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Cappelli F, Costantini V, D'Angeli M, Marin G, Paglialunga E. Local sources of vulnerability to climate change and armed conflicts in East Africa. J Environ Manage 2024; 355:120403. [PMID: 38428181 DOI: 10.1016/j.jenvman.2024.120403] [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] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/13/2023] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Abstract
While socioeconomic and institutional factors are crucial in explaining the onset and evolution of conflicts, recent research suggests that climate change is a further indirect driver acting as a "threat multiplier". This paper focuses on the concept of vulnerability to both climate change and conflicts to explain why some locations are more likely to engage in armed conflicts than others in the presence of a similar level of exposure to climatic changes. In particular, by means of a Spatial Autoregressive Model, we identify a set of local-specific vulnerability factors that increase conflict risk in East Africa. We employ a georeferenced database with a resolution of 25 × 25 km, covering the period 1997-2016. Results from our analysis provide some interesting insights: first, climate change does not increase conflict risk per se, but only in the presence of pre-existing vulnerabilities. Second, resource access and socioeconomic factors play a key role in driving the climate-conflict nexus especially in urban areas. In particular, vulnerability is increased whenever power is not distributed in such a way as to ensure an equitable distribution of resources. Overall, our findings suggest that, by addressing vulnerability factors that prevent adaptive capacity and an equitable distribution of resources, societies may benefit in terms of both diminished conflict risk and alleviation of climate change impacts.
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Affiliation(s)
- Federica Cappelli
- Department of Economics and Management, University of Ferrara, via Voltapaletto, 11 - 44121, Ferrara, Italy.
| | - Valeria Costantini
- Department of Economics, University of Roma Tre, Via Silvio D'Amico 77, 00145, Rome, Italy.
| | - Mariagrazia D'Angeli
- Department of Economics, University of Roma Tre, Via Silvio D'Amico 77, 00145, Rome, Italy.
| | - Giovanni Marin
- Department of Economics, Society, Politics, University of Urbino Carlo Bo, Via Aurelio Saffi, 42, 61029, Urbino, Italy.
| | - Elena Paglialunga
- Department of Economics, University of Roma Tre, Via Silvio D'Amico 77, 00145, Rome, Italy.
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2
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Tikhonoff V, Casiglia E, Virdis A, Grassi G, Angeli F, Arca M, Barbagallo CM, Bombelli M, Cappelli F, Cianci R, Cicero AFG, Cirillo M, Cirillo P, Dell'oro R, D'elia L, Desideri G, Ferri C, Galletti F, Gesualdo L, Giannattasio C, Iaccarino G, Mallamaci F, Maloberti A, Masi S, Masulli M, Mazza A, Mengozzi A, Muiesan ML, Nazzaro P, Palatini P, Parati G, Pontremoli R, Quarti‐Trevano F, Rattazzi M, Reboldi G, Rivasi G, Russo E, Salvetti M, Temporelli PL, Tocci G, Ungar A, Verdecchia P, Viazzi F, Volpe M, Borghi C. Prognostic Value and Relative Cutoffs of Triglycerides Predicting Cardiovascular Outcome in a Large Regional-Based Italian Database. J Am Heart Assoc 2024; 13:e030319. [PMID: 38293920 PMCID: PMC11056112 DOI: 10.1161/jaha.123.030319] [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: 04/02/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Despite longstanding epidemiologic data on the association between increased serum triglycerides and cardiovascular events, the exact level at which risk begins to rise is unclear. The Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension has conceived a protocol aimed at searching for the prognostic cutoff value of triglycerides in predicting cardiovascular events in a large regional-based Italian cohort. METHODS AND RESULTS Among 14 189 subjects aged 18 to 95 years followed-up for 11.2 (5.3-13.2) years, the prognostic cutoff value of triglycerides, able to discriminate combined cardiovascular events, was identified by means of receiver operating characteristic curve. The conventional (150 mg/dL) and the prognostic cutoff values of triglycerides were used as independent predictors in separate multivariable Cox regression models adjusted for age, sex, body mass index, total and high-density lipoprotein cholesterol, serum uric acid, arterial hypertension, diabetes, chronic renal disease, smoking habit, and use of antihypertensive and lipid-lowering drugs. During 139 375 person-years of follow-up, 1601 participants experienced cardiovascular events. Receiver operating characteristic curve showed that 89 mg/dL (95% CI, 75.8-103.3, sensitivity 76.6, specificity 34.1, P<0.0001) was the prognostic cutoff value for cardiovascular events. Both cutoff values of triglycerides, the conventional and the newly identified, were accepted as multivariate predictors in separate Cox analyses, the hazard ratios being 1.211 (95% CI, 1.063-1.378, P=0.004) and 1.150 (95% CI, 1.021-1.295, P=0.02), respectively. CONCLUSIONS Lower (89 mg/dL) than conventional (150 mg/dL) prognostic cutoff value of triglycerides for cardiovascular events does exist and is associated with increased cardiovascular risk in an Italian cohort.
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Affiliation(s)
- Valérie Tikhonoff
- Department of MedicineUniversità degli Studi di PadovaVia Giustiniani 8Padua35128Italy
| | - Edoardo Casiglia
- Studium Patavinum, Department of MedicineUniversità degli Studi di PadovaPaduaItaly
| | - Agostino Virdis
- Department of Clinical and Experimental MedicineUniversity of PisaItaly
| | - Guido Grassi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
| | - Fabio Angeli
- Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
| | - Marcello Arca
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Carlo M. Barbagallo
- Biomedical Department of Internal Medicine and SpecialisticsUniversity of PalermoItaly
| | - Michele Bombelli
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
- Internal Medicine, Pio XI Hospital of Desio, ASST BrianzaDesioItaly
| | - Federica Cappelli
- Department of Clinical and Experimental MedicineUniversity of PisaItaly
| | - Rosario Cianci
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Arrigo F. G. Cicero
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences DepartmentAlma Mater Studiorum University of BolognaBolognaItaly
- IRCCS AOU S.Orsola di BolognaBolognaItaly
| | - Massimo Cirillo
- Department of Medicine “Scuola Medica Salernitana”University of SalernoBaronissi (SA)Italy
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation“Aldo Moro” University of BariBariItaly
| | - Raffaella Dell'oro
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
| | - Lanfranco D'elia
- Department of Clinical Medicine and Surgery“Federico II” University of Naples Medical SchoolNaplesItaly
| | | | - Claudio Ferri
- Department of Life, Health and Environmental SciencesUniversity of L’AquilaItaly
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery“Federico II” University of Naples Medical SchoolNaplesItaly
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation“Aldo Moro” University of BariBariItaly
| | - Cristina Giannattasio
- Cardiology IV, “A.De Gasperi’s” DepartmentNiguarda Ca’ Granda HospitalMilanItaly
- School of Medicine and SurgeryMilano‐Bicocca UniversityMilanItaly
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences“Federico II” University of NaplesNaplesItaly
| | - Francesca Mallamaci
- CNR‐IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal UnitReggio CalabriaItaly
| | - Alessandro Maloberti
- Cardiology IV, “A.De Gasperi’s” DepartmentNiguarda Ca’ Granda HospitalMilanItaly
- School of Medicine and SurgeryMilano‐Bicocca UniversityMilanItaly
| | - Stefano Masi
- Department of Clinical and Experimental MedicineUniversity of PisaItaly
| | - Maria Masulli
- Department of Clinical Medicine and Surgery“Federico II” University of Naples Medical SchoolNaplesItaly
| | - Alberto Mazza
- Department of Internal MedicineSanta Maria della Misericordia General Hospital, AULSS 5 PolesanaRovigoItaly
| | | | | | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense OrgansUniversity of Bari Medical SchoolBariItaly
| | - Paolo Palatini
- Studium Patavinum, Department of MedicineUniversità degli Studi di PadovaPaduaItaly
| | - Gianfranco Parati
- S. Luca HospitalIstituto Auxologico Italiano and University of Milan‐BicoccaMilanItaly
| | - Roberto Pontremoli
- Department of Internal MedicineUniversity of Genoa, and Policlinico San MartinoGenoaItaly
| | | | - Marcello Rattazzi
- Department of MedicineUniversità degli Studi di PadovaVia Giustiniani 8Padua35128Italy
- Medicina Interna ICa’ Foncello University HospitalTrevisoItaly
| | - Gianpaolo Reboldi
- Department of Medical and Surgical ScienceUniversity of PerugiaItaly
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care MedicineCareggi Hospital and University of FlorenceItaly
| | - Elisa Russo
- Department of Internal MedicineUniversity of Genoa, and Policlinico San MartinoGenoaItaly
| | - Massimo Salvetti
- Department of Clinical and Experimental SciencesUniversity of BresciaItaly
| | - Pier Luigi Temporelli
- Division of Cardiac RehabilitationIstituti Clinici Scientifici Maugeri, IRCCS, Gattico‐VerunoItaly
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and PsychologyUniversity of Rome Sapienza, Sant’Andrea HospitalRomeItaly
| | - Andrea Ungar
- Department of Geriatric and Intensive Care MedicineCareggi Hospital and University of FlorenceItaly
| | | | - Francesca Viazzi
- Department of Internal MedicineUniversity of Genoa, and Policlinico San MartinoGenoaItaly
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and PsychologyUniversity of Rome Sapienza, Sant’Andrea HospitalRomeItaly
- IRCCS San Raffaele RomeRomeItaly
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences DepartmentAlma Mater Studiorum University of BolognaBolognaItaly
- IRCCS AOU S.Orsola di BolognaBolognaItaly
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3
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Maloberti A, Mengozzi A, Russo E, Cicero AFG, Angeli F, Agabiti Rosei E, Barbagallo CM, Bernardino B, Bombelli M, Cappelli F, Casiglia E, Cianci R, Ciccarelli M, Cirillo M, Cirillo P, Desideri G, D'Elia L, Dell'Oro R, Facchetti R, Ferri C, Galletti F, Giannattasio C, Gesualdo L, Iaccarino G, Lippa L, Mallamaci F, Masi S, Masulli M, Mazza A, Muiesan ML, Nazzaro P, Parati G, Palatini P, Pauletto P, Pontremoli R, Pugliese NR, Quarti-Trevano F, Rattazzi M, Reboldi G, Rivasi G, Salvetti M, Tikhonoff V, Tocci G, Ungar A, Verdecchia P, Viazzi F, Volpe M, Virdis A, Grassi G, Borghi C. The Results of the URRAH (Uric Acid Right for Heart Health) Project: A Focus on Hyperuricemia in Relation to Cardiovascular and Kidney Disease and its Role in Metabolic Dysregulation. High Blood Press Cardiovasc Prev 2023; 30:411-425. [PMID: 37792253 PMCID: PMC10600296 DOI: 10.1007/s40292-023-00602-4] [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: 07/21/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
The relationship between Serum Uric Acid (UA) and Cardiovascular (CV) diseases has already been extensively evaluated, and it was found to be an independent predictor of all-cause and cardiovascular mortality but also acute coronary syndrome, stroke and heart failure. Similarly, also many papers have been published on the association between UA and kidney function, while less is known on the role of UA in metabolic derangement and, particularly, in metabolic syndrome. Despite the substantial number of publications on the topic, there are still some elements of doubt: (1) the better cut-off to be used to refine CV risk (also called CV cut-off); (2) the needing for a correction of UA values for kidney function; and (3) the better definition of its role in metabolic syndrome: is UA simply a marker, a bystander or a key pathological element of metabolic dysregulation?. The Uric acid Right for heArt Health (URRAH) project was designed by the Working Group on uric acid and CV risk of the Italian Society of Hypertension to answer the first question. After the first papers that individuates specific cut-off for different CV disease, subsequent articles have been published responding to the other relevant questions. This review will summarise most of the results obtained so far from the URRAH research project.
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Affiliation(s)
- Alessandro Maloberti
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Cardiology, Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich, University of Zurich, Schlieren, Switzerland
| | - Elisa Russo
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico SanMartino, Genoa, Italy
| | - Arrigo Francesco Giuseppe Cicero
- Hypertension and Cardiovascular Risk Research Group, Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy.
