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Simeone B, Zuchi C, Mengoni A, Carluccio E, Biagioli P, Lauciello R, Sasso G, Scavelli F, Rocco E, Ambrosio G. A strange case of Transthyretin Cardiac Amyloidosis in the Elderly: a diagnostic challenge. Clin Ter 2023; 174:235-239. [PMID: 37199356 DOI: 10.7417/ct.2023.2526] [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] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Abstract Transthyretin (TTR)-related cardiac amyloidosis is a progressive infiltrative cardiomyopathy that mimics hypertensive, hypertrophic heart disease and may go undiagnosed. We here report the case of a 83-year-old woman, which has rapresented an unique case of transthyretin-related cardiac amyloidosis, as a patient with an initial diagnosis of hypertensive heart disease later develops an infiltrative cardiomyopathy due to amyloid deposits.
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Affiliation(s)
- B Simeone
- Department of Medico-Surgical Sciences and Biotechnologies, Cardiology Unit, ICOT Hospital, Sapienza University of Rome, Latina, Italy
| | - C Zuchi
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - A Mengoni
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - E Carluccio
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - P Biagioli
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - R Lauciello
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - G Sasso
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - F Scavelli
- Department of Cardiology and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - E Rocco
- Department of Medico-Surgical Sciences and Biotechnologies, Cardiology Unit, ICOT Hospital, Sapienza University of Rome, Latina, Italy
| | - G Ambrosio
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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Mandoli G, Pastore M, Giannoni A, Benfari G, Dini F, Correale M, Carluccio E, Guaricci A, Citro R, Novo G, Pasquini A, Degiovanni A, Santoro C, Malagoli A, Cameli M. Deformation imaging by strain in chronic heart failure over sacubitril/valsartan: a multicenter echocardiographic registry (DISCOVER) ARNI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0793] [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: 11/12/2022] Open
Abstract
Abstract
Background
Sacubitril/valsartan changed the treatment of heart failure with reduced ejection fraction (HFrEF), due to the positive effects morbidity and mortality partly mediated by left ventricular reverse remodeling (LVRR). The aim of this multicenter study was to identify echocardiographic predictors of LVRR after sacubitril/valsartan administration.
Methods
Patients with HFrEF requiring therapy with sacubitril/valsartan from 13 Italian centers were included. Echocardiographic indexes including speckle tracking echocardiography (STE) were used to predict LVRR (defined as LV end-systolic volume reduction and ejection fraction [LVEF] improvement >10% at follow-up) at 6 months follow-up as the primary endpoint. Changes in symptoms (NYHA class) and neurohormonal activations (N-terminal-pro-brain natriuretic peptide [NTproBNP]) were also evaluated as secondary endpoints. Patients with poor acoustic windows and missing data were excluded.
Results
The final population consisted of 341 patients (mean age: 65±10 years; 18% female, median LVEF 30% [interquartile range:25; 34]. At 6 months follow-up, cardiac dimensions and function, including left heart STE parameters, improved (Table 1). Moreover, 82 (24%) patients showed early complete response (LVRR and LVEF ≥35%), 55 (16%) early incomplete response (LVRR and LVEF <35%), 204 (60%) no response (no LVRR and LVEF <35%) after 6 months of sacubitril/valsartan. Among patients with ischemic etiology, 68% (108) did not develop LV RR. Age, sex, general characteristics, baseline NYHA class and NT-pro BNP did not significantly differ between the groups.Conversely, baseline LV dimensions and LVEF showed significant differences between the groups (p<0.0001). Also, STE parameters were considerably better in group 1 compared to group 2 and 3 both at baseline and follow-up. Non-ischemic etiology, a lower left atrial volume index and a higher global longitudinal strain were all independent predictors of LVRR at multivariable logistic analysis (all p<0.01). With ROC and spline curves, LV GLS >−9.3% showed a good accuracy in predicting LV RR (Figure 1). LA strain was the best predictor of positive changes in NYHA class and NT-proBNP (all p<0.05).
Conclusions
STE parameters at baseline could be useful to predict LVRR and early clinical response to sacubitril-valsartan, and thus could be used as a guide for treatment in patients with HFrEF.
