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Mele M, Tricarico L, Centola A, Mango F, Favia A, Croella F, Le Rose V, Cuculo A, Bottalico I, Poliseno MC, Lo Caputo S, Santantonio T, Brunetti ND. Impact of vaccination on electrocardiograms of hospitalized patients for Covid-19. Vaccine X 2023; 14:100291. [PMID: 37091728 PMCID: PMC10088278 DOI: 10.1016/j.jvacx.2023.100291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction We sought to assess the impact of SarsCov-2 vaccination on admission12-lead electrocardiogram of hospitalized patients. Methods We retrospectively analyzed and compared admission 12-lead electrocardiograms of all patients hospitalized in dedicated Internal Medicine Unit for Covid-19 both in pre-vaccination period (PV) and after vaccination (V). Results 667 consecutive Covid-19 in-patients were enrolled in the study: PV hospitalized patients were older (68vs57 years, p < 0.01), had higher rates of atrial fibrillation/flutter (13%vs2.5%, p < 0.01), any arrhythmia (26%vs8%, p < 0.01), and ST-T abnormalities (22%vs7.4%, p < 0.01). Mortality rates in hospitalized Covid-19 patients were higher before vaccination period (20%vs4%, p < 0.01). Minimal vaccination coverage of population (V period) was inversely and independently associated with in-hospital mortality (odds ratio 0.09, 95%CI 0.01-0.68, p < 0.05). Conclusions SarsCov-2 vaccination campaign and even partial coverage of local population was associated with less frequent abnormalities at admission ECG in hospitalized non-critically hill Covid-19 patients and lower mortality.
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Affiliation(s)
- Marco Mele
- Cardiothoracic Department, Policlinico Riuniti Foggia, Foggia, Italy
| | - Lucia Tricarico
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
| | - Antonio Centola
- Cardiothoracic Department, Policlinico Riuniti Foggia, Foggia, Italy
| | - Federica Mango
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
| | - Andrea Favia
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
| | - Francesca Croella
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
| | - Valeria Le Rose
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
| | - Andrea Cuculo
- Cardiothoracic Department, Policlinico Riuniti Foggia, Foggia, Italy
| | - Irene Bottalico
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
| | | | - Sergio Lo Caputo
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
| | - Teresa Santantonio
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
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Mele M, Mele A, Cuculo A, Tricarico L, Liantonio A, Imbrici P, Santoro F, Brunetti ND. How brachial access compares to femoral access for invasive cardiac angiography when radial access is not feasible: A meta-analysis. J Vasc Access 2022:11297298221145752. [PMID: 36573696 DOI: 10.1177/11297298221145752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Trans-radial access is considered the best approach for cardiac catheterization. The choice of an alternative access route may be complex and trans-femoral access (TFA) is generally preferred. However, trans-brachial approach (TBA) may represent another feasible alternative. We therefore aimed to compare TBA and TFA in terms of access site bleeding and complications in a meta-analysis study. METHODS We systematically searched principal databases for studies comparing femoral and brachial approach in terms of in-hospital vascular complications in patients undergoing cardiac catheterization (coronary angiography or percutaneous coronary intervention). RESULTS Five retrospective studies and one randomized study were identified for the meta-analysis; 2756 patients undergoing a TBA and 331.208 patients undergoing a TFA for cardiac catheterization were included in the final study. No significant differences between access routes were found in terms of risk of any vascular complications (relative risk 1.18; 95% CI: 0.91-1.53; p n.s.). Brachial access was associated with a significantly lower risk of access site bleeding (relative risk 0.46; 95% CI 0.24-0.88, p = 0.02). CONCLUSIONS TBA for cardiac catheterization was associated with a lower risk of access site bleeding and a comparable risk of any vascular complications compared with TFA. TBA may be considered a reasonable alternative access route for cardiac catheterization, at least as femoral approach.
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Affiliation(s)
- Marco Mele
- Cardiothoracic Department, Policlinico Riuniti Foggia, Foggia, Italy
| | - Antonietta Mele
- Department of Pharmacy and Drug Science, Università Aldo Moro, Bari, Italy
| | - Andrea Cuculo
- Cardiothoracic Department, Policlinico Riuniti Foggia, Foggia, Italy
| | - Lucia Tricarico
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
| | | | - Paola Imbrici
- Department of Pharmacy and Drug Science, Università Aldo Moro, Bari, Italy
| | - Francesco Santoro
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
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Barone R, Goffredo G, Di Terlizzi V, Correale M, Casavecchia G, Ieva R, Cuculo A, Brunetti N, Iacoviello M. P243 RELEVANCE OF RENAL RESISTANCE INDEX INCREASE AFTER CORONARY ANGIOGRAPHY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.235] [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
Renal resistance index is a Doppler derived measure which is able to reflect the pathophysiological background of Cardiorenal Syndrome (CS). There are no data about the influence of the intravascular administration of contrast media on RRI and its relationship with worsening of renal function (WRF).
Aim of the Study
To evaluate changes in renal resistance index (RRI) after coronary angiography in patients with and without WRF. METHODS We enrolled 115 patients (mean age 64 years, 73% males, 84% hypertensive, 43% diabetic, 30% with acute coronary syndrome, 21% affected by chronic heart failure, CHF, with a mean left ventricular ejection fraction, LVEF, of 51±11) with suspected coronary artery disease, stable angina, or acute coronary syndromes who have been referred for coronary angiography (with or without pre–existing renal impairment). Renal arterial echo–color Doppler was used to calculate RRI before and 48 hours after coronary angiography. WRF was defined as an increase of creatinine >0.3 mg/dl and of at least 25% from baseline 24–48 hours after coronary angiography.
Results
Fourteen (12%) among the enrolled patients showed WRF. As expected, a significant increase of creatinine serum levels was observed in patients with WRF (from 1.14±0.40 to 1.71±0.49, p < 0.001) but not those without (from 0.89±0.27 to 0.92±0.28, p n.s.) WRF. On the other hand, RRI significantly increased both in patients with (from 72.8±4.3 to 76.4±5.2, p < 0.05) and without (from 63.1±7.2 to 65.4±7.1, p < 0.05). However, both at baseline and after angiography, patients with WRF showed RRI values significantly greater when compared with those without. At ROC curve analyses for WRF, the baseline and after angiography RRI sowed similar AUC (0.88 and 0.90, respectively) and for both RRI values the best cut–off was 70% (sensitivity of 79% and 93% and Specificity of 93% and 82%, respectively). As shown in the figure, the high predictive accuracy of RRI values was due to the fact that, although increased after angiography, the proportion of patients without WRF and with RRI>70% remained very low.
Conclusion
After coronary angiography RRI significantly increase both in patients with and without WRF. However, a larger proportion of patients with WRF present a critically increased RRI, i.e. equal or above 70%, before and after angiography probably because reflecting the pathophysiological background underlying the progression of cardiorenal syndrome.
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Affiliation(s)
| | | | | | | | | | - R Ieva
- POLICLINICO RIUNITI, FOGGIA
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Goffredo G, Barone R, Di Terlizzi V, Correale M, Casavecchia G, Ieva R, Cuculo A, Brunetti N, Iacoviello M. P216 RENAL RESISTANCE INDEX IS INDEPENDENTLY ASSOCIATED WITH THE WORSENING OF RENAL FUNCTION AFTER CORONARY ANGIOGRAPHY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.208] [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
The term Cardiorenal Syndrome (CS) has been recently introduced to indicate the close relationship between cardiovascular and renal diseases, which are able to reciprocally influence the each other progression. In this setting the renal resistance index (RRI) has been demonstrated to be a useful parameter able to detect patients at higher risk of CS. However, there are no data about its role in predicting worsening of renal function (WRF) mediated by the intravascular administration of contrast.
Aim of the Study
To evaluate the role of RRI in predicting WRF after coronary angiography. METHODS We enrolled 115 patients (mean age 64 years, 73% males, 84% hypertensive, 43% diabetic, 30% with acute coronary syndrome, 21% affected by chronic heart failure, CHF, with a mean left ventricular ejection fraction, LVEF, of 51±11) with suspected coronary artery disease, stable angina, or acute coronary syndromes who have been referred for coronary angiography (with or without pre–existing renal impairment). All patients underwent medical examination, electrocardiogram, echocardiographic and chemical evaluation, and renal arterial echo–color Doppler used to calculate RRI. WRF was defined as an increase of creatinine >0.3 mg/dl and of at least 25% from baseline 24–48 hours after coronary angiography.