- Cardiovascular Medicine Unit, IRCCS AOU S. Orsola di Bologna, Pad. 25 - 1st Floor, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Enrico Agabiti Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Carlo Maria Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
| | - Bruno Bernardino
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Bombelli
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Department of Internal Medicine, Pio XI Hospital of Desio, ASST Brianza, Desio, Italy
| | - Federica Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Rosario Cianci
- Department of Translational and Precision Medicine, University of Rome La Sapienza, Rome, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Massimo Cirillo
- Department of Public Health, ''Federico II'' University of Naples, Naples, Italy
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, ''Aldo Moro'' University of Bari, Bari, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, ''Federico II'' University of Naples, Naples, Italy
| | - Raffaella Dell'Oro
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - Rita Facchetti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, ''Federico II'' University of Naples, Naples, Italy
| | - Cristina Giannattasio
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, ''Aldo Moro'' University of Bari, Bari, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, ''Federico II'' University of Naples, Naples, Italy
| | - Luciano Lippa
- Italian Society of General Medicine (SIMG), Avezzano, L'Aquila, Italy
| | - Francesca Mallamaci
- Reggio Cal Unit, Clinical Epidemiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Calabria, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Masulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Santa Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
| | - Gianfranco Parati
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Paolo Palatini
- Department of Medicine, University of Padua, Padua, Italy
| | - Paolo Pauletto
- Medicina Interna I, Ca' Foncello University Hospital, Treviso, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico SanMartino, Genoa, Italy
| | | | - Fosca Quarti-Trevano
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinica Medica, San Gerardo Hospital, Monza, Italy
| | | | - Gianpaolo Reboldi
- Department of Medical and Surgical Science, University of Perugia, 06100, Perugia, Italy
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Sant'Andrea Hospital, Rome, Italy
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, Rome, Italy
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico SanMartino, Genoa, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Sant'Andrea Hospital, Rome, Italy
- IRCCS San Raffaele, Rome, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Guido Grassi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Research Group, Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS AOU S. Orsola di Bologna, Pad. 25 - 1st Floor, Via Massarenti, 9, 40138, Bologna, Italy
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Moriconi D, Mengozzi A, Duranti E, Cappelli F, Taddei S, Nannipieri M, Bruno RM, Virdis A. The renal resistive index is associated with microvascular remodeling in patients with severe obesity. J Hypertens 2023; 41:1092-1099. [PMID: 37071436 PMCID: PMC10242520 DOI: 10.1097/hjh.0000000000003434] [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: 12/02/2022] [Accepted: 03/03/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Renal hemodynamics is impaired since the early stage of cardiometabolic disease. However, in obesity, its noninvasive ultrasound assessment still fails to provide pathophysiologic and clinical meaningfulness. We aimed to explore the relationship between peripheral microcirculation and renal hemodynamics in severe obesity. METHODS We enrolled fifty severely obese patients with an indication for bariatric referring to our outpatient clinic. Patients underwent an extensive reno-metabolic examination, paired with Doppler ultrasound and measurement of the renal resistive index (RRI). On the day of the surgery, visceral fat biopsies were collected to perform an ex-vivo complete microcirculatory assessment. Media-to-lumen ratio (M/L) and vascular response to acetylcholine (ACh), alone or co-incubated with N G -nitro arginine methyl ester (L-NAME), were measured. RESULTS Patients were stratified according to their normotensive (NT) or hypertensive (HT) status. HT had lower estimated glomerular filtration rate and higher RRI compared to NT, while the presence and extent of albuminuria were similar between the two groups. Concerning microcirculatory assessment, there were no differences between groups as regards the microvascular structure, while the vasorelaxation to ACh was lower in HT ( P = 0.042). Multivariable analysis showed a relationship between M/L and RRI ( P = 0.016, St. β 0.37) and between albuminuria and the inhibitory response of L-NAME to Ach vasodilation ( P = 0.036, St. β = -0.34). Notably, all these correlations were consistent also after adjustment for confounding factors. CONCLUSIONS The RRI and albuminuria relationship with microvascular remodeling in patients affected by severe obesity supports the clinical implementation of RRI to improve risk stratification in obesity and suggests a tight pathophysiologic connection between renal haemodynamics and microcirculatory disruption.
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Affiliation(s)
- Diego Moriconi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Emiliano Duranti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Federica Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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5
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Mengozzi A, Pugliese NR, Desideri G, Masi S, Angeli F, Barbagallo CM, Bombelli M, Cappelli F, Casiglia E, Cianci R, Ciccarelli M, Cicero AFG, Cirillo M, Cirillo P, Dell’Oro R, D’Elia L, Ferri C, Galletti F, Gesualdo L, Giannattasio C, Grassi G, Iaccarino G, Lippa L, Mallamaci F, Maloberti A, Masulli M, Mazza A, Muiesan ML, Nazzaro P, Palatini P, Parati G, Pontremoli R, Quarti-Trevano F, Rattazzi M, Reboldi G, Rivasi G, Russo E, Salvetti M, Tikhonoff V, Tocci G, Ungar A, Verdecchia P, Viazzi F, Volpe M, Borghi C, Virdis A. Serum Uric Acid Predicts All-Cause and Cardiovascular Mortality Independently of Hypertriglyceridemia in Cardiometabolic Patients without Established CV Disease: A Sub-Analysis of the URic acid Right for heArt Health (URRAH) Study. Metabolites 2023; 13:metabo13020244. [PMID: 36837863 PMCID: PMC9959524 DOI: 10.3390/metabo13020244] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 01/22/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
High serum uric acid (SUA) and triglyceride (TG) levels might promote high-cardiovascular risk phenotypes across the cardiometabolic spectrum. However, SUA predictive power in the presence of normal and high TG levels has never been investigated. We included 8124 patients from the URic acid Right for heArt Health (URRAH) study cohort who were followed for over 20 years and had no established cardiovascular disease or uncontrolled metabolic disease. All-cause mortality (ACM) and cardiovascular mortality (CVM) were explored by the Kaplan-Meier estimator and Cox multivariable regression, adopting recently defined SUA cut-offs for ACM (≥4.7 mg/dL) and CVM (≥5.6 mg/dL). Exploratory analysis across cardiometabolic subgroups and a sensitivity analysis using SUA/serum creatinine were performed as validation. SUA predicted ACM (HR 1.25 [1.12-1.40], p < 0.001) and CVM (1.31 [1.11-1.74], p < 0.001) in the whole study population, and according to TG strata: ACM in normotriglyceridemia (HR 1.26 [1.12-1.43], p < 0.001) and hypertriglyceridemia (1.31 [1.02-1.68], p = 0.033), and CVM in normotriglyceridemia (HR 1.46 [1.23-1.73], p < 0.001) and hypertriglyceridemia (HR 1.31 [0.99-1.64], p = 0.060). Exploratory and sensitivity analyses confirmed our findings, suggesting a substantial role of SUA in normotriglyceridemia and hypertriglyceridemia. In conclusion, we report that SUA can predict ACM and CVM in cardiometabolic patients without established cardiovascular disease, independent of TG levels.
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Affiliation(s)
- Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, 8952 Schlieren, Switzerland
- Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Correspondence: or or ; Tel.:+39-05-099-2558
| | | | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, 21100 Varese, Italy
| | - Carlo Maria Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, 90100 Palermo, Italy
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Federica Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Edoardo Casiglia
- Studium Patavinum, Department of Medicine, University of Padua, 35100 Padua, Italy
| | - Rosario Cianci
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Michele Ciccarelli
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80133 Naples, Italy
| | - Arrigo F. G. Cicero
- Department Hypertension and Cardiovascular Disease Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
- Heart-Chest-Vascular Department, IRCCS AOU of Bologna, 40126 Bologna, Italy
| | - Massimo Cirillo
- Department of Public Health, “Federico II” University of Naples, 80133 Naples, Italy
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari, 70122 Bari, Italy
| | - Raffaella Dell’Oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Lanfranco D’Elia
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80133 Naples, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80133 Naples, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari, 70122 Bari, Italy
| | - Cristina Giannattasio
- Cardiology IV, “A.De Gasperi’s” Department, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80133 Naples, Italy
| | - Luciano Lippa
- Italian Society of General Medicine (SIMG), 67051 Avezzano, Italy
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, 89124 Reggio Calabria, Italy
| | - Alessandro Maloberti
- Cardiology IV, “A.De Gasperi’s” Department, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80133 Naples, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Santa Maria Della Misericordia General Hospital, AULSS 5 Polesana, 45100 Rovigo, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
| | - Pietro Nazzaro
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), Neurosciences and Sense Organs, University of Bari Medical School, 70122 Bari, Italy
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine, University of Padua, 35100 Padua, Italy
| | - Gianfranco Parati
- S. Luca Hospital, Istituto Auxologico Italiano & University of Milan-Bicocca, 20126 Milan, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa; IRCSS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Marcello Rattazzi
- Department of Medicine—DIMED, University of Padova, Medicina Interna 1°, Ca’ Foncello University Hospital, 31100 Treviso, Italy
| | - Gianpaolo Reboldi
- Department of Medical and Surgical Science, University of Perugia, 06100 Perugia, Italy
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
| | - Elisa Russo
- Department of Internal Medicine, University of Genoa; IRCSS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
| | | | - Giuliano Tocci
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, 00185 Rome, Italy
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa; IRCSS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, 00185 Rome, Italy
| | - Claudio Borghi
- Department Hypertension and Cardiovascular Disease Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
- Heart-Chest-Vascular Department, IRCCS AOU of Bologna, 40126 Bologna, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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6
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Fumagalli C, Bonanni F, Beltrami M, Ruggiero R, Zocchi C, Tassetti L, Maurizi N, Zampieri M, Lovero F, Di Bari M, Marchionni N, Pieragnoli P, Cappelli F, Fumagalli S, Olivotto I. Incidence of stroke in patients with hypertrophic cardiomyopathy in stable sinus rhythm during long-term monitoring. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1735] [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: 11/13/2022] Open
Abstract
Abstract
Background
Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of atrial fibrillation (AF) and stroke, especially at an advanced disease stage. To date, however, the incidence and factors associated with cardioembolic events in HCM patients without AF remain unresolved.
Purpose
To determine the incidence of stroke in HCM patients in whom cardiac rhythm was monitored with a cardiac implantable electronic device (CIED). The association of stroke with left atrial (LA) enlargement was also examined.
Methods
Retrospective cohort study in an outpatient clinic in a tertiary HCM Referral Center.
All consecutive patients diagnosed with HCM and referred for CIED implantation with >16 years at diagnosis and >1 year follow-up post CIED implantation were reviewed. Severe LA dilatation was defined as a LA dimension (LAD) of >48mm at echocardiogram. Based on CIED monitoring, patients were classified as: Pre-existing AF (diagnosed with AF prior to CIED); De novo AF (diagnosed with AF after CIED implantation); Sinus Rhythm (SR): no episodes of AF. Incidence of stroke after CIED implantation was the primary outcome.
Results
A total of 185 patients (57% men, age: 54±17 years) were implanted with a CIED and were included. Pre-existing AF was present in 72 (36%) patients and de novo AF in 24 (13%); whereas 89 (48%) remained in SR. After 5 [2–9] years, stroke was reported in 19 (10.3%) patients: 7 occurred in patients with pre-existing AF (1.1%/year), 3 in patients with de novo AF (2.2%/year), and 9 in patients with SR (2.3%/year). No difference was captured by CHA2DS2-VASc score among rhythm categories. Patients with AF had larger LAD at baseline. Among patients in SR, those with a LAD>48mm had the greatest risk of stroke (4.8%/year vs 0.5%/year, p<0.01; Hazard Ratio [HR]: 8.56, 95% C.I. 2.03–36.15). At Cox multivariable regression analysis, LA (HR: 1.104, 95%C.I. 1.039–1.173, p=0.001) and AF (HR: 0.310, 95% C.I. 0.102–0.939, p=0.038) were associated with incident stroke.
Conclusions
In HCM patients with CIED long-term monitoring and no prior history of AF, stroke rates were similar in those with de novo AF or stable sinus rhythm. CHA2DS2-VASc considerably underestimated risk, whereas severe LA dilatation was a powerful predictor of risk, irrespective of AF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Fumagalli
- Careggi University Hospital (AOUC), Cardiomyopathies Unit , Florence , Italy
| | - F Bonanni
- Careggi University Hospital (AOUC), Cardiomyopathies Unit , Florence , Italy
| | - M Beltrami
- Careggi University Hospital (AOUC), Cardiomyopathies Unit , Florence , Italy
| | - R Ruggiero
- Careggi University Hospital (AOUC), Cardiomyopathies Unit , Florence , Italy
| | - C Zocchi
- Careggi University Hospital (AOUC), Cardiomyopathies Unit , Florence , Italy
| | - L Tassetti
- Careggi University Hospital (AOUC), Cardiomyopathies Unit , Florence , Italy
| | - N Maurizi
- University Hospital of Lausanne, Cardiology Department , Lausanne , Switzerland
| | - M Zampieri
- Careggi University Hospital (AOUC), Cardiomyopathies Unit , Florence , Italy
| | - F Lovero
- Careggi University Hospital (AOUC), Cardiomyopathies Unit , Florence , Italy
| | - M Di Bari
- Careggi University Hospital , Florence , Italy
| | | | | | - F Cappelli
- Careggi University Hospital (AOUC), Cardiomyopathies Unit , Florence , Italy
| | - S Fumagalli
- Careggi University Hospital , Florence , Italy
| | - I Olivotto
- Careggi University Hospital (AOUC), Cardiomyopathies Unit , Florence , Italy
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7
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Porcari A, Pagura L, Canepa M, Biagini E, Cappelli F, Tini G, Dore F, Longhi S, Sciagra' R, Fontana M, Gillmore J, Rapezzi C, Merlo M, Sinagra G. Prognostic implications of biventricular uptake of bone tracers at planar scintigraphy in transthyretin cardiac amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1770] [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
The prognostic role of bone tracer uptake in transthyretin cardiac amyloidosis (ATTR-CA) is controversial. A further characterization of cardiac retention measured by Perugini scale with differentiation between biventricular (BiV) and isolated left ventricle (LV) uptake has never been attempted previously.
