1
|
Poggiali E, Barbieri G, Salvatore V, Salinaro F. The Emergency Rooms and Emergency Medicine should not be the answer to the weakness of the Italian National Health System. Emer Care J 2021. [DOI: 10.4081/ecj.2021.10304] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Dear Editors,
The COVID-19 pandemic has highlighted several and wellknown limits of the Italian national health system, including the weakness of the territorial medical services and the absence of dedicated structures for patients affected by chronic or end-stage diseases in need of long hospitalization, or with social difficulties. [...]
Collapse
|
2
|
Abstract
One of the greatest and most famous Greek philosophers, Socrates, believed that “here is only one good, knowledge, and one evil: ignorance”, but nowadays we can tentatively add that knowledge without sharing is like sterile ground. Today, social media play a central role not only in connecting people worldwide, but overall to access news and information, and for decision making. [...]
Collapse
|
3
|
La Salvia M, Secco G, Torti E, Florimbi G, Guido L, Lago P, Salinaro F, Perlini S, Leporati F. Deep learning and lung ultrasound for Covid-19 pneumonia detection and severity classification. Comput Biol Med 2021; 136:104742. [PMID: 34388462 PMCID: PMC8349313 DOI: 10.1016/j.compbiomed.2021.104742] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023]
Abstract
The Covid-19 European outbreak in February 2020 has challenged the world's health systems, eliciting an urgent need for effective and highly reliable diagnostic instruments to help medical personnel. Deep learning (DL) has been demonstrated to be useful for diagnosis using both computed tomography (CT) scans and chest X-rays (CXR), whereby the former typically yields more accurate results. However, the pivoting function of a CT scan during the pandemic presents several drawbacks, including high cost and cross-contamination problems. Radiation-free lung ultrasound (LUS) imaging, which requires high expertise and is thus being underutilised, has demonstrated a strong correlation with CT scan results and a high reliability in pneumonia detection even in the early stages. In this study, we developed a system based on modern DL methodologies in close collaboration with Fondazione IRCCS Policlinico San Matteo's Emergency Department (ED) of Pavia. Using a reliable dataset comprising ultrasound clips originating from linear and convex probes in 2908 frames from 450 hospitalised patients, we conducted an investigation into detecting Covid-19 patterns and ranking them considering two severity scales. This study differs from other research projects by its novel approach involving four and seven classes. Patients admitted to the ED underwent 12 LUS examinations in different chest parts, each evaluated according to standardised severity scales. We adopted residual convolutional neural networks (CNNs), transfer learning, and data augmentation techniques. Hence, employing methodological hyperparameter tuning, we produced state-of-the-art results meeting F1 score levels, averaged over the number of classes considered, exceeding 98%, and thereby manifesting stable measurements over precision and recall.
Collapse
Affiliation(s)
- Marco La Salvia
- University of Pavia, Department of Electrical, Computer and Biomedical Engineering, Via Ferrata 5, Pavia I, 27100, Italy.
| | - Gianmarco Secco
- Fondazione IRCCS Policlinico San Matteo, Emergency Department, Viale Camillo Golgi 19, Pavia I, 27100, Italy
| | - Emanuele Torti
- University of Pavia, Department of Electrical, Computer and Biomedical Engineering, Via Ferrata 5, Pavia I, 27100, Italy
| | - Giordana Florimbi
- University of Pavia, Department of Electrical, Computer and Biomedical Engineering, Via Ferrata 5, Pavia I, 27100, Italy
| | - Luca Guido
- University of Pavia, Department of Electrical, Computer and Biomedical Engineering, Via Ferrata 5, Pavia I, 27100, Italy
| | - Paolo Lago
- Fondazione IRCCS Policlinico San Matteo, Emergency Department, Viale Camillo Golgi 19, Pavia I, 27100, Italy
| | - Francesco Salinaro
- Fondazione IRCCS Policlinico San Matteo, Emergency Department, Viale Camillo Golgi 19, Pavia I, 27100, Italy
| | - Stefano Perlini
- Fondazione IRCCS Policlinico San Matteo, Emergency Department, Viale Camillo Golgi 19, Pavia I, 27100, Italy
| | - Francesco Leporati
- University of Pavia, Department of Electrical, Computer and Biomedical Engineering, Via Ferrata 5, Pavia I, 27100, Italy
| |
Collapse
|
4
|
Secco G, Delorenzo M, Salinaro F, Zattera C, Barcella B, Resta F, Sabena A, Vezzoni G, Bonzano M, Briganti F, Cappa G, Zugnoni F, Demitry L, Mojoli F, Baldanti F, Bruno R, Perlini S. Lung ultrasound presentation of COVID-19 patients: phenotypes and correlations. Intern Emerg Med 2021; 16:1317-1327. [PMID: 33646508 PMCID: PMC7917171 DOI: 10.1007/s11739-020-02620-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/24/2020] [Indexed: 12/21/2022]
Abstract
Bedside lung ultrasound (LUS) can play a role in the setting of the SarsCoV2 pneumonia pandemic. To evaluate the clinical and LUS features of COVID-19 in the ED and their potential prognostic role, a cohort of laboratory-confirmed COVID-19 patients underwent LUS upon admission in the ED. LUS score was derived from 12 fields. A prevalent LUS pattern was assigned depending on the presence of interstitial syndrome only (Interstitial Pattern), or evidence of subpleural consolidations in at least two fields (Consolidation Pattern). The endpoint was 30-day mortality. The relationship between hemogasanalysis parameters and LUS score was also evaluated. Out of 312 patients, only 36 (11.5%) did not present lung involvment, as defined by LUS score < 1. The majority of patients were admitted either in a general ward (53.8%) or in intensive care unit (9.6%), whereas 106 patients (33.9%) were discharged from the ED. In-hospital mortality was 25.3%, and 30-day survival was 67.6%. A LUS score > 13 had a 77.2% sensitivity and a 71.5% specificity (AUC 0.814; p < 0.001) in predicting mortality. LUS alterations were more frequent (64%) in the posterior lower fields. LUS score was related with P/F (R2 0.68; p < 0.0001) and P/F at FiO2 = 21% (R2 0.59; p < 0.0001). The correlation between LUS score and P/F was not influenced by the prevalent ultrasound pattern. LUS represents an effective tool in both defining diagnosis and stratifying prognosis of COVID-19 pneumonia. The correlation between LUS and hemogasanalysis parameters underscores its role in evaluating lung structure and function.
Collapse
Affiliation(s)
- Gianmarco Secco
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Internal Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, P.Le Golgi, 19, 27100, Pavia, Italy
| | - Marzia Delorenzo
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Internal Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, P.Le Golgi, 19, 27100, Pavia, Italy
| | - Francesco Salinaro
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Internal Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, P.Le Golgi, 19, 27100, Pavia, Italy
| | - Caterina Zattera
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Internal Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, P.Le Golgi, 19, 27100, Pavia, Italy
| | - Bruno Barcella
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Internal Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, P.Le Golgi, 19, 27100, Pavia, Italy
| | - Flavia Resta
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Internal Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, P.Le Golgi, 19, 27100, Pavia, Italy
| | - Anna Sabena
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Internal Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, P.Le Golgi, 19, 27100, Pavia, Italy
| | - Giulia Vezzoni
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Internal Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, P.Le Golgi, 19, 27100, Pavia, Italy
| | - Marco Bonzano
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Internal Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, P.Le Golgi, 19, 27100, Pavia, Italy
| | - Federica Briganti
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Internal Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, P.Le Golgi, 19, 27100, Pavia, Italy
| | - Giovanni Cappa
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Internal Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, P.Le Golgi, 19, 27100, Pavia, Italy
| | - Francesca Zugnoni
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Internal Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, P.Le Golgi, 19, 27100, Pavia, Italy
| | - Lorenzo Demitry
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Internal Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, P.Le Golgi, 19, 27100, Pavia, Italy
| | - Francesco Mojoli
- Intensive Care Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Fausto Baldanti
- Virology Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Raffaele Bruno
- Infectious Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Stefano Perlini
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Internal Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, P.Le Golgi, 19, 27100, Pavia, Italy.