Funding Acknowledgement
Type of funding sources: None. Table 1Figure 1
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Affiliation(s)
- G.E Mandoli
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M.C Pastore
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - A Giannoni
- Fondazione Toscana Gabriele Monasterio, Cardiology and Cardiovascular Medicine Department, Pisa, Italy
| | - G Benfari
- University of Verona, Division of Cardiology, Department of Medicine, Verona, Italy
| | - F.L Dini
- Major Hospital, Centro Medico Sant'Agostino, Milano, Italy, Milano, Italy
| | - M Correale
- University Hospital Ospedali Riuniti, Cardiology Department, Foggia, Italy
| | - E Carluccio
- Hospital Santa Maria Della Misericordia, Cardiology and Cardiovascular Pathophysiology - Heart Failure Unit, Perugia, Italy
| | - A.I Guaricci
- Polyclinic Hospital of Bari, University Cardiology Unit, Cardiothoracic Department, Bari, Italy
| | - R Citro
- AOU San Giovanni di Dio e Ruggi dAragona, Cardio-Thoracic-Vascular Department, Salerno, Italy
| | - G Novo
- University Hospital Paolo Giaccone, Division of Cardiology, Department ProMISE, Palermo, Italy
| | - A Pasquini
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - A Degiovanni
- Hospital Maggiore Della Carita, Department of Thoracic, Heart and Vascular Diseases, Novara, Italy
| | - C Santoro
- Federico II University Hospital, Department of Advanced Biomedical Science, Naples, Italy
| | - A Malagoli
- University of Modena & Reggio Emilia, Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, Modena, Italy
| | - M Cameli
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
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Rossi A, Carluccio E, Cameli M, Inciardi R, Mandoli G, D'Agostino A, Biagioli P, Pugliese N, Pastore M, Maffeis C, Mengoni A, Dini F. Left atrial remodeling in heart failure: coexistence and additive prognostic power of atrial dilation and dysfunction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1023] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is associated with volumetric and functional changes of left atrium (LA).
Purpose
It is still unclear whether the two atrial abnormalities necessarily coexist and if they have additive prognostic implications.
Methods
690 patients with HF due to reduced left ventricular ejection fraction (EF) formed the study population. Each patients underwent comprehensive echocardiographic evaluation; atrial function was assessed by means of strain analysis during reservoir (PALS). End-point of the study was overall survival free of hospitalization.
Results
Patients were divided in 4 groups according to left atrial size (34 ml/mq) and function (PALS 20%). 64 patients (10%) were characterized by completely normal left atrium (group 1), 150 (25%) by dilated LA by normal PALS (group 2), 130 (20%) by normal LA volume but abnormal PALS (group 3) and 200 patients with dilated LA and decreased PALS (group 4). Clinical and echocardiographic characteristics of the groups are presented in the table. Decreased PALS was associated with worse survival both in patients with normal and abnormal LA volume (p<0.0001 for each group).
Conclusions
Increased volume and decreased function of LA frequently but not necessarily coexist. LA functional impairment affects prognosis independently of LA volume.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Rossi
- University of Verona, Verona, Italy
| | | | - M Cameli
- University of Siena, Siena, Italy
| | | | | | | | | | | | | | | | - A Mengoni
- University of Perugia, Perugia, Italy
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4
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Coiro S, Carluccio E, Biagioli P, Alunni G, Murrone A, D'Antonio A, Zuchi C, Mengoni A, Girerd N, Borghi C, Ambrosio G. Elevated serum uric acid concentration at discharge confers additive prognostic value in elderly patients with acute heart failure. Nutr Metab Cardiovasc Dis 2018; 28:361-368. [PMID: 29501446 DOI: 10.1016/j.numecd.2017.12.009] [Citation(s) in RCA: 15] [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: 10/11/2017] [Revised: 12/13/2017] [Accepted: 12/24/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Elevated serum uric acid (sUA) concentrations have been associated with worse prognosis in heart failure (HF) but little is known about elderly patients. We aimed to assess long-term additive prognostic value of sUA in elderly patients hospitalized for HF. METHODS AND RESULTS Clinical and echocardiographic characteristics of 310 consecutive elderly patients hospitalized for HF were collected. During index period, 206 had sUA concentrations available, which were obtained within 24 h prior to discharge; 10 patients were lost to follow-up, leaving 196 patients available. Patients had a median age of 77 (IQR 69-83) years, and were mostly male (64.5%). sUA ranges for tertiles I-III were: 1.5-6.1, 6.2-8.3, and 8.4-18.9 mg/dl, respectively. During a median follow-up of 27 months (IQR 10.5-39.5), 122 combined events occurred (87 deaths and 73 HF rehospitalizations). Four-year event-free survival for the combined endpoint was 46 ± 7% for tertile I, 34 ± 7% for tertile II, and 21 ± 5% for tertile III (P = 0.001). By multivariable Cox backward analysis, sUA was retained as a significant predictor. Compared with the lowest sUA tertile, tertile III showed a strong association with outcome, also after adjustment for other predictors (HR 1.84, 95% CI 1.16-2.93; P = 0.01). Importantly, addition of sUA to the other significant predictors of outcome resulted in improved risk classification (net reclassification improvement 0.19, P = 0.017). CONCLUSIONS High sUA at discharge is a strong predictor of adverse outcome in elderly hospitalized for HF, and it significantly improves risk classification. Measuring sUA can be a simple and useful tool to identify high-risk elderly hospitalized for HF.
