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Aleksova A, Janjusevic M, Zhou XNO, Zandonà L, Chicco A, Stenner E, Beltrami AP, D'Errico S, Sinagra G, Marketou M, Fluca AL, Zwas DR. Persistence of vitamin D deficiency among Italian patients with acute myocardial infarction. Nutr Metab Cardiovasc Dis 2024; 34:1283-1294. [PMID: 38494368 DOI: 10.1016/j.numecd.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/18/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND AIMS Vitamin D deficiency is a common cardiovascular risk factor associated with the development of atherosclerosis. We evaluated changes in 25(OH)D concentrations in 1510 patients with acute myocardial infarction (AMI) over a long observation period, including the COVID-19 pandemic. METHODS AND RESULTS Patients were separated into four groups according to the year of enrolment, group 1 (2009-2010), group 2 (2014-2016), group 3 (2017-2019), and group 4 (2020-2022). The median 25(OH)D concentration in the overall cohort was 17.15 (10.3-24.7) ng/mL. The median plasma concentrations of 25(OH)D for groups 1, 2, 3, and 4 were 14.45 (7.73-22.58) ng/mL, 17.3 ng/mL (10.33-24.2), 18.95 (11.6-26.73) ng/mL and 19.05 (12.5-27.3) ng/mL, respectively. Although 25(OH)D levels increased over the years, the prevalence of vitamin D deficiency remained high in each group (68.4%, 61.4%, 53.8%, and 52% respectively). Hypovitaminosis D was predicted by the season influence (OR:2.03, p < 0.0001), higher body mass index (OR:1.25; p = 0.001), diabetes mellitus (OR:1.54; p = 0.001), smoking (OR:1.47; p = 0.001), older age (OR:1.07; p = 0.008), higher triglycerides levels (OR:1.02; p = 0.01), and female gender (OR:1.3; p = 0.038). After multivariable adjustment, vitamin D ≤ 20 ng/mL was an independent predictor of mortality. CONCLUSION Vitamin D deficiency is highly prevalent and persistent in patients with AMI despite a trend towards increasing 25(OH)D concentrations over the years. The frequent lockdowns did not reduce the levels of 25(OH)D in the fourth group. Low levels of 25(OH)D are an independent predictor of mortality.
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Affiliation(s)
- Aneta Aleksova
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Milijana Janjusevic
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Xin Ning Oriana Zhou
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Lorenzo Zandonà
- SC Laboratorio Unico, Ospedale Maggiore, ASUGI, 34125 Trieste, Italy
| | - Andrea Chicco
- SC Laboratorio Unico, Ospedale Maggiore, ASUGI, 34125 Trieste, Italy
| | - Elisabetta Stenner
- Department of Diagnostics, Azienda USL Toscana Nordovest, 57100 Livorno, Italy
| | | | - Stefano D'Errico
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Maria Marketou
- Heraklion University General Hospital, University of Crete, School of Medicine, Cardiology Department Crete, Greece
| | - Alessandra Lucia Fluca
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Donna R Zwas
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Heart Institute, Hadassah University Medical Center, Jerusalem, Israel
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Peruch M, Giacomello E, Radaelli D, Concato M, Addobbati R, Fluca AL, Aleksova A, D’Errico S. Subcellular Effectors of Cocaine Cardiotoxicity: All Roads Lead to Mitochondria-A Systematic Review of the Literature. Int J Mol Sci 2023; 24:14517. [PMID: 37833964 PMCID: PMC10573028 DOI: 10.3390/ijms241914517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Cocaine abuse is a serious public health problem as this drug exerts a plethora of functional and histopathological changes that potentially lead to death. Cocaine causes complex multiorgan toxicity, including in the heart where the blockade of the sodium channels causes increased catecholamine levels and alteration in calcium homeostasis, thus inducing an increased oxygen demand. Moreover, there is evidence to suggest that mitochondria alterations play a crucial role in the development of cocaine cardiotoxicity. We performed a systematic review according to the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) scheme to evaluate the mitochondrial mechanisms determining cocaine cardiotoxicity. Among the initial 106 articles from the Pubmed database and the 17 articles identified through citation searching, 14 final relevant studies were extensively reviewed. Thirteen articles included animal models and reported the alteration of specific mitochondria-dependent mechanisms such as reduced energy production, imbalance of membrane potential, increased oxidative stress, and promotion of apoptosis. However, only one study evaluated human cocaine overdose samples and observed the role of cocaine in oxidative stress and the induction of apoptosis though mitochondria. Understanding the complex processes mediated by mitochondria through forensic analysis and experimental models is crucial for identifying potential therapeutic targets to mitigate or reverse cocaine cardiotoxicity in humans.
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Affiliation(s)
- Michela Peruch
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.P.); (E.G.); (D.R.); (M.C.); (A.L.F.); (A.A.)
| | - Emiliana Giacomello
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.P.); (E.G.); (D.R.); (M.C.); (A.L.F.); (A.A.)
| | - Davide Radaelli
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.P.); (E.G.); (D.R.); (M.C.); (A.L.F.); (A.A.)
| | - Monica Concato
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.P.); (E.G.); (D.R.); (M.C.); (A.L.F.); (A.A.)
| | - Riccardo Addobbati
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
| | - Alessandra Lucia Fluca
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.P.); (E.G.); (D.R.); (M.C.); (A.L.F.); (A.A.)
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34149 Trieste, Italy
| | - Aneta Aleksova
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.P.); (E.G.); (D.R.); (M.C.); (A.L.F.); (A.A.)
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34149 Trieste, Italy
| | - Stefano D’Errico
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.P.); (E.G.); (D.R.); (M.C.); (A.L.F.); (A.A.)
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Cattaneo M, Aleksova A, Malovini A, Avolio E, Thomas A, Alvino VV, Kilcooley M, Pieronne-Deperrois M, Ouvrard-Pascaud A, Maciag A, Spinetti G, Kussauer S, Lemcke H, Skorska A, Vasudevan P, Castiglione S, Raucci A, David R, Richard V, Beltrami AP, Madeddu P, Puca AA. BPIFB4 and its longevity-associated haplotype protect from cardiac ischemia in humans and mice. Cell Death Dis 2023; 14:523. [PMID: 37582912 PMCID: PMC10427721 DOI: 10.1038/s41419-023-06011-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023]
Abstract
Long-living individuals (LLIs) escape age-related cardiovascular complications until the very last stage of life. Previous studies have shown that a Longevity-Associated Variant (LAV) of the BPI Fold Containing Family B Member 4 (BPIFB4) gene correlates with an extraordinarily prolonged life span. Moreover, delivery of the LAV-BPIFB4 gene exerted therapeutic action in murine models of atherosclerosis, limb ischemia, diabetic cardiomyopathy, and aging. We hypothesize that downregulation of BPIFB4 expression marks the severity of coronary artery disease (CAD) in human subjects, and supplementation of the LAV-BPIFB4 protects the heart from ischemia. In an elderly cohort with acute myocardial infarction (MI), patients with three-vessel CAD were characterized by lower levels of the natural logarithm (Ln) of peripheral blood BPIFB4 (p = 0.0077). The inverse association between Ln BPIFB4 and three-vessel CAD was confirmed by logistic regression adjusting for confounders (Odds Ratio = 0.81, p = 0.0054). Moreover, in infarcted mice, a single administration of LAV-BPIFB4 rescued cardiac function and vascularization. In vitro studies showed that LAV-BPIFB4 protein supplementation exerted chronotropic and inotropic actions on induced pluripotent stem cell (iPSC)-derived cardiomyocytes. In addition, LAV-BPIFB4 inhibited the pro-fibrotic phenotype in human cardiac fibroblasts. These findings provide a strong rationale and proof of concept evidence for treating CAD with the longevity BPIFB4 gene/protein.
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Grants
- PG/18/66/33838 British Heart Foundation
- British Heart Foundation (BHF)
- Ministery of health RF-2016-02364864 IRCCS MultiMedica
- the Italian Ministry of Health, Ricerca Corrente to the Centro Cardiologico Monzino IRCCS
- EU structural Fund (ESF/14-BM-A55-0024/18), the DFG (DA1296/6-1), the German Heart Foundation (F/01/12), the FORUN Program of Rostock University Medical Centre (889001 and 889003),the Josef and Käthe Klinz Foundation (T319/29737/2017), the DAMP Foundation and the BMBF (VIP+ 00240).
- Regione Friuli Venezia Giulia, within the framework of “legge regionale 17/2004: Contributi per la ricerca clinica, traslazionale, di base, epidemiologica e organizzativa”; Project HEARTzheimer"
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Affiliation(s)
| | - Aneta Aleksova
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Alberto Malovini
- Laboratory of Informatics and Systems Engineering for Clinical Research, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Elisa Avolio
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anita Thomas
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Michael Kilcooley
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Anna Maciag
- Cardiovascular Department, IRCCS MultiMedica, Milan, Italy
| | - Gaia Spinetti
- Cardiovascular Department, IRCCS MultiMedica, Milan, Italy
| | - Sophie Kussauer
- Department of Cardiac Surgery, Rostock University Medical Center, Rostock, Germany
- Faculty of Interdisciplinary Research, Department Life, Light & Matter, University Rostock, Rostock, Germany
| | - Heiko Lemcke
- Department of Cardiac Surgery, Rostock University Medical Center, Rostock, Germany
- Faculty of Interdisciplinary Research, Department Life, Light & Matter, University Rostock, Rostock, Germany
| | - Anna Skorska
- Department of Cardiac Surgery, Rostock University Medical Center, Rostock, Germany
- Faculty of Interdisciplinary Research, Department Life, Light & Matter, University Rostock, Rostock, Germany
| | - Praveen Vasudevan
- Department of Cardiac Surgery, Rostock University Medical Center, Rostock, Germany
- Faculty of Interdisciplinary Research, Department Life, Light & Matter, University Rostock, Rostock, Germany
| | - Stefania Castiglione
- Experimental Cardio-oncology and Cardiovascular Aging Unit Centro Cardiologico Monzino, Milan, Italy
| | - Angela Raucci
- Experimental Cardio-oncology and Cardiovascular Aging Unit Centro Cardiologico Monzino, Milan, Italy
| | - Robert David
- Department of Cardiac Surgery, Rostock University Medical Center, Rostock, Germany
- Faculty of Interdisciplinary Research, Department Life, Light & Matter, University Rostock, Rostock, Germany
| | | | - Antonio Paolo Beltrami
- Department of Medicine, University of Udine, Academic Hospital of Udine, ASUFC, Udine, Italy
| | - Paolo Madeddu
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Annibale Alessandro Puca
- Cardiovascular Department, IRCCS MultiMedica, Milan, Italy.
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.
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Pierri A, Gagno G, Fluca A, Radaelli D, Bonuccelli D, Giusti L, Bulfoni M, Beltrami AP, Aleksova A, D’Errico S. COVID-19-Related Myocarditis: Are We There Yet? A Case Report of COVID-19-Related Fulminant Myocarditis. Biomedicines 2023; 11:2101. [PMID: 37626600 PMCID: PMC10452198 DOI: 10.3390/biomedicines11082101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023] Open
Abstract
There is increasing evidence of cardiac involvement in COVID-19 cases, with a broad range of clinical manifestations spanning from acute life-threatening conditions such as ventricular dysrhythmias, myocarditis, acute myocardial ischemia and pulmonary thromboembolism to long-term cardiovascular sequelae. In particular, acute myocarditis represents an uncommon but frightening complication of SARS-CoV-2 infection. Even if many reports of SARS CoV-2 myocarditis are present in the literature, the majority of them lacks histological confirmation of cardiac injury. Here, we report a case of a young lady, who died suddenly a few days after testing positive for SARS-CoV-2, whose microscopic and genetics features suggested a direct cardiac involvement compatible with fulminant myocarditis.
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Affiliation(s)
- Alessandro Pierri
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34139 Trieste, Italy; (A.P.); (G.G.); (A.F.); or (A.A.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34139 Trieste, Italy;
| | - Giulia Gagno
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34139 Trieste, Italy; (A.P.); (G.G.); (A.F.); or (A.A.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34139 Trieste, Italy;
| | - Alessandra Fluca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34139 Trieste, Italy; (A.P.); (G.G.); (A.F.); or (A.A.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34139 Trieste, Italy;
| | - Davide Radaelli
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34139 Trieste, Italy;
| | - Diana Bonuccelli
- Department of Legal Medicine, Azienda USL Toscana Nordovest, 55100 Lucca, Italy;
| | - Laura Giusti
- Department of Human Pathology, San Luca Hospital, Azienda USL Toscana Nordovest, 55100 Lucca, Italy;
| | - Michela Bulfoni
- Institute of Clinical Pathology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; (M.B.); (A.P.B.)
| | - Antonio P. Beltrami
- Institute of Clinical Pathology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; (M.B.); (A.P.B.)
| | - Aneta Aleksova
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34139 Trieste, Italy; (A.P.); (G.G.); (A.F.); or (A.A.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34139 Trieste, Italy;
| | - Stefano D’Errico
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34139 Trieste, Italy;
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Gortan Cappellari G, Aleksova A, Dal Ferro M, Cannatà A, Semolic A, Guarnaccia A, Zanetti M, Giacca M, Sinagra G, Barazzoni R. n-3 PUFA-Enriched Diet Preserves Skeletal Muscle Mitochondrial Function and Redox State and Prevents Muscle Mass Loss in Mice with Chronic Heart Failure. Nutrients 2023; 15:3108. [PMID: 37513526 PMCID: PMC10383889 DOI: 10.3390/nu15143108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Rationale and Methods: Skeletal muscle derangements, potentially including mitochondrial dysfunction with altered mitochondrial dynamics and high reactive oxygen species (ROS) generation, may lead to protein catabolism and muscle wasting, resulting in low exercise capacity and reduced survival in chronic heart failure (CHF). We hypothesized that 8-week n-3-PUFA isocaloric partial dietary replacement (Fat = 5.5% total cal; EPA + DHA = 27% total fat) normalizes gastrocnemius muscle (GM) mitochondrial dynamics regulators, mitochondrial and tissue pro-oxidative changes, and catabolic derangements, resulting in preserved GM mass in rodent CHF [Myocardial infarction (MI)-induced CHF by coronary artery ligation, left-ventricular ejection fraction <50%]. Results: Compared to control animals (Sham), CHF had a higher GM mitochondrial fission-fusion protein ratio, with low ATP and high ROS production, pro-inflammatory changes, and low insulin signalling. n-3-PUFA normalized all mitochondrial derangements and the pro-oxidative state (oxidized to total glutathione ratio), associated with normalized GM cytokine profile, and enhanced muscle-anabolic insulin signalling and prevention of CHF-induced GM weight loss (all p < 0.05 vs. CHF and p = NS vs. S). Conclusions:n-3-PUFA isocaloric partial dietary replacement for 8 weeks normalizes CHF-induced derangements of muscle mitochondrial dynamics regulators, ROS production and function. n-3-PUFA mitochondrial effects result in preserved skeletal muscle mass, with potential to improve major patient outcomes in clinical settings.