| |
Collapse
|
5
|
Di Castelnuovo A, Costanzo S, Antinori A, Berselli N, Blandi L, Bonaccio M, Bruno R, Cauda R, Gialluisi A, Guaraldi G, Menicanti L, Mennuni M, My I, Parruti A, Patti G, Perlini S, Santilli F, Signorelli C, Stefanini GG, Vergori A, Ageno W, Aiello L, Agostoni P, Al Moghazi S, Arboretti R, Aucella F, Barbieri G, Barchitta M, Bartoloni A, Bologna C, Bonfanti P, Caiano L, Carrozzi L, Cascio A, Castiglione G, Chiarito M, Ciccullo A, Cingolani A, Cipollone F, Colomba C, Colombo C, Crosta F, Dalena G, Dal Pra C, Danzi GB, D'Ardes D, de Gaetano Donati K, Di Gennaro F, Di Tano G, D'Offizi G, Filippini T, Maria Fusco F, Gaudiosi C, Gentile I, Gini G, Grandone E, Guarnieri G, Lamanna GLF, Larizza G, Leone A, Lio V, Losito AR, Maccagni G, Maitan S, Mancarella S, Manuele R, Mapelli M, Maragna R, Marra L, Maresca G, Marotta C, Mastroianni F, Mazzitelli M, Mengozzi A, Menichetti F, Milic J, Minutolo F, Molena B, Mussinelli R, Mussini C, Musso M, Odone A, Olivieri M, Pasi E, Perroni A, Petri F, Pinchera B, Pivato CA, Poletti V, Ravaglia C, Rossato M, Rossi M, Sabena A, Salinaro F, Sangiovanni V, Sanrocco C, Scorzolini L, Sgariglia R, Simeone PG, Spinicci M, Trecarichi EM, Veronesi G, Vettor R, Vianello A, Vinceti M, Visconti E, Vocciante L, De Caterina R, Iacoviello L. Lopinavir/Ritonavir and Darunavir/Cobicistat in Hospitalized COVID-19 Patients: Findings From the Multicenter Italian CORIST Study. Front Med (Lausanne) 2021; 8:639970. [PMID: 34179035 PMCID: PMC8221239 DOI: 10.3389/fmed.2021.639970] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/05/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Protease inhibitors have been considered as possible therapeutic agents for COVID-19 patients. Objectives: To describe the association between lopinavir/ritonavir (LPV/r) or darunavir/cobicistat (DRV/c) use and in-hospital mortality in COVID-19 patients. Study Design: Multicenter observational study of COVID-19 patients admitted in 33 Italian hospitals. Medications, preexisting conditions, clinical measures, and outcomes were extracted from medical records. Patients were retrospectively divided in three groups, according to use of LPV/r, DRV/c or none of them. Primary outcome in a time-to event analysis was death. We used Cox proportional-hazards models with inverse probability of treatment weighting by multinomial propensity scores. Results: Out of 3,451 patients, 33.3% LPV/r and 13.9% received DRV/c. Patients receiving LPV/r or DRV/c were more likely younger, men, had higher C-reactive protein levels while less likely had hypertension, cardiovascular, pulmonary or kidney disease. After adjustment for propensity scores, LPV/r use was not associated with mortality (HR = 0.94, 95% CI 0.78 to 1.13), whereas treatment with DRV/c was associated with a higher death risk (HR = 1.89, 1.53 to 2.34, E-value = 2.43). This increased risk was more marked in women, in elderly, in patients with higher severity of COVID-19 and in patients receiving other COVID-19 drugs. Conclusions: In a large cohort of Italian patients hospitalized for COVID-19 in a real-life setting, the use of LPV/r treatment did not change death rate, while DRV/c was associated with increased mortality. Within the limits of an observational study, these data do not support the use of LPV/r or DRV/c in COVID-19 patients.
Collapse
Affiliation(s)
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Andrea Antinori
- UOC Immunodeficienze Virali, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Roma, Italy
| | - Nausicaa Berselli
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena, Modena, Italy
| | - Lorenzo Blandi
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Raffaele Bruno
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Roberto Cauda
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Roma, Italy
| | | | - Giovanni Guaraldi
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Marco Mennuni
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Ilaria My
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy
| | - Agostino Parruti
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Giuseppe Patti
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Stefano Perlini
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Francesca Santilli
- Department of Medicine and Aging, Clinica Medica, SS. Annunziata Hospital and University of Chieti, Chieti, Italy
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | | | - Alessandra Vergori
- HIV/AIDS Department, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Roma, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Luca Aiello
- UOC, Anestesia e Rianimazione, Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milano, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Samir Al Moghazi
- UOC Infezioni Sistemiche dell'Immunodepresso, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Rosa Arboretti
- Department of Civil Environmental and Architectural Engineering, University of Padova, Padova, Italy
| | - Filippo Aucella
- Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Greta Barbieri
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | | | - Paolo Bonfanti
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Lucia Caiano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Laura Carrozzi
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) - University of Palermo, Palermo, Italy
| | - Giacomo Castiglione
- Servizio di Anestesia e Rianimazione II UO Rianimazione Ospedale San Marco, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Mauro Chiarito
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy
| | - Arturo Ciccullo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Antonella Cingolani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Roma, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging, Clinica Medica, SS. Annunziata Hospital and University of Chieti, Chieti, Italy
| | - Claudia Colomba
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) - University of Palermo, Palermo, Italy
| | - Crizia Colombo
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Francesco Crosta
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Giovanni Dalena
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - Chiara Dal Pra
- Clinica Medica 3, Department of Medicine - DIMED, University Hospital of Padova, Padova, Italy
| | | | - Damiano D'Ardes
- Department of Medicine and Aging, Clinica Medica, SS. Annunziata Hospital and University of Chieti, Chieti, Italy
| | | | | | | | - Gianpiero D'Offizi
- UOC Malattie Infettive-Epatologia, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Roma, Italy
| | - Tommaso Filippini
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena, Modena, Italy
| | - Francesco Maria Fusco
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | | | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Giancarlo Gini
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Elvira Grandone
- Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Gabriella Guarnieri
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | - Giovanni Larizza
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - Armando Leone
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Veronica Lio
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | | | - Gloria Maccagni
- Department of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Stefano Maitan
- UOC, Anestesia e Rianimazione, Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Sandro Mancarella
- ASST Milano Nord - Ospedale Edoardo Bassini Cinisello Balsamo, Milan, Italy
| | - Rosa Manuele
- UOC Malattie Infettive e Tropicali, P.O. San Marco, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Milano, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Riccardo Maragna
- Centro Cardiologico Monzino IRCCS, Milano, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Lorenzo Marra
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Giulio Maresca
- UOC di Medicina - Presidio Ospedaliero S.Maria di Loreto Nuovo, Napoli, Italy
| | | | - Franco Mastroianni
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Jovana Milic
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Beatrice Molena
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - R. Mussinelli
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Cristina Mussini
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Musso
- UOC Malattie Infettive-Apparato Respiratorio, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Roma, Italy
| | - Anna Odone
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Marco Olivieri