Purpose
The study investigated the potential prognostic significance of BiV uptake in ATTR-CA.
Methods
In this multicentre, observational study, we analysed data of ATTR-CA patients who underwent bone tracer scintigraphy with acquisition of both planar and single photon emission computed tomography (SPECT) imaging. Cardiac uptake was defined according to the Perugini visual scale. Planar BiV uptake was defined according to right ventricle (RV) uptake: 0= absent, 1= < bone, 2= equal to bone, and 3= > bone and confirmed by SPECT imaging. The primary outcome was a composite of cardiac death or hospitalization for heart failure. The secondary outcome was all-cause mortality.
Results
All 124 ATTR-CA patients enrolled had LV and RV free wall uptake on SPECT images. Of them, 93 (75%) had BiV uptake visible on planar scintigraphy. BiV uptake was found in 14%, 70%, and 92% of Perugini grade 1, 2 and 3 respectively. Compared to those with isolated LV uptake, patients with BiV uptake were older (81 vs 77 years, p=0.006) and more frequently in NYHA≥3 (32% vs 10%, p=0.018). During a median follow-up of 21 months, BiV uptake was associated with a greater occurrence of the primary outcome compared to isolated LV uptake (40% vs 19%, p=0.021), whereas the Perugini scale was not (p=0.2) (Figure 1). At multivariable analysis, NYHA class ≥3 (hazard ratio [HR] 8.1, p=0.007), eGFR <60 ml/min (HR 2.1, p=0.025) and higher degree of RV uptake (HR 1.69, p=0.007) emerged as independent prognostic parameters. In an external cohort of 463 ATTR-CA patients with a median follow-up of 30 months, planar BiV uptake was independently associated with all-cause mortality, with an incremental risk in higher grades of RV uptake (p<0.001) (Figure 1).
Conclusions
The presence of BiV uptake at planar scintigraphy identified ATTR-CA patients with worse cardiovascular and global outcomes (Figure 2), potentially serving as a novel prognostic marker.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Porcari
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - L Pagura
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - M Canepa
- Ospedale Policlinico San Martino IRCCS, Cardiovascular Unit, Department of Internal Medicine , Genoa , Italy
| | - E Biagini
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, Cardiology Unit , Bologna , Italy
| | - F Cappelli
- Careggi University Hospital, Cardiomyopathy Unit , Florence , Italy
| | - G Tini
- Ospedale Policlinico San Martino IRCCS, Cardiovascular Unit, Department of Internal Medicine , Genoa , Italy
| | - F Dore
- Giuliano Isontina University Health Authority, Department of Nuclear Medicine , Trieste , Italy
| | - S Longhi
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, Cardiology Unit , Bologna , Italy
| | - R Sciagra'
- Careggi University Hospital, Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio” , Florence , Italy
| | - M Fontana
- Royal Free London NHS Foundation Trust, National Amyloidosis Centre, Division of Medicine , London , United Kingdom
| | - J Gillmore
- Royal Free London NHS Foundation Trust, National Amyloidosis Centre, Division of Medicine , London , United Kingdom
| | - C Rapezzi
- University Hospital of Ferrara, Cardiothoracic Department , Ferrara , Italy
| | - M Merlo
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - G Sinagra
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
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8
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Porcari A, Rossi M, Cappelli F, Canepa M, Musumeci B, Cipriani A, Tini G, Varra' GG, Argiro' A, Sessarego E, Sinigiani G, Di Bella G, Rapezzi C, Sinagra G, Merlo M. Incidence and risk factors for pacemaker implantation in light chain and transthyretin cardiac amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1771] [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: 11/13/2022] Open
Abstract
Abstract
Background
The incidence and risk factors of pacemaker (PM) implantation in patients with cardiac amyloidosis (CA) are largely unexplored.
Purpose
We sought to characterise the trends in the incidence of permanent PM and to identify baseline predictors of future PM implantation in light chain (AL) and transthyretin (ATTR) CA.
Methods
Multicentre, retrospective, observational study. Consecutive patients with AL and ATTR-CA diagnosed or referred at participating Centres between 2017 and 2020 were included. Clinical data recorded within ± 1 month from baseline evaluation were collected from electronic medical records. The primary outcome of the study was the need for clinically-indicated PM implantation. Reversible causes of conduction system disease were systematically ruled out before PM implantation. Patients with PM (n=41) and/or permanent defibrillator in situ (n=13) at the time of CA diagnosis were excluded.
Results
The study population consisted of 405 patients: 29.4% AL, 14.6% variant ATTR and 56% wild-type ATTR; 82.5% were males, with median age 76 years. During a median follow-up of 33 months (interquartile range 21–46), 36 (8.9%) patients experienced the primary outcome: 10 patients with AL-CA, 2 with variant ATTR-CA and 24 with wild-type ATTR-CA (p=0.08). At multivariable analysis, history of atrial fibrillation (hazard ratio [HR] 3.80, p=0.002), PR interval (HR 1.013, p=0.002) and QRS >120 ms (HR 4.7, p=0.001) on baseline ECG were independently associated with PM implantation (Figure 1). In the individual patient, the contemporary presence of these 3 factors yielded the highest risk of PM implantation (HR 6.26, p=0.003).
Conclusion
In a large cohort of AL and ATTR-CA, the incidence of PM implantation was high accounting for ≈9% of patients in the 3 years following the diagnosis. History of atrial fibrillation, longer PR interval and QRS >120 ms identified CA patients at high-risk of future PM implantation (Figure 2).
CA patients with these features might need close monitoring during follow-up for the development of conduction system disease requiring PM implantation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Porcari
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - M Rossi
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - F Cappelli
- Careggi University Hospital, Cardiomyopathy Unit , Florence , Italy
| | - M Canepa
- Ospedale Policlinico San Martino IRCCS, Cardiovascular Unit, Department of Internal Medicine , Genoa , Italy
| | - B Musumeci
- Sapienza University of Rome, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology , Rome , Italy
| | - A Cipriani
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences and Public Health , Padua , Italy
| | - G Tini
- Sapienza University of Rome, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology , Rome , Italy
| | - G G Varra'
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - A Argiro'
- Careggi University Hospital, Cardiomyopathy Unit , Florence , Italy
| | - E Sessarego
- Ospedale Policlinico San Martino IRCCS, Cardiovascular Unit, Department of Internal Medicine , Genoa , Italy
| | - G Sinigiani
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences and Public Health , Padua , Italy
| | - G Di Bella
- University of Messina, Department of Cardiology , Messina , Italy
| | - C Rapezzi
- University of Ferrara, Cardiothoracic Department , Ferrara , Italy
| | - G Sinagra
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - M Merlo
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
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9
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Merlo M, Pagura L, Porcari A, Cameli M, Vergaro G, Musumeci B, Biagini E, Canepa M, Crotti L, Imazio M, Forleo C, Cappelli F, Favale S, Di Bella G, Dore F, Girardi F, Tomasoni D, Pavasini R, Rella V, Palmiero G, Caiazza M, Albanese M, Igoren Guarrucci A, Branzi G, Caponetti A, Saturi G, La Malfa G, Merlo A, Andreis A, Bruno F, Longo F, Rossi M, Varra‘ G, Saro R, Di Ienno L, De Carli G, Giacomin E, Spini V, Limongelli G, Autore C, Olivotto I, Badano L, Parati G, Perlini S, Metra M, Emdin M, Rapezzi C, Sinagra G. C64 UNMASKING THE PREVALENCE OF AMYLOID CARDIOMYOPATHY IN THE REAL WORLD: RESULTS FROM PHASE 2 OF AC–TIVE STUDY, AN ITALIAN NATIONWIDE SURVEY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.062] [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: 11/12/2022]
Abstract
Abstract
Background
Clinicians need to identify patients with amyloid cardiomyopathy (AC) at an early stage, due to the availability of disease–modifying therapies. Some echocardiographic findings may rise the suspicion of AC, also in patients with mild or no symptoms, addressing second level diagnostic tests.
Aim
To investigate the prevalence of AC in consecutive patients ≥55 years undergoing clinically indicated, routine transthoracic echocardiogram in Italy and presenting echocardiographic signs suggestive of AC.
Methods
This is a prospective multicentric study conducted in Italy. It comprises two phases: 1) a recording phase consisting in a national survey on prevalence of possible echocardiographic red flags of AC in consecutive unselected patients ≥55 years undergoing routine echocardiogram (previously published) and 2) an AC diagnostic phase involving a diagnostic work–up for AC to investigate AC prevalence among patients with at least one echocardiographic red flag (herein presented). Patients that in Phase 1 presented an “AC suggestive” echocardiogram (i.e., at least one red flag of AC in hypertrophic, non–dilated left ventricles with preserved ejection fraction) underwent clinical evaluation, blood and urine tests and scintigraphy with bone tracer. Diagnosis of transthyretin related–AC (ATTR–AC) was made in presence of grade 2–3 Perugini uptake at scintigraphy and absence of monoclonal protein. The study was registered at ClinicalTrials.gov (#NCT04738266).
Results
Of the 5315 screened echocardiograms, 381 exams (7.2%) were classified as “AC suggestive” and proceeded to Phase 2. 217 patients completed Phase 2 investigations. Main reasons for the 164 non–entering patients into Phase 2 were death (n = 49) and refusal to participate (n = 66). A final diagnosis of AC was made in 62 patients with an estimated prevalence of 28,6% (95% CI: 22,5%–34,7%). ATTR–AC was diagnosed in 51 and AL–AC in 11 patients, ascertaining a prevalence of 23,5% (95% CI: 17,8%–29,2%) and 5,1% (95% CI: 2,2%–8,0%), respectively.
Conclusion
Among a cohort of consecutive unselected patients ≥55 years with echocardiographic findings suggestive of AC, the prevalence of AC ranged from 23% up to 35%. Although ATTR–AC was predominant, AL–AC was diagnosed in a significant number of cases. Echocardiography has a fundamental role in screening patients, raising the suspicion of disease and orienting diagnostic work–up for AC.
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Affiliation(s)
- M Merlo
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - L Pagura
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Porcari
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Cameli
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Vergaro
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - B Musumeci
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - E Biagini
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Canepa
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - L Crotti
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Imazio
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - C Forleo
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Cappelli
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - S Favale
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Di Bella
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Dore
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Girardi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - D Tomasoni
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - R Pavasini
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - V Rella
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Palmiero
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Caiazza
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Albanese
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Igoren Guarrucci
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Branzi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Caponetti
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Saturi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G La Malfa
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Merlo
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Andreis
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Bruno
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Longo
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Rossi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Varra‘
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - R Saro
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - L Di Ienno
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G De Carli
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - E Giacomin
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - V Spini
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Limongelli
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - C Autore
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - I Olivotto
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - L Badano
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Parati
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - S Perlini
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Metra
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Emdin
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - C Rapezzi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Sinagra
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
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Ungania S, Masi M, Cappelli F, Vallati G, Iaccarino G, Soriani A. In vivo quantification of micro-balloon interventions (MBI) advantage: retrospective study of SIRT vs b-SIRT. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00441-0] [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: 10/19/2022] Open
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Argiro A, Rosenblum H, Griffin J, Batra J, Cappelli F, Burkhoff D, Maurer M, Olivotto I. Sex related differences in exercise performance in patients with hypertrophic cardiomyopathy: hemodynamic insights through non-invasive pressure volume analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1558] [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
Women with HCM have worse cardiopulmonary exercise performance compared to men. We used non-invasive pressure-volume (PV) analysis to delineate sex related hemodynamic differences in HCM.
Methods
PV loops were constructed from echocardiograms using left ventricular (LV) volumes indexed to body surface area, Doppler estimates of LV end-diastolic pressure and blood pressure. The end-systolic PV relationship (ESPVR) and end-diastolic PV relationship (EDPVR) were derived from validated single-beat techniques. The area between the ESPVR and EDPVR (isovolumetric PV area), was indexed to an LV end-diastolic pressure of 30mmHg (PVAiso30), as the integrated metric of LV function. LV volume at an end-diastolic pressure of 30mmHg (V30) indexed ventricular capacity.