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Affiliation(s)
- Gianluca Gortan Cappellari
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy
| | - Aneta Aleksova
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128 Trieste, Italy
| | - Matteo Dal Ferro
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128 Trieste, Italy
| | - Antonio Cannatà
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128 Trieste, Italy
| | - Annamaria Semolic
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy
| | - Alberto Guarnaccia
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128 Trieste, Italy
| | - Michela Zanetti
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy
| | - Mauro Giacca
- School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London WC2R 2LS, UK
- Molecular Medicine Laboratory, International Centre for Genetic, Engineering and Biotechnology (ICGEB), 34149 Trieste, Italy
| | - Gianfranco Sinagra
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128 Trieste, Italy
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy
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Marcori S, Pezzato A, Hinojosa AK, Gant A, Uliana A, Koni M, Rakar S, Aleksova A, Sinagra G, Merlo M. [Out-of-hospital cardiac arrest: University of Trieste students' skills on resuscitative maneuvers and automated external defibrillator]. G Ital Cardiol (Rome) 2023; 24:310-317. [PMID: 36971175 DOI: 10.1714/4004.39822] [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: 03/29/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest is the third leading cause of death in industrialized countries. Although most cardiac arrests are witnessed, survival is only 2-10%, since bystanders are often unable to correctly perform cardiopulmonary resuscitation (CPR). This study aims to assess the theoretical and practical knowledge of CPR and the use of the automatic external defibrillator in university students. METHODS The study involved a total of 1686 students from 21 different faculties of the University of Trieste, 662 students from healthcare faculties and 1024 from non-healthcare faculties. Basic life support and early defibrillation (BLS-D) courses and retrainings after 2 years are mandatory for students in their final 2-year healthcare faculties at the University of Trieste. Through the platform "EUSurvey" from March to June 2021, they were given an online questionnaire of 25 multiple choice questions to investigate the performance of BLS-D. RESULTS In the overall population, 68.7% knew how to diagnose a cardiac arrest and 47.5% knew the time frame after which irreversible brain damage occurs. Practical knowledge was analyzed by evaluating the correct answers to all four questions on performing CPR (i.e. hand position during compressions, frequency of compressions, depth of compressions, and ventilation-compression ratio). Health faculties students have better theoretical and practical knowledge of CPR than their colleagues of non-healthcare faculties, with better overall knowledge on the all four practical questions (11.2% vs 4.3%; p<0.001). Final-year medical students of the University of Trieste, who attended the BLS-D course and underwent retraining after 2 years, have achieved better results than first year medical students (without BLS-D training) (38.1% vs 2.7%; p<0.001). CONCLUSION Mandatory BLS-D training and retraining leads to a better knowledge of cardiac arrest management and consequently a better patient outcome. In order to improve patient survival, heartsaver (BLS-D for laics) training should be extended as obligatory in all university courses.
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Affiliation(s)
| | | | - Ana Karina Hinojosa
- Corso di Laurea in Infermieristica, Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Alessia Gant
- S.C. Medicina d'Urgenza, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Andrea Uliana
- Sistema 118, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Miranda Koni
- S.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Trieste
| | - Serena Rakar
- S.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Trieste
| | - Aneta Aleksova
- S.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Trieste
| | - Gianfranco Sinagra
- S.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Trieste
| | - Marco Merlo
- S.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Trieste
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7
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Gortan Cappellari G, Aleksova A, Dal Ferro M, Cannatà A, Semolic A, Zanetti M, Giacca M, Sinagra G, Barazzoni R. N-3 Pufa Enriched Diet Preserves Skeletal Muscle Mitochondrial Function, Redox State And Insulin Signalling In Mice With Chronic Heart Failure. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.274] [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: 03/28/2023]
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8
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Aleksova A, Janjusevic M, Stornaiolo M, Gagno G, Pierri A, Fluca AL, Derin A, Oriana Zhou XN, Hiche C, D’errico S, Novellino E, Sinagra G. 342 TMAO PLASMA LEVELS PREDICT RECURRENT ISCHEMIC EVENTS IN SURVIVORS OF MYOCARDIAL INFARCTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.496] [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: 12/23/2022]
Abstract
Abstract
Background
Recent studies have highlighted a direct link between dietary nutrients, microbiota and cardiovascular disease (CVD). In this context, trimethylamine-N-oxide (TMAO), a metabolite derived from the intestinal microbiota, stands out, paving its way as one of the important biomarkers associated with atherosclerosis, increased risk of CVD, recurrent events and adverse outcomes.
Methods
81 patients who survived acute myocardial infarction (AMI), (both STEMI 50 / NSTEMI 31) were enrolled in this study together with 10 healthy individuals. Further, we evaluated the relationship between plasma TMAO levels and cardiovascular events during the follow-up. The measurement of plasma levels of TMAO was performed using liquid chromatography-tandem mass spectrometry (LC-MS).
Results
The median plasma concentration of TMAO were significantly higher in patients with AMI compared with healthy control (1.62 (1.37–2.25) µM. vs 0.55 (0.35–0.74) µM, p < 0.0001). During a median follow-up of 61.74 (59.34–64.24) months, 10 out of 81 patients (12.3%) had a re-infarction. Patients who had another ischemic event had higher TMAO values compared with individuals who did not (2.29 (1.60–6.49) µM vs 1.60 (1.34–2.09) µM, p = 0.026). Further, TMAO values positively correlate with CRP, a pro-inflammatory marker. However, at multivariate Cox regression analysis, plasma TMAO values were not predictive of re-infarction.
Conclusions
The data of our pilot study show that higher TMAO values are associated with the risk of recurrent ischemic event. A future prospective study, including larger cohort is necessary to analyze this issue.
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Affiliation(s)
- Aneta Aleksova
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And Department Of Medical Surgical And Health Science, University Of Trieste , 34149 Trieste , Italy
| | - Milijana Janjusevic
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And Department Of Medical Surgical And Health Science, University Of Trieste , 34149 Trieste , Italy
| | - Mariano Stornaiolo
- Department Of Pharmacy, University Of Naples Federico Ii , 80131 Naples , Italy
| | - Giulia Gagno
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And Department Of Medical Surgical And Health Science, University Of Trieste , 34149 Trieste , Italy
| | - Alessandro Pierri
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And Department Of Medical Surgical And Health Science, University Of Trieste , 34149 Trieste , Italy
| | - Alessandra Lucia Fluca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And Department Of Medical Surgical And Health Science, University Of Trieste , 34149 Trieste , Italy
| | - Agnese Derin
- Cardiothoracovascular Department , Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), 34149 Trieste , Italy
| | | | - Cristina Hiche
- Cardiothoracovascular Department , Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), 34149 Trieste , Italy
| | - Stefano D’errico
- Department Of Medicine, Surgery And Health, University Of Trieste , 34149 Trieste , Italy
| | - Ettore Novellino
- Department Of Medicine And Surgery, Università Cattolica Del Sacro Cuore , 00168 Rome , Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And Department Of Medical Surgical And Health Science, University Of Trieste , 34149 Trieste , Italy
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9
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Aleksova A, Gagno G, Pierri A, Fluca AL, Janjusevic M, Derin A, Oriana Zhou XN, Restivo L, Hiche C, Stenner E, D’errico S, Zandonà L, Sinagra G. 338 PREVALENCE AND PERSISTENCE OF HYPOVITAMINOSIS D AMONG ITALIAN PATIENTS WITH MYOCARDIAL INFARCTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.495] [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: 12/23/2022]
Abstract
Abstract
Background
Hypovitaminosis D is common in the Italian population and has a comparable effect to diabetes mellitus on survival after an acute myocardial infarction (AMI). We aimed to evaluate if the prevalence of hypovitaminosis D changed over time, considering also frequent lockdowns in the last years due to COVID-19 pandemic.
Methods
According to the year of enrollment, we divided our cohort of 1042 patients hospitalized for AMI, into three groups (group 1 with 368 patients enrolled from 2014 till 2016, group 2 with 470 patients enrolled in the period from 2017 till 2019, and group 3 including 204 patients enrolled in the last three years, from 2020 till 2022) and evaluate whether the concentration of vitamin D changed in the last decade.
Results
The median concentration of vitamin D in our cohort of patients with AMI was 18.2 (11.48-25.73) ng/ml). Throughout the three groups (2014-2016, 2017-2019, 2020-2022), the median plasma vitamin D showed a trend toward an increase (17.3 (10.33–24.2) ng/ml, 18.95 (11.6–26.73) ng/ml, and 19.05 (12.5–27.3) ng/ml respectively), which was significant between the group 1 vs 2 and 3 (p = 0.033 and p = 0.004, respectively), while between the group 2 and 3 did not. Despite the trend of increase, the percentage of patients with hypovitaminosis D in each group remained high (61.4%, 53.8% and 52.0% respectively). As expected, samples taken between May and September have significantly higher vitamin D values compared to ones taken from October to April for each group (the group 1: 21.80 (15.55–31.23) ng/ml vs 15.8 (9.22–23.98) ng/ml, p < 0.0001; the group 2: 22.05 (14.10–30.98) ng/ml vs 16.50 (11.03–23.90) ng/ml, p < 0.0001); the group 3: 20.00 (11.90–26.90) ng/ml vs 16.30 (9.75–22.30) ng/ml, p = 0.001).
Conclusions
There has been a trend of increasing vitamin D values over the years, but hypovitaminosis D remains frequent. During the pandemic, vitamin D levels did not decrease due to frequent lockdowns, possibly due to media awareness that emphasized the significance of vitamin D administration against viral infection.
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Affiliation(s)
- Aneta Aleksova
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And Department Of Medical Surgical And Health Science, University Of Trieste , 34149 Trieste , Italy
| | - Giulia Gagno
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And Department Of Medical Surgical And Health Science, University Of Trieste , 34149 Trieste , Italy
| | - Alessandro Pierri
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And Department Of Medical Surgical And Health Science, University Of Trieste , 34149 Trieste , Italy
| | - Alessandra Lucia Fluca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And Department Of Medical Surgical And Health Science, University Of Trieste , 34149 Trieste , Italy
| | - Milijana Janjusevic
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And Department Of Medical Surgical And Health Science, University Of Trieste , 34149 Trieste , Italy
| | - Agnese Derin
- Cardiothoracovascular Department , Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), 34149 Trieste , Italy
| | | | - Luca Restivo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And Department Of Medical Surgical And Health Science, University Of Trieste , 34149 Trieste , Italy
| | - Cristina Hiche
- Cardiothoracovascular Department , Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), 34149 Trieste , Italy
| | - Elisabetta Stenner
- Department Of Diagnostics , Azienda Usl Toscana Nordovest, 57100 Livorno , Italy
| | - Stefano D’errico
- Department Of Medicine, Surgery And Health, University Of Trieste , 34149 Trieste , Italy
| | - Lorenzo Zandonà
- SC Laboratorio Unico, Ospedale Maggiore, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) , 34125 Trieste , Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And Department Of Medical Surgical And Health Science, University Of Trieste , 34149 Trieste , Italy
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10
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D'Errico S, Bergamini PR, Fattorini P, Zanconati F, Bussani R, Cova MA, Pagnan L, Belgrano M, Gasparini P, Girotto G, Lenarduzzi S, Addobbati R, Rakar S, Aleksova A, Dal Ferro M, Zecchin M, Sinagra G. [The Regional Registry of Sudden Cardiac Death of Friuli Venezia Giulia. Protocols, best practices and results of a multidisciplinary project]. G Ital Cardiol (Rome) 2022; 23:827-835. [PMID: 36300386 DOI: 10.1714/3900.38822] [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: 06/16/2023]
Abstract
With the regional law n. 26 of December 30, 2020, the Friuli Venezia Giulia Region wanted to promote the establishment of the Regional Register of Sudden Cardiac Death, with the aim of favoring the study of all those deaths that occurred suddenly and unexpectedly under the age of 50 years in which it is not possible to trace the cause of death with certainty. Such dramatic events, difficult to quantify considering the complexity of data collection, are often accepted with resignation without any further investigation of the possible causes. The Regional Register of Sudden Cardiac Deaths of Friuli Venezia Giulia was born from this premise and from the awareness of the importance of going back with a rigorous scientific methodology and through a multidisciplinary approach, to the diagnosis of hereditary heart diseases which, when determined, allow the enrollment of relatives in a cardiological screening process and, therefore, primary prevention of potentially fatal events. The authors describe the operating procedures feeding the Regional Register and present the results of the first year of activity on 26 cases.