- Computer Service, University of Molise, Campobasso, Italy
| | - Emanuela Pasi
- Medicina Interna. Ospedale di Ravenna, AUSL della Romagna, Ravenna, Italy
| | - Annalisa Perroni
- Department of Medicine and Aging, Clinica Medica, SS. Annunziata Hospital and University of Chieti, Chieti, Italy
| | - Francesco Petri
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Carlo A. Pivato
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy
| | - Venerino Poletti
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Claudia Ravaglia
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Marco Rossato
- Clinica Medica 3, Department of Medicine - DIMED, University Hospital of Padova, Padova, Italy
| | - Marianna Rossi
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Anna Sabena
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Francesco Salinaro
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Vincenzo Sangiovanni
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | - Carlo Sanrocco
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Laura Scorzolini
- UOC Malattie Infettive ad Alta Intensità di Cura, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | | | - Paola Giustina Simeone
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Enrico Maria Trecarichi
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giovanni Veronesi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine - DIMED, University Hospital of Padova, Padova, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Marco Vinceti
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena, Modena, Italy
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Elena Visconti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Laura Vocciante
- UOC di Medicina - Presidio Ospedaliero S.Maria di Loreto Nuovo, Napoli, Italy
| | - Raffaele De Caterina
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | |
Collapse
|
6
|
Perlini S, Mussinelli R, Salinaro F. New effective treatment options reinforce disease awareness: the case of transthyretin cardiac amyloidosis. Eur J Heart Fail 2021; 23:290-292. [PMID: 33527646 DOI: 10.1002/ejhf.2111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/27/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Stefano Perlini
- Emergency Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy.,Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Roberta Mussinelli
- Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Francesco Salinaro
- Emergency Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| |
Collapse
|
7
|
Vicentini A, Masiello L, D’Amore S, Baldi E, Ghio S, Savastano S, Sanzo A, Di Matteo A, Seminari EM, Lenti MV, Bosio M, Petracci B, Frigerio L, Sabena A, Tavazzi G, Oltrona Visconti L, Rordorf R, Gnecchi M, Totaro R, Ferlini M, Greco A, Magrini G, Scelsi L, Acquaro M, Coccia M, Digiacomo S, Foglia D, Jeva F, Montalto C, Moschella M, Pezza L, Perlini S, Alfano C, Bonzano M, Briganti F, Crescenzi G, Falchi AG, Maggi E, Guarnone R, Guglielmana B, Martino IF, Pioli Di Marco MS, Pettenazza P, Quaglia F, Salinaro F, Speciale F, Zunino I, Sturniolo G, Bracchi F, Lago E, Corsico A, Piloni D, Accordino G, Burattini C, Di Sabatino A, Pellegrino I, Soriano S, Santacroce G, Parodi A, de Andreis FB, Bruno R, Zuccaro V, Moioli F, Dammassi V, Albertini R. QTc Interval and Mortality in a Population of SARS-2-CoV Infected Patients. Circ Arrhythm Electrophysiol 2020; 13:e008890. [DOI: 10.1161/circep.120.008890] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/08/2023]
Affiliation(s)
- Alessandro Vicentini
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lucrezia Masiello
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, Cardiology Unit (L.M., S.D., E.B.), University of Pavia, Italy
| | - Sabato D’Amore
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, Cardiology Unit (L.M., S.D., E.B.), University of Pavia, Italy
| | - Enrico Baldi
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, Cardiology Unit (L.M., S.D., E.B.), University of Pavia, Italy
| | - Stefano Ghio
- Division of Cardiology (S.G., S.S., L.O.V.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Savastano
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Sanzo
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Emergency Department (A.S.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine (A.S.), University of Pavia, Italy
| | - Angela Di Matteo
- Division of Infectious Disease (A.D.M., E.M.S.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elena Maria Seminari
- Division of Infectious Disease (A.D.M., E.M.S.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine (M.V.L.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Bosio
- Division of Respiratory Diseases (M.B.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Barbara Petracci
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Frigerio
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna Sabena
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Guido Tavazzi
- Anaesthesia and Intensive Care (G.T.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Anesthesia and Intensive Care (G.T.), University of Pavia, Italy
| | - Luigi Oltrona Visconti
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Di Castelnuovo A, Bonaccio M, Costanzo S, Gialluisi A, Antinori A, Berselli N, Blandi L, Bruno R, Cauda R, Guaraldi G, My I, Menicanti L, Parruti G, Patti G, Perlini S, Santilli F, Signorelli C, Stefanini GG, Vergori A, Abdeddaim A, Ageno W, Agodi A, Agostoni P, Aiello L, Al Moghazi S, Aucella F, Barbieri G, Bartoloni A, Bologna C, Bonfanti P, Brancati S, Cacciatore F, Caiano L, Cannata F, Carrozzi L, Cascio A, Cingolani A, Cipollone F, Colomba C, Crisetti A, Crosta F, Danzi GB, D'Ardes D, de Gaetano Donati K, Di Gennaro F, Di Palma G, Di Tano G, Fantoni M, Filippini T, Fioretto P, Fusco FM, Gentile I, Grisafi L, Guarnieri G, Landi F, Larizza G, Leone A, Maccagni G, Maccarella S, Mapelli M, Maragna R, Marcucci R, Maresca G, Marotta C, Marra L, Mastroianni F, Mengozzi A, Menichetti F, Milic J, Murri R, Montineri A, Mussinelli R, Mussini C, Musso M, Odone A, Olivieri M, Pasi E, Petri F, Pinchera B, Pivato CA, Pizzi R, Poletti V, Raffaelli F, Ravaglia C, Righetti G, Rognoni A, Rossato M, Rossi M, Sabena A, Salinaro F, Sangiovanni V, Sanrocco C, Scarafino A, Scorzolini L, Sgariglia R, Simeone PG, Spinoni E, Torti C, Trecarichi EM, Vezzani F, Veronesi G, Vettor R, Vianello A, Vinceti M, De Caterina R, Iacoviello L. Common cardiovascular risk factors and in-hospital mortality in 3,894 patients with COVID-19: survival analysis and machine learning-based findings from the multicentre Italian CORIST Study. Nutr Metab Cardiovasc Dis 2020; 30:1899-1913. [PMID: 32912793 PMCID: PMC7833278 DOI: 10.1016/j.numecd.2020.07.031] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS There is poor knowledge on characteristics, comorbidities and laboratory measures associated with risk for adverse outcomes and in-hospital mortality in European Countries. We aimed at identifying baseline characteristics predisposing COVID-19 patients to in-hospital death. METHODS AND RESULTS Retrospective observational study on 3894 patients with SARS-CoV-2 infection hospitalized from February 19th to May 23rd, 2020 and recruited in 30 clinical centres distributed throughout Italy. Machine learning (random forest)-based and Cox survival analysis. 61.7% of participants were men (median age 67 years), followed up for a median of 13 days. In-hospital mortality exhibited a geographical gradient, Northern Italian regions featuring more than twofold higher death rates as compared to Central/Southern areas (15.6% vs 6.4%, respectively). Machine learning analysis revealed that the most important features in death classification were impaired renal function, elevated C reactive protein and advanced age. These findings were confirmed by multivariable Cox survival analysis (hazard ratio (HR): 8.2; 95% confidence interval (CI) 4.6-14.7 for age ≥85 vs 18-44 y); HR = 4.7; 2.9-7.7 for estimated glomerular filtration rate levels <15 vs ≥ 90 mL/min/1.73 m2; HR = 2.3; 1.5-3.6 for C-reactive protein levels ≥10 vs ≤ 3 mg/L). No relation was found with obesity, tobacco use, cardiovascular disease and related-comorbidities. The associations between these variables and mortality were substantially homogenous across all sub-groups analyses. CONCLUSIONS Impaired renal function, elevated C-reactive protein and advanced age were major predictors of in-hospital death in a large cohort of unselected patients with COVID-19, admitted to 30 different clinical centres all over Italy.