Results
After coronary angiography, 14 (12%) of the enrolled patients showed WRF. As shown in the Table, at univariate regression analysis baseline RRI was associated with WRF as well as age, peripheral artery disease, CHF, atrial fibrillation, NYHA class, LVEF, mitral regurgitation (MR), central venous pressure (CVP), tricuspid regurgitation (TR), estimated glomerular filtration rate (GFR). In a multivariate forward stepwise regression model, including all univariate predictors, history of CHF, high CVP and RRI were the only parameters significantly associated with WRF.
Conclusion
Our findings demonstrate that in patients undergoing coronary angiography, history of CHF, high CVP and RRI are independent predictors of WRF. RRI, but not GFR, is independently associated with WRF probably because providing additional relevant information about cardiorenal pathophysiological factors reflecting the hemodynamic status and kidney flow reserve.
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Affiliation(s)
| | | | | | | | | | - R Ieva
- POLICLINICO RIUNITI, FOGGIA
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Corbo MD, Centola A, Fortunato M, Mazzeo P, Vitale E, Della Monica D, Magnesa M, Ieva R, Cuculo A, Iacoviello M, Brunetti ND. Multivessel spontaneous coronary artery dissection and Crohn's disease. J Cardiovasc Med (Hagerstown) 2021; 22:e26-e28. [PMID: 34107504 DOI: 10.2459/jcm.0000000000001217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | - Pietro Mazzeo
- Department of Medical & Surgical Sciences, University of Foggia
| | - Enrica Vitale
- Department of Medical & Surgical Sciences, University of Foggia
| | | | - Michele Magnesa
- Department of Medical & Surgical Sciences, University of Foggia
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Rapetto C, Leoncini M, Cerrato E, Regazzoli D, Cortese B, Rossi A, Fetiveau R, Geraci S, De Angelis MC, Tespili M, Iannaccone M, Centola A, Durante A, De Carlo M, De Caterina A, Ribichini F, Favaretto E, Testa L, Pirisi R, Varbella F, Nicolini E, di Palma G, Loi B, Poli A, Caramanno G, Varricchio A, Garbo R, Cuculo A, Petronio AS, Berti S, Bollati M, Spedicato L, De Candia G, Piva T, Quadri G, Colombo A, Ielasi A. ImpaCt of an Optimal Implantation Strategy on Absorb Long-Term Outcomes: The CIAO Registry. Cardiovascular Revascularization Medicine 2021; 30:1-8. [DOI: 10.1016/j.carrev.2020.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/16/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
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Gravina M, Casavecchia G, Martone A, Sollitto M, Zicchino S, Cuculo A, Macarini L, Biase MD, Brunetti ND. Anomalous Right Coronary Artery Origin from Left Main Stem: Role of Cardio-Computed Tomography in the Diagnosis and Therapeutic Approach. J Cardiovasc Echogr 2019; 29:65-67. [PMID: 31392122 PMCID: PMC6657460 DOI: 10.4103/jcecho.jcecho_49_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Anomalous coronary arteries (ACAs) are rare but potentially life-threatening abnormalities of coronary circulation. Most of the variants are benign; however, some may lead to myocardial ischemia and/or sudden cardiac arrest. We report the case of a 75-year-old male complaining of exertion chest discomfort. Admission electrocardiogram on presentation showed sinus bradycardia with a slight elevation of ST-T in inferior leads. Troponin levels, however, were normal. Coronary angiography showed an anomalous right coronary artery (RCA) originating from the left main stem without significant stenosis. Cardio-CT confirmed the anomalous origin of the RCA from the left main stem and showed its anomalous course between the aorta and the pulmonary artery. The patient was deemed a candidate for surgery and transferred to a cardiac surgery center. Only the exact definition of the anatomic and clinical features of ACAs may allow the identification of the most appropriate and effective treatment. Multislice computed tomography may play a fundamental role in the diagnosis and treatment of ACAs.
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Affiliation(s)
- Matteo Gravina
- Department of Radiology, University of Foggia, Foggia, Italy
| | | | | | - Mario Sollitto
- Department of Radiology, University of Foggia, Foggia, Italy
| | | | - Andrea Cuculo
- Department of Cardiology, University of Foggia, Foggia, Italy
| | - Luca Macarini
- Department of Radiology, University of Foggia, Foggia, Italy
| | - Matteo Di Biase
- Cardiology Department, GVM Care and Research, Santa Maria Hospital, Bari, Italy
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Casavecchia G, Zicchino S, Gravina M, Martone A, Cuculo A, Macarini L, Di Biase M, Brunetti ND. Dual Coronary-Pulmonary Fistula Firstly Found at Routine Doppler Echocardiogram. J Cardiovasc Echogr 2019; 29:23-25. [PMID: 31008035 PMCID: PMC6450228 DOI: 10.4103/jcecho.jcecho_47_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Congenital coronary-pulmonary fistulas (CPFs) are defined as an abnormal direct communication between one or more coronary arteries, with a cardiac or thoracic structure bypassing the capillary network. We report the case of a 73-year-old male, with a history of hypertension, asymptomatic for angina and dyspnea, who was referred for routine clinical control. Echocardiogram unexpectedly showed the presence of diastolic flow from the pulmonary trunk in parasternal short-axis view. Pulsed-wave Doppler confirmed the presence of diastolic flow and displayed the typical coronary flow pattern. Coronary angiography hence showed the presence of dual CPFs originating from the second segment of the left anterior descending coronary and the right coronary arteries. Careful routine Doppler echocardiograph examination may raise the suspicion of CPF in case of otherwise unexplained symptoms and may represent a simple, easy, repeatable tool for the first suspected diagnosis and follow-up of CPFs.
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Affiliation(s)
| | | | - Matteo Gravina
- Cardiology Department, University of Foggia, Foggia, Italy
| | | | - Andrea Cuculo
- Cardiology Department, University of Foggia, Foggia, Italy
| | - Luca Macarini
- Cardiology Department, University of Foggia, Foggia, Italy
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Casavecchia G, Gravina M, Zicchino S, Moranti E, Cuculo A, Macarini L, Di Biase M, Brunetti ND. Tricuspid Papillary Fibroelastoma at Multimodal Imaging. J Cardiovasc Echogr 2019; 28:236-238. [PMID: 30746328 PMCID: PMC6341851 DOI: 10.4103/jcecho.jcecho_48_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Papillary fibroelastoma is a rare benign cardiac tumor, second after cardiac myxoma as more frequent cardiac valvular tumor. The therapy is usually based on surgery according to size, mobility, symptoms, and risks of surgery. We report the case of a 67-year old female with transient ischemic attack. Echocardiography showed the presence of a round mobile formation localized on the atrial side of septal leaflets of tricuspid valve, first identified as an endocarditis vegetation. Cardiac magnetic resonance (cMRI) confirmed the presence of the mass and showed an isointense signal in T1-turbo spin echo sequences, hypointense in cine steady-state free precession and in first-pass sequences, and hyperintense in T2 and phase-sensitive inversion recovery with central hypointense core, with a suspected diagnosis of fibroelastoma. The patient underwent cardiac surgery and histology confirmed the presence of fibroelastic tissue with papillary extroflexions compatible with diagnosis of fibroelastoma. The use of cMRI may be useful in the evaluation of the exact position, dimensions, and nature of cardiac masses and fibroelastomas, diagnostic workup, and preliminary assessment before surgery.
