-DTPA clearances during renal scintigraphy) were evaluated yearly for three years. Echo-Doppler of renal arteries was performed to verify the anatomic patency and flow velocities of the reperfused artery. Analysis of variance compared BP and GFR values changes from baseline to the follow-up; differences for continuous variables were evaluated between groups with the Tukey's post hoc test after adjustment for age, change of BP between baseline and at the follow-up, GFR and body mass index (BMI). RESULTS Baseline systolic BP and GFR values were not different between groups. The significantly greater GFR increase observed in PR-STENT than in NO-STENT at univariate analysis at the end of follow-up (62.5 ± 19.2 vs. 42.24 ± 17.6, P<0.02) disappeared after adjustment for confounding factors. However, systolic BP remained significantly lower in PR-STENT than in NO-STENT (140.1 ± 4.6 vs. 170.0 ± 8.3, P<0.0001) also after adjustment for age, GFR and BMI. CONCLUSION PR-STENT reduces systolic BP without improving GFR. Due to the strong association between high BP and renal damage, this study raises the question on whether PR-STENT should be performed in all HTs with unilateral and incidental RAS.
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Affiliation(s)
- A Mazza
- Department of Internal Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy.
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Mazza A, Beltramello G, Armigliato M, Montemurro D, Zorzan S, Zuin M, Rampin L, Marzola M, Grassetto G, Al-Nahhas A, Rubello D. Arterial hypertension and thyroid disorders: What is important to know in clinical practice? Annales d'Endocrinologie 2011; 72:296-303. [DOI: 10.1016/j.ando.2011.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 04/30/2011] [Accepted: 05/05/2011] [Indexed: 11/27/2022]
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Haren MT, Siddiqui AM, Armbrecht HJ, Kevorkian RT, Kim MJ, Haas MJ, Mazza A, Kumar VB, Green M, Banks WA, Morley JE. Testosterone modulates gene expression pathways regulating nutrient accumulation, glucose metabolism and protein turnover in mouse skeletal muscle. ACTA ACUST UNITED AC 2011; 34:55-68. [DOI: 10.1111/j.1365-2605.2010.01061.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Casiglia E, Tikhonoff V, Caffi S, Bascelli A, Guglielmi F, Mazza A, Martini B, Saugo M, D'Este D, Masiero S, Guidotti F, Boschetti G, Schiavon L, Spinella P, de Kreutzenberg SV, De Lazzari F, Pessina AC. Glycaemic fall after a glucose load. A population-based study. Nutr Metab Cardiovasc Dis 2010; 20:727-733. [PMID: 19822409 DOI: 10.1016/j.numecd.2009.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 06/24/2009] [Accepted: 06/30/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS A blood glucose (BG) fall after an oral glucose load has never been described previously at a population level. This study was aimed at looking for a plasma glucose trend after an oral glucose load for possible blood glucose fall if any, and for its impact on coronary mortality at a population level. METHODS AND RESULTS In subjects from an unselected general population, BG and insulin were detected before and 1 and 2h after a 75-g oral glucose load for insulin sensitivity and β-cell function determination. Blood pressure, blood examinations and left ventricular mass were measured, and mortality was monitored for 18.8±7.7 years. According to discriminant analysis, the population was stratified into cluster 0 (1-h BG < fasting BG; n=497) and cluster 1 (1-h BG ≥ fasting BG; n=1733). To avoid any interference of age and sex, statistical analysis was limited to two age-gender-matched cohorts of 490 subjects from each cluster (n=940). Subjects in cluster 0 showed significantly higher insulin sensitivity and β-cell function, lower visceral adiposity and lower blood pressure values. Adjusted coronary mortality was 8 times lower in cluster 0 than 1 (p<0.001). The relative risk of belonging to cluster 1 was 5.40 (95% CI 2.22-13.1). CONCLUSION It seems that two clusters exist in the general population with respect to their response to an oral glucose load, independent of age and gender. Subjects who respond with a BG decrease could represent a privileged sub-population, where insulin sensitivity and β-cell function are better, some risk factors are less prevalent, and coronary mortality is lower.
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Affiliation(s)
- E Casiglia
- Department of Clinical and Experimental Medicine, Chair of Internal Medicine, University of Padova, Padova, Italy.