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Affiliation(s)
- S Coiro
- Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy
| | - E Carluccio
- Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy
| | - P Biagioli
- Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy
| | - G Alunni
- Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy
| | - A Murrone
- Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy
| | - A D'Antonio
- Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy
| | - C Zuchi
- Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy
| | - A Mengoni
- Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy
| | - N Girerd
- INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux, Nancy, France
| | - C Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - G Ambrosio
- Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy.
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Dini F, Carluccio E, Galeotti G, Biagioli P, Zuchi C, Simioniuc A, Fontanive P. P2439B-type natriuretic response and non-restrictive mitral flow are predictors of left ventricular reverse remodeling and influence the outcome of patients with heart failure with reduced ejection fractio. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mengoni A, Carluccio E, Biagioli P, Cerasa M, D'Antonio A, Coiro S, Oliva V, Zingarini G, Ambrosio G. P2449Mechanical LBBB contraction pattern by speckle tracking echocardiography and left ventricular remodeling after CRT. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Righi E, Girardis M, Marchegiano P, Venturelli C, Tagliazucchi S, Pecorari M, Borsari L, Carluccio E, Codeluppi M, Mussini C, Aggazzotti G. Characteristics and outcome predictors of patients involved in an outbreak of Burkholderia cepacia complex. J Hosp Infect 2013; 85:73-5. [PMID: 23927925 DOI: 10.1016/j.jhin.2013.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 03/28/2013] [Accepted: 06/30/2013] [Indexed: 11/25/2022]
Abstract
A Burkholderia cepacia complex outbreak occurred among ventilated non-cystic fibrosis patients in an intensive care unit (ICU) in Italy: 33 colonized and 13 infected patients were included in a retrospective study aimed at investigating factors related to clinical infection and mortality. Demographic/clinical conditions and mortality did not vary significantly between colonized and infected patients, both groups showing high mortality rates compared with the overall ICU population and similar to that observed in patients with other infections. In multivariate regression analysis, disease severity (defined by the Simplified Acute Physiology Score II) and age were the only independent predictors of early mortality (odds ratio: 1.12; 95% confidence interval: 1.02-1.26; and 1.07; 1.01-1.15, respectively).
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Affiliation(s)
- E Righi
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Italy.