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Affiliation(s)
- Grazia Casavecchia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Matteo Gravina
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Stefano Zicchino
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | - Luca Macarini
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Tarantino N, Santoro F, Guastafierro F, Di Martino LFM, Scarcia M, Ieva R, Ruggiero A, Cuculo A, Mariano E, Di Biase M, Brunetti ND. "Lambda-wave" ST-elevation is associated with severe prognosis in stress (takotsubo) cardiomyopathy. Ann Noninvasive Electrocardiol 2018; 23:e12581. [PMID: 29984535 DOI: 10.1111/anec.12581] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 05/23/2018] [Accepted: 06/05/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Persistent ST-segment elevation in acute coronary syndrome is associated with both short and long-term complications. By contrast, there is limited information about ST-elevation and its evolution during takotsubo (stress) cardiomyopathy (TTC). AIM To evaluate whether persistent downsloping ST-elevation in the early stages of TTC might correlate with short and long-term clinical events. METHODS One-hundred fifty-eight consecutive subjects with TTC were prospectively enrolled and assessed by electrocardiogram. Patients were classified in two groups according to the presence of downsloping ST-elevation ≥5 mm lasting at least 24 hr ("lambda-wave" ST-elevation group vs. without downsloping ST-elevation) in at least one/two contiguous leads. RESULTS Five (3.2%) patients, all female with a mean left ventricular ejection fraction 32 ± 5%, were included in the lambda-wave ST-elevation group. These patients were characterized by a higher prevalence of physical stressor (100% vs. 49%, p = 0.04) and higher admission and peak levels of troponin-I levels during hospitalization. Peak of ST-elevation in the lambda-wave ST-elevation group was reached 6 hr after admission and gradually decreased after 24 hr. In-hospital complications were observed in all the patients presenting lambda ST-elevation (100% vs. 23%, p = 0.03, OR: 29.1, p = 0.04); one patient presented endoventricular thrombosis and two died of cardiogenic shock. At long-term follow-up (mean 443 days), adverse events were observed in 80% of patients with lambda-wave ST-elevation (RR of adverse events at follow-up 32, p < 0.01). CONCLUSION Persistent downsloping lambda-wave ST-elevation during the acute phase of stress cardiomyopathy may be associated with a higher risk of adverse events at short and long-term follow-up.
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Affiliation(s)
- Nicola Tarantino
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
| | - Francesco Santoro
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy.,Asklepios Klinik - St. Georg, Hamburg, Germany
| | | | | | - Maria Scarcia
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
| | - Riccardo Ieva
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
| | - Antonio Ruggiero
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
| | - Andrea Cuculo
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
| | - Enrica Mariano
- Department of Cardiology, University "Tor Vergata", Rome, Italy
| | - Matteo Di Biase
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
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Secco GG, Tebaldi M, Parisi R, Cuculo A, Di Mario C, Sangiorgio P, Ielasi A, Centola A, Fattori R, Vercellino M, Longo G, Pistis G, Biscaglia S, Ruggiero A, Marino PN, Campo G. One-Year Clinical Outcomes of Forty-Eight Millimeter Everolimus-Eluting Stent Implanted in Very Long Lesions: A Propensity-Matched Comparison (The FREIUS Study). J Invasive Cardiol 2018; 30:133-137. [PMID: 29610443] [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: 06/08/2023]
Abstract
BACKGROUND Long coronary lesions still remain a challenge, with poor immediate results and suboptimal outcomes when compared to class A/B1 lesions. The presence of overlapped segments of metal struts and polymer might trigger an abnormal inflammatory reaction, resulting in a higher restenosis rate. The aim of our study was to evaluate the safety, feasibility, and cost effectiveness of a 48 mm everolimus-eluting stent (EES) during treatment of very long coronary lesions. METHODS AND RESULTS The FREIUS study is a prospective data collection of consecutive patients undergoing 48 mm EES implantation in six high-volume European centers. Each patient was matched through a propensity score to a comparable patient treated with two or more second-generation overlapped drug-eluting stents. The primary endpoint was the combined incidence of cardiac death, target-vessel myocardial infarction, and target-lesion revascularization (device-oriented composite endpoint [DOCE]). The secondary endpoints were all-cause death, each individual component of the primary endpoint, and definite/probable stent thrombosis. From January 2014 to April 2015, a total of 218 patients were treated with at least one 48 mm EES and were compared with 218 matched controls. Overall, 9% of patients reached the primary endpoint. Cumulative survival free from DOCE incidence did not differ between the two groups (7% in the cases vs 10.5% in the controls; P=.10). After multivariable analysis, only clinical presentation with myocardial infarction (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.5-2.1; P=.01) and stent number (HR, 1.4; 95% CI, 1.1-1.8; P=.02) emerged as independent predictors of DOCE. CONCLUSION The use of 48 mm EES offers a safe and effective strategy for the treatment of very long coronary lesions.
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Affiliation(s)
- Gioel Gabrio Secco
- Interventional Cardiology, "Santi Antonio e Biagio e Cesare Arrigo" Hospital, Via Venezia 16, 15121 Alessandria, Italy.
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12
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Cuculo A, Ruggiero A, Centola A, Campanale G, Passero T, Gaglione A, Di Biase M, Brunetti ND. Bioresorbable coronary stent for the treatment of complex coronary lesions: Data from an all-comer registry. Int J Cardiol 2017; 230:136-141. [PMID: 28038806 DOI: 10.1016/j.ijcard.2016.12.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 12/14/2016] [Accepted: 12/16/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The study aimed to report the results from an all-comers registry of patients undergoing coronary angioplasty and treated with bioresorbable vascular scaffold (BVS). METHODS Fifty-five consecutive patients with type B/C coronary lesions according to the AHA classification and treated with BVS were enrolled in the study. The clinical and procedural characteristics of enrolled patients were recorded. Fifty-five consecutive subjects with coronary lesions type B/C treated with everolimus eluting stent (EES) were used as control group. RESULTS The incidence of adverse events was not statistically significant comparing subjects treated with BVS with those treated with EES. Non significant differences were also found in the follow-up considering the presence of diabetes, multivessel disease, use of more than one stent at the same time, diagnosis (STEMI vs UA/NSTEMI), use of coronary stents in overlapping. The differences were significant considering the type of lesion (Log-Rank p<0.05), stenoses treated in correspondence of a coronary bifurcation (p<0.05), the SYNTAX score (cut off 22) (p<0.001); after multivariable correction for age and gender, however, differences remained significant only for SYNTAX score. CONCLUSIONS The use of BVS in an all-comers registry of patients undergoing coronary angioplasty on complex coronary lesions is associated with a safety profile comparable to that obtained with EES; the use of BVS in particular conditions, such as very high SYNTAX score, should be further assessed.
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Affiliation(s)
- Andrea Cuculo
- Cardiology Departement, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Antonio Ruggiero
- Cardiology Departement, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Antonio Centola
- Cardiology Departement, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Giulio Campanale
- Cardiology Departement, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Tommaso Passero
- Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Gaglione
- Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
| | - Matteo Di Biase
- Cardiology Departement, Ospedali Riuniti University Hospital, Foggia, Italy; Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
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Gravina M, Casavecchia G, D'Alonzo N, Totaro A, Manuppelli V, Cuculo A, Vinci R, Macarini L, Di Biase M, Brunetti ND. Pheochromocytoma behind takotsubo(stress)-cardiomyopathy: The great pretender. Am J Emerg Med 2016; 35:514. [PMID: 27988250 DOI: 10.1016/j.ajem.2016.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- Matteo Gravina
- University of Foggia, Radiology Department, Foggia, Italy.
| | | | | | - Antonio Totaro
- University of Foggia, Cardiology Department, Foggia, Italy.
| | | | - Andrea Cuculo
- University of Foggia, Cardiology Department, Foggia, Italy.
| | - Roberta Vinci
- University of Foggia, Radiology Department, Foggia, Italy.
| | - Luca Macarini
- University of Foggia, Radiology Department, Foggia, Italy.