Results
202 patients were included, 56 women. Women were older (51 vs 44 yrs, p=0.012) and had reduced exercise capacity (5.6 vs 6.9 METs, p<0.001). Only 32 patients (16%) had a peak gradient >30mmHg at rest with no sex differences. Women had significantly lower indexed PVAiso30 (6577 vs 7767 mmHg·mL/m2, p<0.001) driven by reduced ventricular capacitance (V30 54 vs 62 ml/m2, p<0.001). In multivariable linear regression indexed V30 was an independent predictor of exercise capacity.
Conclusion
Impaired exercise capacity in women with HCM appears strongly related to abnormalities in passive diastolic properties, suggesting a unique pathophysiology compared to men, and a potential difference in viable therapeutic molecular targets
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Argiro
- Careggi University Hospital (AOUC), Cardiomyopathy Unit, Heart, Lung and Vessels Department, Florence, Italy
| | - H Rosenblum
- Columbia University Irving Medical Center-NYP Hospital, Division of Cardiology, Department of Medicine, New York, United States of America
| | - J Griffin
- Columbia University Irving Medical Center-NYP Hospital, Division of Cardiology, Department of Medicine, New York, United States of America
| | - J Batra
- Columbia University Irving Medical Center-NYP Hospital, Division of Cardiology, Department of Medicine, New York, United States of America
| | - F Cappelli
- Careggi University Hospital (AOUC), Cardiomyopathy Unit, Heart, Lung and Vessels Department, Florence, Italy
| | - D Burkhoff
- Cardiovascular Research Foundation, New York, United States of America
| | - M Maurer
- Columbia University Irving Medical Center-NYP Hospital, Division of Cardiology, Department of Medicine, New York, United States of America
| | - I Olivotto
- Careggi University Hospital (AOUC), Cardiomyopathy Unit, Heart, Lung and Vessels Department, Florence, Italy
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Fumagalli C, Sasso L, Zocchi C, Tassetti L, Celata A, Berteotti M, Mori F, Mecacci F, Livi P, Cappelli F, Baldini K, Tomberli A, Favilli S, Olivotto I. Clinical course and outcome of pregnancy in patients with hypertrophic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1782] [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: 11/13/2022] Open
Abstract
Abstract
Background
Hypertrophic Cardiomyopathy (HCM) is the most common genetic cardiomyopathy. However, few studies have systematically investigated the clinical course of pregnancy in HCM.
Purpose
To determine whether pregnancy is well tolerated in HCM.
Methods
Women consecutively referred to our Tertiary Clinic for Cardiomyopathies from 1969 to
2019 were retrospectively reviewed. Only women with complete data regarding pregnancy and with a follow up (FU)>1 year were included in the study. Overall, of the 647 women followed at our center, 378 (58%) fulfilled our inclusion criteria. Demographic, clinical and instrumental records were retrieved. The peripartum period was defined as the timeframe from −1 to 6 months after delivery.
Results
There were 433 pregnancies in 239 (63%) women with 132 (62%) having >1 pregnancy. By contrast, 139 (37%) reported no pregnancy or miscarriages: in 6 cases pregnancy was discouraged due to advanced disease stage. Twenty-eight (12%) women had 39 pregnancies after HCM diagnosis and were followed by the obstetrics department: this subset was significantly younger at diagnosis (age at diagnosis: 21 [13–29] vs 56 [47–66] vs 45 [24–62] years, p<0.001, in women with a pregnancy after diagnosis vs women diagnosed after the pregnancy vs women with no pregnancy, respectively). Instrumental characteristics were comparable among women. Thirty percent presented with obstructive physiology at baseline. Among the 39 pregnancies in women who had a pregnancy after the diagnosis, there were 3 reported episodes of paroxysmal atrial fibrillation, one sustained ventricular tachycardia with pulse and three episodes of non-sustained ventricular tachycardia in the peripartum period. In this cohort, prevalence of intra-uterine growth delay and miscarriage was 8%. Only 3 women experienced a worsening clinical profile requiring hospitalization during the peripartum period: 2 were hospitalized for acute heart failure (AHF) and 1 was experienced a resuscitated cardiac arrest. Of note, 2/3 of patients were carriers of a (likely)pathogenic troponin mutation.
Long-term (FU: 5±3 years), nulligravida women were more symptomatic at last evaluation (NYHA III/IV: 25 vs 17, p<0.05), reported a higher incidence of ICD appropriate shocks (26 vs 12%p=0.02) but had similar rates of heart transplant (2.1 vs 0.5%, p=0.143) and episodes of AHF (12 vs 14%, p=0.193). Eighteen patients (8.2%) died: incidence of cardiovascular mortality was 4.8%, with a lower rate in patients who reported a pregnancy (0.8%/year vs 2.8%/year, p=0.01).
Conclusions
Women with HCM tolerate pregnancy well. Rare complications occurred in the peripartum period which were manageable. In the long-term, pregnancy, even when multiple, did not influence the long-term course of the disease nor its outcome. Strategies to support appropriate counselling and antenatal care should be implemented to identify those at greater risk of disease progression.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Fumagalli
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - L Sasso
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - C Zocchi
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - L Tassetti
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - A Celata
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - M Berteotti
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - F Mori
- Careggi University Hospital, Florence, Italy
| | - F Mecacci
- Careggi University Hospital, Florence, Italy
| | - P Livi
- Careggi University Hospital, Florence, Italy
| | - F Cappelli
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - K Baldini
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - A Tomberli
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - S Favilli
- Meyer Children's Hospital, Cardiology Department, Florence, Italy
| | - I Olivotto
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
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13
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Cappelli F, Zampieri M, Fumagalli C, Nardi G, Del Monaco G, Matucci Cerinic M, Allinovi M, Taborchi G, Martone R, Gabriele M, Ungar A, Moggi Pignone A, Marchionni N, Di Mario C, Olivotto I, Perfetto F. Tenosynovial complications identify TTR cardiac amyloidosis among patients with hypertrophic cardiomyopathy phenotype. J Intern Med 2021; 289:831-839. [PMID: 33615623 DOI: 10.1111/joim.13200] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 12/19/2022]
Abstract
UNLABELLED Recent evidence suggests that carpal tunnel syndrome (CTS) and brachial biceps tendon rupture (BBTR) represent red flags for ATTR cardiac amyloidosis (ATTR-CA). The prevalence of upper limb tenosynovial complications in conditions entering differential diagnosis with CA, such as HCM or Anderson-Fabry disease (AFD), and hence their predictive accuracy in this setting, still remains unresolved. OBJECTIVE To investigate the prevalence of CTS and BBTR in a consecutive cohort of ATTR-CA patients, compared with patients with HCM or AFD and with individuals without cardiac disease history. PARTICIPANTS Consecutive patients with a diagnosis of ATTR-CA, HCM and AFD were evaluated. A control group of consecutive patients was recruited among subjects hospitalized for noncardiac reasons and no cardiac disease history. The presence of BBTR, CTS or prior surgery related to these conditions was ascertained. RESULTS 342 patients were prospectively enrolled, including 168 ATTR-CA (141 ATTRwt, 27 ATTRm), 81 with HCM/AFD (N = 72 and 9, respectively) and 93 controls. CTS was present in 75% ATTR-CA patients, compared with 13% and 10% of HCM/AFD and controls (P = 0.0001 for both comparisons). Bilateral CTS was present in 60% of ATTR-CA patients, while it was rare (2%) in the other groups. BBTR was present in 44% of ATTR-CA patients, 8% of controls and 1% in HCM/AFD. CONCLUSIONS CTS and BBTR are fivefold more prevalent in ATTR-CA patients compared with cardiac patients with other hypertrophic phenotypes. Positive predictive accuracy for ATTR-CA is highest when involvement is bilateral. Upper limb assessment of patients with HCM phenotypes is a simple and effective way to raise suspicion of ATTR-CA.
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Affiliation(s)
- F Cappelli
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.,Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - M Zampieri
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - C Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.,Geriatric Medicine Department, Azienda Ospedaliera Careggi, Florence, Italy
| | - G Nardi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - G Del Monaco
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - M Matucci Cerinic
- Dipartimento di Medicina Sperimentale e Clinica, Careggi University Hospital, Florence, Italy
| | - M Allinovi
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - G Taborchi
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - R Martone
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - M Gabriele
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - A Ungar
- Geriatric Medicine Department, Azienda Ospedaliera Careggi, Florence, Italy
| | - A Moggi Pignone
- IV Internal Medicine Division, Careggi University Hospital, Florence, Italy
| | - N Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Division of General Cardiology, Careggi University Hospital, Florence, Italy
| | - C Di Mario
- Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - I Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.,IV Internal Medicine Division, Careggi University Hospital, Florence, Italy
| | - F Perfetto
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.,Geriatric Medicine Department, Azienda Ospedaliera Careggi, Florence, Italy
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14
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Bandera F, Martone R, Chacko L, Ganesananthan S, Gilbertson JA, Ponticos M, Petrie A, Cappelli F, Guazzi M, Potena L, Rapezzi C, Leone O, Hawkins P, Gillmore JD, Fontana M. Clinical importance of left atrial infiltration in cardiac transthyretin amyloidosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.176] [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
Funding Acknowledgements
Type of funding sources: None.
INTRODUCTION
The clinical significance of left atrial (LA) involvement in ATTR amyloidosis cardiomyopathy (ATTR-CM) has not been characterized. The aims of this study were to characterize: (1)LA pathology in explanted ATTR-CM hearts; (2)LA mechanics using echocardiographic speckle-tracking in a large cohort of ATTR-CM patients; (3)to study the association with mortality.
METHODS AND RESULTS
Congo red staining and immunohistochemistry was performed to assess the presence, type and extent of amyloid and associated changes in 5 explanted ATTR-CM atria. Echo speckle-tracking was used to assess LA reservoir, conduit, contractile function and stiffness in 906 ATTR-CM patients (551 wt-ATTR-CM;93 T60A-ATTR-CM;241 V122I-ATTR-CM;21 other).
There was extensive ATTR amyloid infiltration in the 5 atria with loss of normal architecture, vessels remodelling, capillary disruption and subendocardial fibrosis. Echo speckle-tracking in 906 ATTR-CM patients demonstrated increased atrial stiffness [median(25th-75th quartile) 1.83(1.15-2.92)] that remained independently associated with prognosis, after adjusting for known predictors (lnLA stiff:HR = 1.26,CI 1.07-1.57;p = 0.009). There was substantial impairment of the three phasic functional atrial components [reservoir 8.86(5.94-12.97)%; conduit 6.5(4.53-9.28)%; contraction function 4.0(2.29-6.56)%]. Atrial contraction was absent in 21.6% of patients whose ECG showed sinus rhythm (SR)-"atrial electro-mechanical dissociation"(AEMD). AEMD was associated with poorer prognosis compared to SR patients with effective mechanical contraction (p < 0.0001). AEMD conferred a similar prognosis to patients in AF.
CONCLUSION
The phenotype of ATTR-CM includes significant infiltration of the atrial walls with progressive loss of atrial function and increased stiffness, which is a strong independent predictor of mortality. AEMD emerged as a distinctive phenotype identifying patients in SR with poor prognosis.
Abstract Figure.
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Affiliation(s)
- F Bandera
- IRCCS Polyclinic San Donato, Department of University Cardiology, Milan, Italy
| | - R Martone
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - L Chacko
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Ganesananthan
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - JA Gilbertson
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Ponticos
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - A Petrie
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - F Cappelli
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Center, Florence, Italy
| | - M Guazzi
- IRCCS Polyclinic San Donato, Department of University Cardiology, Milan, Italy
| | - L Potena
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - C Rapezzi
- University Hospital of Ferrara, Ferrara, Italy
| | - O Leone
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - P Hawkins
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - JD Gillmore
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
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15
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Grandis M, Obici L, Luigetti M, Briani C, Benedicenti F, Bisogni G, Canepa M, Cappelli F, Danesino C, Fabrizi GM, Fenu S, Ferrandes G, Gemelli C, Manganelli F, Mazzeo A, Melchiorri L, Perfetto F, Pradotto LG, Rimessi P, Tini G, Tozza S, Trevisan L, Pareyson D, Mandich P. Recommendations for pre-symptomatic genetic testing for hereditary transthyretin amyloidosis in the era of effective therapy: a multicenter Italian consensus. Orphanet J Rare Dis 2020; 15:348. [PMID: 33317601 PMCID: PMC7734774 DOI: 10.1186/s13023-020-01633-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 05/04/2020] [Accepted: 11/27/2020] [Indexed: 12/13/2022] Open
Abstract
Hereditary transthyretin amyloidosis (ATTRv, v for variant) is a late-onset, autosomal dominant disease caused by progressive extracellular deposition of transthyretin amyloid fibrils, leading to organ damage and death. For other late-onset fatal diseases, as Huntington’s disease, protocols for pre-symptomatic genetic testing (PST) are available since decades. For ATTRv, limited experience has been reported to date, mostly gathered before the availability of approved therapies. We aimed at developing recommendations for a safe and feasible PST protocol in ATTRv in the era of emerging treatments, taking also into account Italian patients’ characteristics and healthcare system rules. After an initial survey on ongoing approaches to PST for ATTRv in Italy, two roundtable meetings were attended by 24 experts from 16 Italian centers involved in the diagnosis and care of this disease. Minimal requirements for PST offer and potential critical issues were highlighted. By November 2019, 457 families affected by ATTRv with 209 molecularly confirmed pre-symptomatic carriers were counted. The median age at PST was 41.3 years of age, regardless of the specific mutation. Half of the Italian centers had a multidisciplinary team, including a neurologist, an internist, a cardiologist, a medical geneticist and a psychologist, although in most cases not all the specialists were available in the same center. A variable number of visits was performed at each site. Experts agreed that PST should be offered only in the context of genetic counselling to at risk individuals aged 18 or older. Advertised commercial options for DNA testing should be avoided. The protocol should consist of several steps, including a preliminary clinical examination, a pre-test information session, an interval time, the genetic test and a post-test session with the disclosure of the test results, in the context of an experienced multidisciplinary team. Recommendations for best timing were also defined. Protocols for PST in the context of ATTRv can be refined to offer at risk individuals the best chance for early diagnosis and timely treatment start, while respecting autonomous decisions and promoting safe psychological adjustment to the genetic result.