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Mazza A, Bendini MG, Cristofori M, Nardi S, Leggio M, De Cristofaro R, Giordano A, Cozzari L, Giordano G, Cappato R. Baseline apnoea/hypopnoea index and high-sensitivity C-reactive protein for the risk of recurrence of atrial fibrillation after successful electrical cardioversion: a predictive model based upon the multiple effects of significant variables. Europace 2009; 11:902-9. [DOI: 10.1093/europace/eup107] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Ferraro A, Masi AS, Mazza A, Brusin MR, Conte M. Increased stimulation threshold in a patient with autoimmune disease: successful management with oral prednisolone and azathioprine. Europace 2008; 11:527-9. [DOI: 10.1093/europace/eup010] [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: 11/12/2022] Open
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Mazza A, Armigliato M, Zamboni S, Rempelou P, Rubello D, Pessina AC, Casiglia E. Endocrine arterial hypertension: therapeutic approach in clinical practice. MINERVA ENDOCRINOL 2008; 33:297-312. [PMID: 18923367] [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: 05/26/2023]
Abstract
This review describes the therapeutic approach of endocrine arterial hypertension in clinical practice. In mineralocorticoid-related hypertension, adrenalectomy is the treatment of choice for aldosterone-producing adenomas and monolateral primary aldosteronism, whereas pharmacologic blood pressure (BP) control is indicated for the other forms of primary aldosteronism such as bilateral adrenal hyperplasia. Spironolactone is the drug of choice, but intolerable side effects limit its use; amiloride or eplerenone are a valid alternative. If BP remains uncontrolled, angiotensin converting enzyme inhibitors (ACE-I), angiotensin II receptor antagonists (AII-RA) and calcium channel blockers (CCB) may be added. Hypertension accompanying Cushing's syndrome can be approached with surgery, but antihypertensive treatment both pre- and postoperative is required as well. Eplerenone, AII-RA and ACE-I are indicated, while peroxisome proliferator activated receptor upsilon agonists may help for the insulin resistance syndrome. Drugs that suppress steroidogenesis should be used with care because of their serious side effects. Subjects with catecholamine-dependent hypertension due to a neuroendocrine neoplasm need to undergo preoperative alpha-adrenergic blockade with phenoxybenzamine or doxazozine. When adequate alpha-adrenergic blockade is achieved, beta-adrenergic blockade with low dose propranolol may be added. If target BP is not achieved, CCB and/or metyrosine are indicated. Laparoscopic adrenalectomy is the procedure of choice for solitary intra-adrenal neoplasms <8 cm. Acute hypertensive crises that may occur before or during surgery should be treated intravenously with sodium nitroprusside, phentolamine, nicardipine or labetalol. For malignant neoplasms, chemo- and radiopharmaceutical therapy may be considered.
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Affiliation(s)
- A Mazza
- Department of Internal Medicine, Rovigo General Hospital, Rovigo, Italy.
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Leggio M, Sgorbini L, Cruciani G, Cristinziani G, Mazza A, Bendini M, Leggio F, Jesi A. 5.14 Obesity-Related Adjunctive Systo-Diastolic Ventricular Dysfunction in Patients with Hypertension: Echocardiographic Evaluation with Tissue Velocity and Strain Imaging. High Blood Press Cardiovasc Prev 2008. [DOI: 10.1007/bf03263634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Mazza A, Zamboni S, Marcolongo A, Casiglia E, Pessina A, Rempelou P, Bascelli A, Tikhonoff V, Cuppini S. 3.1 Genetics of Cardiovascular Risk in the Elderly: the ROVIGO study (Risk of Vascular Complication: Impact of Genetics in Old People). High Blood Press Cardiovasc Prev 2008. [DOI: 10.1007/bf03263602] [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: 11/29/2022] Open
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Mazza A, Zamboni S, Armigliato M, Zennaro R, Cuppini S, Rempelou P, Rubello D, Pessina AC. Endocrine arterial hypertension: diagnostic approach in clinical practice. MINERVA ENDOCRINOL 2008; 33:127-146. [PMID: 18272953] [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: 05/25/2023]
Abstract
Endocrine arterial hypertension (EAH) a condition in which hormone excess results in clinically significant hypertension is a rare cause of hypertension. However in the last years its prevalence has increased, mostly due to the improvement of diagnostic work-up. In clinical practice, hypertensive subjects with suspicion of EAH currently undergo hormonal screening of the renin-aldosterone and catecholamines and glucocorticoids excess. This paper reviews current understanding for earlier recognition of the main forms of EAH and discusses screening laboratory methods and localization techniques that have enhanced the clinician's ability to make the diagnosis of EAH. Primary aldosteronism (PA) has recently been recognised as the most frequent cause of EAH. The aldosterone to renin ratio (ARR) is a highly recommended screening test for PA. When ARR is increased, confirmatory tests as saline infusion or fludrocortisone suppression are required. Differential diagnosis of PA requires adrenal gland imaging by computed tomography (CT) or magnetic resonance imaging (MRI), biochemical testing of the aldosterone response to posture, and selective adrenal venous sampling to differentiate unilateral aldosterone-producing adenoma from bilateral hyperplasia. Hypertension is frequently found in endogenous Cushing's Syndrome (CS). Twenty-four-hour urinary free cortisol measurement is the gold standard for the diagnosis of CS, but it must be confirmed by the overnight dexamethasone suppression test. CT and MRI are the primary imaging studies to perform, while scintigraphy is a useful confirmatory method. The most specific and sensitive diagnostic test for catecholamine-producing neoplasms is determination of urinary metanephrine levels; the neoplasms can be located by CT, MRI and metaiodo-benzylguanidine scintigraphy.