Collapse
Affiliation(s)
| | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy
| | | | - Andrea Antinori
- UOC Immunodeficienze Virali, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Nausicaa Berselli
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Blandi
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Raffaele Bruno
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Roberto Cauda
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Italy
| | - Giovanni Guaraldi
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ilaria My
- Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milano, Italy
| | | | - Giustino Parruti
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Giuseppe Patti
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Stefano Perlini
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Francesca Santilli
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | | | - Alessandra Vergori
- HIV/AIDS Department, National Institute for Infectious Diseases "Lazzaro Spallanzani"-IRCCS, Roma, Italy
| | - Amina Abdeddaim
- UOC Malattie Infettive-Epatologia, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, AOU Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Luca Aiello
- UOC Anestesia e Rianimazione. Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni Forlì, Italy
| | - Samir Al Moghazi
- UOC Infezioni Sistemiche dell'Immunodepresso, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Filippo Aucella
- Fondazione I.R.C.C.S "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Greta Barbieri
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | | | - Paolo Bonfanti
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Serena Brancati
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences. University of Naples, Federico II, Naples, Italy
| | - Lucia Caiano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Francesco Cannata
- Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milano, Italy
| | - Laura Carrozzi
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) - University of Palermo, Palermo, Italy
| | - Antonella Cingolani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | - Claudia Colomba
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) - University of Palermo, Palermo, Italy
| | - Annalisa Crisetti
- Fondazione I.R.C.C.S "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Francesca Crosta
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Gian B Danzi
- Department of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Damiano D'Ardes
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | | | | | - Gisella Di Palma
- UOC Medicina - PO S. Maria di Loreto Nuovo -ASL Napoli 1 Centro, Napoli, Italy
| | | | - Massimo Fantoni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Italy
| | - Tommaso Filippini
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Fioretto
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Francesco M Fusco
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples "Federico II". Napoli, Italy
| | - Leonardo Grisafi
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Gabriella Guarnieri
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Francesco Landi
- UOC Anestesia e Rianimazione. Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni Forlì, Italy
| | - Giovanni Larizza
- COVID-19 Unit. EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - Armando Leone
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Gloria Maccagni
- Department of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Sandro Maccarella
- ASST Milano Nord - Ospedale Edoardo Bassini, Cinisello Balsamo, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Riccardo Maragna
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Giulio Maresca
- Centro Cardiologico Monzino IRCCS, Milano, Italy; UOC Medicina - PO S. Maria di Loreto Nuovo -ASL Napoli 1 Centro, Napoli, Italy
| | | | - Lorenzo Marra
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Franco Mastroianni
- COVID-19 Unit. EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Jovana Milic
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Rita Murri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Italy
| | - Arturo Montineri
- U.O. C. Malattie Infettive e Tropicali, P.O. "San Marco", AOU Policlinico "G. Rodolico - San Marco", Catania, Italy
| | | | - Cristina Mussini
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Musso
- UOC Malattie Infettive-Apparato Respiratorio, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Anna Odone
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Marco Olivieri
- Computer Service, University of Molise, Campobasso, Italy
| | - Emanuela Pasi
- Medicina Interna. Ospedale di Ravenna. AUSL della Romagna, Ravenna, Italy
| | - Francesco Petri
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples "Federico II". Napoli, Italy
| | - Carlo A Pivato
- Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milano, Italy
| | - Roberto Pizzi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Venerino Poletti
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni Forlì, Forlì, Italy
| | | | - Claudia Ravaglia
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni Forlì, Forlì, Italy
| | - Giulia Righetti
- COVID-19 Unit. EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Marco Rossato
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Marianna Rossi
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Anna Sabena
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Francesco Salinaro
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Vincenzo Sangiovanni
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | - Carlo Sanrocco
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Antonio Scarafino
- COVID-19 Unit. EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - Laura Scorzolini
- UOC Malattie Infettive ad Alta Intensità di Cura, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | | | - Paola G Simeone
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Enrico Spinoni
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Carlo Torti
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences "Magna Graecia" University, Catanzaro, Italy
| | - Enrico M Trecarichi
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences "Magna Graecia" University, Catanzaro, Italy
| | - Francesca Vezzani
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | - Giovanni Veronesi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Marco Vinceti
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Raffaele De Caterina
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy.
| |
Collapse
|
9
|
Perlini S, Canevari F, Cortesi S, Sgromo V, Brancaglione A, Contri E, Pettenazza P, Salinaro F, Speciale F, Sechi G, Mare C, Cutti S, Novelli V, Marena C, Muzzi A, Bruno R, Palo A. Emergency Department and Out-of-Hospital Emergency System (112-AREU 118) integrated response to Coronavirus Disease 2019 in a Northern Italy centre. Intern Emerg Med 2020; 15:825-833. [PMID: 32507926 PMCID: PMC7276336 DOI: 10.1007/s11739-020-02390-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/28/2020] [Indexed: 01/08/2023]
Abstract
Since December 2019, the world has been facing the life-threatening disease, named Coronavirus disease-19 (COVID-19), recognized as a pandemic by the World Health Organization. The response of the Emergency Medicine network, integrating "out-of-hospital" and "hospital" activation, is crucial whenever the health system has to face a medical emergency, being caused by natural or human-derived disasters as well as by a rapidly spreading epidemic outbreak. We here report the Pavia Emergency Medicine network response to the COVID-19 outbreak. The "out-of-hospital" response was analysed in terms of calls, rescues and missions, whereas the "hospital" response was detailed as number of admitted patients and subsequent hospitalisation or discharge. The data in the first 5 weeks of the Covid-19 outbreak (February 21-March 26, 2020) were compared with a reference time window referring to the previous 5 weeks (January 17-February 20, 2020) and with the corresponding historical average data from the previous 5 years (February 21-March 26). Since February 21, 2020, a sudden and sustained increase in the calls to the AREU 112 system was noted (+ 440%). After 5 weeks, the number of calls and missions was still higher as compared to both the reference pre-Covid-19 period (+ 48% and + 10%, respectively) and the historical control (+ 53% and + 22%, respectively). Owing to the overflow from the neighbouring hospitals, which rapidly became overwhelmed and had to temporarily close patient access, the population served by the Pavia system more than doubled (from 547.251 to 1.135.977 inhabitants, + 108%). To minimize the possibility of intra-hospital spreading of the infection, a separate "Emergency Department-Infective Disease" was created, which evaluated 1241 patients with suspected infection (38% of total ED admissions). Out of these 1241 patients, 58.0% (n = 720) were admitted in general wards (n = 629) or intensive care unit (n = 91). To allow this massive number of admissions, the hospital reshaped many general ward Units, which became Covid-19 Units (up to 270 beds) and increased the intensive care unit beds from 32 to 60. In the setting of a long-standing continuing emergency like the present Covid-19 outbreak, the integration, interaction and team work of the "out-of-hospital" and "in-hospital" systems have a pivotal role. The present study reports how the rapid and coordinated reorganization of both might help in facing such a disaster. AREU-112 and the Emergency Department should be ready to finely tune their usual cooperation to respond to a sudden and overwhelming increase in the healthcare needs brought about by a pandemia like the current one. This lesson should shape and reinforce the future.
Collapse
Affiliation(s)
- Stefano Perlini
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, Pavia, Italy.
| | - Fabrizio Canevari
- SOREU Pianura, AREU (Azienda Regionale Emergenza Urgenza), Pavia, Italy
| | - Sergio Cortesi
- SOREU Pianura, AREU (Azienda Regionale Emergenza Urgenza), Pavia, Italy
| | - Vito Sgromo
- SOREU Pianura, AREU (Azienda Regionale Emergenza Urgenza), Pavia, Italy
| | | | - Enrico Contri
- SOREU Pianura, AREU (Azienda Regionale Emergenza Urgenza), Pavia, Italy
| | - Pietro Pettenazza
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Francesco Salinaro
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Francesco Speciale
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Giuseppe Sechi
- AREU (Azienda Regionale Emergenza Urgenza), Milan, Italy
| | - Claudio Mare
- AREU (Azienda Regionale Emergenza Urgenza), Milan, Italy
| | - Sara Cutti
- Medical Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Viola Novelli
- Medical Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Carlo Marena
- Medical Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Alba Muzzi
- Medical Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Raffaele Bruno
- Infectious Disease Unit, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Alessandra Palo
- AAT 118 Pavia, AREU (Azienda Regionale Emergenza Urgenza), Department of Intensive Medicine, Policlinico San Matteo Foundation, Pavia, Italy
| |
Collapse
|
10
|
Secco G, Delorenzo M, Zattera C, Giacomuzzi Moore B, Demitry L, Vezzoni G, Resta F, Barcella B, Cappa G, Perrone T, Salinaro F, Perlini S. Lung ultrasound in COVID-19: a useful diagnostic tool. Emerg Care J 2020. [DOI: 10.4081/ecj.2020.9017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Coronavirus disease 2019 (Covid-19), caused by a novel enveloped RNA betacoronavirus, has recently been declared a public health emergency by the World Health Organization (WHO). The lack of knowledge at the beginning of the pandemics, associated with the inherent risk of infective spreading, makes initial recognition and management particularly complex, in terms of defining effective diagnostic and therapeutic protocols. In the Emergency setting, Lung Ultrasound (LUS) can play an important role in the management of patients with SARS-CoV2-related pneumonia, expanding from the initial diagnosis to the subsequent monitoring and follow-up. Among many other potential advantages (such has the absence of ionizing radiation, its inherent costeffectiveness, and bedside repeatability), LUS provides immediate diagnostic response and might prevent the risk of spreading the infection by moving the patient from the Emergency Room to the Radiology facilities. Aim of this short review is to define the potential role of lung ultrasound in Covid-19 patients, according to the evidence in the medical literature
Collapse
|
11
|
Cassaniti I, Novazzi F, Giardina F, Salinaro F, Sachs M, Perlini S, Bruno R, Mojoli F, Baldanti F. Performance of VivaDiag COVID-19 IgM/IgG Rapid Test is inadequate for diagnosis of COVID-19 in acute patients referring to emergency room department. J Med Virol 2020; 92:1724-1727. [PMID: 32227490 PMCID: PMC7228409 DOI: 10.1002/jmv.25800] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Irene Cassaniti
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Novazzi
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Giardina
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Salinaro
- Emergency Medicine, Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Michele Sachs
- Department of Infectious Diseases, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Stefano Perlini
- Emergency Medicine, Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Raffaele Bruno
- Department of Infectious Diseases, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesco Mojoli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Department of Anaesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | |
Collapse
|
12
|
Secco G, Falchi AG, Salinaro F, Blatti C, Giacomuzzi Moore B, Perlini S. Pulmonary hypertension: when the acute event leads to diagnosis. Case report in a patient with Ehlers-Danlos syndrome. Emerg Care J 2020. [DOI: 10.4081/ecj.2020.8310] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a pulmonary vascular pathology caused by the chronic obstruction of the major pulmonary arteries, usually being the consequence of recurrent episodes of pulmonary embolism. Such events are usually unknown; the delay in such a diagnosis can therefore lead to a deterioration of the clinical picture, worsening the overall prognosis. This is a case of a 55-year-old man who came to the Emergency Room (ER) because of an acute exacerbation of chronic dyspnea, that he experienced for several years, in the absence of an explanatory diagnosis. Acute pulmonary embolism was diagnosed in the setting of the ER, with bedside echography resulting to be crucial to the work up. A multidisciplinary approach allowed proper treatment, management and a favourable outcome.
