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Bonome P, Pezzulla D, Lancellotta V, Scrofani AR, Macchia G, Rodolfino E, Tagliaferri L, Kovács G, Deodato F, Iezzi R. Combination of Local Ablative Techniques with Radiotherapy for Primary and Recurrent Lung Cancer: A Systematic Review. Cancers (Basel) 2023; 15:5869. [PMID: 38136413 PMCID: PMC10741973 DOI: 10.3390/cancers15245869] [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: 09/28/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
In patients with early-stage or recurrent NSCLC who are unable to tolerate surgery, a benefit could derive only from a systemic therapy or another few forms of local therapy. A systematic review was performed to evaluate the feasibility and the effectiveness of radiotherapy combined with local ablative therapies in the treatment of primary and recurrent lung cancer in terms of toxicity profile and local control rate. Six studies featuring a total of 115 patients who met eligibility criteria and 119 lesions were included. Three studies evaluated lung cancer patients with a medically inoperable condition treated with image-guided local ablative therapies followed by radiotherapy: their local control rate (LC) ranged from 75% to 91.7% with only 15 patients (19.4%) reporting local recurrence after combined modality treatment. The other three studies provided a salvage option for patients with locally recurrent NSCLC after RT: the median follow-up period varied from 8.3 to 69.3 months with an LC rate ranging from 50% to 100%. The most common complications were radiation pneumonitis (9.5%) and pneumothorax (29.8%). The proposed intervention appears to be promising in terms of toxicity profile and local control rate. Further prospective studies are need to better delineate combining LTA-RT treatment benefits in this setting.
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Affiliation(s)
- Paolo Bonome
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy; (D.P.); (G.M.); (F.D.)
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy; (D.P.); (G.M.); (F.D.)
| | - Valentina Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (V.L.); (L.T.)
| | - Anna Rita Scrofani
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia d’Urgenza ed Interventistica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.S.); (R.I.)
| | - Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy; (D.P.); (G.M.); (F.D.)
| | - Elena Rodolfino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia Addomino-Pelvica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy;
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (V.L.); (L.T.)
| | - György Kovács
- Gemelli-INTERACTS, Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
| | - Francesco Deodato
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy; (D.P.); (G.M.); (F.D.)
- Radiology Institute, Università Cattolica del Sacro Cuore, 00135 Rome, Italy
| | - Roberto Iezzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia d’Urgenza ed Interventistica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.S.); (R.I.)
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Rella R, Bufi E, Belli P, Scrofani AR, Petta F, Borghetti A, Marazzi F, Valentini V, Manfredi R. Association between contralateral background parenchymal enhancement on MRI and outcome in patients with unilateral invasive breast cancer breast receiving neoadjuvant chemotherapy. Diagn Interv Imaging 2022; 103:486-494. [DOI: 10.1016/j.diii.2022.04.004] [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] [Received: 12/28/2021] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 11/03/2022]
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Contegiacomo A, Scrofani AR, Punzi E, Manfredi R. Post-Traumatic Pudendal Bleeding: Beyond the Satisfaction of Search. JEVTM 2021. [DOI: 10.26676/jevtm.v5i1.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Contegiacomo A, Cina A, Di Stasi C, Barone M, Scrofani AR, Barbieri P, Punzi E, Manfredi R. Uterine Myomas: Endovascular Treatment. Semin Ultrasound CT MR 2021; 42:13-24. [PMID: 33541585 DOI: 10.1053/j.sult.2020.07.002] [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: 11/11/2022]
Abstract
Uterine fibroids embolization is a safe and effective organ sparing treatment for fibroid-related symptoms based on a broad range of published evidence including randomized-controlled trials. Indication to treatment is usually the presence of symptomatic uterine fibroids. In this review, a systematic search of journal articles relevant to the treatment of symptomatic uterine fibroids was conducted, with a special focus on the indication to treatment, technique, procedural outcomes and pain control. All clinical trials published in English language, representing original research, and reporting clinical outcomes associated with interventions for the management of symptomatic uterine fibroids were considered.