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Affiliation(s)
- A Mazza
- Unit of Internal Medicine, Rovigo General Hospital, Rovigo, Italy.
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Torrisi G, Sampugnaro EG, Pappalardo EM, D'Urso E, Vecchio M, Mazza A. Postpartum urinary stress incontinence: analysis of the associated risk factors and neurophysiological tests. Minerva Ginecol 2007; 59:491-8. [PMID: 17912175] [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: 05/17/2023]
Abstract
AIM The aim of this paper is to estimate the prevalence of postpartum urinary stress incontinence (USI) three months after vaginal delivery and to analyze the risk factors more frequently correlated with USI. Pelvic floor neurophysiology was performed to assess pudendal nerve damage in symptomatic women. METHODS A total of 562 women were interviewed and underwent urogynecological evaluation three days after vaginal delivery. They were contacted by telephone 12 weeks later. Chart abstraction was conducted to obtain obstetrical data. Three months after delivery women presenting persistent USI were invited to return for electrophysiological tests. Univariate and logistic regression analyses were performed to reveal any significant association between USI and risk factors. RESULTS Prevalence of postpartum USI three days after delivery was 15%, decreasing to 10.6% at follow-up three months later. Multivariate analysis of risk factors revealed that persistent USI was significantly associated with: preconception USI (P<0.05), USI developed de novo after delivery (P<0.05), family history of incontinence (P<0.05), chronic cough (P<0.05) and smoking (P<0.05). No obstetric variables were independently connected with incontinence. Neurophysiological tests revealed nerve damage in 36% of the symptomatic puerperae. CONCLUSION Persistent postpartum incontinence is associated with several maternal and urogynecological risk factors that can help to detect women at risk for early intervention.
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Affiliation(s)
- G Torrisi
- Department of Obstetrics and Gynecology, Vittorio Emanuele Hospital, University of Catania, Catania, Italy.
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Mazza A, Zamboni S, Rizzato E, Pessina AC, Tikhonoff V, Schiavon L, Casiglia E. Serum uric acid shows a J-shaped trend with coronary mortality in non-insulin-dependent diabetic elderly people. The CArdiovascular STudy in the ELderly (CASTEL). Acta Diabetol 2007; 44:99-105. [PMID: 17721747 DOI: 10.1007/s00592-007-0249-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Accepted: 01/11/2007] [Indexed: 11/29/2022]
Abstract
The relationship between serum uric acid (SUA) and risk of coronary heart disease (CHD) mortality remains controversial, particularly in diabetic subjects. The aim of the present study is to evaluate whether SUA independently predicts CHD mortality in non-insulin-dependent elderly people from the general population and to investigate the interactions between SUA and other risk factors. Five hundred and eighty-one subjects aged >/=65 years with non-insulin-dependent diabetes mellitus were prospectively studied in the frame of the CArdiovascular STudy in the ELderly (CASTEL). Historical and clinical data, blood tests and 12-year fatal events were recorded. SUA as a continuous item was divided into tertiles and, for each tertile, adjusted relative risk (RR) with 95% confidence intervals (CI) was derived from multivariate Cox analysis. CHD mortality was predicted by SUA in a J-shaped manner. Mortality rate was 7.9% (RR 1.28, CI 1.05-1.72), 6.0% (reference tertile) and 12.1% (RR 1.76, CI 1.18-2.27) in the increasing tertiles of SUA, respectively, without any difference between genders. In diabetic elderly subjects, SUA independently predicts the risk of CHD mortality in a J-shaped manner.
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Affiliation(s)
- A Mazza
- Department of Internal Medicine, General Hospital of Rovigo, Rovigo, Italy
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