Collapse
|
13
|
Salinaro F, Meier-Ewert HK, Miller EJ, Pandey S, Sanchorawala V, Berk JL, Seldin DC, Ruberg FL. Longitudinal systolic strain, cardiac function improvement, and survival following treatment of light-chain (AL) cardiac amyloidosis. Eur Heart J Cardiovasc Imaging 2018; 18:1057-1064. [PMID: 27965280 DOI: 10.1093/ehjci/jew298] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/07/2016] [Indexed: 11/14/2022] Open
Abstract
Aims To determine whether echocardiographic longitudinal systolic strain (LS) parameters identify short-term improvement following chemotherapy for light-chain (AL) cardiac amyloidosis (CA). Among patients with CA, standard echocardiographic measures are commonly unchanged at 1 year following successful chemotherapy, despite observed reductions in cardiac biomarkers. Methods and results We retrospectively identified 61 patients with AL-CA treated with high-dose melphalan or bortezomib-based regimens. Patients were classified by hematologic response at 1 year into two groups: complete response (CR; n = 18, or 30%) or non-CR (non-CR; n = 43, or 70%), and followed for 20 months. Serum free light chains (FLC), B-type natriuretic peptide (BNP), troponin I (TnI), and echocardiography including LS, were acquired at baseline and 1 year. Seven patients died (11.5%), all in the non-CR group (P < 0.01). At 1 year, while reductions were observed in BNP (44% CR, 18% non-CR) and FLC (94% CR, 73% non-CR), both P < 0.05 from baseline, there were no differences in wall thickness, EF, or diastolic function in either group. LS improved only in the CR group with notable improvement in apical to basal strain ratio (P < 0.05). Strain improvement and BNP reduction were correlated (R = 0.6, P < 0.01). Baseline global LS < -10.2% was associated with survival and proved superior to BNP and TnI. The addition of global LS to biomarkers identified the patients at highest risk of mortality. Conclusion These data suggest that LS is a sensitive measure of pre-treatment cardiac functional impairment in AL-CA, can predict survival over and above that of cardiac biomarkers, and detect early cardiac functional improvement following chemotherapy.
Collapse
Affiliation(s)
- Francesco Salinaro
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.,Department of Internal Medicine, Experimental Medicine PhD program, University of Pavia School of Medicine, Pavia, Italy
| | - Hans K Meier-Ewert
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.,Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine Boston, Boston Medical Center, 88 E Newton St., Boston, MA 02118, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Shivda Pandey
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Vaishali Sanchorawala
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.,Section of Hematology/Oncology, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - John L Berk
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - David C Seldin
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.,Section of Hematology/Oncology, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Frederick L Ruberg
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.,Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine Boston, Boston Medical Center, 88 E Newton St., Boston, MA 02118, USA
| |
Collapse
|
14
|
Perrone T, Maggi A, Sgarlata C, Palumbo I, Mossolani E, Ferrari S, Melloul A, Mussinelli R, Boldrini M, Raimondi A, Cabassi A, Salinaro F, Perlini S. Lung ultrasound in internal medicine: A bedside help to increase accuracy in the diagnosis of dyspnea. Eur J Intern Med 2017; 46:61-65. [PMID: 28793969 DOI: 10.1016/j.ejim.2017.07.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 07/26/2017] [Accepted: 07/31/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Dyspnea is one of the most frequent causes of admission in Internal Medicine wards, leading to a sizeable utilization of medical resources. STUDY DESIGN AND METHODS The role of bedside lung ultrasound (LUS) was evaluated in 130 consecutive patients (age: 81±9years), in whom blindly collected LUS results were compared with data obtained by clinical examination, medical history, blood analysis, and chest X-ray. Dyspnea etiology was classified as "cardiac" (n=80), "respiratory" (n=36) or "mixed" (n=14), according to the discharge diagnosis (congestive heart failure either alone [n=80] or associated with pneumonia [n=14], pneumonia [n=24], and obstructive disventilatory syndrome [n=12]). An 8-window LUS protocol was applied to evaluate B-line distribution, "interstitial syndrome" pattern, pleural effusion and images of static or dynamic air bronchogram/focal parenchymal consolidation. RESULTS The presence of a generalized "interstitial syndrome" at the initial LUS evaluation allowed to discriminate "cardiac" from "pulmonary" Dyspnea with high sensitivity (93.75%; confidence intervals: 86.01%-97.94%) and specificity (86.11%; 70.50%-95.33%). Positive and negative predictive values were 93.76% (86.03%-97.94%) and 86.09% (70.47%-95.32%), respectively. Moreover, LUS diagnostic accuracy for the diagnosis of pneumonia was not inferior to that of chest X-ray. CONCLUSIONS Bedside LUS evaluation contributes with high sensitivity and specificity to the differential diagnosis of Dyspnea. This holds true not only in the emergency setting, but also in the sub-acute Internal Medicine arena. A wider use of this portable technique in our wards is warranted.
Collapse
Affiliation(s)
- Tiziano Perrone
- Clinica Medica I, Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy
| | - Alessia Maggi
- Clinica Medica II, Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy
| | - Carmelo Sgarlata
- Clinica Medica II, Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy
| | - Ilaria Palumbo
- Clinica Medica II, Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy
| | - Elisa Mossolani
- Clinica Medica II, Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy
| | - Sara Ferrari
- Clinica Medica II, Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy
| | - Ariel Melloul
- Clinica Medica II, Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy
| | - Roberta Mussinelli
- Clinica Medica II, Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy
| | - Michele Boldrini
- Clinica Medica II, Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy
| | - Ambra Raimondi
- Clinica Medica II, Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy
| | - Aderville Cabassi
- Cardiorenal Research Unit, Department of Clinical and Experimental Medicine, University of Parma, Italy
| | - Francesco Salinaro
- Emergency Department, Fondazione Policlinico IRCCS San Matteo, University of Pavia, Italy; Experimental Medicine PhD Program, University of Pavia, Pavia, Italy
| | - Stefano Perlini
- Clinica Medica II, Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy.
| |
Collapse
|
15
|
Castelvecchio S, Palladini G, Baryshnikova E, Salinaro F, Mussinelli R, Menicanti L, Perlini S. P3634Left ventricular (LV) geometry in severe post-ischemic LV dysfunction: the effect of remote area extracellular matrix remodeling. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3634] [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
|
16
|
Abstract
Systemic amyloidoses are rare and proteiform diseases, caused by extracellular accumulation of insoluble misfolded fibrillar proteins. Prognosis is dictated by cardiac involvement, which is especially frequent in light chain (AL) and in transthyretin variants (ATTR, both mutated, (ATTRm), and wild-type, (ATTRwt)). Recently, ATTRwt has emerged as a potentially relevant cause of a heart failure with preserved ejection fraction (HFpEF). Cardiac amyloidosis is an archetypal example of restrictive cardiomyopathy, with signs and symptoms of global heart failure and diastolic dysfunction. Independent of the aetiology, cardiac amyloidosis is associated with left ventricular concentric "hypertrophy" (i.e. increased wall thickness), preserved (or mildly depressed) ejection fraction, reduced midwall fractional shortening and global longitudinal function, as well as evident diastolic dysfunction, up to an overly restrictive pattern of the left ventricular filling. Cardiac biomarkers such as troponins and natriuretic peptides are very robust and widely accepted diagnostic as well as prognostic tools. Owing to its dismal prognosis, accurate and early diagnosis is mandatory and potentially life-saving. Although pathogenesis is still not completely understood, direct cardiomyocyte toxicity of the amyloidogenic precursor proteins and/or oligomer aggregates adds on tissue architecture disruption caused by amyloid deposition. The clarification of mechanisms of cardiac damage is offering new potential therapeutic targets, and several treatment options with a relevant impact on prognosis are now available.