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Affiliation(s)
- Andrea Contegiacomo
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Alessandro Cina
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carmine Di Stasi
- UOC Radiodiagnostica Ospedale SS. Annunziata, Presidio Ospedaliero Centrale ASL Taranto, Taranto, Italy
| | - Michele Barone
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
| | - Anna Rita Scrofani
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
| | - Pierluigi Barbieri
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
| | - Ernesto Punzi
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
| | - Riccardo Manfredi
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
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Contegiacomo A, Attempati N, Scrofani AR, Punzi E, Rella R, Manfredi R. Right brachial vein access for pulmonary arteriovenous malformation embolization. Diagn Interv Imaging 2020; 102:55-57. [PMID: 33229286 DOI: 10.1016/j.diii.2020.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Andrea Contegiacomo
- Department of Radiology, Radiotherapy and Hematology. Fondazione Policlinico Universitario A. Gemelli IRCCS; L.go A. Gemelli 8, 00168 Rome, Italy.
| | - Nico Attempati
- Department of Radiology, Radiotherapy and Hematology. Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica Sacro Cuore; L.go A. Gemelli 8, 00168 Rome, Italy
| | - Anna Rita Scrofani
- Department of Radiology, Radiotherapy and Hematology. Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica Sacro Cuore; L.go A. Gemelli 8, 00168 Rome, Italy
| | - Ernesto Punzi
- Department of Radiology, Radiotherapy and Hematology. Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica Sacro Cuore; L.go A. Gemelli 8, 00168 Rome, Italy
| | - Rossella Rella
- Department of Radiology, Radiotherapy and Hematology. Fondazione Policlinico Universitario A. Gemelli IRCCS; L.go A. Gemelli 8, 00168 Rome, Italy
| | - Riccardo Manfredi
- Department of Radiology, Radiotherapy and Hematology. Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica Sacro Cuore; L.go A. Gemelli 8, 00168 Rome, Italy
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Rella R, Bufi E, Belli P, Petta F, Serra T, Masiello V, Scrofani AR, Barone R, Orlandi A, Valentini V, Manfredi R. Association between background parenchymal enhancement and tumor response in patients with breast cancer receiving neoadjuvant chemotherapy. Diagn Interv Imaging 2020; 101:649-655. [PMID: 32654985 DOI: 10.1016/j.diii.2020.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To analyze the relationships between background parenchymal enhancement (BPE) of the contralateral healthy breast and tumor response after neoadjuvant chemotherapy (NAC) in women with breast cancer. MATERIALS AND METHODS A total of 228 women (mean age, 47.6 years±10 [SD]; range: 24-74 years) with invasive breast cancer who underwent NAC were included. All patients underwent breast magnetic resonance imaging (MRI) before and after NAC and 127 patients underwent MRI before, during (after the 4th cycle of NAC) and after NAC. Quantitative semi-automated analysis of BPE of the contralateral healthy breast was performed. Enhancement level on baseline MRI (baseline BPE) and MRI after chemotherapy (final BPE), change in enhancement rate between baseline MRI and final MRI (total BPE change) and between baseline MRI and midline MRI (early BPE change) were recorded. Associations between BPE and tumor response, menopausal status, tumor phenotype, NAC type and tumor stage at diagnosis were searched for. Pathologic complete response (pCR) was defined as the absence of residual invasive cancer cells in the breast and ipsilateral lymph nodes. RESULTS No differences were found in baseline BPE, final BPE, early and total BPE changes between pCR and non-pCR groups. Early BPE change was higher in non-pCR group in patients with stages 3 and 4 breast cancers (P=0.019) and in human epidermal growth factor receptor 2 (HER2)-negative patients (P=0.020). CONCLUSION Early reduction of BPE in the contralateral breast during NAC may be an early predictor of loss of tumor response, showing potential as an imaging biomarker of treatment response, especially in women with stages 3 or 4 breast cancers and in HER2 - negative breast cancers.