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Tarantini G, Saia F, Capranzano P, Cortese B, Mojoli M, Boccuzzi G, Cuculo A, Geraci S, Mattesini A, Oreglia J, Summaria F, Testa L, Berti S, Esposito G, La Manna A, Limbruno U, Marchese A, Mauro C, Tarantino F, Salvi A, Santoro G, Varbella F, Violini R, Musumeci G. [SICI-GISE Position paper: Use of Absorb BVS in clinical practice]. G Ital Cardiol (Rome) 2016; 17:28S-44. [PMID: 27729667 DOI: 10.1714/2372.25480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Drug-eluting stents (DES) are the current gold standard for percutaneous treatment of coronary artery disease. However, DES are associated with a non-negligible risk of long-term adverse events related to persistence of foreign material in the coronary artery wall. In addition, DES implantation causes permanent caging of the native vessel, thus impairing normal vasomotricity and the possibility of using non-invasive coronary imaging or preforming subsequent bypass surgery. On the contrary, coronary bioresorbable stents (BRS) may provide temporary mechanical support to coronary wall without compromising the subsequent recovery of normal vascular physiology, and have the potential to prevent late adverse events related to permanent elements. Several types of BRS have been introduced into clinical practice in Europe or are being tested. However, most of available clinical data relate to a single BRS, the Absorb bioresorbable Vascular Scaffold (Absorb BVS) (Abbott Vascular, Santa Clara, CA). Despite encouraging clinical results, no societal guidelines are available on the use of BRS in clinical practice.A panel of Italian expert cardiologists assembled under the auspices of the Italian Society of Interventional Cardiology (SICI-GISE) for comprehensive discussion and consensus development, with the aim to provide recommendations on the use of bioresorbable stents in terms of clinical indications, procedural aspects, post-percutaneous coronary angioplasty pharmacologic treatment and follow-up. Based on current evidence and BRS availability in Italian cath-labs, the panel decided unanimously to provide specific recommendations for the Absorb BVS device. These recommendations do not necessarily extend to other BRS, unless specified, although significant overlap may exist with Absorb BVS, particularly in terms of clinical rationale.
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Affiliation(s)
- Giuseppe Tarantini
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Policlinico Universitario, Padova
| | - Francesco Saia
- Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna
| | - Piera Capranzano
- Dipartimento Cardiovascolare, Ospedale Ferrarotto, Università degli Studi, Catania
| | | | - Marco Mojoli
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Policlinico Universitario, Padova
| | - Giacomo Boccuzzi
- Cardiologia Interventistica, Azienda Sanitaria Locale Torino 2, Torino
| | - Andrea Cuculo
- Dipartimento di Cardiologia, A.O. Ospedali Riuniti, Foggia
| | - Salvatore Geraci
- Cardiologia Interventistica, Ospedale S. Giovanni di Dio, Agrigento
| | - Alessio Mattesini
- Cardiologia Interventistica, Ospedale Moriggia Pelascini, Gravedona (CO)
| | - Jacopo Oreglia
- Emodinamica, ASST Grande Ospedale Metropolitano Niguarda, Milano
| | | | - Luca Testa
- Dipartimento di Cardiologia, IRCCS Policlinico S. Donato, S. Donato Milanese (MI)
| | - Sergio Berti
- U.O. Cardiologia Diagnostica ed Interventistica, Fondazione Toscana "Gabriele Monasterio", Ospedale del Cuore, Massa
| | - Giovanni Esposito
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli
| | - Alessio La Manna
- Dipartimento Cardiovascolare, Ospedale Ferrarotto, Università degli Studi, Catania
| | - Ugo Limbruno
- U.O.C. Cardiologia, Azienda USL Toscana Sudest, Grosseto
| | - Alfredo Marchese
- U.O.C. Cardiologia Interventistica, Anthea Hospital, GVM Care & Research, Bari
| | - Ciro Mauro
- Dipartimento Cardiovascolare, Ospedale Cardarelli, Napoli
| | - Fabio Tarantino
- Laboratorio di Emodinamica, U.O. Cardiologia, Ospedale G.B. Morgagni-L. Pierantoni, Forlì
| | - Alessandro Salvi
- Dipartimento Cardiovascolare, Ospedali Riuniti, Università degli Studi, Trieste
| | | | | | - Roberto Violini
- Cardiologia Interventistica, Ospedale S. Camillo-Forlanini, Roma
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Ruggiero A, Cuculo A, Centola A, Campanale G, Russo D, Gaglione A, Di Biase M, Brunetti ND, Alfonso F, García-Guimaraes M, Cuesta J, Navarrete G, Bastante T, Saw J. How should I treat an extended spontaneous coronary artery dissection in a young woman without cardiovascular risk factors mimicking Takotsubo cardiomyopathy? EUROINTERVENTION 2016; 12:e1073-e1076. [DOI: 10.4244/eijv12i8a175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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16
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Correale M, Lopizzo A, Santoro F, Ruggero A, Cuculo A, Leva R, Di Biase M. Acute heart failure in an adult with unrecognized congenital heart disease. Monaldi Arch Chest Dis 2015; 76:149-50. [DOI: 10.4081/monaldi.2011.187] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report a case of 46 year-old man, admitted to our Department for a possible massive pulmonary embolism. Instead, diagnosis of Tetralogy of Fallot was established by echocardiography and cardiac catetherization.
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Cortese B, Ielasi A, Romagnoli E, Varricchio A, Cuculo A, Loi B, Pisano F, Corrado D, Sesana M, La Vecchia L, Summaria F, Tespili M, Silva Orrego P, Tognoni G, Steffenino G. Clinical Comparison With Short-Term Follow-Up of Bioresorbable Vascular Scaffold Versus Everolimus-Eluting Stent in Primary Percutaneous Coronary Interventions. Am J Cardiol 2015; 116:705-10. [PMID: 26100584 DOI: 10.1016/j.amjcard.2015.05.049] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 11/30/2022]
Abstract
Objective of this study was to assess the clinical performance of bioresorbable vascular scaffold (BVS) compared to everolimus-eluting stent (EES) in subjects with ST-segment elevation myocardial infarction (STEMI). We included all consecutive patients with STEMI who underwent percutaneous coronary intervention (PCI) with BVS implantation in centers participating to the Italian ABSORB Prospective Registry (BVS-RAI) and PCI with EES in the same centers during the same period. The 2 groups were compared. The primary end point was patient-oriented composite end point (POCE) including cardiac death, myocardial infarction, and target lesion revascularization (TLR) at the longest available follow-up. BVS or EES thrombosis at follow-up was also evaluated. Of the 563 patients with STEMI included, 122 received BVS and 441 EES. Procedural success was obtained in 549 (97.5%) cases without significant differences between the 2 groups (BVS 99.3% vs EES 97.0%, p = 0.2). At a median of 220-day (interquartile range 178 to 369) follow-up, no significant differences were observed in terms of POCE (BVS 4.9% vs EES 7.0%, p = 0.4); death (BVS 0.8%, EES 2.0%, p = 0.4), MI (BVS 4.1%, EES 2.0%, p = 0.2), TLR (BVS 4.1%, EES 4.5%, p = 0.8), device thrombosis (BVS 2.5%, EES 1.4%, p = 0.4). All TLR cases were successfully managed with re-PCI in both groups. A propensity matching of the study populations showed no significant differences regarding POCE at the longest available follow-up (odds ratio 0.53, 0.1 to 4.3). In conclusion, in this direct prospective comparison, BVS was associated with similar clinical results compared to EES in the STEMI setting. Larger and adequately powered randomized trials are needed to fully assess the potential clinical benefit of BVS versus the current standard of care in patients with STEMI.