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Lestuzzi C, Biscottini E, Viel E, Tartuferi L, Massa L, Carluccio E, Loaf F, Pagnotta F, Alunni G, Ambrosio G. Prognosis and predictors of functional recovery at follow-up in patients with anthracyclines cardiomyopathy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.4571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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Andreoli C, Carluccio E, Biagioli P, D'Addario S, Zingarini G, Lauciello R, Zuchi C, Alunni G, Cavallini C, Ambrosio G. Clinical and echocardiographic predictors of super-responders to CRT and its related longterm follow-up. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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10
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Carluccio E, Biagioli P, Alunni G, Murrone A, Leonelli V, Pantano P, Vincenti G, Giombolini C, Ragni T, Reboldi G, Gentile F, Ambrosio G. Effect of revascularizing viable myocardium on left ventricular diastolic function in patients with ischaemic cardiomyopathy. Eur Heart J 2009; 30:1501-9. [DOI: 10.1093/eurheartj/ehp125] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Carluccio E, Tommasi S, Bentivoglio M, Buccolieri M, Filippucci L, Prosciutti L, Corea L. Prognostic value of left ventricular hypertrophy and geometry in patients with a first, uncomplicated myocardial infarction. Int J Cardiol 2000; 74:177-83. [PMID: 10962119 DOI: 10.1016/s0167-5273(00)00264-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [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: 12/28/2022]
Abstract
BACKGROUND The prognostic impact of left ventricular (LV) geometry on cardiovascular risk for patients with a first, uncomplicated acute myocardial infarction (AMI), and echocardiographic ejection fraction > or =50% has not been well described. METHODS AND RESULTS Accordingly, 111 AMI consecutive patients (mean age 59.3+/-10 years) performed echocardiographic examination at predischarge. LV mass was calculated by means of Devereux's formula and subsequently indexed by body surface area. Fifty-three patients had LV hypertrophy and 58 patients had normal LV mass. The two groups were homogeneous for demographic, clinical and angiographic variables as well as for the incidence of residual ischemia on predischarge stress testing. During follow-up period there were 24 cardiac events (cardiac death, unstable angina and non-fatal reinfarction) in the 53 patients with LV hypertrophy and only four events in the remaining 58 patients without LV hypertrophy (RR=2.45; CI=1.76-3.41; P<0.0001). The patients with concentric LV hypertrophy showed a higher incidence of events (64%) than patients with eccentric LV hypertrophy (32%, P<0. 05) and patients with normal geometry and mass (6%, P<0.0001). Multivariate Cox regression model identified concentric geometry as the most powerful predictor of combined end-points (chi(2)=32.7, P<0. 0001). CONCLUSIONS An increased LV mass and concentric geometry resulted important independent markers of an adverse outcome in patients with a first, uncomplicated myocardial infarction and good LV function.
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Affiliation(s)
- E Carluccio
- Department of Clinical and Experimental Medicine, Division of Cardiology, Policlinico Monteluce, University of Perugia, Via Brunamonti, 1, 06100 Perugia, Italy
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Carluccio E, Tommasi S, Bentivoglio M, Buccolieri M, Prosciutti L, Corea L. Usefulness of the severity and extent of wall motion abnormalities as prognostic markers of an adverse outcome after a first myocardial infarction treated with thrombolytic therapy. Am J Cardiol 2000; 85:411-5. [PMID: 10728942 DOI: 10.1016/s0002-9149(99)00764-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [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: 11/27/2022]
Abstract
The prognostic value of wall motion score index (WMSI), assessed at predischarge after a first acute myocardial infarction (AMI) in the thrombolytic era, is still not well known. One-hundred forty-four consecutive patients with a first AMI treated with thrombolytic therapy underwent exercise testing and echocardiography at rest before discharge and were followed-up for a mean period of 18 months. During follow-up, there were 32 cardiac events (12 patients had cardiac deaths, 8 had unstable angina pectoris, 1 had nonfatal reinfarction, and 11 patients had congestive heart failure). The patients who experienced any cardiac event had a higher WMSI (1.67+/-0.15 vs. 1.30+/-0.16, p<0.0001), a higher end-systolic volume (75.1+/-34 vs. 59.5+/-22 ml, p<0.01), and a lower ejection fraction (47+/-16% vs. 55+/-10%, p<0.001) at predischarge than patients without events. The incidence of a positive predischarge exercise testing did not differ between patients with and without cardiac events (22% vs. 24%, p = NS). Multivariate Cox regression analysis, including clinical, exercise results, and echocardiographic parameters, showed that the most powerful predictor of a subsequent event was a resting WMSI > or =1.50 before discharge (chi-square 17.8, p<0.0001). Thus, in patients with a first AMI who underwent thrombolysis, the severity and extent of echocardiographically detected wall motion abnormalities are important independent predictors of cardiac events.
