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Serenelli M, Dal Passo B, Biscaglia S, Tolomeo P, Di Ienno L, Cantone A, Sanguettoli F, Campana R, Marchini F, Arzenton M, Maio D, Santori V, Campo G. Diagnostic accuracy of baseline troponin and troponin change for the diagnosis of myocardial infarction complicated with heart failure. Open Heart 2024; 11:e002538. [PMID: 38485286 PMCID: PMC10941125 DOI: 10.1136/openhrt-2023-002538] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/11/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The diagnosis of myocardial infarction (MI) in the presence of heart failure (HF) presents a clinical problem. While diagnostic algorithms using high-sensitivity cardiac troponin have been established for suspected MI, their accuracy in patients with HF remains uncertain. This study aims to assess the diagnostic accuracy of high-sensitivity troponin I (TnI) levels in identifying acute MI among patients with HF, focusing on baseline, absolute and relative TnI changes. METHODS Data from 562 individuals admitted to the emergency department with suspected MI were retrospectively analysed. Two-point TnI and baseline brain natriuretic peptide (BNP) test results were available. HF status was determined based on clinical, laboratory and instrumental criteria. RESULTS Among the 562 patients, 299 (53.2%) were confirmed having MI. Baseline TnI demonstrated predictive capability for MI in the overall population (area under the curve (AUC) 0.63), while TnI relative change exhibited superior performance (AUC 0.83). Baseline TnI accuracy varied significantly by group, notably decreasing in the third group (severe HF) (AUC 0.54) compared with the first and second groups (AUC 0.67 and AUC 0.71, respectively). TnI relative change demonstrated consistent accuracy across all groups, with AUCs of 0.79, 0.79 and 0.89 for the first, second and third groups, respectively, even after adjustment for age, sex and glomerular filtration rate. DISCUSSION Troponin relative change is a reliable predictor of MI, even in patients with acute HF. Baseline TnI accuracy is influenced by HF severity. It is essential to consider HF status and BNP levels when employing high-sensitivity cardiac troponin testing to rule out suspected MIs.
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Affiliation(s)
- Matteo Serenelli
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Beatrice Dal Passo
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Simone Biscaglia
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Paolo Tolomeo
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Luca Di Ienno
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Anna Cantone
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Federico Sanguettoli
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Roberta Campana
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Federico Marchini
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Matteo Arzenton
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Daniele Maio
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Valentino Santori
- Department of Statistics, Informatics, Applications 'Giuseppe Parenti' (DISIA), University of Florence Unit of Methodological and Statistical Support to Clinical Research, AOU of Modena, Modena, Italy
| | - Gianluca Campo
- Department of Cardiology, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
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Barchitta A, Rossitto G, Ruzza L, Maio D, Scaparotta G, Bagordo D, Antonini Canterin F, Piovesana P, Seccia TM, Nalesso F, Calò L, Rossi GP. Coronary sinus diameter to estimate congestion and predict survival. Int J Cardiol Heart Vasc 2023; 49:101294. [PMID: 38020054 PMCID: PMC10663896 DOI: 10.1016/j.ijcha.2023.101294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
Background Congestion predicts a poor prognosis, but its assessment is challenging in clinical practice and requires a multiparametric approach. We investigated if the coronary sinus (CS) diameter can predict mortality in a human model of rapid fluid unloading. Methods We measured by echocardiography the CS, and the inferior vena cava (IVC) for comparison, in 60 patients with end-stage chronic kidney disease (ESKD) immediately before and after hemodialysis (HD; age 76 [57-81] years, 40% female, left ventricular ejection fraction 57 [53-56]%). Patients were prospectively followed up for all-cause mortality. Results HD-induced decongestion decreased the maximum diameters of both CS and IVC (p ≤ 0.001 for all). The maximum diameter of the CS (CSmax) was as accurate as the IVC maximum diameter and collapsibility for the identification of congestion, defined as pre-hemodialysis status (AUROC CSmax = 0.902 vs IVC = 0.895, p = n.s.). A CSmax diameter after hemodialysis > 9 mm predicted all-cause mortality at 12 months (Log-rank Chi square = 11.49, p < 0.001). Conclusions A persistently dilated CS after hemodialysis is a marker of residual congestion and predicts death at one year in high-risk ESKD patients.