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Affiliation(s)
- Bernardo Cortese
- Department of Interventional Cardiology, A.O. Fatebenefratelli, Milano, Italy.
| | - Alfonso Ielasi
- Department of Cardiology, A.O. Bolognini, Seriate, Italy
| | | | | | - Andrea Cuculo
- Department of Cardiology, A.O. Ospedali Riuniti, Foggia, Italy
| | - Bruno Loi
- Department of Interventional Cardiology, A.O. Brotzu, Cagliari, Italy
| | - Francesco Pisano
- Department of Interventional Cardiology, Ospedale Regionale Parini, Aosta, Italy
| | - Donatella Corrado
- Centro di Ricerche Farmacologiche e Biomediche "Mario Negri", Milano, Italy
| | - Marco Sesana
- Department of Interventional Cardiology, A.O. Desenzano del Garda, Desenzano del Garda, Italy
| | - Luigi La Vecchia
- Department of Interventional Cardiology, Ospedale San Bortolo, Vicenza, Italy
| | - Francesco Summaria
- Department of Interventional Cardiology, Policlinico Casilino, Roma, Italy
| | | | - Pedro Silva Orrego
- Department of Interventional Cardiology, A.O. Fatebenefratelli, Milano, Italy
| | - Gianni Tognoni
- Centro di Ricerche Farmacologiche e Biomediche "Mario Negri", Milano, Italy
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Brunetti ND, Correale M, Ieva R, De Gennaro L, Pellegrino PL, Cuculo A, Di Biase M. Atrioventricular 2. J Cardiovasc Med (Hagerstown) 2015; 16 Suppl 1:S35-7. [DOI: 10.2459/jcm.0b013e32833cdd46] [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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Brunetti ND, Correale M, Pellegrino PL, Munno I, Cuculo A, De Gennaro L, Gaglione A, Di Biase M. Early inflammatory cytokine response: a direct comparison between spontaneous coronary plaque destabilization vs angioplasty induced. Atherosclerosis 2014; 236:456-60. [PMID: 25173071 DOI: 10.1016/j.atherosclerosis.2014.07.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 06/13/2014] [Accepted: 07/27/2014] [Indexed: 11/29/2022]
Abstract
AIM To compare inflammatory response accompanying acute coronary syndrome (ACS) with that following coronary plaque rupture caused by coronary angioplasty (PCI). METHODS Twenty-seven consecutive subjects with either ACS or treated with PCI in the subacute phase of ACS underwent serial evaluation of circulating interleukin (IL)-2, IL-8, IL-10, interferon (IFN)-γ and tumor-necrosis-factor (TNF)-α levels. Blood samples were drawn immediately before angioplasty (T0) in the PCI group or at admission in the ACS group, 12 h (T1) and 24 h later (T2). RESULTS Differences between cytokine levels were substantially not statistically significant when comparing PCI, non-ST-elevation-ACS, and ST-elevation-ACS groups, especially 24 h after plaque rupture (T2, Type-II error 85-94%). CONCLUSIONS Inflammatory activation during the first 24 h of ACS or after PCI is comparable, regardless of myocardial damage in terms of troponin levels. Coronary plaque rupture may be presumed as being the main responsible for increased circulating cytokine levels in this early phase.
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Affiliation(s)
| | - Michele Correale
- Cardiology Department, University of Foggia, Viale Pinto 1, 71100 Foggia, Italy
| | | | - Irene Munno
- Immunology Department, University of Bari, Piazza Giulio Cesare, 1, 70121 Bari, Italy
| | - Andrea Cuculo
- Cardiology Department, University of Foggia, Viale Pinto 1, 71100 Foggia, Italy
| | - Luisa De Gennaro
- Cardiology Department, University of Foggia, Viale Pinto 1, 71100 Foggia, Italy
| | - Antonio Gaglione
- Cardiology Department, University of Foggia, Viale Pinto 1, 71100 Foggia, Italy
| | - Matteo Di Biase
- Cardiology Department, University of Foggia, Viale Pinto 1, 71100 Foggia, Italy
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Santoro F, Lopizzo A, Centola A, Cuculo A, Ruggiero A, Di Biase M, Brunetti ND. Very late coronary spasm inducing acute myocardial infarction in a heart transplant recipient. J Cardiovasc Med (Hagerstown) 2014; 17 Suppl 2:e235-e236. [PMID: 25010504 DOI: 10.2459/jcm.0000000000000049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: We report coronary angio findings of very late (10-year) coronary spasm inducing acute myocardial infarction with typical chest pain in a heart transplant recipient. Coronary spasm was promptly relieved by intra-coronary infusion of nitrates.
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Brunetti ND, Delli Carri F, Ruggiero MA, Cuculo A, Ruggiero A, Ziccardi L, De Gennaro L, Di Biase M. Comparative cath-lab assessment of coronary stenosis by radiology technician, junior and senior interventional cardiologist in patients treated with coronary angioplasty. Interv Med Appl Sci 2014; 6:26-30. [PMID: 24672672 DOI: 10.1556/imas.6.2014.1.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 12/29/2013] [Accepted: 01/02/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Exact quantification of plaque extension during coronary angioplasty (PCI) usually falls on interventional cardiologist (IC). Quantitative coronary stenosis assessment (QCA) may be possibly committed to the radiology technician (RT), who usually supports cath-lab nurse and IC during PCI. We therefore sought to investigate the reliability of QCA performed by RT in comparison with IC. METHODS Forty-four consecutive patients with acute coronary syndrome underwent PCI; target coronary vessel size beneath target coronary lesion (S) and target coronary lesion length (L) were assessed by the RT, junior IC (JIC), and senior IC (SIC) and then compared. SIC evaluation, which determined the final stent selection for coronary stenting, was considered as a reference benchmark. RESULTS RT performance with QCA support in assessing target vessel size and target lesion length was not significantly different from SIC (r = 0.46, p < 0.01; r = 0.64, p < 0.001, respectively) as well as JIC (r = 0.79, r = 0.75, p < 0.001, respectively). JIC performance was significantly better than RT in assessing target vessel size (p < 0.05), while not significant when assessing target lesion length. CONCLUSIONS RT may reliably assess target lesion by using adequate QCA software in the cath-lab in case of PCI; RT performance does not differ from SIC.
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Affiliation(s)
| | | | | | - Andrea Cuculo
- Cardiology Department, University of Foggia Foggia Italy
| | | | - Luigi Ziccardi
- Cardiology Department, University of Foggia Foggia Italy
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Brunetti ND, Salvemini G, Cuculo A, Ruggiero A, De Gennaro L, Gaglione A, Di Biase M. Coronary artery ectasia is related to coronary slow flow and inflammatory activation. Atherosclerosis 2014; 233:636-640. [PMID: 24553454 DOI: 10.1016/j.atherosclerosis.2014.01.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/18/2013] [Accepted: 01/07/2014] [Indexed: 01/30/2023]
Abstract
AIM To evaluate possible links between coronary flow anomalies, inflammatory activation and coronary artery ectasia (CAE). METHODS Fourteen consecutive patients with CAE diagnosed at coronary angiography were enrolled in the study and compared with 17 patients with coronary atherosclerosis without CAE and 15 controls with normal coronary angiography. All patients underwent blood assay with evaluation of circulating levels of interleukin (IL)-1b, IL-2, IL-8, IL-10 and tumor-necrosis-factor(TNF)-α. The number of coronary segments showing CAE at coronary angiography, the Markis class, and coronary flow assessed with TIMI frame count (TFC) were also assessed. RESULTS Subjects with CAE showed higher levels of IL-1b, TNF-α, and IL-10 (p<0.05). The number of coronary segments showing CAE was related to TFC both in left anterior descending (LAD) coronary artery (p<0.01) and in right coronary artery (RCA) (p<0.001), and to circulating levels of IL-1b and IL-10 (p<0.01). TFC on LAD (p<0.05) and on RCA (p<0.001), circulating IL-1b levels (p<0.01), IL-8 (p<0.05), and IL-10 (p<0.01) were proportionally increased comparing controls, subjects with coronary atherosclerosis without CAE, and with decreasing Markis class. In subjects with CAE involving LAD, TFC on LAD was related to IL-8 and TNF-α levels (p<0.05); subjects with IL-1b levels above median showed higher TFC values on LAD (p<0.01), CONCLUSIONS: In subjects with CAE, the extension of disease is related to the impairment of coronary circulation and to inflammatory activation. The inflammatory response is also related to an impaired coronary circulation.