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Affiliation(s)
- Stefano D'Errico
- SC UCO Medicina Legale, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Pier Riccardo Bergamini
- SC UCO Medicina Legale, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Paolo Fattorini
- Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Fabrizio Zanconati
- SC UCO Anatomia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Rossana Bussani
- SC UCO Anatomia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Maria Assunta Cova
- SC UCO Diagnostica per Immagini, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Lorenzo Pagnan
- SC UCO Diagnostica per Immagini, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Manuel Belgrano
- SC UCO Diagnostica per Immagini, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Paolo Gasparini
- Dipartimento dei Servizi e di Diagnostica Avanzata, IRCCS Materno Infantile Burlo Garofolo, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Giorgia Girotto
- Dipartimento dei Servizi e di Diagnostica Avanzata, IRCCS Materno Infantile Burlo Garofolo, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Stefania Lenarduzzi
- Dipartimento dei Servizi e di Diagnostica Avanzata, IRCCS Materno Infantile Burlo Garofolo, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Riccardo Addobbati
- Dipartimento dei Servizi e di Diagnostica Avanzata, IRCCS Materno Infantile Burlo Garofolo, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Serena Rakar
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Rete Europea Malattie Cardiache Rare (ERN Guard-Heart), Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Aneta Aleksova
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Rete Europea Malattie Cardiache Rare (ERN Guard-Heart), Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Matteo Dal Ferro
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Rete Europea Malattie Cardiache Rare (ERN Guard-Heart), Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Massimo Zecchin
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Rete Europea Malattie Cardiache Rare (ERN Guard-Heart), Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Gianfranco Sinagra
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Rete Europea Malattie Cardiache Rare (ERN Guard-Heart), Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
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11
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Aleksova A, Fluca AL, Gagno G, Pierri A, Padoan L, Derin A, Moretti R, Noveska EA, Azzalini E, D'Errico S, Beltrami AP, Zumla A, Ippolito G, Sinagra G, Janjusevic M. Long-term effect of SARS-CoV-2 infection on cardiovascular outcomes and all-cause mortality. Life Sci 2022; 310:121018. [PMID: 36183780 PMCID: PMC9561478 DOI: 10.1016/j.lfs.2022.121018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 12/03/2022]
Abstract
Since the very beginning of the coronavirus disease 2019 (COVID-19) pandemic in early 2020, it was evident that patients with cardiovascular disease (CVD) were at an increased risk of developing severe illness, and complications spanning cerebrovascular disorders, dysrhythmias, acute coronary syndrome, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure, thromboembolic disease, stroke, and death. Underlying these was excessive systemic inflammation and coagulopathy due to SARS-COV-2 infection, the effects of which also continued long-term as evidenced by post-COVID-19 cardiovascular complications. The acute and chronic cardiovascular effects of COVID-19 occurred even among those who were not hospitalized and had no previous CVD or those with mild symptoms. This comprehensive review summarizes the current understanding of molecular mechanisms triggered by the SARS-CoV-2 virus on various cells that express the angiotensin-converting enzyme 2, leading to endothelial dysfunction, inflammation, myocarditis, impaired coagulation, myocardial infarction, arrhythmia and a multisystem inflammatory syndrome in children or Kawasaki-like disease.
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Affiliation(s)
- Aneta Aleksova
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Alessandra Lucia Fluca
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giulia Gagno
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Alessandro Pierri
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Laura Padoan
- Department of Cardiology and Cardiovascular Physiopathology, Università degli Studi di Perugia, Perugia, Italy
| | - Agnese Derin
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy
| | - Rita Moretti
- Department of Internal Medicine and Neurology, Neurological Clinic, University of Trieste, Trieste, Italy
| | - Elena Aleksova Noveska
- Department of Pediatric and Preventive Dentistry, Faculty of Dental Medicine, Ss. Cyril and Methodius University, Skopje, Macedonia
| | - Eros Azzalini
- Department of Medical Sciences (DSM), University of Trieste, Trieste, Italy
| | - Stefano D'Errico
- Department of Medicine, Surgery and Health, University of Trieste, Trieste, Italy
| | | | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, UK; National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, UK
| | | | - Gianfranco Sinagra
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Milijana Janjusevic
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
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12
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Janjusevic M, Gagno G, Fluca A, Beltrami A, Sinagra G, Aleksova A. P205 PROGNOSTIC VALUE OF AMYLOID–Β (1–40) IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.197] [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
Survivors of acute myocardial infarction (AMI) have an increased risk of various cardiovascular complications during follow–up; therefore, adequate risk stratification remains the main challenge in the clinical setting. Amyloid β 1–40 (Aβ (1–40)) has already emerged as a negative prognostic marker for cardiovascular mortality, both in patients with stable chronic coronary artery disease and in patients with NSTEMI–type infarction. This is probably due to the pro–inflammatory and pro–atherosclerotic role of this peptide.
Methods
Plasma Aβ (1–40) values were tested acutely in a large prospective cohort of patients hospitalized for AMI (both NSTEMI and STEMI). The primary end–point was defined as all–cause mortality during the period of follow–up.
Results
894 individuals were enrolled in the study (607 with STEMI and 287 with NSTEMI). The median plasma concentration of Aβ (1–40) at the time of admission was 96.59 (60.94–134.5) pg/ml. During a median follow–up of 43 months, 123 patients died (primary endpoint). Higher Aβ (1–40) concentrations were associated with an increased risk of mortality, both on univariate analysis and after correction for other confounding variables. Furthermore, we found a strong positive correlation between plasma Aβ (1–40) values and age. The prognostic value of Aβ (1–40) was maintained only in the subgroup of patients with greater than the median age of 67 years.
Conclusions
This is currently the largest single–centre study evaluating the role of plasma Aβ (1–40) concentrations in predicting outcome in a population of patients admitted for AMI, both STEMI and NSTEMI. Our data represent a strong correlation between plasma (1–40) values and the increased risk of all–cause mortality during follow–up.
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Affiliation(s)
- M Janjusevic
- CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA (ASUGI) AND DEPARTMENT OF MEDICAL SURGICAL AND HEALTH SCIENCE, UNIVERSITY OF TRIESTE, TRIESTE; CLINICAL PATHOLOGY DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE (ASUFC) AND DEPARTMENT OF MEDICINE (DAME), UNIVERSITY OF UDINE, UDINE
| | - G Gagno
- CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA (ASUGI) AND DEPARTMENT OF MEDICAL SURGICAL AND HEALTH SCIENCE, UNIVERSITY OF TRIESTE, TRIESTE; CLINICAL PATHOLOGY DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE (ASUFC) AND DEPARTMENT OF MEDICINE (DAME), UNIVERSITY OF UDINE, UDINE
| | - A Fluca
- CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA (ASUGI) AND DEPARTMENT OF MEDICAL SURGICAL AND HEALTH SCIENCE, UNIVERSITY OF TRIESTE, TRIESTE; CLINICAL PATHOLOGY DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE (ASUFC) AND DEPARTMENT OF MEDICINE (DAME), UNIVERSITY OF UDINE, UDINE
| | - A Beltrami
- CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA (ASUGI) AND DEPARTMENT OF MEDICAL SURGICAL AND HEALTH SCIENCE, UNIVERSITY OF TRIESTE, TRIESTE; CLINICAL PATHOLOGY DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE (ASUFC) AND DEPARTMENT OF MEDICINE (DAME), UNIVERSITY OF UDINE, UDINE
| | - G Sinagra
- CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA (ASUGI) AND DEPARTMENT OF MEDICAL SURGICAL AND HEALTH SCIENCE, UNIVERSITY OF TRIESTE, TRIESTE; CLINICAL PATHOLOGY DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE (ASUFC) AND DEPARTMENT OF MEDICINE (DAME), UNIVERSITY OF UDINE, UDINE
| | - A Aleksova
- CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA (ASUGI) AND DEPARTMENT OF MEDICAL SURGICAL AND HEALTH SCIENCE, UNIVERSITY OF TRIESTE, TRIESTE; CLINICAL PATHOLOGY DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE (ASUFC) AND DEPARTMENT OF MEDICINE (DAME), UNIVERSITY OF UDINE, UDINE
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13
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Fabris E, Menzio S, Gregorio C, Pezzato A, Stolfo D, Aleksova A, Vitrella G, Rakar S, Perkan A, Van't Hof AW, Sinagra G. Effect of prehospital treatment in STEMI patients undergoing primary PCI. Catheter Cardiovasc Interv 2022; 99:1500-1508. [PMID: 35289471 PMCID: PMC9546098 DOI: 10.1002/ccd.30153] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/21/2022] [Indexed: 12/03/2022]
Abstract
Background The appropriate timing to administer antithrombotic therapies in ST‐elevation myocardial infarction (STEMI) remains uncertain. This study aims to evaluate the role of antithrombotic therapy administration at first medical contact (FMC) compared with the administration in the Cathlab. Methods We conducted a “before‐after” observational study enrolling STEMI undergoing primary percutaneous coronary intervention (PCI). Outcomes were evaluated during two successive periods, before (control group: aspirin only at FMC) and after (pretreated intervention group: heparin, aspirin plus ticagrelor at FMC) the introduction of a new regional pretreatment protocol. Results A total of 537 consecutive patients (300 in control vs. 237 in intervention group) were enrolled. The pretreated compared with no pretreated population showed better basal reperfusion, expressed as basal Thrombolysis in Myocardial Infarction (TIMI)‐flow (p for trend p < 0.001). Pretreated population showed lower frequency of TIMI 0 (56.5% vs. 73.7%, odds ratio [OR]: 0.46, 95% confidence interval [CI]: 0.32–0.67, p < 0.001) and higher frequency of TIMI 2‐3 (33.3% vs. 19.3% OR: 2.0, 95% CI: 1.38–2.00, p < 0.001) and TIMI 3 (14.3% vs. 9.7%, OR: 1.56, 95% CI: (0.92–2.65), p = 0.094). Pretreated compared with no pretreated population showed reduced infarct size expressed as Troponin Peak (20,286 (8726–75,027) versus 48,676 (17,229–113,900), p = 0.001), and higher left ventricular ejection fraction at discharge (53% (44–59) vs. 50% (44–56), p = 0.027). In‐hospital BARC ≥ 2 bleeding were similar (2.1% vs. 2.0%, p = 0.929, in pretreated versus no pretreated population, respectively). Conclusion This study provides support for an early pretreatment strategy in STEMI patients and confirmed the importance of an efficient organization of STEMI networks which allow initiation of antithrombotic treatment at FMC.
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Affiliation(s)
- Enrico Fabris
- Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy
| | - Sara Menzio
- Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy
| | - Caterina Gregorio
- Department of Medical Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy
| | - Andrea Pezzato
- Postgraduate School in Cardiovascular Sciences, University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy
| | - Aneta Aleksova
- Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy
| | - Giancarlo Vitrella
- Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy
| | - Serena Rakar
- Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy
| | - Andrea Perkan
- Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy
| | - Arnoud Wj Van't Hof
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy
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14
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Janjusevic M, Fluca AL, Gagno G, Pierri A, Padoan L, Sorrentino A, Beltrami AP, Sinagra G, Aleksova A. Old and Novel Therapeutic Approaches in the Management of Hyperglycemia, an Important Risk Factor for Atherosclerosis. Int J Mol Sci 2022; 23:ijms23042336. [PMID: 35216451 PMCID: PMC8878509 DOI: 10.3390/ijms23042336] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 12/13/2022] Open
Abstract
Hyperglycemia is considered one of the main risk factors for atherosclerosis, since high glucose levels trigger multiple pathological processes, such as oxidative stress and hyperproduction of pro-inflammatory mediators, leading to endothelial dysfunction. In this context, recently approved drugs, such as glucagon-like-peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2i), could be considered a powerful tool for to reduce glucose concentration and cardiovascular risk. Interestingly, many patients with type 2 diabetes mellitus (T2DM) and insulin resistance have been found to be deficient in vitamin D. Recent studies pointed out the unfavorable prognostic values of T2DM and vitamin D deficiency in patients with cardiac dysfunction, either when considered individually or together, which shed light on the role of vitamin D in general health status. New evidence suggests that SGLT2i could adversely affect the production of vitamin D, thereby increasing the risk of fractures, which are common in patients with T2DM. Therefore, given the biological effects of vitamin D as an anti-inflammatory mediator and a regulator of endothelial function and calcium equilibrium, these new findings should be taken into consideration as well. The aim of this review is to gather the latest advancements regarding the use of antidiabetic and antiplatelet drugs coupled with vitamin D supplementation to control glucose levels, therefore reducing the risk of coronary artery disease (CAD).
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Affiliation(s)
- Milijana Janjusevic
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Deparment of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (G.G.); (A.P.); (A.S.); (G.S.)
| | - Alessandra Lucia Fluca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Deparment of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (G.G.); (A.P.); (A.S.); (G.S.)
| | - Giulia Gagno
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Deparment of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (G.G.); (A.P.); (A.S.); (G.S.)
| | - Alessandro Pierri
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Deparment of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (G.G.); (A.P.); (A.S.); (G.S.)
| | - Laura Padoan
- Cardiology and Cardiovascular Physiopathology, Azienda Ospedaliero-Universitaria S. Maria Della Misericordia, 06156 Perugia, Italy;
| | - Annamaria Sorrentino
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Deparment of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (G.G.); (A.P.); (A.S.); (G.S.)
| | | | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Deparment of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (G.G.); (A.P.); (A.S.); (G.S.)
| | - Aneta Aleksova
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Deparment of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (G.G.); (A.P.); (A.S.); (G.S.)