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Affiliation(s)
- M Grandis
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy.,IRCCS Policlinico San Martino, Genova, Italy
| | - L Obici
- Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - M Luigetti
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Briani
- Department of Neuroscience, University of Padova, Padova, Italy
| | - F Benedicenti
- Medical Genetics, Azienda Sanitaria Dell'Alto Adige, Bolzano, Italy
| | - G Bisogni
- Centro Clinico Nemo Adulti-Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - M Canepa
- Cardiovascular Disease Unit, IRCCS Policlinico San Martino, Genova, and IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - F Cappelli
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Firenze, Italy
| | - C Danesino
- Molecular Medicine Department, University of Pavia, Pavia, Italy
| | - G M Fabrizi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology, University of Verona and University Hospital GB Rossi, Verona, Italy
| | - S Fenu
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - G Ferrandes
- IRCCS Policlinico San Martino, Genova, Italy
| | - C Gemelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy.,Neuromuscular Omnicentre (NEMO)-Fondazione Serena Onlus, Arenzano, GE, Italy
| | - F Manganelli
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Napoli, Italy
| | - A Mazzeo
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - L Melchiorri
- Medical Genetics Unit, Azienda Ospedaliero Universitaria Di Ferrara, Ferrara, Italy
| | - F Perfetto
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Firenze, Italy
| | - L G Pradotto
- Department of Neurosciences, University of Turin, Torino, Italy.,Division of Neurology and Neurorehabilitazion, IRCCS Istituto Auxologico Italiano, Piancavallo, VB, Italy
| | - P Rimessi
- Medical Genetics Unit, Azienda Ospedaliero Universitaria Di Ferrara, Ferrara, Italy
| | - G Tini
- Cardiovascular Disease Unit, IRCCS Policlinico San Martino, Genova, and IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - S Tozza
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Napoli, Italy
| | - L Trevisan
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy.,IRCCS Policlinico San Martino, Genova, Italy
| | - D Pareyson
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - P Mandich
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy. .,IRCCS Policlinico San Martino, Genova, Italy.
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16
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Fumagalli C, Ruggieri R, De Filippo V, Cappelli F, Beltrami M, Bertini A, Carrassa G, Marchi A, Tomberli A, Baldini K, Olivotto I. Prevalence of device-detected atrial fibrillation and stroke in patients with hypertrophic cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2094] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Atrial fibrillation (AF) is highly prevalent in patients with hypertrophic cardiomyopathy (HCM) and is associated with adverse outcome, impaired quality of life, loss of productivity, and the risk for embolic stroke. However, still today, the real burden of AF is unresolved due to the unknown frequency of silent asymptomatic episodes.
Purpose
To assess the prevalence of device-detected AF and stroke in patients with HCM implanted with cardiac implantable electronic devices (CIEDs) at our institution, a long-standing high flow referral center for cardiomyopathies.
Methods
Clinical and instrumental data of HCM patients implanted with CIEDs (either pacemakers [PM] or implantable cardioverter defibrillator [ICD]) from 1998 to 2019 were retrospectively reviewed. Inclusion criteria were site-designated diagnosis of HCM, age at diagnosis >18 years, >1 follow up visit, follow up >1 year. HCM phenocopies (e.g. Fabry disease) were carefully excluded.
Patients were divided into three categories according to presence of AF (“AF prior to CIED implantation” vs “AF after CIED implantation” vs “no arrhythmia detected”). Outcome was measured against prevalence of thromboembolic events (stroke or transient ischemic attack [TIA]) at follow up. All-cause and cardiovascular (CV) mortality were also assessed.
Results
A total of 255 patients received a CIED (57% men, mean age at implantation 54±17 years). Men were younger at implantation (52±17 vs 56±18 years, p=0.022). At baseline, AF was present in 90 (35.3%) patients.
During 5.0±4.1 years, de novo AF was detected in 30 (11.8%) individuals, resulting in an annual incidence rate of 6.1%/year. Overall, 135 (52.9%) of patients remained is sinus rhythm.
Stroke/TIAs were reported in 30 (11.8%) patients: 16 (53.3%) occurred in patients with prior history of AF, 3 (10%) in patients with de novo AF (with men being at higher risk, OR 3.73, 95% CI 1.88–6.09, p=0.041), and 11 (36.7%) in patients with no history of arrhythmias.
Long term, 45 (17.6%) patients died (CV mortality N=38, 14.9%). At multivariable analysis, history of stroke was directly related to all-cause mortality irrespective of AF in men (OR 4.15, 95% CI 1.35–12.77, p=0.018) but not in women (OR 0.891, 95% CI 0.17–4.64, p=0.801).
Conclusions
In a large cohort of consecutive high risk HCM patients referred to CIED implantation, the incidence of de-novo AF was high. Thromboembolic events were associated to worse outcome only in men, likely due to competing heart failure related causes in women. Strategies promoting early identification of AF and anticoagulation may play an important role in management and prevention of disease-related complications.
Prevalence of AF and Stroke
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Fumagalli
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - R Ruggieri
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - V De Filippo
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - F Cappelli
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - M Beltrami
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - A Bertini
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - G Carrassa
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - A Marchi
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - A Tomberli
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - K Baldini
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - I Olivotto
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
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17
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Martone R, Taborchi G, Bartolini S, Morini S, Lossi A, Perlini S, Mussinelli R, Sabena A, Palladini G, Gabriele M, Vignini E, Di Mario C, Olivotto I, Perfetto F, Cappelli F. P2732Prevalence of electrocardiographic abnormalities in patients with cardiac amyloidosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1049] [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
Electrocardiographic (ECG) abnormalities are common in patients presenting with Light-Chain (AL) or Transthyretin (ATTR) related Cardiac Amyloidosis (CA). Type of amyloid may differently affect electrical properties of the heart being responsible for variable patterns of ECG anomalies at presentation.
Purpose
In this retrospective, observational study we sought to compare prevalence of ECG abnormalities between AL and ATTR patients with CA.
Methods
Clinical files from two Referral Centres were reviewed; ECG recordings were analysed by trained cardiologists and relevant findings were reported about rhythm (sinus vs atrial fibrillation [AF]), grade I or grade II atrio-ventricular (AV) delays, intra-ventricular (IV) conduction abnormalities, low-voltage QRS and pseudo-necrosis pattern. Presence of pace-maker (PM) and stimulated QRS were regarded to as clinical equivalents for AV block, after review of indications to implantation.
Results
Two hundred and fifty-one patients were identified (127 ATTR vs 124 AL; among ATTR, 27 patients had mutation in TTR gene: 10 Val142Ile, 11 Ile88Leu, 6 other). As expected, most ATTR patients were male (89% vs 56% in AL, p: <0.001), and AL patients were younger (mean age 64 [53–70] vs 79 [73–83]; p: <0.001).
Pathological ECG findings were common in both subgroups, involving more than three-quarters of the overall population (82% in ATTR, vs 72% in AL, p: 0.06). Atrial fibrillation was more common in ATTR, prevailing in 39% vs 5.6% (p: <0.001). ATTR had a higher burden of AV block (53% vs 13%, p: <0.001) and IV conduction delays (43% vs 21%, p: <0.001), and consistently presented a higher prevalence of PMs (24 patients vs 1). Low-voltage QRS was more prevalent in AL patients (52% vs 28%, p: <0.001), while no significant difference was found in prevalence of pseudo-necrosis patterns (ATTR: 29%, AL: 40%; p: ns).
Due to imbalance in age and gender and relative possible confounding effect on rhythm disturbances, adjusted odds ratios (OR) were calculated. It resulted that ATTR was independently associated with a higher prevalence of AF and AV conduction delays when compared to AL (adjusted OR: 4 [95% CI: 1.4–11.2], p: 0.008, and 6.2 [95% CI: 2.6–14.9], p: <0.001; respectively), while being inversely associated with low-voltage QRS (adjusted OR: 0.4 [95% CI: 0.2–0.9], p: 0.026).
Conclusions
ECG abnormalities are common in CA. Rhythm disturbances are more prevalent in ATTR, while AL more often results in low-voltage QRS. Such differences remain relevant after adjustment for age and gender imbalance, thus suggesting an aetiology-specific link.
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Affiliation(s)
- R Martone
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Center, Florence, Italy
| | - G Taborchi
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Center, Florence, Italy
| | - S Bartolini
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Center, Florence, Italy
| | - S Morini
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Center, Florence, Italy
| | - A Lossi
- University of Florence, Florence, Italy
| | - S Perlini
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - R Mussinelli
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - A Sabena
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - G Palladini
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - M Gabriele
- Careggi University Hospital (AOUC), Florence, Italy
| | - E Vignini
- Careggi University Hospital (AOUC), Florence, Italy
| | - C Di Mario
- Careggi University Hospital (AOUC), Florence, Italy
| | - I Olivotto
- Careggi University Hospital (AOUC), Cardiomyopathy Unit, Florence, Italy
| | - F Perfetto
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Center, Florence, Italy
| | - F Cappelli
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Center, Florence, Italy
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18
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Cappelli F, Mazzarotto F, Frusconi S, Contini E, Polimanti R, Buxbaum J, Martone R, Morini S, Taborchi G, Bartolini S, Olivotto I, Pelo E, Di Mario C, Perfetto F. P2731Genetic ancestry analysis of the Italian founder population carrying the cardiac amyloidosis-causing variant Val122Ile in the transthyretin gene. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Transthyretin amyloidosis is a life-threatening disorder caused by the deposition of TTR amyloid in various tissues and organs. The most common worldwide pathogenic variant with almost exclusive cardiac involvement is Val122Ile (rs76992529), with an allele frequency of 3.5% in the U.S. African-American population, but rare in Caucasians. Unexpectedly, we identified 23 Caucasian individuals with Val122Ile in our amyloidosis referral center (9 affected patients, 14 carriers), belonging to 9 unrelated families.
Purpose
To determine the ancestral origin of the Tuscan founder population of TTR Val122Ile carriers.
Methods
A total of 24 individuals were included in the analysis (our 23 probands and relatives from Val122Ile families and the Caucasian reference sample NA10851 (CEU – Utah resident with European ancestry). All samples were genotyped using the EUROFORGEN Global AIM-SNP array1, inclusive of 127 highly informative SNPs to infer genetic ancestry. We have performed a principal component analysis (PCA) of the 9 unrelated probands and NA10851, compared with the Phase 3 of the 1000 Genomes Project data, comprising 2504 unrelated individuals from >20 distinct populations.(Figure 1).
Results
As shown in Figure 1, all our samples but one (from Argentina) cluster very close to the super-cluster of European populations, and distant from the populations of African ancestry. The proband from Argentina and the Caucasian reference sample NA10851 cluster close to Mexicans and Peruvians, and the super-cluster of European populations, respectively, confirming the robustness of the analysis.
Conclusion
Based on this result, we can confidently conclude that our samples from Tuscan families in which the TTR Val122Ile variant segregates are of ancestral European origin, with no mixed African ancestry, implying that the same variant originated in Africans and Europeans independently and not as result of genetic admixture. These findings suggest the presence of a mutational hot spots in TTR, with potential impact on the epidemiology of amyloidosis worldwide.
Acknowledgement/Funding
The present study was supported by an Investigator-Initiated Research to Azienda Ospedaliero Universitaria Careggi from Pfizer Srl.