Collapse
Affiliation(s)
- Stefano Perlini
- Clinica Medica II, Department of Internal Medicine, University of Pavia, P. le Golgi 19, 27100, Pavia, Italy.
- Amyloidosis Research and Treatment Center, Fondazione Policlinico IRCCS San Matteo, University of Pavia, P. le Golgi 19, 27100, Pavia, Italy.
| | - Roberta Mussinelli
- Clinica Medica II, Department of Internal Medicine, University of Pavia, P. le Golgi 19, 27100, Pavia, Italy
| | - Francesco Salinaro
- Clinica Medica II, Department of Internal Medicine, University of Pavia, P. le Golgi 19, 27100, Pavia, Italy
- Experimental Medicine PhD Program, University of Pavia, Pavia, Italy
| |
Collapse
|
17
|
Connors LH, Sam F, Skinner M, Salinaro F, Sun F, Ruberg FL, Berk JL, Seldin DC. Heart Failure Resulting From Age-Related Cardiac Amyloid Disease Associated With Wild-Type Transthyretin: A Prospective, Observational Cohort Study. Circulation 2015; 133:282-90. [PMID: 26660282 DOI: 10.1161/circulationaha.115.018852] [Citation(s) in RCA: 192] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 11/09/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Heart failure caused by wild-type transthyretin amyloidosis (ATTRwt) is an underappreciated cause of morbidity and mortality in the aging population. The aims of this study were to examine features of disease and to characterize outcomes in a large ATTRwt cohort. METHODS AND RESULTS Over 20 years, 121 patients with ATTRwt were enrolled in a prospective, observational study. Median age at enrollment was 75.6 years (range, 62.6-87.8 years); 97% of patients were white. The median survival, measured from biopsy diagnosis, was 46.69 months (95% confidence interval, 41.95-56.77); 78% of deaths were attributable to cardiac causes. By Kaplan-Meier analysis, 5-year survival was 35.7% (95% confidence interval, 25-46). Impaired functional capacity (mean Vo2max, 13.5 mL·kg(-1)·min(-1)) and atrial fibrillation (67%) were common clinical features. Multivariate predictors of reduced survival were elevated serum brain natriuretic peptide (482 ± 337 pg/mL) and uric acid (8.2 ± 2.6 mg/dL), decreased left ventricular ejection fraction (50% median; range, 10%-70%), and increased relative wall thickness (0.75 ± 0.19). CONCLUSIONS In this series of patients with biopsy-proven ATTRwt, poor functional capacity and atrial arrhythmias were common clinical features. Elevated brain natriuretic peptide and uric acid, decreased left ventricular ejection fraction, and increased relative wall thickness were associated with limited survival of only 35.7% at 5 years for the group as a whole. These data establish the natural history of ATTRwt, provide statistical basis for the design of future interventional clinical trials, and highlight the need for more sensitive diagnostic tests and disease-specific treatments for this disease.
Collapse
Affiliation(s)
- Lawreen H Connors
- From Amyloidosis Center (L.H.C., F. Sam, M.S., F. Salinaro, F.L.R., J.L.B., D.C.S.), Department of Pathology and Laboratory Medicine (L.H.C), and Department of Medicine (F. Sam, M.S., F.L.R., J.L.B., D.C.S.), Boston University School of Medicine, MA; Department of Medicine, University of Pavia, Italy (F. Salinaro); and Department of Biostatistics, Boston University School of Public Health, MA (F. Sun).
| | - Flora Sam
- From Amyloidosis Center (L.H.C., F. Sam, M.S., F. Salinaro, F.L.R., J.L.B., D.C.S.), Department of Pathology and Laboratory Medicine (L.H.C), and Department of Medicine (F. Sam, M.S., F.L.R., J.L.B., D.C.S.), Boston University School of Medicine, MA; Department of Medicine, University of Pavia, Italy (F. Salinaro); and Department of Biostatistics, Boston University School of Public Health, MA (F. Sun)
| | - Martha Skinner
- From Amyloidosis Center (L.H.C., F. Sam, M.S., F. Salinaro, F.L.R., J.L.B., D.C.S.), Department of Pathology and Laboratory Medicine (L.H.C), and Department of Medicine (F. Sam, M.S., F.L.R., J.L.B., D.C.S.), Boston University School of Medicine, MA; Department of Medicine, University of Pavia, Italy (F. Salinaro); and Department of Biostatistics, Boston University School of Public Health, MA (F. Sun)
| | - Francesco Salinaro
- From Amyloidosis Center (L.H.C., F. Sam, M.S., F. Salinaro, F.L.R., J.L.B., D.C.S.), Department of Pathology and Laboratory Medicine (L.H.C), and Department of Medicine (F. Sam, M.S., F.L.R., J.L.B., D.C.S.), Boston University School of Medicine, MA; Department of Medicine, University of Pavia, Italy (F. Salinaro); and Department of Biostatistics, Boston University School of Public Health, MA (F. Sun)
| | - Fangui Sun
- From Amyloidosis Center (L.H.C., F. Sam, M.S., F. Salinaro, F.L.R., J.L.B., D.C.S.), Department of Pathology and Laboratory Medicine (L.H.C), and Department of Medicine (F. Sam, M.S., F.L.R., J.L.B., D.C.S.), Boston University School of Medicine, MA; Department of Medicine, University of Pavia, Italy (F. Salinaro); and Department of Biostatistics, Boston University School of Public Health, MA (F. Sun)
| | - Frederick L Ruberg
- From Amyloidosis Center (L.H.C., F. Sam, M.S., F. Salinaro, F.L.R., J.L.B., D.C.S.), Department of Pathology and Laboratory Medicine (L.H.C), and Department of Medicine (F. Sam, M.S., F.L.R., J.L.B., D.C.S.), Boston University School of Medicine, MA; Department of Medicine, University of Pavia, Italy (F. Salinaro); and Department of Biostatistics, Boston University School of Public Health, MA (F. Sun)
| | - John L Berk
- From Amyloidosis Center (L.H.C., F. Sam, M.S., F. Salinaro, F.L.R., J.L.B., D.C.S.), Department of Pathology and Laboratory Medicine (L.H.C), and Department of Medicine (F. Sam, M.S., F.L.R., J.L.B., D.C.S.), Boston University School of Medicine, MA; Department of Medicine, University of Pavia, Italy (F. Salinaro); and Department of Biostatistics, Boston University School of Public Health, MA (F. Sun)
| | - David C Seldin
- From Amyloidosis Center (L.H.C., F. Sam, M.S., F. Salinaro, F.L.R., J.L.B., D.C.S.), Department of Pathology and Laboratory Medicine (L.H.C), and Department of Medicine (F. Sam, M.S., F.L.R., J.L.B., D.C.S.), Boston University School of Medicine, MA; Department of Medicine, University of Pavia, Italy (F. Salinaro); and Department of Biostatistics, Boston University School of Public Health, MA (F. Sun)
| |
Collapse
|
18
|
Cappelli F, Baldasseroni S, Bergesio F, Perlini S, Salinaro F, Padeletti L, Attanà P, Paoletti Perini A, Moggi Pignone A, Grifoni E, Fabbri A, Marchionni N, Gensini GF, Perfetto F. Echocardiographic and biohumoral characteristics in patients with AL and TTR amyloidosis at diagnosis. Clin Cardiol 2015; 38:69-75. [PMID: 25645201 DOI: 10.1002/clc.22353] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 10/01/2014] [Accepted: 10/03/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Few studies have analyzed the clinical and echocardiographic differences between light-chain (AL) and transthyretin (TTR) amyloidosis. HYPOTHESIS The aim of the present research was to compare, in a real-world setting, the clinical and echocardiographic profiles of these kinds of amyloidosis, at the time of diagnosis, using new-generation echocardiography. METHODS Seventy-nine patients with AL and 48 patients with TTR amyloidosis were studied. RESULTS According to the criterion of mean left ventricular (LV) thickness >12 mm, 45 AL (C-AL) and all TTR patients had cardiac amyloidotic involvement, whereas 34 AL patients did not. TTR patients had increased right ventricular (RV) and LV chambers with increased RV and LV wall thickness and reduced LV ejection fraction and fractional shortening. Furthermore, TTR patients showed lower N-terminal pro Brain Natriuretic Peptide concentrations and New York Heart Association functional class when compared with C-AL. CONCLUSIONS Our data show that at time of first diagnosis, TTR patients have a more advanced amyloidotic involvement of the heart, despite less severe symptoms and biohumoral signs of heart failure. We can hypothesize that we observed different diseases at different stages. In fact, AL amyloidosis is a multiorgan disease with quick progression rate, that becomes rapidly symptomatic, whereas TTR amyloidosis might have a slow progression rate and might remain poorly symptomatic for a greater amount of time.