- Correspondence: or ; Tel.: +39-3405507762; Fax: +39-040-3994878
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15
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Aleksova A, Janjusevic M, Gagno G, Pierri A, Padoan L, Fluca AL, Carriere C, Beltrami AP, Sinagra G. The Role of Exercise-Induced Molecular Processes and Vitamin D in Improving Cardiorespiratory Fitness and Cardiac Rehabilitation in Patients With Heart Failure. Front Physiol 2022; 12:794641. [PMID: 35087418 PMCID: PMC8787056 DOI: 10.3389/fphys.2021.794641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Heart failure (HF) still affects millions of people worldwide despite great advances in therapeutic approaches in the cardiovascular field. Remarkably, unlike pathological hypertrophy, exercise leads to beneficial cardiac hypertrophy characterized by normal or enhanced contractile function. Exercise-based cardiac rehabilitation improves cardiorespiratory fitness and, as a consequence, ameliorates the quality of life of patients with HF. Particularly, multiple studies demonstrated the improvement in left ventricular ejection fraction (LVEF) among patients with HF due to the various processes in the myocardium triggered by exercise. Exercise stimulates IGF-1/PI3K/Akt pathway activation involved in muscle growth in both the myocardium and skeletal muscle by regulating protein synthesis and catabolism. Also, physical activity stimulates the activation of the mitogen-activated protein kinase (MAPK) pathway which regulates cellular proliferation, differentiation and apoptosis. In addition, emerging data pointed out the anti-inflammatory effects of exercises as well. Therefore, it is of utmost importance for clinicians to accurately evaluate the patient’s condition by performing a cardiopulmonary exercise test and/or a 6-min walking test. Portable devices with the possibility to measure exercise capacity proved to be very useful in this setting as well. The aim of this review is to gather together the molecular processes triggered by the exercise and available therapies in HF settings that could ameliorate heart performance, with a special focus on strategies such as exercise-based cardiac rehabilitation.
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Affiliation(s)
- Aneta Aleksova
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Milijana Janjusevic
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Giulia Gagno
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Alessandro Pierri
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Laura Padoan
- Cardiology and Cardiovascular Physiopathology, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Perugia, Italy
| | - Alessandra Lucia Fluca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Cosimo Carriere
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Antonio Paolo Beltrami
- Department of Clinical Pathology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), University of Udine, Udine, Italy.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
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16
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Janjusevic M, Gagno G, Fluca AL, Padoan L, Beltrami AP, Sinagra G, Moretti R, Aleksova A. The peculiar role of vitamin D in the pathophysiology of cardiovascular and neurodegenerative diseases. Life Sci 2022; 289:120193. [PMID: 34864062 DOI: 10.1016/j.lfs.2021.120193] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 09/03/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023]
Abstract
Vitamin D is a hormone with both genomic and non-genomic actions. It exerts its activity by binding vitamin D receptor (VDR), which belongs to the superfamily of nuclear receptors and ligand-activated transcription factors. Since VDR has been found in various tissues, it has been estimated that it regulates approximately 3% of the human genome. Several recent studies have shown pleiotropic effects of vitamin D in various processes such as cellular proliferation, differentiation, DNA repair and apoptosis and its involvement in different pathophysiological conditions as inflammation, diabetes mellitus, and anemia. It has been suggested that vitamin D could play an important role in neurodegenerative and cardiovascular disorders. Moderate to strong associations between lower serum vitamin D concentrations and stroke and cardiovascular events have been identified in different analytic approaches, even after controlling for traditional demographic and lifestyle covariates. The mechanisms behind the associations between vitamin D and cerebrovascular and cardiologic profiles have been widely examined both in animal and human studies. Optimization of vitamin D levels in human subjects may improve insulin sensitivity and beta-cell function and lower levels of inflammatory markers. Moreover, it has been demonstrated that altered gene expression of VDR and 1,25D3-membrane-associated rapid response steroid-binding (1,25D3-MARRS) receptor influences the role of vitamin D within neurons and allows them to be more prone to degeneration. This review summarizes the current understanding of the molecular mechanisms underlying vitamin D signaling and the consequences of vitamin D deficiency in neurodegenerative and cardiovascular disorders.
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Affiliation(s)
- Milijana Janjusevic
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy
| | - Giulia Gagno
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy
| | - Alessandra Lucia Fluca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy
| | - Laura Padoan
- Cardiology and Cardiovascular Physiopathology, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, 06156 Perugia, Italy
| | - Antonio Paolo Beltrami
- Clinical Pathology Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC) and Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy
| | - Rita Moretti
- Department of Internal Medicine and Neurology, Neurological Clinic, Complex Case Section, Trieste, Italy
| | - Aneta Aleksova
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy.
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Fabris E, Menzio S, Gregorio C, Pezzato A, Stolfo D, Aleksova A, Vitrella G, Rakar S, Perkan A, Van’t Hof AWJ, Sinagra G. 350 Effect of pre-hospital treatment for STEMI patients undergoing primary PCI. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.032] [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: 11/15/2022]
Abstract
Abstract
Aims
The appropriate timing to administer antithrombotic therapies in ST-elevation myocardial infarction (STEMI) remains uncertain. This study aims to evaluate the role of antithrombotic therapy administration at first medical contact (FMC) compared to the administration in the Cathlab.
Methods and results
We conducted a ‘before-after’ observational study enrolling STEMI undergoing primary percutaneous coronary intervention (PCI). Outcomes were evaluated during two successive periods, before (control group: aspirin only at FMC) and after (pre-treated intervention group: heparin, aspirin plus ticagrelor at FMC) the introduction of a new regional pre-treatment protocol. 537 consecutive patients (300 in control vs. 237 in intervention group) were enrolled. The pre-treated compared to no pre-treated population showed better basal reperfusion, expressed as basal thrombolysis in myocardial Infarction (TIMI)-flow (p for trend P < 0.001). Pre-treated population showed lower frequency of TIMI 0 (56.5% vs. 73.7%, OR: 0.46, 95% CI: 0.32–0.67, P < 0.001) and higher frequency of TIMI 2–3 (33.3% vs. 19.7%; OR: 2.0; 95% CI: 1.38–2.00, P < 0.001) and TIMI 3 [14.3% vs. 9.7%, OR: 1.56, 95% CI: (0.92–2.65), P = 0.094]. Pre-treated compared to no pre-treated population showed reduced infarct size expressed as Troponin Peak [20 286 (8726–75027) vs. 48 676 (17229–113900), P = 0.001], and higher left ventricular ejection fraction at discharge [53% (44–59) vs. 50% (44–56), P = 0.027]. In-Hospital BARC ≥2 bleeding were similar (2.1% vs. 2.0%, P = 0.929, in pre-treated vs. no pre-treated population, respectively).
Conclusions
This study provides support for an early pre-treatment strategy in STEMI patients and confirmed the importance of an efficient organization of STEMI networks which allow initiation of antithrombotic treatment at FMC.
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Affiliation(s)
- Enrico Fabris
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
| | - Sara Menzio
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
| | - Caterina Gregorio
- Department of Medical Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy
| | - Andrea Pezzato
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
| | - Aneta Aleksova
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
| | - Giancarlo Vitrella
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
| | - Serena Rakar
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
| | - Andrea Perkan
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
| | - Arnoud W. J Van’t Hof
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Gianfranco Sinagra
- Division of Cardiology, Cardiothoracvascular Department, University of Trieste, Trieste, Italy
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Gagno G, Janjusevic M, Fluca AL, Beltrami AP, Sinagra G, Aleksova A. 191 Prognostic value of amyloid beta (1–40) in patients with acute myocardial infarction. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.003] [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
Aims
Patients who have survived acute myocardial infarction (AMI) are at higher risk of developing several cardiovascular complications during follow-up and, unfortunately, appropriate risk stratification remains a major challenge. Amyloid-β 1–40 [Aβ (1–40)] has already emerged as a prognostic biomarker of cardiovascular mortality among patients with stable coronary heart disease due to its pathophysiological vascular inflammation properties.
Methods and results
The relationship between plasma Aβ (1–40) concentrations and follow-up outcome was examined in a large prospective cohort of patients hospitalized for AMI (NSTEMI or STEMI). Total RNA was extracted from peripheral blood mononuclear cells (PBMC) to assess the expression levels of BACE1 and BACE1-AS. A total of 894 subjects (607 patients with STEMI and 287 patients with NSTEMI) were included in this study. The median plasma Aβ (1–40) concentration at admission was 96.59 (60.94–134.5) pg/ml. During the 83 month follow-up, 123 patients died and 78 patients developed HF. Higher Aβ (1–40) concentrations were able to predict an increased mortality risk during follow-up. In addition, in the cohort of patients older than 67 years, the plasma concentration of Aβ (1–40) strongly correlated with an unfavourable outcome, whereas in the cohort younger than 67 years did not.
Conclusions
This is the largest single centre study investigating the role of plasma Aβ (1–40) concentration in predicting patient outcomes after AMI both STEMI and NSTEMI. Our data show a strong correlation between plasma Aβ (1–40) levels and mortality risk during follow-up. In addition, we confirmed a correlation between age and plasma Aβ (1–40) concentration, noting that Aβ (1–40) values are an incremental risk factor in relation to age for adverse outcomes.
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Affiliation(s)
- Giulia Gagno
- Università di Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Italy
| | - Milijana Janjusevic
- Università di Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Italy
| | - Alessandra Lucia Fluca
- Università di Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Italy
| | - Antonio Paolo Beltrami
- Università di Udine, Italy
- Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Italy
| | - Gianfranco Sinagra
- Università di Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Italy
| | - Aneta Aleksova
- Università di Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Italy
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Aleksova A, Sinagra G, Beltrami AP, Pierri A, Ferro F, Janjusevic M, Gagno G. Biomarkers in the management of acute heart failure: state of the art and role in COVID-19 era. ESC Heart Fail 2021; 8:4465-4483. [PMID: 34609075 PMCID: PMC8652929 DOI: 10.1002/ehf2.13595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/07/2021] [Accepted: 08/19/2021] [Indexed: 12/14/2022] Open
Abstract
Acute heart failure (AHF) affects millions of people worldwide, and it is a potentially life‐threatening condition for which the cardiologist is more often brought into play. It is crucial to rapidly identify, among patients presenting with dyspnoea, those with AHF and to accurately stratify their risk, in order to define the appropriate setting of care, especially nowadays due to the coronavirus disease 2019 (COVID‐19) outbreak. Furthermore, with physical examination being limited by personal protective equipment, the use of new alternative diagnostic and prognostic tools could be of extreme importance. In this regard, usage of biomarkers, especially when combined (a multimarker approach) is beneficial for establishment of an accurate diagnosis, risk stratification and post‐discharge monitoring. This review highlights the use of both traditional biomarkers such as natriuretic peptides (NP) and troponin, and emerging biomarkers such as soluble suppression of tumourigenicity (sST2) and galectin‐3 (Gal‐3), from patients' emergency admission to discharge and follow‐up, to improve risk stratification and outcomes in terms of mortality and rehospitalization.
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Affiliation(s)
- Aneta Aleksova
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, Via Valdoni 7, Trieste, 34149, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, Via Valdoni 7, Trieste, 34149, Italy
| | - Antonio P Beltrami
- Clinical Pathology Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC) and Department of Medicine (DAME), University of Udine, Udine, 33100, Italy
| | - Alessandro Pierri
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, Via Valdoni 7, Trieste, 34149, Italy
| | | | - Milijana Janjusevic
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, Via Valdoni 7, Trieste, 34149, Italy
| | - Giulia Gagno
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, Via Valdoni 7, Trieste, 34149, Italy
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20
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Janjusevic M, Fluca AL, Ferro F, Gagno G, D’Alessandra Y, Beltrami AP, Sinagra G, Aleksova A. Traditional and Emerging Biomarkers in Asymptomatic Left Ventricular Dysfunction-Promising Non-Coding RNAs and Exosomes as Biomarkers in Early Phases of Cardiac Damage. Int J Mol Sci 2021; 22:ijms22094937. [PMID: 34066533 PMCID: PMC8125492 DOI: 10.3390/ijms22094937] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022] Open
Abstract
Heart failure (HF) is one of the major causes of morbidity and mortality worldwide and represents an escalating problem for healthcare systems. The identification of asymptomatic patients with underlying cardiac subclinical disease would create an opportunity for early intervention and prevention of symptomatic HF. Traditional biomarkers are very useful as diagnostic and prognostic tools in the cardiovascular field; however, their application is usually limited to overt cardiac disease. On the other hand, a growing number of studies is investigating the diagnostic and prognostic potential of new biomarkers, such as micro-RNAs (miRNA), long non-coding RNAs, and exosome cargo, because of their involvement in the early phases of cardiac dysfunction. Unfortunately, their use in asymptomatic phases remains a distant goal. The aim of this review is to gather the current knowledge of old and novel biomarkers in the early diagnosis of cardiac dysfunction in asymptomatic individuals.
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Affiliation(s)
- Milijana Janjusevic
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (F.F.); (G.G.); (G.S.)
| | - Alessandra Lucia Fluca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (F.F.); (G.G.); (G.S.)
| | - Federico Ferro
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (F.F.); (G.G.); (G.S.)
| | - Giulia Gagno
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (F.F.); (G.G.); (G.S.)
| | - Yuri D’Alessandra
- Cardiovascular Proteomics Unit, Centro Cardiologico Monzino-IRCCS, Via Parea 4, 20138 Milan, Italy;
| | | | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (F.F.); (G.G.); (G.S.)
| | - Aneta Aleksova
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (F.F.); (G.G.); (G.S.)
- Correspondence: or ; Tel.: +39-3405507762; Fax: +39-040-3994878
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21
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Aleksova A, Gagno G, Sinagra G, Beltrami AP, Janjusevic M, Ippolito G, Zumla A, Fluca AL, Ferro F. Effects of SARS-CoV-2 on Cardiovascular System: The Dual Role of Angiotensin-Converting Enzyme 2 (ACE2) as the Virus Receptor and Homeostasis Regulator-Review. Int J Mol Sci 2021; 22:4526. [PMID: 33926110 PMCID: PMC8123609 DOI: 10.3390/ijms22094526] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 02/06/2023] Open
Abstract
Angiotensin-converting enzyme 2 (ACE2) is the entry receptor for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the cause of Coronavirus Disease-2019 (COVID-19) in humans. ACE-2 is a type I transmembrane metallocarboxypeptidase expressed in vascular endothelial cells, alveolar type 2 lung epithelial cells, renal tubular epithelium, Leydig cells in testes and gastrointestinal tract. ACE2 mediates the interaction between host cells and SARS-CoV-2 spike (S) protein. However, ACE2 is not only a SARS-CoV-2 receptor, but it has also an important homeostatic function regulating renin-angiotensin system (RAS), which is pivotal for both the cardiovascular and immune systems. Therefore, ACE2 is the key link between SARS-CoV-2 infection, cardiovascular diseases (CVDs) and immune response. Susceptibility to SARS-CoV-2 seems to be tightly associated with ACE2 availability, which in turn is determined by genetics, age, gender and comorbidities. Severe COVID-19 is due to an uncontrolled and excessive immune response, which leads to acute respiratory distress syndrome (ARDS) and multi-organ failure. In spite of a lower ACE2 expression on cells surface, patients with CVDs have a higher COVID-19 mortality rate, which is likely driven by the imbalance between ADAM metallopeptidase domain 17 (ADAM17) protein (which is required for cleavage of ACE-2 ectodomain resulting in increased ACE2 shedding), and TMPRSS2 (which is required for spike glycoprotein priming). To date, ACE inhibitors and Angiotensin II Receptor Blockers (ARBs) treatment interruption in patients with chronic comorbidities appears unjustified. The rollout of COVID-19 vaccines provides opportunities to study the effects of different COVID-19 vaccines on ACE2 in patients on treatment with ACEi/ARB.