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Affiliation(s)
- R Rella
- UOC di Diagnostica per Immagini ed Interventistica Generale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - E Bufi
- UOC di Diagnostica per Immagini ed Interventistica Generale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
| | - P Belli
- UOC di Diagnostica per Immagini ed Interventistica Generale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - F Petta
- UOC di Diagnostica per Immagini ed Interventistica Generale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - T Serra
- UOC di Diagnostica per Immagini ed Interventistica Generale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - V Masiello
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - A R Scrofani
- UOC di Diagnostica per Immagini ed Interventistica Generale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - R Barone
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - A Orlandi
- U.O.C Oncologia Medica, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - V Valentini
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - R Manfredi
- UOC di Diagnostica per Immagini ed Interventistica Generale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Università Cattolica Sacro Cuore, 00168 Rome, Italy
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Iezzi R, Valente I, Cina A, Posa A, Contegiacomo A, Alexandre A, D'Argento F, Lozupone E, Barone M, Giubbolini F, Milonia L, Romi A, Scrofani AR, Pedicelli A, Manfredi R, Colosimo C. Longitudinal study of interventional radiology activity in a large metropolitan Italian tertiary care hospital: how the COVID-19 pandemic emergency has changed our activity. Eur Radiol 2020; 30:6940-6949. [PMID: 32607633 PMCID: PMC7326392 DOI: 10.1007/s00330-020-07041-y] [Citation(s) in RCA: 16] [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: 05/21/2020] [Revised: 06/02/2020] [Accepted: 06/17/2020] [Indexed: 12/13/2022]
Abstract
Objectives To retrospectively analyze interventional radiology (IR) activity changes in the COVID-19 era and to describe how to safely and effectively reorganize IR activity. Methods All IR procedures performed between January 30 and April 8, 2020 (COVID-era group) and the same 2019 period (non-COVID-era group) were retrospectively included and compared. A sub-analysis for the lockdown period (LDP: 11 March–8 April) was also conducted. Demographic, hospitalization, clinical, and procedural data were obtained for both groups and statistically compared with univariable analysis. Results A total of 1496 procedures (non-COVID era, 825; COVID era, 671) performed in 1226 patients (64.9 ± 15.1 years, 618 women) were included. The number of procedures decreased by 18.6% between 2019 and 2020 (825 vs 671, p < .001), with a reduction by 48.2% in LDP (188 vs 363, p < .0001). In the LDP COVID era, bedside procedures were preferred (p = .013), with an increase in procedures from the intensive care unit compared with the emergency department and outpatients (p = .048), and an increased activity for oncological patients (p = .003). No incidents of cross-infection of non-infected from infected patients and no evidence of COVID-19 infection of healthcare workers in the IR service was registered. Conclusions Coronavirus disease outbreak changed the interventional radiology activity with an overall reduction in the number of procedures. However, this study confirms that interventional radiology continuum of care can be safely performed also during the pandemic, following defined measures and protocols, taking care of all patients. Key Points • Coronavirus disease pandemic determined a reduction of interventional radiology activity as compared to the same period of the previous year. • Interventional radiology procedures for life-threatening conditions and non-deferrable oncologic treatments were prioritized as opposed to elective procedures. • Strict adoption of safe procedures allowed us to have until now no incidents of cross-infection of non-infected from infected patients and no evidence of COVID-19 infection of HCWs in the IR service.
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Affiliation(s)
- Roberto Iezzi
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia - Area di Diagnostica per Immagini, UOC Radiologia Diagnostica e Interventistica Generale, L.go A. Gemelli 8, 00168, Rome, Italy. .,Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy.