Collapse
Affiliation(s)
- Francesco Cappelli
- Intensive Cardiac Care Unit, Heart and Vessel Department, University Hospital Careggi, Florence, Italy; Tuscan Regional Amyloid Center, University Hospital Careggi, Florence, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Perlini S, Salinaro F, Santalucia P, Musca F. Simulation-guided cardiac auscultation improves medical students' clinical skills: the Pavia pilot experience. Intern Emerg Med 2014; 9:165-72. [PMID: 22767224 DOI: 10.1007/s11739-012-0811-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 06/21/2012] [Indexed: 11/27/2022]
Abstract
Clinical evaluation is the cornerstone of any cardiac diagnosis, although excessive over-specialisation often leads students to disregard the value of clinical skills, and to overemphasize the approach to instrumental cardiac diagnosis. Time restraints, low availability of "typical" cardiac patients on whom to perform effective bedside teaching, patients' respect and the underscoring of the value of clinical skills all lead to a progressive decay in teaching. Simulation-guided cardiac auscultation may improve clinical training in medical students and residents. Harvey(©) is a mannequin encompassing more than 50 cardiac diagnoses that was designed and developed at the University of Miami (Florida, USA). One of the advantages of Harvey(©) simulation resides in the possibility of listening, comparing and discussing "real" murmurs. To objectively assess its teaching performance, the capability to identify five different cardiac diagnoses (atrial septal defect, normal young subject, mitral stenosis with tricuspid regurgitation, chronic mitral regurgitation, and pericarditis) out of more than 50 diagnostic possibilities was assessed in 523 III-year medical students (i.e. at the very beginning of their clinical experience), in 92 VI-year students, and in 42 residents before and after a formal 10-h teaching session with Harvey(©). None of them had previously experienced simulation-based cardiac auscultation in addition to formal lecturing (all three groups) and bedside teaching (VI-year students and residents). In order to assess the "persistence" of the acquired knowledge over time, the test was repeated after 3 years in 85 students, who did not repeat the formal 10-h teaching session with Harvey(©) after the III year. As expected, the overall response was poor in the "beginners" who correctly identified 11.0 % of the administered cardiac murmurs. After simulation-guided training, the ability to recognise the correct cardiac diagnoses was much better (72.0 %; p < 0.001 vs. baseline). Rather unexpectedly, before the tutorial, the performance of VI-year students and of residents was not significantly different from their III-year colleagues, since the two groups correctly identified 14.2 and 16.2 % of the diagnoses, respectively. After the tutorial, the VI-year students and the residents also improved their overall performance (to 73.1 and 76.1 %, respectively; p < 0.001 for both when compared to before the tutorial). The persistence of this capability after 3 years was remarkable, since the 85 students who repeated the test without any further exposure to the 10-h teaching session with Harvey(©) correctly identified 68.4 % of the possible cardiac diagnoses (p < 0.001 vs. baseline). These data underscore the importance of clinical training in order to improve auscultation skills in our academic setting, prompting to redesign teaching curricula. Simulation-based cardiac auscultation should be considered as the "missing link" between formal lecturing and bedside teaching of heart sounds and murmurs.
Collapse
Affiliation(s)
- Stefano Perlini
- Clinica Medica II, Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, P. le Golgi 19, 27100, Pavia, Italy,
| | | | | | | |
Collapse
|
20
|
Perlini S, Salinaro F, Cappelli F, Perfetto F, Bergesio F, Alogna A, Mussinelli R, Boldrini M, Raimondi A, Musca F, Palladini G, Merlini G. Prognostic value of fragmented QRS in cardiac AL amyloidosis. Int J Cardiol 2013; 167:2156-61. [DOI: 10.1016/j.ijcard.2012.05.097] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 05/16/2012] [Accepted: 05/27/2012] [Indexed: 11/16/2022]
|
21
|
Cappelli F, Perlini S, Attanà P, Ciuti G, Salinaro F, Perfetto F. As we cannot afford to renounce to new generation echocardiography in systemic amyloidosis. Amyloid 2013; 20:195-6. [PMID: 23786581 DOI: 10.3109/13506129.2013.808993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
22
|
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
|
23
|
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
|
24
|
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
|
25
|
Savioli G, Salinaro F, Surbone S, Giovi I, Oggionni T, Meloni F, Perlini S. Incidence and treatment of new-onset hypertension after lung transplantation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
26
|
Matteelli A, Sulis G, Capelli M, Apostoli A, Toninelli G, D’Aversa FB, Gargiulo F, Salinaro F, Castelli F, Donato F. P3.020 Prevalence of Genital Chlamydia Trachomatis and Neisseria Gonorrhoeae Infections Among Adolescents in Northern Italy. Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
27
|
Savioli G, Surbone S, Giovi I, Salinaro F, Preti P, Meloni F, Oggionni T, Perlini S. Early development of metabolic syndrome in patients subjected to lung transplantation. Clin Transplant 2013; 27:E237-43. [DOI: 10.1111/ctr.12098] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 12/19/2022]
Affiliation(s)
- Gabriele Savioli
- Clinica Medica II; Department of Internal Medicine; Fondazione Policlinico IRCCS San Matteo; University of Pavia; Pavia; Italy
| | - Sara Surbone
- Division of Pneumology; Fondazione Policlinico IRCCS San Matteo; University of Pavia; Pavia; Italy
| | - Ilaria Giovi
- Clinica Medica II; Department of Internal Medicine; Fondazione Policlinico IRCCS San Matteo; University of Pavia; Pavia; Italy
| | - Francesco Salinaro
- Clinica Medica II; Department of Internal Medicine; Fondazione Policlinico IRCCS San Matteo; University of Pavia; Pavia; Italy
| | - Paola Preti
- Clinica Medica II; Department of Internal Medicine; Fondazione Policlinico IRCCS San Matteo; University of Pavia; Pavia; Italy
| | - Federica Meloni
- Division of Pneumology; Fondazione Policlinico IRCCS San Matteo; University of Pavia; Pavia; Italy
| | - Tiberio Oggionni
- Division of Pneumology; Fondazione Policlinico IRCCS San Matteo; University of Pavia; Pavia; Italy
| | - Stefano Perlini
- Clinica Medica II; Department of Internal Medicine; Fondazione Policlinico IRCCS San Matteo; University of Pavia; Pavia; Italy
| |
Collapse
|
28
|
Boldrini M, Salinaro F, Mussinelli R, Raimondi A, Alogna A, Musca F, Palladini G, Merlini G, Perlini S. Prevalence and prognostic value of conduction disturbances at the time of diagnosis of cardiac AL amyloidosis. Ann Noninvasive Electrocardiol 2013; 18:327-35. [PMID: 23879272 DOI: 10.1111/anec.12032] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the prevalence and the prognostic implications of conduction delays in a large cohort of cardiac AL patients. METHODS Echo Doppler and 12-lead ECG were collected in 344 consecutive patients in whom diagnosis of AL amyloidosis was concluded between 2008 and 2010. Patients were subdivided according to the presence (n = 240) or absence (n = 104) of cardiac involvement. RESULTS When compared with patients without myocardial involvement, cardiac AL was associated with prolonged PQ, QRS, QT and QTc intervals (P < 0.05), and with higher prevalence of intraventricular blocks (27.5% vs. 16.5%, P < 0.05), that was associated with higher wall thickness, worse diastolic and regional systolic function, higher NT-proBNP values (all P < 0.05), and higher mortality (P = 0.0001; median follow-up: 402 days). CONCLUSION Intraventricular conduction delays have a negative prognostic impact in patients with cardiac AL amyloidosis. Their presence should not be overlooked in the diagnostic workup, prompting a more accurate cardiological support.