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Affiliation(s)
- Aneta Aleksova
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (G.G.); (G.S.); (M.J.); (A.L.F.); (F.F.)
| | - Giulia Gagno
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (G.G.); (G.S.); (M.J.); (A.L.F.); (F.F.)
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (G.G.); (G.S.); (M.J.); (A.L.F.); (F.F.)
| | | | - Milijana Janjusevic
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (G.G.); (G.S.); (M.J.); (A.L.F.); (F.F.)
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00135 Rome, Italy;
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London NW3 2PF, UK;
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London NW1 2BU, UK
| | - Alessandra Lucia Fluca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (G.G.); (G.S.); (M.J.); (A.L.F.); (F.F.)
| | - Federico Ferro
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (G.G.); (G.S.); (M.J.); (A.L.F.); (F.F.)
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Merlo M, Cappelletto C, De Angelis G, Porcari A, Caiffa T, Lardieri G, Pagnan L, Severini GM, Dal Ferro M, Stolfo D, Vitrella G, De Luca A, Korkova R, Massa L, Tavcˇar I, Aleksova A, Barbati G, Zanchi C, Ramani F, Di Lenarda A, Perkan A, Mestroni L, Zecchin M, Pinamonti B, Bussani R, Sinagra G. [Diagnostic work-up and clinical management of cardiomyopathies: the operative protocol from the Cardiothoracovascular Department of Trieste, Italy]. G Ital Cardiol (Rome) 2020; 21:935-953. [PMID: 33231213 DOI: 10.1714/3472.34548] [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: 06/11/2023]
Abstract
Cardiomyopathies are primary myocardial disorders, genetically determined, with clinical onset between the third and the fifth decade of life. They represent the main causes of sudden cardiac death and heart failure in the youth. The more common myocardial diseases in clinical practice are dilated cardiomyopathy, arrhythmogenic cardiomyopathy and hypertrophic cardiomyopathy. Next generation sequencing techniques, recently available for genetics researches, together with the diffusion of advanced imaging techniques, permitted in the last years a deeper knowledge of these pathologies. Nevertheless, diagnosis, etiology and several aspects of patients' clinical management remain complex and controversial. This review paper aims to propose some operative flow-charts, derived from scientific evidences and the internal protocol of the Cardiothoracovascular Department of Trieste Hospital, Italian referral Center for cardiomyopathies and heart failure, with more than 30 years of experience in diagnosis and management of patients who suffer from primary myocardial disorders.
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Affiliation(s)
- Marco Merlo
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Chiara Cappelletto
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Giulia De Angelis
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Aldostefano Porcari
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Thomas Caiffa
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Gerardina Lardieri
- Cardiologia, Ospedale di Gorizia e Monfalcone, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Lorenzo Pagnan
- S.C. Radiologia Diagnostica ed Interventistica, Dipartimento di Diagnostica per Immagini, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | | | - Matteo Dal Ferro
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste - Centro di Cardiologia Traslazionale, Laboratorio di Cardiologia Molecolare, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Davide Stolfo
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Giancarlo Vitrella
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Antonio De Luca
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Renata Korkova
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Laura Massa
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Irena Tavcˇar
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Aneta Aleksova
- Centro di Cardiologia Traslazionale, Laboratorio di Cardiologia Molecolare, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Giulia Barbati
- Unità di Biostatistica, Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste
| | - Cristiana Zanchi
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Federica Ramani
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Andrea Di Lenarda
- Centro Cardiovascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Andrea Perkan
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Massimo Zecchin
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Bruno Pinamonti
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
| | - Rossana Bussani
- S.S. Patologia Cardiovascolare, Anatomia e Istologia Patologica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Gianfranco Sinagra
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina e Università degli Studi di Trieste
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23
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Rolle IG, Crivellari I, Caragnano A, Cervellin C, Aleksova A, Cesselli D, Beltrami AP. Cell Senescence in Cardiac Repair and Failure. Curr Stem Cell Res Ther 2020; 15:685-695. [PMID: 31906841 DOI: 10.2174/1574888x15666200106144345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/12/2019] [Accepted: 11/29/2019] [Indexed: 11/22/2022]
Abstract
Although the lack of a robust cardiomyocyte proliferative response has been considered to be a crucial determinant of cardiac pathology and Heart Failure in adult mammalians, the emerging picture is that myocardial regeneration is a complex phenotype involving many actors, including acute cellular senescence and inflammation. However, three major and interconnected events occur in response to tissue injury: loss of protein homeostasis, accumulation of dysfunctional mitochondria and chronic inflammation. These events blunt the reparative response of the heart, are associated with the accumulation of chronically senescent cells and progressively lead to cardiac dysfunction. Therefore, it is crucial to understand which are the pivotal players of this process, in order to devise strategies aimed at reducing the occurrence of chronic cell senescence in the heart in vivo.
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Affiliation(s)
| | | | - Angela Caragnano
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | | | - Aneta Aleksova
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Daniela Cesselli
- Department of Medicine (DAME), University of Udine, Udine, Italy
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24
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Rolle IG, Crivellari I, Zanello A, Mazzega E, Dalla E, Bulfoni M, Avolio E, Battistella A, Lazzarino M, Cellot A, Cervellin C, Sponga S, Livi U, Finato N, Sinagra G, Aleksova A, Cesselli D, Beltrami AP. Heart failure impairs the mechanotransduction properties of human cardiac pericytes. J Mol Cell Cardiol 2020; 151:15-30. [PMID: 33159916 DOI: 10.1016/j.yjmcc.2020.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022]
Abstract
The prominent impact that coronary microcirculation disease (CMD) exerts on heart failure symptoms and prognosis, even in the presence of macrovascular atherosclerosis, has been recently acknowledged. Experimental delivery of pericytes in non-revascularized myocardial infarction improves cardiac function by stimulating angiogenesis and myocardial perfusion. Aim of this work is to verify if pericytes (Pc) residing in ischemic failing human hearts display altered mechano-transduction properties and to assess which alterations of the mechano-sensing machinery are associated with the observed impaired response to mechanical cues. RESULTS: Microvascular rarefaction and defects of YAP/TAZ activation characterize failing human hearts. Although both donor (D-) and explanted (E-) heart derived cardiac Pc support angiogenesis, D-Pc exert this effect significantly better than E-Pc. The latter are characterized by reduced focal adhesion density, decreased activation of the focal adhesion kinase (FAK)/ Crk-associated substrate (CAS) pathway, low expression of caveolin-1, and defective transduction of extracellular stiffness into cytoskeletal stiffening, together with an impaired response to both fibronectin and lysophosphatidic acid. Importantly, Mitogen-activated protein kinase kinase inhibition restores YAP/TAZ nuclear translocation. CONCLUSION: Heart failure impairs Pc mechano-transduction properties, but this defect could be reversed pharmacologically.
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Affiliation(s)
| | | | - Andrea Zanello
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Elisa Mazzega
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Emiliano Dalla
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Michela Bulfoni
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Elisa Avolio
- Translational Health Sciences, Bristol Medical School, University of Bristol, UK
| | | | | | - Alice Cellot
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | | | - Sandro Sponga
- Department of Cardiothoracic Surgery, Academic Hospital Santa Maria della Misericordia, Udine, Italy
| | - Ugolino Livi
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Cardiothoracic Surgery, Academic Hospital Santa Maria della Misericordia, Udine, Italy
| | - Nicoletta Finato
- Department of Medicine (DAME), University of Udine, Udine, Italy; Institute of Pathology, Academic Hospital Santa Maria della Misericordia, Udine, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Aneta Aleksova
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Daniela Cesselli
- Department of Medicine (DAME), University of Udine, Udine, Italy; Institute of Pathology, Academic Hospital Santa Maria della Misericordia, Udine, Italy.
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25
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Aleksova A, Santon D, Stenner E, Gagno G, Francescut C, Padoan L, Saro R, Beltrami A, Sinagra G. Prognostic implications of previously known or newly diagnosed diabetes and hypovitaminosis D in patients with myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Vitamin D deficiency and diabetes mellitus are frequent among patients with acute myocardial infarction. Independently, both were associated with a worse prognosis after myocardial infarction (MI). However, it is unclear whether the risk of worse outcome, associated with diabetes mellitus, may be accentuated in presence of hypovitaminosis D.
Purpose
We assessed if previously known or newly diagnosed diabetes is associated with worse outcome (major cardiovascular events) in combination with hypovitaminosis D in patients with acute MI.
Methods and results
Were enrolled 1004 patients with acute MI; 64.7% of them, had hypovitaminosis D and 37% were diabetic.
We grouped our population by diabetic status: previously known diabetes (diagnosis of diabetes before MI, n=330; 32.9%); newly diagnosed diabetes (during hospitalization for MI, but no known diabetes at presentation, n=47; 4.7%); or no diabetes (n=627; 62.5%).
Hypovitaminosis D was more frequent among patients with previously known (70.2%) and newly diagnosed diabetes (73.3%), when compared to non diabetic patients (61.2%).
During median follow-up of 15.6 months, patients with previously known and newly diagnosed diabetes had increased risks of major cardiovascular events (HR 1.72; 95% CI, 1.26 to 2.36. The risk of major events during the follow-up among diabetic patients, was further increased in presence of hypovitaminosis D (Figure 1).
Conclusions
The presence of both, previously known or newly diagnosed diabetes and hypovitaminosis D, in patients with MI is synergistically associated with a worse outcome.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Aleksova
- Azienda Sanitaria Universitaria Giuliano Isontina, trieste, Italy
| | - D Santon
- Azienda Sanitaria Universitaria Giuliano Isontina, trieste, Italy
| | - E Stenner
- Azienda Sanitaria Universitaria Giuliano Isontina, trieste, Italy
| | - G Gagno
- University of Trieste, Trieste, Italy
| | | | - L Padoan
- University of Perugia, Perugia, Italy
| | - R Saro
- University of Trieste, Trieste, Italy
| | | | - G Sinagra
- Azienda Sanitaria Universitaria Giuliano Isontina, trieste, Italy
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26
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Aleksova A, Ferro F, Gagno G, Cappelletto C, Santon D, Rossi M, Ippolito G, Zumla A, Beltrami AP, Sinagra G. COVID-19 and renin-angiotensin system inhibition: role of angiotensin converting enzyme 2 (ACE2) - Is there any scientific evidence for controversy? J Intern Med 2020; 288:410-421. [PMID: 32459372 PMCID: PMC7283873 DOI: 10.1111/joim.13101] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/15/2022]
Abstract
Renin-angiotensin system (RAS) blockers are extensively used worldwide to treat many cardiovascular disorders, where they are effective in reducing both mortality and morbidity. These drugs are known to induce an increased expression of angiotensin-converting enzyme 2 (ACE2). ACE2 acts as receptor for the novel SARS coronavirus-2 (SARS-CoV-2) which raising the important issue of possible detrimental effects that RAS blockers could exert on the natural history and pathogenesis of the coronavirus disease-19 (COVID-19) and associated excessive inflammation, myocarditis and cardiac arrhythmias. We review the current knowledge on the interaction between SARS-CoV-2 infection and RAS blockers and suggest a scientific rationale for continuing RAS blockers therapy in patients with COVID-19 infection.
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Affiliation(s)
- A Aleksova
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - F Ferro
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - G Gagno
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - C Cappelletto
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - D Santon
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - M Rossi
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - G Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani - IRCCS, Rome, Italy
| | - A Zumla
- Division of Infection and Immunity, University College London, London, UK.,National Institute of Health Research, Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - G Sinagra
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
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27
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Nuzzi V, Cannatà A, Manca P, Castrichini M, Barbati G, Aleksova A, Fabris E, Zecchin M, Merlo M, Boriani G, Sinagra G. Atrial fibrillation in dilated cardiomyopathy: Outcome prediction from an observational registry. Int J Cardiol 2020; 323:140-147. [PMID: 32853666 DOI: 10.1016/j.ijcard.2020.08.062] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 05/08/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Little is known about the role of different types of atrial fibrillation (AF) in dilated cardiomyopathy (DCM). We investigated the epidemiological and prognostic impact of different types of AF in DCM during long-term follow-up. METHOD We evaluated consecutive DCM patients enrolled in the Trieste Muscle Heart Disease Registry. Uni- and multivariable, extended Kaplan-Meier and propensity score-matching analyses were performed for a composite outcome including death/heart transplantation/ventricular-assist device implantation. RESULTS Out of 1181 DCM patients (71% males, age 49 ± 15 years, left ventricular ejection fraction 33 ± 11%), 46 (3.9%) had baseline permanent AF (permAF), while 66 (5.6%) had a history of paroxysmal/persistent AF. Compared with sinus rhythm (SR) patients, permAF patients were older (48 ± 15 vs. 61 ± 11 respectively, p = 0.001), were more frequently in NYHA class III-IV (18% vs. 30%, p = 0.002) and had larger left atrium diameter (40 ± 8 vs. 50 ± 10 mm, respectively). Paroxysmal/persistent AF patients had intermediate characteristics between permAF and SR. During a median follow-up of 135 (75-210) months, 63 patients developed permAF (0.45 new cases/100patients/year). At multivariable analysis, permAF as a time-dependent variable was an independent outcome predictor (HR 2.45; 95% C.I. 2.61-3.63, p < 0.001), together with creatinine, NYHA class, restrictive filling pattern and moderate-severe mitral regurgitation, while paroxysmal/persistent AF was neutral. Propensity score-matching analysis confirmed the higher rate of primary outcome events in patients with baseline or incident permAF versus patients without permAF during a very long-term follow-up (70% vs. 20%, p < 0.001). CONCLUSIONS PermAF in a large DCM cohort had low prevalence and incidence but had a relevant. prognostic role on hard outcomes.