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Affiliation(s)
- F Cappelli
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Referral center, Florence, Italy
| | - F Mazzarotto
- Careggi University Hospital (AOUC), Cardiomyopathy Unit, Florence, Italy
| | - S Frusconi
- Careggi University Hospital, Florence, Italy
| | - E Contini
- Careggi University Hospital, Florence, Italy
| | - R Polimanti
- Yale School of Medicine, Department of Psychiatry, West Haven, United States of America
| | - J Buxbaum
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, United States of America
| | - R Martone
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Referral center, Florence, Italy
| | - S Morini
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Referral center, Florence, Italy
| | - G Taborchi
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Referral center, Florence, Italy
| | - S Bartolini
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Referral center, Florence, Italy
| | - I Olivotto
- Careggi University Hospital (AOUC), Cardiomyopathy Unit, Florence, Italy
| | - E Pelo
- Careggi University Hospital, Florence, Italy
| | - C Di Mario
- Careggi University Hospital, Florence, Italy
| | - F Perfetto
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Referral center, Florence, Italy
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Morini S, Aquaro GD, Taborchi G, Martone R, Gabriele M, Bartolini S, Vignini E, Vergaro G, Barison A, Emdin M, Olivotto I, Perfetto F, Di Mario C, Cappelli F. P2728Prognostic impact of left atrial function in patients with cardiac amyloidosis: a cardiac magnetic resonance study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1045] [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: 11/13/2022] Open
Abstract
Abstract
Background
Left atrial function (AEF) is a parameter of paramount importance that has a prognostic value in a number of heart conditions. Cardiac involvement in both light-chain and transthyretin amyloidosis is the main driver of prognosis and influences treatment strategies. Cardiac magnetic resonance (CMR) provides high quality images of the left and right atria using high temporal resolution steady state free precession (SSFP) cine sequences.
Purpose
The aim of our study was to assess by CMR left atrial function and his correlation with prognosis in patients with cardiac amyloidosis.
Method
We enrolled 80 consecutive patients with diagnosis of cardiac amyloidosis: 38 patients (47%) with light-chain and 42 patients (53%) with transthyretin one. CMR was performed using a 1.5-T scanner. In all subjects, the study of atria was obtained by acquiring cine steady-state free precession (SSFP). Left Atrial function was evaluated by the ratio between the maximum and the minimum LA volume. A median follow up of 937 days was performed and 36 patients (44%) died of cardiac causes. We evaluated cardiac death as endpoint. We split out all the patient in 4 different quartiles depending on left atrial function: in the first quartile patients with AEF≤14% that reflects severe atrial dysfunction, in the second quartile patients with AEF between 14 and 19%, in the third quartile patients with AEF between 19 and 36% and in the last one patients with AEF≥36% that represent patients with normal value of left atrial function.
Results
We found that CMR assessed left atrial function allowed to individuate and stratify the prognosis in patients with cardiac amyloidosis. The most effective parameter to evaluate cardiac death was left atrial function with a cut off ≤14% that could predict cardiac related mortality with the same accuracy in both light-chain and transthyretin amyloidosis patients. Kaplan Meier analysis showed that patients with AEF≤14% had a worse prognosis as compared to patient with AEF≥14% (log rank p. 0001). Furthermore patients with AEF≤14% have a cardiac death risk of 32% at 1 year and 61% at 3 years.
Kaplan Meier analysis
Conclusion
Cardiac magnetic resonance is an imaging modality that allows to individuate with great accuracy left atrial function in patients with various heart conditions and especially cardiac amyloidosis. CMR left atrial function assessment clearly identifies a subgroup of cardiac amyloid patients with an increased risk of death.
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Affiliation(s)
- S Morini
- Careggi University Hospital (AOUC), Florence, Italy
| | - G D Aquaro
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - G Taborchi
- Careggi University Hospital (AOUC), Florence, Italy
| | - R Martone
- Careggi University Hospital (AOUC), Florence, Italy
| | - M Gabriele
- Careggi University Hospital (AOUC), Florence, Italy
| | - S Bartolini
- Careggi University Hospital (AOUC), Florence, Italy
| | - E Vignini
- Careggi University Hospital (AOUC), Florence, Italy
| | - G Vergaro
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - A Barison
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - M Emdin
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - I Olivotto
- Careggi University Hospital (AOUC), Florence, Italy
| | - F Perfetto
- Careggi University Hospital (AOUC), Florence, Italy
| | - C Di Mario
- Careggi University Hospital (AOUC), Florence, Italy
| | - F Cappelli
- Careggi University Hospital (AOUC), Florence, Italy
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20
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Pontecorboli G, Gabriele M, Cappelli F, Acquafresca M, Pradella S, Morini S, Taborchi G, Martone R, Migliorini A, Carrabba N, Marchionni N, Marcucci R, Valenti R. P387Chest pain and mild left ventricular hypertrophy: a challenging diagnosis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109.028] [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)
| | - M Gabriele
- Careggi University Hospital (AOUC), Florence, Italy
| | - F Cappelli
- Careggi University Hospital (AOUC), Florence, Italy
| | | | - S Pradella
- Careggi University Hospital (AOUC), Florence, Italy
| | - S Morini
- Careggi University Hospital (AOUC), Florence, Italy
| | - G Taborchi
- Careggi University Hospital (AOUC), Florence, Italy
| | - R Martone
- Careggi University Hospital (AOUC), Florence, Italy
| | - A Migliorini
- Careggi University Hospital (AOUC), Florence, Italy
| | - N Carrabba
- Careggi University Hospital (AOUC), Florence, Italy
| | - N Marchionni
- Careggi University Hospital (AOUC), Florence, Italy
| | - R Marcucci
- Careggi University Hospital (AOUC), Florence, Italy
| | - R Valenti
- Careggi University Hospital (AOUC), Florence, Italy
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21
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Paladini A, Vallati G, Beomonte Zobel D, Paladini L, Annovazzi A, Sciuto R, Cappelli F, Borzelli A, Pane F, Negroni D, Cernigliaro M, Galbiati A, Del Sette B, Spinetta M, Guzzardi G, Carriero A, Pizzi G. Delivery of selective internal radiation therapy complicated by variant hepatic vascular anatomy. Radiol Case Rep 2019; 14:662-672. [PMID: 30956745 PMCID: PMC6434105 DOI: 10.1016/j.radcr.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 11/19/2022] Open
Abstract
“Difficult vascular anatomy” is a challenge for Interventional Radiologists especially in liver directed therapies such as trans arterial radio embolization. Trans arterial radio embolization is a long and difficult procedure in which the basic knowledge of hepatic and gastro-enteric vascularization, with its high degree of variations, is very important in order to correctly administer the therapeutic drug selectively. In this report, we present a case of an atypical patient affected by an unresectable hepatocellular carcinoma, candidate for Radio-embolization treatment. His vascular anatomy was very difficult to manage, but the Interventional Radiologist was not only able to go over the “difficult anatomy,” but also to take advantage of it.
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22
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Paladini A, Lucatelli P, Cappelli F, Pizzi G, Anelli V, Amodeo EM, Beomonte Zobel D, Paladini L, Biagini R, Attala D, Zoccali C, Vallati GE. Osteoid osteoma treated with radiofrequency ablation in non-operating room anesthesia. A different way of approaching ablative therapy on osteoid osteoma. Eur Rev Med Pharmacol Sci 2018; 22:5438-5446. [PMID: 30229814 DOI: 10.26355/eurrev_201809_15803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study is to verify the effectiveness and complications occurrence of radiofrequency ablation (RFA) in the treatment of osteoid osteoma (OO) in non-operating room anesthesia (N.O.R.A.). PATIENTS AND METHODS From 2014 to 2017, 61 patients affected by OO (40 men and 21 women) with an age of 20.7 years on average (range, 4-51 years; 12 patients aged 20 years or younger) underwent computed tomography-guided percutaneous radiofrequency ablation (RFA) in N.O.R.A. (Non-Operating Room Anesthesia). Lesion sites treated were: femur (27), tibia (22), pelvis (2), talar bone (3), distal radius (1), and humerus (6). Mean follow-up time was 36 months. In each case, anesthesiologic support followed a new protocol (N.O.R.A. protocol), approved by our Institute. Primary success rate, complications, symptom-free intervals, and follow-up results were evaluated. RESULTS Pain relief (evaluated with Visual Analogue Scale - VAS) was significant in 97% of patients; it disappeared within 24 hours of the procedure in 44 patients, within 3 days in 10 patients, and within 7 days in 7 patients. After 6 months of observation time, 60 of 61 patients were successfully treated and had no more complaints. In 2 patients, two major complications were found: infection of the site treated, healed with antibiotics, and a nerve lesion, healed with steroid therapy. No other complications were observed. CONCLUSIONS RFA is a highly effective, efficient, minimally invasive and safe method for the treatment of OO following N.O.R.A. PROTOCOL
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Affiliation(s)
- A Paladini
- Diagnostic Imaging Area, Catholic University of the Sacred Heart, Gemelli Foundation, School of Medicine, Rome, Italy.
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23
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Pizzi G, Paladini A, Vallati G, Anelli V, Cappelli F. 3:09 PM Abstract No. 251 Osteoid osteoma treated with radiofrequency ablation in non–operating room anesthesia: our experience in 61 cases. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.281] [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: 11/17/2022] Open
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24
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Bocci V, Di Paolo N, Garosi G, Aldinucci C, Borrelli E, Valacchi G, Cappelli F, Guerri L, Gavioli G, Corradeschi F, Rossi R, Giannerini F, Di Simplicio P. Ozonation of Blood during Extracorporeal Circulation. I. Rationale, Methodology and Preliminary Studies. Int J Artif Organs 2018. [DOI: 10.1177/039139889902200910] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated whether exposure of blood ex-vivo to oxygen-ozone (O2-O3) through a gas exchanger is feasible and practical. We first evaluated the classical dialysis-type technique but we soon realized that semipermeable membranes are unsuitable because they are hydrophilic and vulnerable to O3. We therefore adopted a system with hydrophobic O3-resistant hollow fibers enclosed in a polycarbonate housing with a membrane area of about 0.5 m2. First we tested the system with normal saline, determining the production of hydrogen peroxide (H2O2) at O3 concentrations from 5 to 40 μg/ml. We then evaluated critical parameters by circulating swine blood in vitro; this revealed that heparin is not an ideal anticoagulant for this system. Finally, we performed several experiments in sheep and defined optimal anticoagulant dose (sodium citrate, ACD), priming solution, volume of blood flow per min, volume and concentration of O2-O3 mixture flowing counter-current with respect to blood and the time necessary for perfusion in vivo. The biochemical parameters showed that an O3 concentration as low as 10 μg/ml is effective; this means that gas exchange and O3 reactivity are rapid and capable of inducing biological effects. The sheep showed no adverse effects even after 50 min of extracorporeal circulation at higher O3 concentrations (20 to 40 μg/ml) but the exchanger became less effective (low pO2 values) due to progressive clogging with cells.
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Affiliation(s)
- V. Bocci
- Institute of General Physiology, University of Siena, Siena
| | - N. Di Paolo
- Dialysis and Nephrology Unit, Azienda Ospedaliera Senese, Siena
| | - G. Garosi
- Dialysis and Nephrology Unit, Azienda Ospedaliera Senese, Siena
| | - C. Aldinucci
- Institute of General Physiology, University of Siena, Siena
| | - E. Borrelli
- Institute of Thoracic and Cardiovascular Surgery, University of Siena, Siena
| | - G. Valacchi
- Institute of General Physiology, University of Siena, Siena
| | - F. Cappelli
- Dialysis and Nephrology Unit, Azienda Ospedaliera Senese, Siena
| | - L. Guerri
- Veterinary Clinic, University of Siena, Siena
| | | | - F. Corradeschi
- Institute of General Physiology, University of Siena, Siena
| | - R. Rossi
- Institute for Mental and Nervous Diseases, Pharmacology Section, University of Siena, Siena - Italy
| | - F. Giannerini
- Institute for Mental and Nervous Diseases, Pharmacology Section, University of Siena, Siena - Italy
| | - P. Di Simplicio
- Institute for Mental and Nervous Diseases, Pharmacology Section, University of Siena, Siena - Italy
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25
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Barison A, Aquaro GD, Pugliese NR, Cappelli F, Chiappino S, Vergaro G, Mirizzi G, Todiere G, Passino C, Masci PG, Perfetto F, Emdin M. Measurement of myocardial amyloid deposition in systemic amyloidosis: insights from cardiovascular magnetic resonance imaging. J Intern Med 2015; 277:605-14. [PMID: 25346163 DOI: 10.1111/joim.12324] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Cardiac involvement in systemic amyloidosis is caused by the extracellular deposition of misfolded proteins, mainly immunoglobulin light chains (AL) or transthyretin (ATTR), and may be detected by cardiovascular magnetic resonance (CMR). The aim of this study was to measure myocardial extracellular volume (ECV) in amyloid patients with a novel T1 mapping CMR technique and to determine the correlation between ECV and disease severity. METHODS Thirty-six patients with biopsy-proven systemic amyloidosis (mean age 70 ± 9 years, 31 men, 30 with AL and six with ATTR amyloidosis) and seven patients with possible amyloidosis (mean age 64 ± 10 years, six men) underwent comprehensive clinical and CMR assessment, with ECV estimation from pre- and postcontrast T1 mapping. Thirty healthy subjects (mean age 39 ± 17 years, 21 men) served as the control group. RESULTS Amyloid patients presented with left ventricular (LV) concentric hypertrophy with impaired biventricular systolic function. Cardiac ECV was higher in amyloid patients (definite amyloidosis, 0.43 ± 0.12; possible amyloidosis, 0.34 ± 0.11) than in control subjects (0.26 ± 0.04, P < 0.05); even in amyloid patients without late gadolinium enhancement (0.35 ± 0.10), ECV was significantly higher than in the control group (P < 0.01). A cut-off value of myocardial ECV >0.316, corresponding to the 95th percentile in normal subjects, showed a sensitivity of 79% and specificity of 97% for discriminating amyloid patients from control subjects (area under the curve of 0.884). Myocardial ECV was significantly correlated with LV ejection fraction (R(2) = 0.16), LV mean wall thickness (R(2) = 0.41), LV diastolic function (R(2) = 0.21), right ventricular ejection fraction (R(2) = 0.13), N-terminal fragment of the pro-brain natriuretic peptides (R(2) = 0.23) and cardiac troponin (R(2) = 0.33). CONCLUSION Myocardial ECV was increased in amyloid patients and correlated with disease severity. Thus, measurement of myocardial ECV represents a potential noninvasive index of amyloid burden for use in early diagnosis and disease monitoring.