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Affiliation(s)
- E Carluccio
- Department of Clinical and Experimental Medicine, Policlinico Monteluce, University of Perugia, Italy
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Tommasi S, Carluccio E, Bentivoglio M, Corea L, Picano E. Low-dose dipyridamole infusion acutely increases exercise capacity in angina pectoris: a double-blind, placebo controlled crossover stress echocardiographic study. J Am Coll Cardiol 2000; 35:83-8. [PMID: 10636264 DOI: 10.1016/s0735-1097(99)00534-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to assess whether endogenous accumulation of adenosine, induced by low-dose dipyridamole infusion, protects from exercise-induced ischemia. BACKGROUND Adenosine is a recognized mediator of ischemic preconditioning in experimental settings. METHODS Ten patients (all men: mean age 63.4 +/- 7.3 years) with chronic stable angina, angiographically assessed coronary artery disease (n = 7) or previous myocardial infarction (n = 3) and exercise-induced ischemia underwent on different days two exercise-stress echo tests after premedication with placebo or dipyridamole (15 mg in 30 min, stopped 5 min before testing) in a double-blind, placebo controlled, randomized crossover design. RESULTS In comparison with placebo, dipyridamole less frequently induced chest pain (20% vs. 100%, p = 0.001) and >0.1 mV ST segment depression (50% vs. 100%, p < 0.05). Wall motion abnormalities during exercise-stress test were less frequent (placebo = 100% vs. dipyridamole = 70%, p = ns) and significantly less severe (wall motion score index at peak stress: placebo = 1.55 +/- 0.17 vs. dipyridamole = 1.27 +/- 0.2, p < 0.01) following dipyridamole, which also determined an increase in exercise time up to echocardiographic positivity (placebo = 385.9 +/- 51.4 vs. dipyridamole = 594.4 +/- 156.9 s, p < 0.01). CONCLUSIONS Low-dose dipyridamole infusion increases exercise tolerance in chronic stable angina, possibly by endogenous adenosine accumulation acting on high affinity A1 myocardial receptors involved in preconditioning or positively modulating coronary flow through collaterals.
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Affiliation(s)
- S Tommasi
- Department of Clinical and Experimental Medicine, University of Perugia, Italy
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14
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Ambrosio G, Bentivoglio M, Carluccio E, Sardone M. [Dyslipidemia as cardiovascular and cerebrovascular risk factor: epidemiology and physiopathology]. Cardiologia 1999; 44 Suppl 1:91-4. [PMID: 12497889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- G Ambrosio
- Università degli Studi Ospedale Silvestrini Via S Andrea delle Fratte, 06156 Perugia.
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15
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Tommasi S, Carluccio E, Bentivoglio M, Buccolieri M, Mariotti M, Politano M, Corea L. C-reactive protein as a marker for cardiac ischemic events in the year after a first, uncomplicated myocardial infarction. Am J Cardiol 1999; 83:1595-9. [PMID: 10392860 DOI: 10.1016/s0002-9149(99)00162-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The prognostic role of C-reactive protein levels in patients with a first acute myocardial infarction, an uncomplicated in-hospital course, and the absence of residual ischemia on a predischarge ergometer test and with an echocardiographic ejection fraction > or = 50% has not been described. C-reactive protein was determined during hospitalization in 64 patients (55 men, mean age 64.6 +/- 10.4 years). The patients were followed up for 13 +/- 4 months and the following cardiac events were recorded: cardiac death, new-onset angina pectoris, and recurrent myocardial infarction. Patients who developed cardiac events during the follow-up period had significantly higher C-reactive protein values than patients without events (3.61 +/- 2.83 vs 1.48 +/- 2.07 mg/dl, p <0.001). The probability of cumulative end points was: 6%, 12%, 31%, and 56% (p = 0.006; RR 3.55; confidence interval 1.56 to 8.04), respectively, in patients stratified by quartiles of C-reactive protein (< 0.45, 0.45 to 0.93, 0.93 to 2.55 and > 2.55 mg/dl). In the Cox regression model, only increased C-reactive protein levels were independently related to the incidence of subsequent cardiac events (chi-square 9.8, p = 0.001). Thus, increased C-reactive protein levels are associated with a worse outcome among patients with a first acute myocardial infarction, an uncomplicated in-hospital course without residual ischemia on the ergometer test, and with normal left ventricular function.
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Affiliation(s)
- S Tommasi
- Department of Clinical and Experimental Medicine, Policlinico Monteluce, University of Perugia, Italy.
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