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Affiliation(s)
- Vincenzo Nuzzi
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Antonio Cannatà
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Paolo Manca
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Matteo Castrichini
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Giulia Barbati
- Department of Medical Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy
| | - Aneta Aleksova
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Enrico Fabris
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Massimo Zecchin
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy.
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
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28
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Corradi D, Saffitz JE, Novelli D, Asimaki A, Simon C, Oldoni E, Masson S, Meessen JMTA, Monaco R, Manuguerra R, Latini R, Libby P, Tavazzi L, Marchioli R, Dozza L, Cavallotti L, Aleksova A, Gregorini R, Mozaffarian D. Prospective Evaluation of Clinico-Pathological Predictors of Postoperative Atrial Fibrillation: An Ancillary Study From the OPERA Trial. Circ Arrhythm Electrophysiol 2020; 13:e008382. [PMID: 32654517 DOI: 10.1161/circep.120.008382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) occurs in 30% to 50% of patients undergoing cardiac surgery and is associated with increased morbidity and mortality. Prospective identification of structural/molecular changes in atrial myocardium that correlate with myocardial injury and precede and predict risk of POAF may identify new molecular pathways and targets for prevention of this common morbid complication. METHODS Right atrial appendage samples were prospectively collected during cardiac surgery from 239 patients enrolled in the OPERA trial (Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation), fixed in 10% buffered formalin, and embedded in paraffin for histology. We assessed general tissue morphology, cardiomyocyte diameters, myocytolysis (perinuclear myofibril loss), accumulation of perinuclear glycogen, interstitial fibrosis, and myocardial gap junction distribution. We also assayed NT-proBNP (N-terminal pro-B-type natriuretic peptide), hs-cTnT, CRP (C-reactive protein), and circulating oxidative stress biomarkers (F2-isoprostanes, F3-isoprostanes, isofurans) in plasma collected before, during, and 48 hours after surgery. POAF was defined as occurrence of postcardiac surgery atrial fibrillation or flutter of at least 30 seconds duration confirmed by rhythm strip or 12-lead ECG. The follow-up period for all arrhythmias was from surgery until hospital discharge or postoperative day 10. RESULTS Thirty-five percent of patients experienced POAF. Compared with the non-POAF group, they were slightly older and more likely to have chronic obstructive pulmonary disease or heart failure. They also had a higher European System for Cardiac Operative Risk Evaluation and more often underwent valve surgery. No differences in left atrial size were observed between patients with POAF and patients without POAF. The extent of atrial interstitial fibrosis, cardiomyocyte myocytolysis, cardiomyocyte diameter, glycogen score or Cx43 distribution at the time of surgery was not significantly associated with incidence of POAF. None of these histopathologic abnormalities were correlated with levels of NT-proBNP, hs-cTnT, CRP, or oxidative stress biomarkers. CONCLUSIONS In sinus rhythm patients undergoing cardiac surgery, histopathologic changes in the right atrial appendage do not predict POAF. They also do not correlate with biomarkers of cardiac function, inflammation, and oxidative stress. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Domenico Corradi
- Department of Medicine & Surgery, Unit of Pathology, University of Parma, Italy (D.C., R. Monaco, R. Manuguerra)
| | - Jeffrey E Saffitz
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA (J.E.S., A. Asimaki)
| | - Deborah Novelli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan (D.N., E.O., S.M., J.M.T.A.M., R.L.)
| | - Angeliki Asimaki
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA (J.E.S., A. Asimaki)
| | - Caterina Simon
- USC Cardiochirurgia ASST Papa Giovanni XXIII, Bergamo, Italy (C.S.)
| | - Emanuela Oldoni
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan (D.N., E.O., S.M., J.M.T.A.M., R.L.)
| | - Serge Masson
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan (D.N., E.O., S.M., J.M.T.A.M., R.L.)
| | - Jennifer M T A Meessen
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan (D.N., E.O., S.M., J.M.T.A.M., R.L.)
| | - Rodolfo Monaco
- Department of Medicine & Surgery, Unit of Pathology, University of Parma, Italy (D.C., R. Monaco, R. Manuguerra)
| | - Roberta Manuguerra
- Department of Medicine & Surgery, Unit of Pathology, University of Parma, Italy (D.C., R. Monaco, R. Manuguerra)
| | - Roberto Latini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan (D.N., E.O., S.M., J.M.T.A.M., R.L.)
| | - Peter Libby
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.L.)
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (L.T.)
| | - Roberto Marchioli
- Cardiovascular, Renal, & Metabolic Medical & Scientific Services; IQVIA Milan, Italy (R. Marchioli)
| | - Luca Dozza
- Cardiothoracic & Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (L.D.)
| | | | - Aneta Aleksova
- Ospedali Riuniti & University of Trieste, Italy (A. Aleksova)
| | | | - Dariush Mozaffarian
- Brigham and Women's Hospital, Boston, MA (D.M.).,Friedman School of Nutrition Science & Policy, Tufts University, Boston, MA (D.M.)
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Aleksova A, Ferro F, Gagno G, Padoan L, Saro R, Santon D, Stenner E, Barbati G, Cappelletto C, Rossi M, Beltrami AP, Sinagra G. Diabetes Mellitus and Vitamin D Deficiency:Comparable Effect on Survival and a DeadlyAssociation after a Myocardial Infarction. J Clin Med 2020; 9:jcm9072127. [PMID: 32640692 PMCID: PMC7408858 DOI: 10.3390/jcm9072127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 02/06/2023] Open
Abstract
Survivors after a myocardial infarction (MI), especially those with diabetes mellitus (DM), remain at high risk of further events. Identifying and treating factors that may influence survival may open new therapeutic strategies. We assessed the impact on prognosis of DM and hypovitaminosis D (hypovitD), alone or combined. In this prospective, observational study, 1081 patients were enrolled surviving an MI and divided into four groups according to their diabetic and VitD status. The primary end-point was composite of all-cause mortality, angina/MI and heart failure (HF). Secondary outcomes were mortality, HF and angina/MI. During a follow-up of 26.1 months (IQR 6.6–64.5), 391 subjects experienced the primary end-point. Patients with DM or hypovitD had similar rate of the composite end-point. Patients with only hypovitD or DM did not differ regarding components of composite end-point (angina p = 0.97, HF p = 0.29, mortality p = 0.62). DM and VitD deficiency had similarly adjusted risks for primary end-point (HR 1.3, 95%CI 1.05–1.61; HR 1.3, 95% CI 1.04–1.64). The adjusted HR for primary composite end-point for patients with hypovitD and DM was 1.69 (95%CI 1.25–2.29, p = 0.001) in comparison to patients with neither hypoD nor DM. In conclusion, DM and hypovitD, individually and synergistically, are associated with a worse outcome after MI.
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Affiliation(s)
- Aneta Aleksova
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (F.F.); (G.G.); (R.S.); (C.C.); (M.R.); (G.S.)
- Correspondence: ; Tel.: +39-340-550-7762; Fax: +39-040-399-4878
| | - Federico Ferro
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (F.F.); (G.G.); (R.S.); (C.C.); (M.R.); (G.S.)
| | - Giulia Gagno
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (F.F.); (G.G.); (R.S.); (C.C.); (M.R.); (G.S.)
| | - Laura Padoan
- Azienda Ospedaliera di Perugia and University of Perugia, Cardiology and Cardiovascular Physiopathology, 06156 Perugia, Italy;
| | - Riccardo Saro
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (F.F.); (G.G.); (R.S.); (C.C.); (M.R.); (G.S.)
| | - Daniela Santon
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34100 Trieste, Italy; (D.S.); (E.S.)
| | - Elisabetta Stenner
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34100 Trieste, Italy; (D.S.); (E.S.)
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy;
| | - Chiara Cappelletto
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (F.F.); (G.G.); (R.S.); (C.C.); (M.R.); (G.S.)
| | - Maddalena Rossi
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (F.F.); (G.G.); (R.S.); (C.C.); (M.R.); (G.S.)
| | | | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (F.F.); (G.G.); (R.S.); (C.C.); (M.R.); (G.S.)
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Porcari A, Merlo M, Crosera L, Stolfo D, Cittar M, Della Paolera M, Barbati G, Pagnan L, Belgrano M, Cova MA, Gentile P, Aleksova A, Vitrella G, Sinagra G. 229Strain analysis reveals subtle systolic dysfunction in "confirmed" and "suspected" myocarditis with normal LVEF: a cardiac magnetic resonance study. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez113.002] [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: 11/13/2022] Open
Affiliation(s)
- A Porcari
- University Hospital Riuniti, Trieste, Italy
| | - M Merlo
- University Hospital Riuniti, Trieste, Italy
| | - L Crosera
- University Hospital Riuniti, Trieste, Italy
| | - D Stolfo
- University Hospital Riuniti, Trieste, Italy
| | - M Cittar
- University Hospital Riuniti, Trieste, Italy
| | | | - G Barbati
- University Hospital Riuniti, Biostatistics Unit, Department of Medical Sciences, Trieste, Italy
| | - L Pagnan
- University Hospital Riuniti, Department of Radiology, Trieste, Italy
| | - M Belgrano
- University Hospital Riuniti, Department of Radiology, Trieste, Italy
| | - M A Cova
- University Hospital Riuniti, Department of Radiology, Trieste, Italy
| | - P Gentile
- University Hospital Riuniti, Trieste, Italy
| | - A Aleksova
- University Hospital Riuniti, Trieste, Italy
| | - G Vitrella
- University Hospital Riuniti, Trieste, Italy
| | - G Sinagra
- University Hospital Riuniti, Trieste, Italy
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Merlo M, Ammirati E, Gentile P, Artico J, Cannatà A, Finocchiaro G, Barbati G, Sormani P, Varrenti M, Perkan A, Fabris E, Aleksova A, Bussani R, Petrella D, Cipriani M, Raineri C, Frigerio M, Sinagra G. Persistent left ventricular dysfunction after acute lymphocytic myocarditis: Frequency and predictors. PLoS One 2019; 14:e0214616. [PMID: 30921422 PMCID: PMC6438511 DOI: 10.1371/journal.pone.0214616] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Persistent left ventricular (LV) systolic dysfunction in patients with acute lymphocytic myocarditis (LM) is widely unexplored. OBJECTIVES To assess the frequency and predictors of persistent LV dysfunction in patients with LM and reduced LVEF at admission. METHODS AND RESULTS We retrospectively evaluated 89 consecutive patients with histologically-proven acute myocarditis enrolled at three Italian referral hospitals. A subgroup of 48 patients with LM, baseline systolic impairment and an available echocardiographic assessment at 12 months (6-18) from discharge constituted the study population. The primary study end-point was persistent LV dysfunction, defined as LVEF <50% at 1-year, and was observed in 27/48 patients (56.3%). Higher LV end-diastolic diameter at admission (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.04-1.43, p = 0.002), non-fulminant presentation (OR 8.46, 95% CI 1.28-55.75, p = 0.013) and presence of a poor lymphocytic infiltrate (OR 12.40, 95% CI 1.23-124.97, p = 0.010) emerged as independent predictors of persistent LV dysfunction at multivariate analysis (area under the curve 0.91, 95% CI 0.82-0.99). Pre-discharge LVEF was lower in patients with persistent LV dysfunction compared to the others (32%±8 vs. 53%±8, p <0.001), and this single variable showed the best accuracy in predicting the study end-point (area under the curve 0.95, 95% CI 0.89-1.00). CONCLUSIONS More than half of patients presenting with acute LM and LVEF <50% who survive the acute phase show persistent LV dysfunction after 1-year from hospital discharge. Features of subacute inflammatory process and of established myocardial damage at initial hospitalization emerged as predictors of this end-point.
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Affiliation(s)
- Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste, Trieste, Italy
- * E-mail:
| | - Enrico Ammirati
- “De Gasperis” Cardio Center, Niguarda Hospital, Milan, Italy
| | - Piero Gentile
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste, Trieste, Italy
| | - Jessica Artico
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste, Trieste, Italy
| | - Antonio Cannatà
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste, Trieste, Italy
| | - Gherardo Finocchiaro
- Cardiology Clinical and Academic Group, St. George’s, University of London, London, United Kingdom
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Paola Sormani
- “De Gasperis” Cardio Center, Niguarda Hospital, Milan, Italy
| | - Marisa Varrenti
- “De Gasperis” Cardio Center, Niguarda Hospital, Milan, Italy
| | - Andrea Perkan
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste, Trieste, Italy
| | - Enrico Fabris
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste, Trieste, Italy
| | - Aneta Aleksova
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste, Trieste, Italy
| | - Rossana Bussani
- Department of Pathology, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste, Trieste, Italy
| | | | - Manlio Cipriani
- “De Gasperis” Cardio Center, Niguarda Hospital, Milan, Italy
| | - Claudia Raineri
- Department of Cardiology, Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maria Frigerio
- “De Gasperis” Cardio Center, Niguarda Hospital, Milan, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste, Trieste, Italy
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Gentile P, Paldino A, Cannatà A, Artico J, Barbati G, Ramani F, Fabris E, Aleksova A, Stolfo D, Zecchin M, Merlo M, Sinagra G. Left bundle branch block in dilated cardiomyopathy with intermediate left ventricular dysfunction: Clinical phenotyping and outcome correlates. Int J Cardiol 2019; 278:180-185. [DOI: 10.1016/j.ijcard.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/19/2018] [Accepted: 11/02/2018] [Indexed: 01/12/2023]
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Aleksova A, Paldino A, Beltrami AP, Padoan L, Iacoviello M, Sinagra G, Emdin M, Maisel AS. Cardiac Biomarkers in the Emergency Department: The Role of Soluble ST2 (sST2) in Acute Heart Failure and Acute Coronary Syndrome-There is Meat on the Bone. J Clin Med 2019; 8:jcm8020270. [PMID: 30813357 PMCID: PMC6406787 DOI: 10.3390/jcm8020270] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 01/02/2023] Open
Abstract
Soluble ST2 (sST2) has recently emerged as a promising biomarker in the field of acute cardiovascular diseases. Several clinical studies have demonstrated a significant link between sST2 values and patients' outcome. Further, it has been found that higher levels of sST2 are associated with an increased risk of adverse left ventricular remodeling. Therefore, sST2 could represent a useful tool that could help the risk stratification and diagnostic and therapeutic work-up of patients admitted to an emergency department. With this review, based on recent literature, we have built sST2-assisted flowcharts applicable to three very common clinical scenarios of the emergency department: Acute heart failure, type 1, and type 2 acute myocardial infarction. In particular, we combined sST2 levels together with clinical and instrumental evaluation in order to offer a practical tool for emergency medicine physicians.