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Affiliation(s)
| | - Giuseppe Salvemini
- University of Foggia, Cardiology Department, Viale Pinto 1, 71100 Foggia, Italy
| | - Andrea Cuculo
- University of Foggia, Cardiology Department, Viale Pinto 1, 71100 Foggia, Italy
| | - Antonio Ruggiero
- University of Foggia, Cardiology Department, Viale Pinto 1, 71100 Foggia, Italy
| | - Luisa De Gennaro
- University of Foggia, Cardiology Department, Viale Pinto 1, 71100 Foggia, Italy
| | - Antonio Gaglione
- University of Foggia, Cardiology Department, Viale Pinto 1, 71100 Foggia, Italy
| | - Matteo Di Biase
- University of Foggia, Cardiology Department, Viale Pinto 1, 71100 Foggia, Italy
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Brunetti ND, Correale M, De Gennaro L, Cuculo A, Pellegrino PL, Di Biase M. Blunted inflammatory response in STEMI patients timely reperfused. J Cardiovasc Med (Hagerstown) 2014; 15:48-52. [DOI: 10.2459/jcm.0b013e328365c13a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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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Brunetti N, De Gennaro L, Cuculo A, Gaglione A, Di Biase M. History of allergy is a predictor of adverse events in unstable angina treated with coronary angioplasty. Allergol Immunopathol (Madr) 2013; 41:25-9. [PMID: 22417939 DOI: 10.1016/j.aller.2011.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 11/20/2011] [Accepted: 12/03/2011] [Indexed: 12/25/2022]
Abstract
BACKGROUND The aim was to investigate prognostic relevance of history of allergy in subjects with unstable angina treated with coronary angioplasty. METHODS Fifty-seven consecutive patients with unstable angina who underwent coronary angioplasty were enrolled in the study and were divided into two groups: those with a history of allergy (Group A, N = 15); and controls (Group C, N =42). Major adverse cardiac events were recorded over a six-month follow-up period. Patients with primary or unsuccessful angioplasty and patients treated with drug eluting stent were excluded from the study. RESULTS Group A patients (history of allergy) showed a 46.67% incidence of major adverse cardiac events at six-month follow-up (vs. 9.52% Group C, p < 0.01): results remained significant even in a multiple Cox regression analysis (hazard ratio 7.17, 95% CI 1.71-29.98, p < 0.01). CONCLUSION History of allergy is an independent predictor of major adverse cardiac events after coronary angioplasty in a six-month follow-up period in unstable angina.
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Santoro F, Ferraretti A, Centola A, Cuculo A, Totaro A, Cocco D, Di Biase M, Brunetti ND. Early clinical presentation of diffuse, severe, multi-district atherosclerosis after radiation therapy for Hodgkin lymphoma. Int J Cardiol 2012; 165:373-4. [PMID: 22981279 DOI: 10.1016/j.ijcard.2012.08.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
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Brunetti ND, Centola A, Campanale EG, Cuculo A, Ruggiero A, Ziccardi L, De Gennaro L, Di Biase M. How should I treat a "swinging" left main thrombosis complicating coronary angioplasty in an obese, diabetic, elderly woman treated with fondaparinux? EUROINTERVENTION 2012; 7:1470-5. [PMID: 22522557 DOI: 10.4244/eijv7i12a229] [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: 11/23/2022]
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De Gennaro L, Brunetti ND, Montrone D, De Rosa F, Cuculo A, Di Biase M. Inflammatory activation and carbohydrate antigen-125 levels in subjects with atrial fibrillation. Eur J Clin Invest 2012; 42:371-5. [PMID: 21913917 DOI: 10.1111/j.1365-2362.2011.02592.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) might be associated with an inflammatory activation and reduced left ventricular (LV) function. Less is known with regard to newly introduced markers of LV dysfunction such as carbohydrate antigen-125 (CA-125) in subjects with AF. The aim of this study was therefore to assess possible associations between AF, inflammatory markers and CA-125. METHODS AND RESULTS Forty-eight consecutive patients with AF and 58 control patients in sinus rhythm were enrolled in this study. Patients with acute heart failure, chronic inflammatory or neoplastic disease were excluded from the study. Circulating levels of hs-C-reactive protein (CRP), interleukin-8 (IL-8), IL-6, soluble IL-2 receptor (sIL-2r), TNF-α and CA-125 were assessed; all patients underwent clinical examination with NYHA class assessment and echocardiography. Patients with AF were characterised by higher levels of IL-8 (180 ± 266 vs. 39 ± 43 pg/mL, P < 0·001), sIL-2r (987 ± 1045 vs. 680 ± 336 U/mL, P < 0·05) and TNF-α (26 ± 25 vs. 9 ± 4 pg/mL, P < 0·001). Patients with AF duration < 6 months had higher levels of CRP (54 ± 73 vs. 12 ± 14 mg/dL, P < 0·05) and IL-8 (251 ± 225 vs. 99 ± 123 pg/mL, P < 0·05) when compared with AF duration > 6 months. CA-125 levels were not statistically different if comparing subjects with AF with controls and AF > 6 months with AF < 6 months. Among patients with AF, CA-125 levels were significantly related to NYHA class, (r = 0·33, P < 0·05) as well as IL-6 levels (r = 0·31, P < 0·05). Results remained statistically significant even after multivariable correction for age, gender and LV ejection fraction. RESULTS AND CONCLUSION AF is characterised by an inflammatory activation. Impaired functional class in AF subjects might be associated with increased CA-125 levels and higher inflammatory markers.
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Brunetti ND, Cuculo A, Ruggiero A, Ziccardi L, De Gennaro L, Correale M, Di Biase M. Coronary atherosclerosis and a rare combination of congenital coronary anomalies in ST-elevation acute myocardial infarction. J Cardiovasc Med (Hagerstown) 2012; 13:269-70. [PMID: 22367576 DOI: 10.2459/jcm.0b013e328351dbca] [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: 11/05/2022]
Abstract
A 68-year-old man with anterior ST-elevation acute myocardial infarction was treated with primary angioplasty of the proximal left anterior descending (LAD) artery. Coronary angiography showed coronary atherosclerosis and a rare combination of congenital coronary anomalies on other coronary vessels (myocardial bridge on mid-LAD and ectopic origin of the circumflex coronary). Coronary angioplasty on the ectopic circumflex was therefore required.
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Brunetti ND, Centola A, Campanale EG, Cuculo A, Ruggiero A, Ziccardi L, De Gennaro L, Di Biase M. Coronary angioplasty in an adult with acute myocardial infarction and aortic coarctation diagnosed during catheterization. J Cardiovasc Med (Hagerstown) 2011; 13:209-10. [PMID: 21926636 DOI: 10.2459/jcm.0b013e32834abf18] [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: 11/05/2022]
Abstract
We report the case of a 52-year-old man with acute myocardial infarction and diagnosis of severe aortic coarctation in concomitance with coronary angiography. Coronary angioplasty on the left anterior descending coronary artery was performed with the femoral approach. Aortic coarctation was confirmed at three-dimensional computed tomography.
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Brunetti ND, Centola A, Campanale EG, Guaricci AI, Ieva R, Cuculo A, Ziccardi L, De Gennaro L, Di Biase M. A worrisome ‘normal’ ECG: implementation of multislice coronary CT scan in an integrated approach to ST-elevation suspected as not associated with acute coronary syndrome. J Cardiovasc Med (Hagerstown) 2011; 12:516-7. [DOI: 10.2459/jcm.0b013e32834672a3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Brunetti ND, Munno I, Pellegrino PL, Ruggero V, Correale M, De Gennaro L, Cuculo A, Campanale EG, Di Biase M. Inflammatory cytokines imbalance in the very early phase of acute coronary syndrome: correlations with angiographic findings and in-hospital events. Inflammation 2011; 34:58-66. [PMID: 20405189 DOI: 10.1007/s10753-010-9208-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The aim of this study is to investigate the release of some inflammatory cytokines (Cks) during the very early phase (first 24 h) of acute coronary syndrome (ACS). Twenty-six consecutive subjects admitted to coronary care unit with ACS underwent serial blood sampling in order to evaluate concentrations of interleukin (IL)-2, IL-10, IL-18, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ. Blood samples were taken within 6 h after onset of chest pain (T₀), at 12 h (T₁), and at 24 h (T₂). Patients were thus divided into four groups comparing pro-inflammatory Ck release (IL-2, TNF-α, and IFN-γ) and anti-inflammatory activity (IL-10). Clinical features, risk factors, incidence of adverse events, and coronary angiography findings were compared with Ck activation. Ck levels were significantly increased if compared with baseline. Subjects with marked inflammatory response showed a higher incidence of left anterior descending coronary disease (IL-2, p < 0.001; TNF-α and IFN-γ, p < 0.05) and more often incurred early complications (IL-2, p < 0.05; IFN-γ, p < 0.001). A correlation was detectable between IL-18 levels and myocardial enzyme release (creatine kinase, r = 0.47; lactate dehydrogenase, r = 0.54; troponin I, r = 0.58; p < 0.05). TNF-α levels were associated with a worse prognosis at follow-up (Log rank, p < 0.05). A Ck activation characterizes the early phase of ACS. Early inflammatory reaction seems to correlate with coronary disease and adverse events.