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Affiliation(s)
- A Barison
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Scuola Superiore Sant'Anna, Pisa, Italy
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26
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Galli I, Bartalini S, Cancio P, Cappelli F, Giusfredi G, Mazzotti D, Akikusa N, Yamanishi M, De Natale P. Mid-infrared frequency comb for broadband high precision and sensitivity molecular spectroscopy. Opt Lett 2014; 39:5050-3. [PMID: 25166071 DOI: 10.1364/ol.39.005050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We report on the experimental demonstration of the metrological and spectroscopic performances of a mid-infrared comb generated by a nonlinear downconversion process from a Ti:sapphire-based near-infrared comb. A quantum cascade laser at 4330 nm was phase-locked to a single tooth of this mid-infrared comb and its frequency-noise power spectral density was measured. The mid-infrared comb itself was also used as a multifrequency highly coherent source to perform ambient air direct comb spectroscopy with the Vernier technique, by demultiplexing it with a high-finesse Fabry-Perot cavity.
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27
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Galli I, Cappelli F, Cancio P, Giusfredi G, Mazzotti D, Bartalini S, De Natale P. High-coherence mid-infrared frequency comb. Opt Express 2013; 21:28877-85. [PMID: 24514401 DOI: 10.1364/oe.21.028877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We report on the generation of a frequency comb around 4330 nm with an unprecedented coherence of the single teeth. Generating the comb within a Ti:sapphire laser cavity by a difference-frequency process and using a phase-lock scheme based on direct digital synthesis, we achieve a tooth linewidth of 2.0 kHz in a 1-s timescale (750 Hz in 20 ms). The generated per-tooth power of 1 μW ranks this comb among the best ever realized in the mid-infrared in terms of power spectral density.
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28
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Musca F, Salinaro F, Mussinelli R, Boldrini M, Raimondi A, Cappelli F, Perfetto F, Palladini G, Merlini G, Perlini S. Is a restrictive LV filling pattern invariably present in restrictive cardiomyopathy? The case of cardiac AL amyloidosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2442] [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: 11/14/2022] Open
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29
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Boldrini M, Salinaro F, Musca F, Mussinelli R, Raimondi A, Cappelli F, Palladini G, Merlini G, Rapezzi C, Perlini S. An ECG/ECHO comparison between AL and ATTR cardiac amyloidosis at diagnosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2991] [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: 11/12/2022] Open
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30
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Quarta C, Longhi S, Cappelli F, Perfetti F, Ferlini A, Perlini S, Cinelli MM, Gentile N, Merlini G, Rapezzi C. Late onset cardiomyopathy due to transthyretin Ile68Leu mutation: a cardiogenic variant of familial amyloidosis potentially mimicking sarcomeric hypertrophic cardiomyopathy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2958] [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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31
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Raimondi A, Salinaro F, Mussinelli R, Boldrini M, Cappelli F, Perfetto F, Palladini G, Merlini G, Rapezzi C, Perlini S. The role of gender and age in cardiac AL amyloidosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2996] [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: 11/14/2022] Open
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32
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Borri S, Galli I, Cappelli F, Bismuto A, Bartalini S, Cancio P, Giusfredi G, Mazzotti D, Faist J, De Natale P. Direct link of a mid-infrared QCL to a frequency comb by optical injection. Opt Lett 2012; 37:1011-1013. [PMID: 22446207 DOI: 10.1364/ol.37.001011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A narrow-linewidth comb-linked nonlinear source is used as master radiation to injection lock a room-temperature mid-infrared quantum cascade laser (QCL). This process leads to a direct lock of the QCL to the optical frequency comb, providing the unique features of narrow linewidth, absolute frequency, higher output power, and wide mode-hop-free tunability. The QCL reproduces the injected radiation within more than 94%, with a reduction of the frequency-noise spectral density by 3 to 4 orders of magnitude up to about 100 kHz, and a linewidth narrowing from a few MHz to 20 kHz.
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Affiliation(s)
- S Borri
- Istituto Nazionale di Ottica (INO), Consiglio Nazionale delle Richerche (CNR), Firenze FI, Italy.
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33
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Cappelli F, Porciani MC, Bergesio F, Perlini S, Attana P, Moggi Pignone A, Salinaro F, Musca F, Padeletti L, Perfetto F. Right ventricular function in AL amyloidosis: characteristics and prognostic implication. Eur Heart J Cardiovasc Imaging 2011; 13:416-22. [DOI: 10.1093/ejechocard/jer289] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [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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34
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Pham QH, Von Lueder TG, Namtvedt SK, Rosjo H, Omland T, Steine K, Timoteo AT, Mota Carmo M, Simoes M, Branco LM, Ferreira RC, Kato R, Ito J, Tahara T, Yokoyama Y, Ashikaga T, Satoh Y, Na JO, Hong HE, Kim MN, Shin SY, Choi CU, Kim EJ, Rha SW, Park CG, Seo HS, Oh DJ, Ticulescu R, Brigido S, Vriz O, Sparacino L, Popescu BA, Ginghina C, Carerj S, Nicolosi GL, Antonini-Canterin F, Onaindia Gandarias JJ, Romero A, Laraudogoitia E, Velasco S, Quintana O, Cacicedo A, Rodriguez I, Alarcon JA, Gonzalez J, Lekuona I, Onaindia Gandarias JJ, Laraudogoitia E, Romero A, Velasco S, Cacicedo A, Quintana O, Subinas A, Gonzalez J, Alarcon JA, Lekuona I, Abdula G, Lund LH, Winter R, Brodin L, Sahlen A, Masaki M, Cha YM, Yuasa T, Dong K, Dong YX, Mankad SV, Oh JK, Vallet F, Lequeux B, Diakov C, Sosner P, Christiaens L, Coisne D, Kihara C, Murata K, Wada Y, Uchida K, Ueyama T, Okuda S, Susa T, Matsuzaki M, Cho EJ, Choi KY, Kwon BJ, Kim DB, Jang SW, Cho JS, Jung HO, Jeon HK, Youn HJ, Kim JH, Cikes M, Bijnens B, Velagic V, Kopjar T, Milicic D, Biocina B, Gasparovic H, Almuntaser I, Brown A, Foley B, Mulvihill N, Crean P, King G, Murphy R, Takata Y, Taniguchi M, Nobusada S, Sugawara M, Toh N, Kusano K, Itoh H, Wellnhofer E, Kriatselis C, Nedios S, Gerds-Li JH, Fleck E, Poulsen MK, Henriksen JE, Dahl J, Johansen A, Haghfelt T, Hoilund-Carlsen PF, Beck-Nielsen H, Moller JE, Dankowski R, Wierzchowiecki M, Michalski M, Nowicka A, Szymanowska K, Pajak A, Poprawski K, Szyszka A, Kasner M, Westermann D, Schultheiss HP, Tschoepe C, Watanabe T, Iwai-Takano M, Kobayashi A, Machii H, Takeishi Y, Paelinck BP, Van Herck PL, Bosmans JM, Vrints CJ, Lamb HJ, Doltra A, Vidal B, Silva E, Poyatos S, Mont L, Berruezo A, Castel A, Tolosana JM, Brugada J, Sitges M, Dencker M, Bjorgell O, Hlebowicz J, Szelenyi ZS, Szenasi G, Kiss M, Prohaszka Z, Patocs A, Karadi I, Vereckei A, Saha SK, Anderson PL, Govind S, Govindan M, Moggridge JC, Kiotsekoglou A, Gopal AS, Loegstrup BB, Christophersen TB, Hoefsten DE, Moeller JE, Boetker HE, Egstrup K, Wellnhofer E, Kriatselis C, Nedios S, Gerds-Li JH, Fleck E, Graefe M, Huang FQ, Zhang RS, Le TT, Tan RS, Sattarzadeh Badkoubeh R, Tavoosi A, Elahian AR, Drapkina O, Ivashkin VI, Vereckei A, Szelenyi ZS, Fazakas A, Pepo L, Janosi O, Karadi I, Kopitovic I, Goncalves A, Marcos-Alberca P, Almeria C, Feltes G, Rodriguez E, Garcia E, Hernandez-Antolin R, Macaya C, Silva Cardoso J, Zamorano JL, Navarro MS, Valentin M, Banes CM, Rigo F, Grolla E, Tona F, Cuaia V, Moreo A, Badano L, Raviele A, Iliceto S, Tarzia P, Sestito A, Nerla R, Di Monaco A, Infusino F, Matera D, Greco F, Tacchino RM, Lanza GA, Crea F, Nemes A, Balazs E, Pinter KS, Egyed A, Csanady M, Forster T, Loegstrup BB, Christophersen TB, Hoefsten DE, Moeller JE, Boetker HE, Egstrup K, Holte E, Vegsundvag J, Hole T, Hegbom K, Wiseth R, Nemes A, Balazs E, Pinter KS, Egyed A, Csanady M, Forster T, Sharif D, Sharif-Rasslan A, Shahla C, Khalil A, Rosenschein U, Zagatina A, Zhuravskaya N, Tyurina TV, Tagliamonte E, Cirillo T, Coppola A, Marinelli U, Romano C, Riccio G, Citro R, Astarita C, Capuano N, Tagliamonte E, Cirillo T, Marinelli U, Quaranta G, Desiderio A, Riccio G, Romano C, Capuano N, Frattini S, Faggiano P, Zilioli V, Locantore E, Longhi S, Bellandi F, Faden G, Triggiani M, Dei Cas L, Dalsgaard M, Kjaergaard J, Iversen K, Hassager C, Dinh W, Nickl WN, Smettan JS, Koehler TK, Scheffold TD, Coll Barroso MCB, Guelker JG, Fueth RF, Kamperidis V, Hadjimiltiades S, Sianos G, Efthimiadis G, Karvounis H, Parcharidis G, Styliadis IH, Velasco Del Castillo MS, Cacicedo A, Onaindia JJ, Quintana O, Alarcon JA, Rodriguez I, Telleria M, Subinas A, Lekuona I, Laraudogoitia E, Carstensen HG, Nordenberg C, Sogaard P, Fritz-Hansen T, Bech J, Galatius S, Jensen JS, Mogelvang R, Bartko PE, Graf S, Rosenhek R, Burwash IG, Bergler-Klein J, Clavel MA, Baumgartner H, Pibarot P, Mundigler G, Kirilmaz B, Eser I, Tuzun N, Komur B, Dogan H, Taskiran Comez A, Ercan E, Cusma-Piccione M, Zito C, Oreto G, Piluso S, Tripepi S, Oreto L, Longordo C, Ciraci L, Di Bella G, Carerj S, Piatkowski R, Kochanowski J, Scislo P, Grabowski M, Marchel M, Roik M, Kosior D, Opolski G, Sknouril L, Dorda M, Holek B, Gajdusek L, Chovancik J, Branny M, Fiala M, Szymanski P, Lipczynska M, Klisiewicz A, Hoffman P, Jander N, Minners J, Martin G, Zeh W, Allgeier M, Gohlke-Baewolf C, Gohlke H, Nistri S, Porciani MC, Attanasio M, Abbate R, Gensini GF, Pepe G, Duncan RF, Piantadosi C, Nelson AJ, Wittert G, Dundon B, Worthley MI, Worthley SG, Jung P, Berlinger K, Rieber J, Sohn HZ, Schneider P, Leibig M, Koenig A, Klauss V, Tomkiewicz-Pajak L, Kolcz J, Olszowska M, Pieculewicz M, Podolec P, Pieculewicz M, Przewlocki T, Tomkiewicz-Pajak L, Suchon E, Sobien B, Podolec P, Pieculewicz M, Przewlocki T, Wilkolek P, Tomkiewicz-Pajak L, Ziembicka A, Podolec P, Pieculewicz M, Przewlocki T, Tomkiewicz-Pajak L, Hlawaty M, Wilkolek P, Sobien B, Suchon E, Podolec P, Van De Bruaene A, Hermans H, Buys R, Vanhees L, Delcroix M, Voigt JU, Budts W, De Cillis E, Acquaviva T, Basile D, Bortone