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Affiliation(s)
- Aneta Aleksova
- Cardiovascular Department, Azienda Sanitaria Universitaria di Trieste and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy.
| | - Alessia Paldino
- Cardiovascular Department, Azienda Sanitaria Universitaria di Trieste and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy.
| | | | - Laura Padoan
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, 35122 Padova, Italy.
| | - Massimo Iacoviello
- University Cardiology Unit, Cardiothoracic Department, University Policlinic Hospital of Bari, 70124 Bari, Italy.
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria di Trieste and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy.
| | - Michele Emdin
- Department of Life science, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Fondazione Toscana Gabriele Monasterio, National Research Council, 56124 Pisa, Italy.
| | - Alan S Maisel
- Division of Cardiology, University of California San Diego, San Diego, CA 92093, USA.
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Cesselli D, Parisse P, Aleksova A, Veneziano C, Cervellin C, Zanello A, Beltrami AP. Extracellular Vesicles: How Drug and Pathology Interfere With Their Biogenesis and Function. Front Physiol 2018; 9:1394. [PMID: 30327618 PMCID: PMC6174233 DOI: 10.3389/fphys.2018.01394] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 09/13/2018] [Indexed: 12/13/2022] Open
Abstract
Extracellular vesicles (EV) are at the center of an intense activity of investigation, both for their possible employment as biomarkers of ongoing pathologic processes and for their broad range of biological activities. EV can promote tissue repair in very different pathologic settings, including hindlimb and myocardial ischemia. Importantly, the exact mode of action of EV is still partly understood, since they may act by modulating growth factors and cytokines, signaling pathways, and by transferring non-coding RNAs to target cells. However, the term EV identifies cell derived, enveloped particles very heterogeneous in size, composition, and biogenesis. Therefore, part of the controversies on the biological effects exerted by EV is a consequence of differences in methods of separation that result in the enrichment of different entities. Since technical challenges still hamper the highly specific sorting of different EV subpopulations, up to now only few investigators have tried to verify differences in the biological effects of specific EV subtypes. This review summarizes the current state of the art on the comprehension of mechanisms involved in EV biogenesis and release, which is a prerequisite for understanding and investigating the impact that pathology and drug therapy may exert on the secretion and composition of EV. Finally, we described both the mechanism involved in the modulation of EV secretion by drugs commonly used in patients affected by heart failure, and how pathophysiological mechanisms involved in heart disease modify EV secretion.
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Affiliation(s)
| | | | - Aneta Aleksova
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste - University of Trieste, Trieste, Italy
| | | | | | - Andrea Zanello
- Department of Medicine, University of Udine, Udine, Italy
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Gortan Cappellari G, Aleksova A, Dal Ferro M, Cannatà A, Semolic A, Zanetti M, Springer J, Anker S, Giacca M, Sinagra G, Barazzoni R. Preserved skeletal muscle mitochondrial function, redox state and mass in obese mice with chronic heart failure. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1373] [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: 10/28/2022]
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Aleksova A, Beltrami AP, Carriere C, Barbati G, Lesizza P, Perrieri-Montanino M, Isola M, Gentile P, Salvioni E, Not T, Agostoni P, Sinagra G. Interleukin-1β levels predict long-term mortality and need for heart transplantation in ambulatory patients affected by idiopathic dilated cardiomyopathy. Oncotarget 2018; 8:25131-25140. [PMID: 28212578 PMCID: PMC5421915 DOI: 10.18632/oncotarget.15349] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/09/2017] [Indexed: 01/19/2023] Open
Abstract
Aims The prognostic stratification of patients with Idiopathic Dilated Cardiomyopathy (iDCM) is a difficult task. Here, we assessed the additive value of the evaluation of biomarkers of inflammasome activation and systemic inflammation for the long-term risk stratification of iDCM patients. Methods and Results We studied 156 ambulatory iDCM patients (mean age 58 years, 77% men, 79% in NYHA class 1-2, median Left Ventricular Ejection Fraction (LVEF) 35%, mean sodium 139 mEq/L, median BNP 189 pg/mL, median IL-1 beta (IL-1β) 1.08 pg/mL, median IL-6 1.7 pg/mL and median IL-10 2.7 pg/mL). During the follow-up period of 89.6 months, 35 patients (22%) died/underwent heart transplantation. Patients who died/underwent heart transplantation were more likely to be male, to be in NYHA class III, to have atrial fibrillation, to have lower LVEF and higher BNP levels. IL-1β, IL-6 and IL-10 levels did not differ significantly between the groups of patients with good or bad prognosis. IL-1β levels did not vary significantly among either the different NYHA classes or the quartiles of LVEF. In a multivariable model, however, IL-1β was a strong and independent predictor of all-cause mortality (HR 1.193, 95% CI 1.056 – 1.349, p=0.005 for log squared transformed values). Other factors associated with the outcome were: male gender, presence of atrial fibrillation and sodium concentration. The estimated time-dependent ROC curve of the multivariable model showed an AUC 0.74 (95% CI 0.65-0.86). Conclusions Serum levels of IL-1β could be useful to predict the long-term outcome of patients with iDCM.
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Affiliation(s)
- Aneta Aleksova
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste, Trieste, Italy
| | | | - Cosimo Carriere
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste, Trieste, Italy
| | - Giulia Barbati
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste, Trieste, Italy
| | - Pierluigi Lesizza
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste, Trieste, Italy
| | - Martina Perrieri-Montanino
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste, Trieste, Italy
| | - Miriam Isola
- Department of Medical and Biological Sciences, University of Udine, Italy
| | - Piero Gentile
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste, Trieste, Italy
| | - Elisabetta Salvioni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Tarcisio Not
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo" Trieste and University of Trieste, Trieste, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste, Trieste, Italy
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Cesselli D, Aleksova A, Mazzega E, Caragnano A, Beltrami AP. Cardiac stem cell aging and heart failure. Pharmacol Res 2018; 127:26-32. [DOI: 10.1016/j.phrs.2017.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/07/2017] [Accepted: 01/11/2017] [Indexed: 12/11/2022]
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Cesselli D, Aleksova A, Sponga S, Cervellin C, Di Loreto C, Tell G, Beltrami AP. Cardiac Cell Senescence and Redox Signaling. Front Cardiovasc Med 2017; 4:38. [PMID: 28612009 PMCID: PMC5447053 DOI: 10.3389/fcvm.2017.00038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/10/2017] [Indexed: 12/12/2022] Open
Abstract
Aging is characterized by a progressive loss of the ability of the organism to cope with stressors and to repair tissue damage. As a result, chronic diseases, including cardiovascular disease, increase their prevalence with aging, underlining the existence of common mechanisms that lead to frailty and age-related diseases. In this frame, the progressive decline of the homeostatic and reparative function of primitive cells has been hypothesized to play a major role in the evolution of cardiac pathology to heart failure. Although initially it was believed that reactive oxygen species (ROS) were produced in an unregulated manner as a byproduct of cellular metabolism, causing macromolecular damage and aging, accumulating evidence indicate the major role played by redox signaling in physiology. Aim of this review is to critically revise evidence linking ROS to cell senescence and aging and to provide evidence of the primary role played by redox signaling, with a particular emphasis on the multifunctional protein APE1/Ref in stem cell biology. Finally, we will discuss evidence supporting the role of redox signaling in cardiovascular cells.
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Affiliation(s)
| | - Aneta Aleksova
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Trieste, Italy
| | - Sandro Sponga
- Cardiothoracic Surgery, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | | | | | - Gianluca Tell
- Department of Medicine, University of Udine, Udine, Italy
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Aleksova A, Nucci MD, Gobbo M, Pradella P, Salam K, Barbati G, Luca AD, Mascaretti L, Sinagra G. Factor-V HR2 haplotype and thromboembolic disease. Acta Cardiol 2017. [DOI: 10.1080/ac.70.6.3120184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Aneta Aleksova
- Cardiovascular Department, “Ospedali Riuniti” and University of Trieste, Trieste, Italy
| | - Milena Di Nucci
- Cardiovascular Department, “Ospedali Riuniti” and University of Trieste, Trieste, Italy
| | - Marco Gobbo
- Cardiovascular Department, “Ospedali Riuniti” and University of Trieste, Trieste, Italy
| | - Paola Pradella
- Transfusion Medicine Department, “Ospedali Riuniti”, Trieste, Italy
| | - Kassem Salam
- Cardiovascular Department, “Ospedali Riuniti” and University of Trieste, Trieste, Italy
| | - Giulia Barbati
- Cardiovascular Department, “Ospedali Riuniti” and University of Trieste, Trieste, Italy
| | - Antonio De Luca
- Cardiovascular Department, “Ospedali Riuniti” and University of Trieste, Trieste, Italy
| | - Luca Mascaretti
- Transfusion Medicine Department, “Ospedali Riuniti”, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, “Ospedali Riuniti” and University of Trieste, Trieste, Italy
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Aleksova A, Beltrami AP, Belfiore R, Barbati G, Di Nucci M, Scapol S, De Paris V, Carriere C, Sinagra G. U-shaped relationship between vitamin D levels and long-term outcome in large cohort of survivors of acute myocardial infarction. Int J Cardiol 2016; 223:962-966. [PMID: 27589046 DOI: 10.1016/j.ijcard.2016.08.322] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/19/2016] [Accepted: 08/20/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Previous studies in the setting of patients with acute myocardial infarction (AMI) have demonstrated that hypovitaminosis D is associated with increased mortality risk during a follow-up whose median did not exceed two years. OBJECTIVE To evaluate the impact of vitamin D levels on long-term mortality in patients with AMI. RESULTS In our study 477 patients with AMI were included. During a median follow-up period of 57 (IQR 53-64) months, 93 patients (20%) died. A non-linear U-shaped relationship between 25(OH)D levels and long-term mortality was observed; patients with vitamin D<10ng/mL and >30ng/mL had higher mortality rate than those with intermediate values. After adjustment for differences in baseline features and treatment, it was confirmed that extreme values of vitamin D (<10 or >30ng/mL) are independent predictors of mortality with HR of 3.02 (95% CI 1.78-5.11). Other independent predictors of outcome were age, NYHA class at discharge, treatment with ACE inhibitors and statins. The estimated time-dependent ROC curve of the multivariable model including vitamin D showed an AUC significantly higher than the model without vitamin D: AUC 0.82 (95% CI 0.76-0.87) vs. 0.77 (95% CI 0.71-0.83), p=0.005. Addition of vitamin D to the model that included all significant factors for mortality improved the prognostic accuracy as showed by the metrics of reclassification (NRI 0.34 (95% CI 0.14-0.48), p=0.003 and IDI 0.06 (95% CI 0.01-0.12, p=0.005 p=0.03). CONCLUSIONS We report a U-shaped relationship between vitamin D levels and long-term outcome of patients surviving AMI.
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Affiliation(s)
- Aneta Aleksova
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
| | | | - Rita Belfiore
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Giulia Barbati
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Milena Di Nucci
- Department of Internal Medicine and Degenerative-Atherothrombotic Diseases, University Hospital of Verona, Italy
| | - Sara Scapol
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Valerio De Paris
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Cosimo Carriere
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
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Gianfranceschi G, Caragnano A, Piazza S, Manini I, Ciani Y, Verardo R, Toffoletto B, Finato N, Livi U, Beltrami CA, Scoles G, Sinagra G, Aleksova A, Cesselli D, Beltrami AP. Critical role of lysosomes in the dysfunction of human Cardiac Stem Cells obtained from failing hearts. Int J Cardiol 2016; 216:140-50. [DOI: 10.1016/j.ijcard.2016.04.155] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 04/10/2016] [Accepted: 04/20/2016] [Indexed: 12/01/2022]
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Ristagno G, Varpula T, Masson S, Greco M, Bottazzi B, Milani V, Aleksova A, Sinagra G, Assandri R, Tiainen M, Vaahersalo J, Kurola J, Barlera S, Montanelli A, Latini R, Pettilä V, Bendel S, Skrifvars MB. Elevations of inflammatory markers PTX3 and sST2 after resuscitation from cardiac arrest are associated with multiple organ dysfunction syndrome and early death. Clin Chem Lab Med 2016; 53:1847-57. [PMID: 25993733 DOI: 10.1515/cclm-2014-1271] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/13/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND A systemic inflammatory response is observed after cardiopulmonary resuscitation. We investigated two novel inflammatory markers, pentraxin 3 (PTX3) and soluble suppression of tumorigenicity 2 (sST2), in comparison with the classic high-sensitivity C-reactive protein (hsCRP), for prediction of early multiple organ dysfunction syndrome (MODS), early death, and long-term outcome after out-of-hospital cardiac arrest. METHODS PTX3, sST2, and hsCRP were assayed at ICU admission and 48 h later in 278 patients. MODS was defined as the 24 h non-neurological Sequential Organ Failure Assessment (SOFA) score ≥ 12. Intensive care unit (ICU) death and 12-month Cerebral Performance Category (CPC) were evaluated. RESULTS In total, 82% of patients survived to ICU discharge and 48% had favorable neurological outcome at 1 year (CPC 1 or 2). At ICU admission, median plasma levels of hsCRP (2.8 mg/L) were normal, while levels of PTX3 (19.1 ng/mL) and sST2 (117 ng/mL) were markedly elevated. PTX3 and sST2 were higher in patients who developed MODS (p<0.0001). Admission levels of PTX3 and sST2 were also higher in patients who died in ICU and in those with an unfavorable 12-month neurological outcome (p<0.01). Admission levels of PTX3 and sST2 were independently associated with subsequent MODS [OR: 1.717 (1.221-2.414) and 1.340, (1.001-1.792), respectively] and with ICU death [OR: 1.536 (1.078-2.187) and 1.452 (1.064-1.981), respectively]. At 48 h, only sST2 and hsCRP were independently associated with ICU death. CONCLUSIONS Higher plasma levels of PTX3 and sST2, but not of hsCRP, at ICU admission were associated with higher risk of MODS and early death.