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Brunetti ND, De Gennaro L, Pellegrino PL, Cuculo A, Ziccardi L, Gaglione A, Di Biase M. Direct renin inhibition: update on clinical investigations with aliskiren. ACTA ACUST UNITED AC 2011; 18:424-37. [PMID: 21450645 DOI: 10.1177/1741826710389387] [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: 01/13/2023]
Abstract
The renin–angiotensin–aldosterone system (RAAS) plays a pivotal role in regulating blood pressure, volume, and electrolytes. The final product of RAAS cascade is angiotensin II, which exerts diverse biological activities via binding to one of three known receptor types, with different binding consequences. Despite the success with conventional strategies to limit angiotensin II production and action, these agents promote a reflex rise in plasma renin activity, which is thought to be associated with an increased incidence of cardiovascular events. Several renin inhibitors have been synthesized in order to counteract deleterious consequences of renin activity and RAAS activation; aliskiren is the first of these new non-peptide direct renin inhibitors to be approved for the treatment of hypertension. The paper reviews pharmacokinetics of aliskiren and its role in hypertension, with particular regard to those studies that compared clinical efficacy of aliskiren in comparison and in addition to other antihypertensive drug strategies.
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Brunetti ND, Centola A, Campanale EG, Cuculo A, Ruggiero A, Ziccardi L, Gennaro LD, Biase MD. Three-vessel coronary artery disease with multi-vessel proximal aneurysms. Acute Card Care 2010; 12:77-78. [PMID: 20443654 DOI: 10.3109/17482941003792968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We report the case of a 47-year-old man, referred for chest pain radiating to jaws associated with sweating. At coronary angiography, left anterior descending coronary artery was occluded with distal perfusion by collateral flow, and proximal coronary aneurysms involving proximal left circumflex (LCX) right coronary artery with diffuse coronary atherosclerosis were present. Coronary thrombosis was also present into LCX proximal aneurysm.
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Brunetti ND, Centola A, Campanale EG, Cuculo A, Ziccardi L. Combined Finding of Left Ventricular Non-Compaction and Dilated Cardiomyopathy. Exp Clin Cardiol 2010. [DOI: 10.4172/2155-9880.1000113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Brunetti ND, Correale M, Ieva R, De Gennaro L, Pellegrino PL, Cuculo A, Biase MD. An unusual case of left anterior descending coronary artery occlusion—anterior ST depression and inferior ST elevation. J Electrocardiol 2009; 42:449-52. [DOI: 10.1016/j.jelectrocard.2009.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Indexed: 11/27/2022]
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Brunetti ND, De Gennaro L, Correale M, Pellegrino PL, Cuculo A, Di Biase M. Les liaisons dangereuses: Tako-Tsubo syndrome after an adulterous intercourse in an elderly male. Int J Cardiol 2009; 149:e113-7. [PMID: 19564056 DOI: 10.1016/j.ijcard.2009.05.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 05/30/2009] [Indexed: 12/14/2022]
Abstract
We report the case of an 81-year-old man who presented with chest pain after an adulterous intercourse with a young woman. At echocardiography a typical apical ballooning phenomenon was detectable and completely reversed after one week. Coronary angiography did not show significant coronary atherosclerosis.
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De Gennaro L, Brunetti ND, Cuculo A, Pellegrino PL, Di Biase M. Systemic inflammation in nonischemic dilated cardiomyopathy. Heart Vessels 2008; 23:445-50. [DOI: 10.1007/s00380-008-1075-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 06/01/2008] [Indexed: 11/29/2022]
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Brunetti ND, Ieva R, Rossi G, Barone N, De Gennaro L, Pellegrino PL, Mavilio G, Cuculo A, Di Biase M. Ventricular outflow tract obstruction, systolic anterior motion and acute mitral regurgitation in Tako-Tsubo syndrome. Int J Cardiol 2008; 127:e152-7. [PMID: 17692942 DOI: 10.1016/j.ijcard.2007.04.149] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Accepted: 04/23/2007] [Indexed: 10/23/2022]
Abstract
Tako-Tsubo syndrome is characterized by ECG changes mimicking acute myocardial infarction, left ventricular wall motion abnormalities in the apical region with preserved function of base, and normal coronary arteries. We report the cases of two old women, presenting apical akinesis, basal hyperkinesis, severe systolic dysfunction and severe mitral regurgitation (MR). Doppler echocardiography showed a left ventricular outflow tract obstruction (LVOTO), systolic anterior motion (SAM) of the mitral valve anterior leaflet. The patients recovered and, early later, left ventricular ejection fraction was documented as normal at echocardiography. The contemporary presence of LVOTO, SAM and MR might explain worsening of heart failure or incidence of cardiogenic shock in some patients with Tako-Tsubo syndrome.
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Brunetti ND, De Gennaro L, Pellegrino PL, Ieva R, Di Nardo F, Cuculo A, Campanale G, Di Biase M. Intra day ECG variation after general anesthesia in Brugada syndrome. J Interv Card Electrophysiol 2008; 21:219-22. [DOI: 10.1007/s10840-007-9196-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 12/04/2007] [Indexed: 11/29/2022]
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Brunetti ND, Pellegrino PL, Correale M, De Gennaro L, Cuculo A, Di Biase M. Acute phase proteins and systolic dysfunction in subjects with acute myocardial infarction. J Thromb Thrombolysis 2007; 26:196-202. [PMID: 18038115 DOI: 10.1007/s11239-007-0088-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 08/06/2007] [Indexed: 08/30/2023]
Abstract
AIM To investigate correlations between plasmatic concentrations of acute phase proteins (APPs) and left ventricular systolic function during the early phase of acute myocardial infarction. METHODS Plasmatic concentrations of alpha-1-anti-trypsin (A1AT), alpha 1 glyco-protein (A1GP), haptoglobin (HG), caeruloplasmin (CP) and C-reactive protein (CRP) were evaluated in 123 patients with ST elevation acute myocardial infarction (STEMI) within 12 h after onset of chest pain. Systolic function was assessed with bi-dimensional echography and incidence of in-hospital adverse events was compared to APPs levels. RESULTS A1AT, A1GP, HG and CP showed a statistically significant correlation with admission CRP concentrations (P < 0.001). Left ventricular ejection fraction inversely correlated with plasmatic concentrations of A1GP, A1AT, CP and HG. Incidence of acute heart failure correlated with values of APPs and, in a stepwise analysis, CP values were the most significant markers of acute heart failure. CONCLUSIONS Systolic dysfunction in STEMI patients seems to be associated with an inflammatory response featured by a rise in plasmatic concentration of APPs; increase in APPs concentrations seems to own a short-term prognostic relevance.
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Brunetti N, Cuculo A, Pellegrino P, De Gennaro L, Di Biase M. Non-cardiovascular determinants of C-reactive protein levels in patients with cardiovascular diseases. Int J Cardiol 2007. [DOI: 10.1016/j.ijcard.2006.08.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brunetti ND, Munno I, Pellegrino PL, Ruggiero V, Correale M, Cuculo A, De Gennaro L, Campanale G, Mavilio G, Ziccardi L, Di Biase M. Inflammatory Cytokine Imbalance after Coronary Angioplasty: Links with Coronary Atherosclerosis. J Interv Cardiol 2007; 20:248-57. [PMID: 17680854 DOI: 10.1111/j.1540-8183.2007.00266.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIM To investigate release of some inflammatory cytokines (Cys) after coronary angioplasty and its links with coronary atherosclerosis. METHODS Twenty-seven consecutive subjects with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) were enrolled in the study: serial blood samples were taken in order to evaluate plasma concentrations of Interleukin (IL)-2, IL-10, IL-18, TNFalpha, and IFNgamma just before PCI at 12 and 24 hours. Patients were then divided, considering balance between each inflammatory Cy and IL-10, an antiinflammatory Cy, into four groups, ranging from a prevalent antiinflammatory response (stable inflammatory Cy-increasing IL-10 values) to a marked inflammatory imbalance (increasing inflammatory Cy-stable IL-10 values). RESULTS All Cys showed significant increases in plasma concentrations if compared with baseline values. Release curves were not significantly different when comparing subjects with ST-elevation myocardial infarction (STEMI) versus unstable angina-non-STEMI (UA-NSTEMI), diabetics versus controls. Subjects with marked inflammatory response showed a higher incidence of stenosis on left anterior descending (LAD) coronary artery (IL-2 chi(2) and IFNgamma P < 0.05); Cy release was higher in patients with multivessel coronary disease (IL-2 and IFNgamma, ANOVA P < 0.01). Correlations were also referable between Cys and myocardial enzyme release. Subjects treated with sirolimus-eluting stents (SES) showed significantly lower Cy periprocedure ratio if compared with those treated with bare metal stents. CONCLUSIONS A significant Cy release is detectable after PCI: inflammatory response seems to correlate with both PCI due to plaque instabilization and coronary atherosclerosis. A blunted inflammatory response is detectable in subjects treated with SES.