AS, Kalimanovska-Ostric D, Nastasovic T, Vujisic-Tesic B, Jovanovic I, Milakovic B, Dostanic M, Stosic M, Frogoudaki A, Andreou K, Parisis J, Triantafyllidi E, Gaitani S, Paraskevaidis J, Anastasiou-Nana M, Pieculewicz M, Przewlocki T, Tomkiewicz-Pajak L, Sobien B, Hlawaty M, Podolec P, De Pasquale G, Kuehn A, Petzuch K, Mueller J, Meierhofer C, Fratz S, Hager A, Hess J, Vogt M, Attenhofer Jost CH, Dearani JA, Scott CG, Burkhart HM, Connolly HM, Vitarelli A, Battaglia D, Caranci F, Padella V, Continanza G, Dettori O, Capotosto L, Vitarelli M, De Cicco V, Cortez Morichetti M, Mohanan Nair KK, Sasidaharan B, Thajudeen A, Tharakan JM, Mertens L, Ahmad N, Kantor PK, Grosse-Wortmann L, Friedberg MK, Bernard YF, Morel MA, Descotes-Genon V, Jehl J, Meneveau N, Schiele F, Kaldararova M, Simkova I, Tittel P, Masura J, Trojnarska O, Szczepaniak L, Mizia -Stec K, Cieplucha A, Bartczak A, Grajek S, Tykarski A, Gasior Z, Attenhofer Jost CH, Babovicvuksanovic D, Scott CG, Bonnichsen CR, Burkhart HM, Connolly HM, Morgan GJ, Slorach C, Hui W, Sarkola T, Lee KJ, Chaturvedi R, Benson L, Mertens L, Bradley T, Iancu ME, Ghiorghiu I, Serban M, Craciunescu I, Hodo A, Popescu BA, Ginghina C, Morgan J, Morgan GJ, Slorach C, Hui W, Roche L, Lee K, Chaturvedi R, Benson L, Bradley T, Mertens L, Morgan J, Morgan GJ, Slorach C, Hui W, Sarkola T, Lee K, Chaturvedi R, Benson L, Bradley T, Mertens L, Milanesi O, Favero V, Padalino M, Biffanti R, Cerutti A, Maschietto N, Reffo E, Vida V, Stellin G, Irtyuga O, Gamazin D, Voronkina I, Tsoyi N, Gudkova E, Moiseeva O, Aggeli C, Kazazaki C, Felekos I, Lagoudakou S, Roussakis G, Skoumas J, Pitsavos C, Stefanadis C, Cueff C, Keenan N, Steg PG, Cimadevilla C, Ducrocq G, Vahanian A, Messika-Zeitoun D, Petrella L, Mazzola AM, Villani CV, Giancola RG, Ciocca MC, Di Eusanio DEM, Nolan S, Ionescu A, Skaug TR, Amundsen BH, Hergum T, Torp H, Haugen BO, Lopez Aguilera J, Mesa Rubio D, Ruiz Ortiz M, Delgado Ortega M, Villanueva Fernandez E, Cejudo Diaz Del Campo L, Toledano Delgado F, Leon Del Pino M, Romo Pena E, Suarez De Lezo Cruz-Conde J, De Marco E, Colucci A, Comerci G, Gabrielli FA, Natali R, Garramone B, Savino M, Lotrionte M, Sonaglioni A, Loperfido F, Zdravkovic M, Perunicic J, Krotin M, Ristic M, Vukomanovic V, Zaja M, Radovanovic S, Saric J, Zdravkovic D, Cotrim C, Almeida AR, Miranda R, Almeida AG, Picano E, Carrageta M, D'andrea A, Cocchia R, Riegler L, Golia E, Scarafile R, Citro R, Caso P, Russo MG, Bossone E, Calabro' R, Noman H, Adel A, Elfaramawy AMR, Abdelraouf M, Elnaggar WAEL, Baligh E, Sargento L, Silva D, Goncalves S, Ribeiro S, Vinhas Sousa G, Almeida A, Lopes M, Rodriguez-Manero M, Aguado Gil L, Azcarate P, Lloret Luna P, Macias Gallego A, Castano SARA, Garcia M, Pujol Salvador C, Barba J, Redondo P, Tomasoni L, Sitia S, Atzeni F, Gianturco L, Ricci C, Sarzi-Puttini P, Turiel M, Sitia S, Tomasoni L, Atzeni F, De Gennaro Colonna V, Sarzi-Puttini P, Turiel M, Uejima T, Jaroch J, Antonini-Canterin F, Polombo C, Carerj S, Hughes A, Vinereanu D, Evanvelista A, Leftheriotis G, Fraser AG, Lewczuk A, Sobkowicz B, Tomaszuk-Kazberuk A, Sawicki R, Hirnle T, Michalski BW, Filipiak D, Kasprzak JD, Lipiec P, Dalen H, Haugen BO, Mjolstad OC, Klykken BE, Graven T, Martensson M, Olsson M, Brodin LA, Antonini-Canterin F, Ticulescu R, Vriz O, Enache R, Leiballi E, Popescu BA, Ginghina C, Nicolosi GL, Penhall A, Perry R, Altman M, Sinhal A, Bennetts J, Chew DP, Joseph MX, Larsen LH, Kjaergaard J, Kristensen T, Kober LV, Kofoed KF, Hassager C, Moscoso Costa F, Ribeiras R, Brito J, Boshoff S, Neves J, Teles R, Canada M, Andrade MJ, Gouveia R, Silva A, Miskovic A, Poerner TP, Stiller CS, Goebel BG, Moritz AM, Stefani L, Galanti GG, Moraldo M, Bergamini C, Pabari PA, Dhutia NM, Malaweera ASN, Willson K, Davies J, Hughes AD, Xu XY, Francis DP, Jasaityte R, Amundsen B, Barbosa D, Loeckx D, Kiss G, Orderud F, Robesyn V, Claus P, Torp H, D'hooge J, Kihara C, Murata K, Wada Y, Uchida K, Nao T, Okuda S, Susa T, Miura T, Matsuzaki M, Shams K, Samir S, Samir R, El-Sayed M, Anwar AM, Nosir Y, Galal A, Chamsi-Pasha H, Ciobanu A, Dulgheru R, Bennett S, Vinereanu D, De Luca A, Toncelli L, Cappelli F, Stefani L, Cappelli B, Vono MCR, Galanti G, Zorman Y, Yilmazer MS, Akyildiz M, Gurol T, Aydin A, Dagdeviren B, Kalangos A. Poster session V * Saturday 11 December 2010, 08:30-12:30. European Journal of Echocardiography 2010. [DOI: 10.1093/ejechocard/jeq148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Amicuzi I, Cappelli F, Stortini M, Cherubini S, Pierro MM. Follow-up of neuropsychological function recovery in a 9-year-old girl with anoxic encephalopathy: a window on the brain re-organization processes. Brain Inj 2006; 19:371-88. [PMID: 16094785 DOI: 10.1080/02699050400004286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate comprehensive neuropsychological outcome, disabilities in daily life and individual recovery processes in a case of anoxic encephalopathy. DESIGN A 9-year-old child's functional outcome after anoxic coma was evaluated in a follow-up study with assessments at 5, 9 and 12 months post-injury. A comprehensive neuropsychological protocol was administered. Qualitative methods of analysis and ecological observation were associated with standard and non-standard quantitative measures. RESULTS The child presented pervasive functional deficits with prevalence of gnosic, praxic and self-regulatory dysfunction. Dissociated functional recovery was documented in 12 months time. Improvement of self-regulatory abilities was likely a 'propeller' of global system re-organization. CONCLUSION A descriptive longitudinal study of functional and ecological behavioural changes after anoxic coma provides insight into the re-adaptation processes in the brain connected to post-lesion ecological and training experiences. Contextual factors and their relations to functional improvements deserve further study.
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Affiliation(s)
- I Amicuzi
- Department of Paediatric Rehabilitation, Children's Hospital Bambino Gesù, Rome, Italy
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Macioce R, Cappelli F, Demarchi G, Lilli A, Ricciardi G, Pieragnoli P, Colella A, Michelucci A, Porciani MC, Padeletti L. Resynchronization of mitral valve annular segments reduces functional mitral regurgitation in cardiac resynchronization therapy. Minerva Cardioangiol 2005; 53:329-33. [PMID: 16177677] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
AIM Cardiac resynchronization therapy (CRT) reduces the severity of functional mitral regurgitation (FMR) in patients with heart failure and left bundle branch block. Our hypothesis was that the induction of a more synchronous mitral valve anulus contraction can be a mechanism of FMR reduction in CRT patients. METHODS An echo tissue Doppler imaging (TDI) examination was performed at baseline and 6 months after biventricular pacing system implant in 30 patients (4 females and 26 males, 74.1+/-6.1 years) with dilatative or ischemic chronic heart failure, NYHA class = or >III, ejection fraction (EF) = or <35% and QRS = or >140 ms. EF, Myocardial Performance Index (MPI), left end-diastolic and systolic volumes (LVEDV, LVESV), mitral regurgitation jet area/left atrial area (JA/LAA), effective regurgitant orifice area (EROA), mitral anulus contraction (MAC) were evaluated. Using TDI, at the 6 left ventricle (LV) basal segments the time to the peak myocardial sustained systolic velocity (Ts) and the standard deviation (SD) of TS were evaluated. RESULTS At 6 months follow-up NYHA class, EF, MPI were significantly improved, LV volumes were reduced. FMR degree, evaluated both as JA/LAA and EROA, was significantly reduced. This effect was associated with the 6 basal segments resynchronization and with a more effective annular contraction. CONCLUSIONS Our data show that CRT by resynchronizing left ventricular basal segments produces a more effective mitral valve annulus contraction and contributes to FMR improvement. Further studies need to evaluate if this could be taken into account as new therapeutic perspective of functional mitral valve regurgitation.
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Affiliation(s)
- R Macioce
- Clinical Medicine and Cardiology Institute, University of Florence, Florence, Italy.
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Bocci V, Di Paolo N, Garosi G, Aldinucci C, Borrelli E, Valacchi G, Cappelli F, Guerri L, Gavioli G, Corradeschi F, Rossi R, Giannerini F, Di Simplicio P. Ozonation of blood during extracorporeal circulation. I. Rationale, methodology and preliminary studies. Int J Artif Organs 1999; 22:645-51. [PMID: 10532435] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
We investigated whether exposure of blood ex-vivo to oxygen-ozone (O2-O3) through a gas exchanger is feasible and practical. We first evaluated the classical dialysis-type technique but we soon realized that semipermeable membranes are unsuitable because they are hydrophilic and vulnerable to O3. We therefore adopted a system with hydrophobic O3-resistant hollow fibers enclosed in a polycarbonate housing with a membrane area of about 0.5 m2. First we tested the system with normal saline, determining the production of hydrogen peroxide (H2O2) at O3 concentrations from 5 to 40 microg/ml. We then evaluated critical parameters by circulating swine blood in vitro; this revealed that heparin is not an ideal anticoagulant for this system. Finally, we performed several experiments in sheep and defined optimal anticoagulant dose (sodium citrate, ACD), priming solution, volume of blood flow per min, volume and concentration of O2-O3 mixture flowing countercurrent with respect to blood and the time necessary for perfusion in vivo. The biochemical parameters showed that an O3 concentration as low as 10 microg/ml is effective; this means that gas exchange and O3 reactivity are rapid and capable of inducing biological effects. The sheep showed no adverse effects even after 50 min of extracorporeal circulation at higher O3 concentrations (20 to 40 microg/ml) but the exchanger became less effective (low pO2 values) due to progressive clogging with cells.
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Affiliation(s)
- V Bocci
- Institute of General Physiology, University of Siena, Italy.
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Cappelli F, Casadio V, Mazzola C, Bosisio E, Sacerdoti C. [Contribution to the study of the electrocardiogram in chronic pulmonary tuberculosis]. G Ital Tuberc Mal Torace 1965; 19:252-66. [PMID: 5862845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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