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Latini R, Aleksova A, Masson S. Novel biomarkers and therapies in cardiorenal syndrome. Curr Opin Pharmacol 2016; 27:56-61. [DOI: 10.1016/j.coph.2016.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/19/2016] [Accepted: 01/29/2016] [Indexed: 01/11/2023]
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Aleksova A, Belfiore R, Carriere C, Kassem S, La Carrubba S, Barbati G, Sinagra G. Vitamin D Deficiency in Patients with Acute Myocardial Infarction: An Italian Single-Center Study. INT J VITAM NUTR RES 2016; 85:23-30. [PMID: 26780274 DOI: 10.1024/0300-9831/a000220] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 12/16/2022]
Abstract
BACKGROUND Hypovitaminosis D is a vitamin deficiency that has been increasing in developed countries; it was also suggested as an emerging risk factor for developing of atherosclerosis and acute myocardial infarction. The primary source of vitamin D is its cutaneous synthesis under exposure to sunlight. It has been suggested that 30 min of sun exposure twice weekly leads to sufficient vitamin D synthesis. The residents of Trieste (Italy) are well-known for their high exposure to sunlight in all seasons. We aimed to investigate the vitamin D status in subjects with acute myocardial infarction living in this area. METHODS Vitamin D status was identified in 478 subjects diagnosed with acute myocardial infarction. RESULTS The median serum 25-hydroxyvitamin D concentration was 14.5 [7.8 - 22.7] ng/mL. Vitamin D deficiency and insufficiency were present in 324 (68 %) and 107 (22 %) subjects, respectively. Vitamin D deficiency was less frequent among subjects enrolled in the period from July to the end of September (p < 0.001). In a multivariate analysis vitamin D deficiency was predicted by older age (p = 0.02), female gender (p = 0.002), higher body mass index (p = 0.05), autumn/winter sampling (p < 0.001), increased parathyroid hormone (p = 0.03) and alkaline phosphatase (p = 0.003). CONCLUSIONS We observed very high prevalence of vitamin D deficiency among subjects with myocardial infarction in all seasons of enrollment. However, it was lower in the summer when sun exposure is higher. The exposure to sunlight may be a cost-saving therapeutic strategy for the management of vitamin D deficiency.
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Affiliation(s)
- Aneta Aleksova
- 1 Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Rita Belfiore
- 1 Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Cosimo Carriere
- 1 Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Salam Kassem
- 1 Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | | | - Giulia Barbati
- 1 Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- 1 Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
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Aleksova A, Di Nucci M, Gobbo M, Bevilacqua E, Pradella P, Salam K, Barbati G, De Luca A, Mascaretti L, Sinagra G. Factor-V HR2 haplotype and thromboembolic disease. Acta Cardiol 2015; 70:707-11. [PMID: 26717220 DOI: 10.2143/ac.70.6.3120184] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objective of this study is to evaluate the prevalence of HR2 polymorphism among patients with pulmonary embolism (PE) and healthy subjects. BACKGROUND Polymorphism in the factor V gene named HR2 has been described as a possible risk factor for venous thromboembolism (VTE) development. Contradictive results on this association have been reported. METHODS Eighty-five patients admitted for PE and 72 healthy subjects were included in the study. Thrombophilia screening using genetic tests for factor V Leiden (G1691A/Leiden and HR2 haplotype) and other genetic mutations were investigated. RESULTS Of 85 patients with PE, 20 (23.53%) carried the HR2 haplotype. Further, a majority of the patients with HR2 haplotype had recurrent venous thrombosis or PE (15 out of 20 patients). The HR2 haplotype was detected in 6 (8.3%) out of 72 healthy subjects. Patients had significantly higher HR2 haplotype frequency than healthy controls (P = 0.001). HR2 carriers had a three-fold increase in risk of developing PE (OR = 3.38, 95% CI = 1.27-8.96, P = 0.011). After adjustment for other tested defects for thrombophilia, HR2 haplotype was associated with increased risk of thromboembolic events (OR = 3.05, 95% CI = 1.11-8.35, P = 0.03). However, after adjustment for sex and age, HR2 polymorphism was no longer associated with the risk of thromboembolic event (OR = 1.22, 95% CI = 0.34-4.38, P = 0.76). CONCLUSIONS Our study does not support the notion that factor V HR2 haplotype might be a risk factor for thrombosis despite its high prevalence among patients with PE.
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Masson S, Wu JHY, Simon C, Barlera S, Marchioli R, Mariani J, Macchia A, Lombardi F, Vago T, Aleksova A, Dreas L, Favaloro RR, Hershson AR, Puskas JD, Dozza L, Silletta MG, Tognoni G, Mozaffarian D, Latini R. Circulating cardiac biomarkers and postoperative atrial fibrillation in the OPERA trial. Eur J Clin Invest 2015; 45:170-8. [PMID: 25510286 DOI: 10.1111/eci.12393] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 12/10/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery and predicts increased morbidity and mortality. Identification of patients at high risk of POAF with the help of circulating biomarkers may enable early preventive treatment but data are limited, especially in contemporary surgical patients. METHODS Plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) were measured at enrollment, on the morning of cardiac surgery, at end surgery, and 2 days postsurgery in 562 patients undergoing cardiac surgery, randomized to perioperative supplementation with oral fish oil or placebo in the Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation trial (OPERA). The primary endpoint was incident POAF lasting ≥ 30 s, centrally adjudicated and confirmed electrocardiographically. RESULTS Higher levels of NT-proBNP and hs-cTnT before surgery were associated with older age, renal or cardiac dysfunction and EuroSCORE. NT-proBNP peaked on postoperative day 2 (2172 [1238-3758] ng/L, median [Q1-Q3]), while hs-cTnT peaked at the end of surgery (373 [188-660] ng/L). Fish oil supplementation did not alter the time course of the cardiac biomarkers (P > 0.05). Concentrations of NT-proBNP or hs-cTnT, on the morning of surgery, or changes in their level between morning of surgery and postsurgery, were not significantly associated with POAF after adjustment for clinical and surgical characteristics. CONCLUSION Among patients undergoing cardiac surgery, NT-proBNP and hs-cTnT are related to clinical and surgical characteristics, have different perioperative time courses but are not independently associated with risk of POAF.
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Affiliation(s)
- Serge Masson
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
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Aleksova A, Carriere C, Zecchin M, Barbati G, Vitrella G, Di Lenarda A, Sinagra G. New-onset left bundle branch block independently predicts long-term mortality in patients with idiopathic dilated cardiomyopathy: data from the Trieste Heart Muscle Disease Registry. Europace 2014; 16:1450-9. [DOI: 10.1093/europace/euu016] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Barazzoni R, Aleksova A, Carriere C, Cattin MR, Zanetti M, Vinci P, Stolfo D, Guarnieri G, Sinagra G. Obesity and high waist circumference are associated with low circulating pentraxin-3 in acute coronary syndrome. Cardiovasc Diabetol 2013; 12:167. [PMID: 24215445 PMCID: PMC3828395 DOI: 10.1186/1475-2840-12-167] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/06/2013] [Indexed: 12/01/2022] Open
Abstract
Background Long pentraxin 3 (PTX3) is a component of the pentraxin superfamily and a potential marker of vascular damage and inflammation, associated with negative outcome in patients with acute coronary syndromes (ACS). Obesity is a risk factor for cardiovascular disease and PTX3 production is reported in abdominal adipose tissue. Low PTX3 is however reported in the obese population, and obesity per se may be associated with less negative ACS outcome. Methods We investigated the potential impact of obesity and high waist circumference (reflecting abdominal fat accumulation) on plasma PTX3 concentration in ACS patients (n = 72, 20 obese) compared to age-, sex- and BMI-matched non-ACS individuals. Results Both obese and non-obese ACS patients had higher PTX3 than matched non-ACS counterparts, but PTX3 was lower in obese than non-obese individuals in both groups (all P < 0.05). PTX3 was also lower in ACS subjects with high than in those with normal waist circumference (WC). Plasma PTX3 was accordingly associated negatively with BMI and WC, independently of age and plasma creatinine. No associations were observed between PTX3 and plasma insulin, glucose or the short pentraxin and validated inflammation marker C-reactive protein, that was higher in ACS than in non-ACS individuals independently of BMI or WC. Conclusions Obesity is associated with low circulating PTX3 in ACS. This association is also observed in the presence of abdominal fat accumulation as reflected by elevated waist circumference. Low PTX3 is a novel potential modulator of tissue damage and outcome in obese ACS patients.
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Affiliation(s)
- Rocco Barazzoni
- Clinica Medica-Department of Medical, Surgical and Health Sciences University of Trieste, Trieste, Italy.
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Aleksova A, Masson S, Maggioni AP, Lucci D, Fabbri G, Beretta L, Mos L, Paino AM, Nicolosi GL, Marchioli R, Tognoni G, Tavazzi L, Sinagra G, Latini R. n-3 polyunsaturated fatty acids and atrial fibrillation in patients with chronic heart failure: the GISSI-HF trial. Eur J Heart Fail 2013; 15:1289-95. [PMID: 23839902 DOI: 10.1093/eurjhf/hft103] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS In the last few years, n-3 polyunsaturated acids (PUFAs) have been extensively studied for the prevention of AF, mostly in patients without heart failure (HF) or LV dysfunction. This post-hoc analysis of the GISSI-HF trial assessed the effect of n-3 PUFAs on AF in patients with chronic HF without AF at study entry over a median follow-up of 3.9 years. METHODS AND RESULTS In the GISSI-HF trial, 6975 patients with chronic HF were randomized to 1 g daily of n-3 PUFAs or placebo on top of recommended therapy for HF. Of these, 1140 (16.3%) had AF at baseline ECG and were excluded from the present analysis. AF during the trial was defined as the presence of AF on the ECGs done at each visit during the trial or AF as a cause of worsening HF or hospital admission or as an event during hospitalization. Dietary fish consumption and the circulating levels of n-3 PUFAs (the latter in a subset of 1203 patients) were also available. Among the 5835 patients without AF at study entry, 444 randomized to n-3 PUFAs (15.2%) and 408 to placebo (14.0%) developed AF (unadjusted hazard 1.10, P = 0.19). Lower circulating n-3 PUFA levels were independently associated with higher AF prevalence at study entry, but not with its new occurrence. CONCLUSIONS Despite an inverse relationship between plasma n-3 PUFA levels and prevalent AF, this study found no evidence that 1 g daily n-3 PUFA supplementation in patients with chronic HF reduces incident AF.
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Affiliation(s)
- Aneta Aleksova
- Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste, Trieste, Italy
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Barazzoni R, Aleksova A, Armellini I, Cattin MR, Zanetti M, Carriere C, Giacca M, Dore F, Guarnieri G, Sinagra G. Adipokines, ghrelin and obesity-associated insulin resistance in nondiabetic patients with acute coronary syndrome. Obesity (Silver Spring) 2012; 20:2348-53. [PMID: 22653312 DOI: 10.1038/oby.2012.121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Altered glucose metabolism negatively modulates outcome in acute coronary syndromes (ACS). Insulin resistance is commonly associated with increasing BMI in the general population and these associations may involve obesity-related changes in circulating ghrelin and adipokines. We aimed at investigating interactions between BMI, insulin resistance and ACS and their associations with plasma ghrelin and adipokine concentrations. Homeostasis model assessment of insulin resistance (HOMA(IR))-insulin resistance index, plasma adiponectin, leptin, total (T-Ghrelin), acylated (Acyl-Ghrelin), and desacylated ghrelin (Desacyl-Ghrelin) were measured in 60 nondiabetic ACS patients and 44 subjects without ACS matched for age, sex, and BMI. Compared with non-ACS, ACS patients had similar HOMA(IR) and plasma adipokines, but lower T- and Desacyl-Ghrelin and higher Acyl-Ghrelin. Obesity (BMI > 30) was associated with higher HOMA(IR), lower adiponectin, and higher leptin (P < 0.05) similarly in ACS and non-ACS subjects. In ACS (n = 60) HOMA(IR) remained associated negatively with adiponectin and positively with leptin independently of BMI and c-reactive protein (CRP) (P < 0.05). On the other hand, low T- and Desacyl-Ghrelin with high Acyl-Ghrelin characterized both obese and non-obese ACS patients and were not associated with HOMA(IR). In conclusion, in ACS patients, obesity and obesity-related changes in plasma leptin and adiponectin are associated with and likely contribute to negatively modulate insulin resistance. ACS per se does not however enhance the negative impact of obesity on insulin sensitivity. High acylated and low desacylated ghrelin characterize ACS patients independently of obesity, but are not associated with insulin sensitivity.
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Affiliation(s)
- Rocco Barazzoni
- Clinica Medica-Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
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