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Affiliation(s)
- Agatella Barchitta
- University of Padova, Emergency Medicine and Hypertension, University Hospital, Padova, Italy
| | - Giacomo Rossitto
- University of Padova, Emergency Medicine and Hypertension, University Hospital, Padova, Italy
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Luisa Ruzza
- University of Padova, Emergency Medicine and Hypertension, University Hospital, Padova, Italy
| | - Daniele Maio
- University of Ferrara, Cardiology, St Anna Hospital, Ferrara, Italy
| | | | - Domenico Bagordo
- University of Padova, Emergency Medicine and Hypertension, University Hospital, Padova, Italy
| | | | | | - Teresa Maria Seccia
- University of Padova, Emergency Medicine and Hypertension, University Hospital, Padova, Italy
| | - Federico Nalesso
- University of Padova, Nephrology, University Hospital, Padova, Italy
| | - Lorenzo Calò
- University of Padova, Nephrology, University Hospital, Padova, Italy
| | - Gian Paolo Rossi
- University of Padova, Emergency Medicine and Hypertension, University Hospital, Padova, Italy
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D’Onghia M, Cartocci A, Calabrese L, Maio D, Sirchio A, Erasti M, Tognetti L, Rubegni P, Bocchia M, Cencini E, Fabbri A, Cinotti E. Characteristics of Primary Cutaneous Lymphoma in Italy: A Tertiary Care, Single-Center Study. Curr Oncol 2023; 30:9813-9823. [PMID: 37999132 PMCID: PMC10670225 DOI: 10.3390/curroncol30110712] [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] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023] Open
Abstract
Data on primary cutaneous lymphomas (PCLs) patients in the Italian population are limited, and, despite the existence of several treatment options, the management of those patients remains challenging. Our study aimed to investigate the clinical and therapeutic features of PCL patients in a referral center in Italy. We conducted a retrospective study on 100 consecutive PCL patients between January 2017 and December 2022. The mean (SD) age of our cohort was 70.33 (14.14) years. Cutaneous T-cell lymphomas (CTCLs) represented 65% of all cases; the majority were mycosis fungoides (42%), followed by cases of Sezary syndrome (10%) and primary cutaneous anaplastic large cell lymphoma (4%). Cutaneous B-cell lymphomas (CBCLs) accounted for 35 % of PCLs, with 15 cases of primary cutaneous follicle center lymphoma, 10 cases of primary cutaneous diffuse large B-cell lymphoma leg type, and 9 cases of marginal zone B-cell lymphoma. A higher frequency of pruritus (p = 0.008) and higher peripheral blood levels of beta-2 microglobulin (p ≤ 0.001) and lactate dehydrogenase (p = 0.025) were found in CTCLs compared to those of CBCLs. Considering all therapeutic lines performed, treatments were extremely heterogeneous and skin-directed therapies represented the most frequently used approach. Our study confirms the distribution of PCL subtypes formerly reported in the literature and highlights the utility of real-life data in treatments to improve the current management of PCL patients.
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Affiliation(s)
- Martina D’Onghia
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Alessandra Cartocci
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Laura Calabrese
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Daniele Maio
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Azzurra Sirchio
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Maria Erasti
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Linda Tognetti
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Monica Bocchia
- Department of Medical, Surgical and Neurological Sciences, Hematology Section, University of Siena, 53100 Siena, Italy; (M.B.); (E.C.); (A.F.)
| | - Emanuele Cencini
- Department of Medical, Surgical and Neurological Sciences, Hematology Section, University of Siena, 53100 Siena, Italy; (M.B.); (E.C.); (A.F.)
| | - Alberto Fabbri
- Department of Medical, Surgical and Neurological Sciences, Hematology Section, University of Siena, 53100 Siena, Italy; (M.B.); (E.C.); (A.F.)
| | - Elisa Cinotti
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
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Cantone A, Serenelli M, Sanguettoli F, Maio D, Fabbri G, Dal Passo B, Agostoni P, Grazzi G, Campo G, Rapezzi C. Cardiopulmonary exercise testing predicts prognosis in amyloid cardiomyopathy: a systematic review and meta-analysis. ESC Heart Fail 2023. [PMID: 37264762 PMCID: PMC10375073 DOI: 10.1002/ehf2.14406] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/17/2023] [Accepted: 05/08/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The clinical value of cardiopulmonary exercise testing (CPET) in cardiac amyloidosis (CA) is uncertain. Due to the growing prevalence of the disease and the current availability of disease-modifying drugs, prognostic stratification is becoming fundamental to optimizing the cost-effectiveness of treatment, patient phenotyping, follow-up, and management. Peak VO2 and VE/VCO2 slope are currently the most studied CPET variables in clinical settings, and both demonstrate substantial, independent prognostic value in several cardiovascular diseases. We aim to study the association of peak VO2 and VE/VCO2 slope with prognosis in patients with CA. METHODS AND RESULTS We performed a systematic review and searched for clinical studies performing CPET for prognostication in patients with transthyretin-CA and light-chain-CA. Studies reporting hazard ratio (HR) for mortality and peak VO2 or VE/VCO2 slope were further selected for quantitative analysis. HRs were pooled using a random-effect model. Five studies were selected for qualitative and three for quantitative analysis. A total of 233 patients were included in the meta-analysis. Mean peak VO2 resulted consistently depressed, and VE/VCO2 slope was increased. Our pooled analysis showed peak VO2 (pooled HR 0.89, 95% CI 0.84-0.94) and VE/VCO2 slope (pooled HR 1.04, 95% CI 1.01-1.07) were significantly associated with the risk of death in CA patients, with no significant statistical heterogeneity for both analyses. CONCLUSIONS CPET is a valuable tool for prognostic stratification in CA, identifying patients at increased risk of death. Large prospective clinical trials are needed to confirm this exploratory finding.
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Affiliation(s)
- Anna Cantone
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Matteo Serenelli
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Federico Sanguettoli
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Daniele Maio
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Gioele Fabbri
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Beatrice Dal Passo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giovanni Grazzi
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Claudio Rapezzi
- Cardiovascular Institute, University of Ferrara, Ferrara, Italy
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Blanzieri E, Grandi F, Maio D. High-order behaviour in learning gate networks with lateral inhibition. Biol Cybern 1996; 74:73-83. [PMID: 8573655 DOI: 10.1007/bf00199139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In this work we present a neural network model incorporating activity-dependent presynaptic facilitation with multidimensional inputs. The processing unit used is based on a slightly simplified version of the Learning Gate Model proposed by Ciaccia et al. (1992). The network topology integrates a well-known biological neural circuit with a lateral inhibition connection subnet. By means of simulation experiments, we show that the proposed networks exhibit basic and high-order features of associative learning. In particular, overshadowing and blocking are reproduced in the presence of both noise-free and noisy inputs. The role of noise in the development of high-order learning capabilities is also discussed.
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