| | - Iacopo Valente
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia - Area di Diagnostica per Immagini, UOC Radiologia Diagnostica e Interventistica Generale, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Alessandro Cina
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia - Area di Diagnostica per Immagini, UOC Radiologia Diagnostica e Interventistica Generale, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Alessandro Posa
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia - Area di Diagnostica per Immagini, UOC Radiologia Diagnostica e Interventistica Generale, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Andrea Contegiacomo
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia - Area di Diagnostica per Immagini, UOC Radiologia Diagnostica e Interventistica Generale, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Andrea Alexandre
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia - Area di Diagnostica per Immagini, UOC Radiologia Diagnostica e Interventistica Generale, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Francesco D'Argento
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia - Area di Diagnostica per Immagini, UOC Radiologia Diagnostica e Interventistica Generale, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Emilio Lozupone
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia - Area di Diagnostica per Immagini, UOC Radiologia Diagnostica e Interventistica Generale, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Michele Barone
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia - Area di Diagnostica per Immagini, UOC Radiologia Diagnostica e Interventistica Generale, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Francesca Giubbolini
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia - Area di Diagnostica per Immagini, UOC Radiologia Diagnostica e Interventistica Generale, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Luca Milonia
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia - Area di Diagnostica per Immagini, UOC Radiologia Diagnostica e Interventistica Generale, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Andrea Romi
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia - Area di Diagnostica per Immagini, UOC Radiologia Diagnostica e Interventistica Generale, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Anna Rita Scrofani
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia - Area di Diagnostica per Immagini, UOC Radiologia Diagnostica e Interventistica Generale, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Alessandro Pedicelli
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia - Area di Diagnostica per Immagini, UOC Radiologia Diagnostica e Interventistica Generale, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Riccardo Manfredi
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia - Area di Diagnostica per Immagini, UOC Radiologia Diagnostica e Interventistica Generale, L.go A. Gemelli 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy
| | - Cesare Colosimo
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia - Area di Diagnostica per Immagini, UOC Radiologia Diagnostica e Interventistica Generale, L.go A. Gemelli 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy
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Moroni C, Tolone S, Lopreiato F, Scrofani AR, Bossini A, Affricano C, Cassone R, Gaudio C. Effects of losartan on left ventricular mass: a three-year follow-up in elderly hypertensives with myocardial hypertrophy despite successful conventional antihypertensive treatment. Eur Rev Med Pharmacol Sci 2017; 21:1323-1328. [PMID: 28387895] [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: 06/07/2023]
Abstract
OBJECTIVE Reversal of left ventricular hypertrophy (LVH) in hypertensive patients appears to be a desirable goal to the reduction cardiac risk. The Renin-Angiotensin System (RAS) seems to play a major role in the establishment and maintenance of LVH through the activated systemic RAS and the Intracardiac Angiotensin System (IAS). We focused on the effects of a three-year treatment with losartan supplement in hypertensive patients with LVH not responding to eight years of an effective previous antihypertensive pharmacological treatment. PATIENTS AND METHODS Two groups of 28 sex-, age- and therapy-matched subjects with essential hypertension and LVH were taken into consideration. The two groups were in effective pharmacological treatment (BP < 140/90) for eight years previous to their enrollment. Patients of Group A were treated for three years with a losartan (100 mg/die) on-top treatment, whereas patients of Group B continued the follow-up of the previous conventional therapy. Both groups were submitted to an echocardiographic follow-up. RESULTS Group A, showed a significant reduction of the mean LVH since the first step at six months with a further significant trend during the whole period (variance analysis: p < 0.001). Group B showed a non-significant trend toward LVH reduction during the three-year follow-up. No significant further reduction of systolic or diastolic blood pressure values was observed in both groups. CONCLUSIONS The effects of losartan in hypertensive and hypertrophic patients are in agreement with the results of LIFE Trial. However, the reduction of left ventricular hypertrophy in our patients seems to be related to changes inducted by losartan on the IAS, since no further hemodynamic effects were observed. Losartan induced both a significant reduction of LVH and an improvement of LV diastolic function with a subsequent expected beneficial shift on the prognosis.
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Affiliation(s)
- C Moroni
- Cardiovascular Sciences Department, Medical Therapy Institute, Statistical Department; "Sapienza" University, Rome, Italy.
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