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Brunetti ND, Correale M, Pellegrino PL, Cuculo A, Biase MD. Acute phase proteins in patients with acute coronary syndrome: Correlations with diagnosis, clinical features, and angiographic findings. Eur J Intern Med 2007; 18:109-17. [PMID: 17338962 DOI: 10.1016/j.ejim.2006.07.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Revised: 05/18/2006] [Accepted: 07/06/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND C-reactive protein (CRP) plasma levels increase in patients with acute coronary syndrome (ACS). The role and implications of increased plasma concentrations of other acute phase proteins (APPs), such as alpha-1-antitrypsin (A1AT), alpha-1 glycoprotein (A1GP), haptoglobin (HG), ceruloplasmin (CP), and C3c and C4 complement fraction, in patients with ACS are still not completely defined. METHODS A total of 218 consecutive patients with ACS were included in the study, 185 with acute myocardial infarction (AMI) and 33 with unstable angina (UA). In all patients, A1AT, A1GP, HG, CP, C3c and C4 complement fraction, and CRP were evaluated within 12 h after the onset of symptoms. Sixty-two patients with AMI underwent coronary angiography. RESULTS APPs showed a significant correlation with CRP concentrations. Patients with AMI had higher concentrations of A1AT and HG than UA patients. Cholesterol levels were correlated with APPs in patients with AMI. Patients with three coronary vessel disease or LAD disease had significantly higher C3c concentrations. Coronary collateral flow was associated with higher A1GP and CP concentrations, and total coronary occlusion with A1AT and CP. CONCLUSIONS APPs were correlated with CRP concentrations in subjects with ACS. The increase in APPs in patients with ACS seems to be linked to the entity of myocardial damage and coronary atherosclerotic burden.
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Brunetti ND, Pellegrino PL, Mavilio G, Cuculo A, Ziccardi L, Correale M, Di Biase M. Spontaneous coronary dissection complicating unstable coronary plaque in young women with acute coronary syndrome: case reports. Int J Cardiol 2006; 115:105-7. [PMID: 16753230 DOI: 10.1016/j.ijcard.2005.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 12/10/2005] [Indexed: 11/28/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) causing acute myocardial infarction is a rare event. It occurs mostly in young women without traditional risk factors for coronary artery disease, particularly during the peripartum period. We describe two occurrences of SCAD in young women in whom coronary atherosclerosis was also present. In both cases, angiography showed extended coronary dissection on the left anterior descending coronary artery (LAD), starting from an atheromasic stenosis on the middle LAD segment. Coronary dissection could complicate an unstable atheromasic plaque, especially in young women presenting with acute coronary syndrome.
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Meo A, Quaranta G, Liuzzo G, Cuculo A, Summaria F, van de Greef W, Kluft C, Biasucci LM, Maseri A. [Clinical presentation of unstable angina may influence the formation of thrombin during spontaneous episodes of ischemia]. Cardiologia 1998; 43:493-7. [PMID: 9701880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In order to evaluate whether different clinical presentations of unstable angina are associated with a different degree or pattern of activation of the hemostatic, fibrinolytic and inflammatory systems, we measured plasma levels of thrombin-antithrombin III, plasmin-alpha2- antiplasmin complexes and C-reactive protein, as markers of activation of coagulation, fibrinolysis and inflammation respectively, in two groups of patients: 7 patients with de novo unstable angina (Group 1) and 7 patients with destabilizing unstable angina (Group 2). Blood samples were taken on admission for measuring levels of C-reactive protein and during ischemic episodes at the onset of ECG changes and pain (0 min) and after 5, 15 and 60 min in order to assess the peak values of thrombin-antithrombin III and plasmin-alpha2-antiplasmin during the episode. Thrombin-antithrombin III levels in Group 1 were 1.8 microgram/l (0.3-4.15) at 0 min and increased to 17 micrograms/l (2.8-60) after 5 to 15 min (p = 0.013); conversely thrombin-antithrombin III levels in Group 2 were 2.15 microgram/l (1.4-3.8) at 0 min and raised to 4 micrograms/l (2-43) after 5 to 15 min (NS). No significant differences in both groups were observed in plasmin-alpha2-antiplasmin levels (Group 1:650 micrograms/l, ranged 492-956, at 0 min vs 670 microgram/l, range 415-977, at peak; Group 2: 480 micrograms/l, range 274-955, at 0 min vs 502 micrograms/l, range 304-1027, at peak; NS). Inversely, C-reactive protein levels on admission were 4 mg/dl (range 2-27) in Group 1, and 1 mg/dl (range 0.6-4) in Group 2 (p = 0.006). In conclusion, patients with de novo unstable angina have significantly enhanced thrombin (but not plasmin) production during spontaneous ischemic episodes than patients with destabilizing unstable angina. Furthermore, patients with de novo unstable angina have enhanced acute phase responses than patients with destabilizing unstable angina. Our data suggest that different pathogenetic mechanisms may be responsible for acute ischemic episodes in unstable angina and may explain different response to antithrombotic therapy in unstable angina patients.
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Affiliation(s)
- A Meo
- Istituto di Cardiologia, Universitá Cattolica del Sacro Cuore, Roma
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Cuculo A, Summaria F, Schiavino D, Liuzzo G, Meo A, Patriarca G, Maseri A, Biasucci LM. [Tryptase levels are elevated during spontaneous ischemic episodes in unstable angina but not after the ergonovine test in variant angina]. Cardiologia 1998; 43:189-93. [PMID: 9557375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Activated mast cells are present in human coronary atheromas, as well as in the adventitia of patients with variant angina, and may play an important role in plaque rupture and coronary vasomotion. To assess whether or not activation of mast cells is a primary event, we measured serum levels of tryptase, a specific marker of mast cell activation, in 8 patients with unstable angina during a spontaneous ischemic episode (Group 1) and in 5 patients with variant angina (Group 2) during ergonovine-induced coronary spasm. Blood samples were collected as soon as possible after the onset of pain and ECG changes (0 min), and after 5, 15 and 60 min. Tryptase levels in Group 1 were 0.13 U/l (range 0.017-0.44) at the onset of pain and significantly raised to 0.75 U/l (range 0.05-2.49) at 5 min, decreasing to 0.076 U/l (range 0.018-0.16) at 15 min and to 0.085 U/l (range 0.01-0.25) at 60 min (p = 0.035). Conversely, tryptase levels in Group 2 were 0.09 U/l (range 0.07-0.13) at 0 min, 0.11 U/l (range 0.07-0.22) at 5 min, 0.10 U/l (range 0.07-0.18) at 15 min, 0.11 U/l (range 0.07-0.17) at 60 min (NS). In conclusion, tryptase levels raise during spontaneous ischemic episodes in unstable angina, but not after ergonovine-provoked ischemia in variant angina, suggesting that a primary, yet unknown stimulus, may activate mast cells during some ischemic episodes in unstable angina.
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Affiliation(s)
- A Cuculo
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma
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Monaco C, Rossi E, Milazzo D, Liuzzo G, Cuculo A, Citterio F, D'Onofrio G, van de Greef W, Meo A, Biasucci L, Maseri A. Different thrombotic and inflammatory patterns between unstable angina and peripheral vascular disease. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)80476-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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