Collapse
Affiliation(s)
- Michele Boldrini
- Clinica Medica II Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Mussinelli R, Salinaro F, Alogna A, Boldrini M, Raimondi A, Musca F, Palladini G, Merlini G, Perlini S. Diagnostic and prognostic value of low QRS voltages in cardiac AL amyloidosis. Ann Noninvasive Electrocardiol 2013; 18:271-80. [PMID: 23714086 DOI: 10.1111/anec.12036] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [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: 12/01/2022] Open
Abstract
BACKGROUND In cardiac AL amyloidosis, myocardial infiltration is typically associated with "low QRS voltages" at the 12-lead electrocardiogram (ECG). Although considered as one of the hallmarks of the disease, its reported prevalence varies from 45% to 70%, mainly because of nonhomogeneous definitions. METHODS To identify the "low QRS voltage" parameter having the best diagnostic value in identifying cardiac amyloidosis, and to assess its possible prognostic role, ECG and echocardiographic data were collected at diagnosis in 337 consecutive never-treated AL patients (233 with, 104 without cardiac involvement). Prognosis was assessed after a median follow-up of 14.5 months. RESULTS "Low QRS voltage" prevalence varied from 84.12% when using Sokolow-Lyon index ≤15 mm to 27.04% with the definition of low total voltages (QRS amplitude ≤5 mm in each peripheral and ≤10 mm in each precordial lead), the widely used definition of low peripheral voltages (≤5 mm in each peripheral lead) being able to identify 66.52% cardiac AL patients. The presence of "low peripheral voltages" was associated with a more severe cardiac involvement, and was able to differentiate Mayo stage II patients' survival (i.e., AL patients with intermediate prognosis). According to receiver operator characteristic (ROC) curve analysis, sensitivity and specificity were 58.72% and 80.00%, for a peripheral QRS amplitude ≤24.5 mm (the sum of QRS in all the 6 peripheral leads), and 76.26% and 65.00% for a Sokolow-Lyon index ≤11 mm. CONCLUSIONS In cardiac AL amyloidosis the prevalence of low QRS voltages is highly dependent on the method used for defining this ECG alteration.
Collapse
Affiliation(s)
- Roberta Mussinelli
- Clinica Medica II, Department of Internal Medicine, University of Pavia, P. le Golgi 19, 27100 Pavia, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Mussinelli R, Salinaro F, Alogna A, Boldrini M, Raimondi A, Musca F, Palladini G, Merlini G, Perlini S. Diagnostic and prognostic value of low QRS voltages in cardiac AL amyloidosis. Ann Noninvasive Electrocardiol 2013. [PMID: 23714086 DOI: 10.1111/anec.12036;10.1111/anec.12036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In cardiac AL amyloidosis, myocardial infiltration is typically associated with "low QRS voltages" at the 12-lead electrocardiogram (ECG). Although considered as one of the hallmarks of the disease, its reported prevalence varies from 45% to 70%, mainly because of nonhomogeneous definitions. METHODS To identify the "low QRS voltage" parameter having the best diagnostic value in identifying cardiac amyloidosis, and to assess its possible prognostic role, ECG and echocardiographic data were collected at diagnosis in 337 consecutive never-treated AL patients (233 with, 104 without cardiac involvement). Prognosis was assessed after a median follow-up of 14.5 months. RESULTS "Low QRS voltage" prevalence varied from 84.12% when using Sokolow-Lyon index ≤15 mm to 27.04% with the definition of low total voltages (QRS amplitude ≤5 mm in each peripheral and ≤10 mm in each precordial lead), the widely used definition of low peripheral voltages (≤5 mm in each peripheral lead) being able to identify 66.52% cardiac AL patients. The presence of "low peripheral voltages" was associated with a more severe cardiac involvement, and was able to differentiate Mayo stage II patients' survival (i.e., AL patients with intermediate prognosis). According to receiver operator characteristic (ROC) curve analysis, sensitivity and specificity were 58.72% and 80.00%, for a peripheral QRS amplitude ≤24.5 mm (the sum of QRS in all the 6 peripheral leads), and 76.26% and 65.00% for a Sokolow-Lyon index ≤11 mm. CONCLUSIONS In cardiac AL amyloidosis the prevalence of low QRS voltages is highly dependent on the method used for defining this ECG alteration.
Collapse
Affiliation(s)
- Roberta Mussinelli
- Clinica Medica II, Department of Internal Medicine, University of Pavia, P. le Golgi 19, 27100 Pavia, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Quarta CC, Perlini S, Longhi S, Berardini A, Musca F, Salinaro F, Obici L, Milandri A, Gallo P, Gagliardi C, Biagini E, Mingardi F, Pazzi C, Merlini G, Rapezzi C. A SIMPLE VOLTAGE/MASS INDEX IMPROVES DIAGNOSIS OF CARDIAC AMYLOIDOSIS: AN ELECTROCARDIOGRAPHIC AND ECHOCARDIOGRAPHIC STUDY OF 570 PATIENTS WITH LEFT VENTRICULAR HYPERTROPHY. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61587-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
32
|
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
|
33
|
Perlini S, Musca F, Salinaro F, Fracchioni I, Palladini G, Obici L, Albertini R, Moratti R, Lavatelli F, Palladini G, Rapezzi C, Merlini G. Functional correlates of N-terminal natriuretic peptide type B (NT-proBNP) response to therapy in cardiac light chain (AL) amyloidosis. Amyloid 2011; 18 Suppl 1:96-7. [PMID: 21838447 DOI: 10.3109/13506129.2011.574354035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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]
Affiliation(s)
- S Perlini
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Perlini S, Salinaro F, Musca F, Fracchioni I, Milan A, Quarta CC, Longhi S, Palladini G, Obici L, Rapezzi C, Veglio F, Merlini G. THE CONTRIBUTION OF THE EKG / ECHOCARDIOGRAPHIC MASS RATIO TO THE DIAGNOSIS OF CARDIAC AL AMYLOIDOSIS IN UNEXPLAINED LV HYPERTROPHY: 4C.05. J Hypertens 2010. [DOI: 10.1097/01.hjh.0000378857.91998.b9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
35
|
Rapezzi C, Merlini G, Quarta CC, Riva L, Longhi S, Leone O, Salvi F, Ciliberti P, Pastorelli F, Biagini E, Coccolo F, Cooke RMT, Bacchi-Reggiani L, Sangiorgi D, Ferlini A, Cavo M, Zamagni E, Fonte ML, Palladini G, Salinaro F, Musca F, Obici L, Branzi A, Perlini S. Systemic cardiac amyloidoses: disease profiles and clinical courses of the 3 main types. Circulation 2009; 120:1203-12. [PMID: 19752327 DOI: 10.1161/circulationaha.108.843334] [Citation(s) in RCA: 533] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Most studies of amyloidotic cardiomyopathy consider as a single entity the 3 main systemic cardiac amyloidoses: acquired monoclonal immunoglobulin light-chain (AL); hereditary, mutated transthyretin-related (ATTRm); and wild-type transthyretin-related (ATTRwt). In this study, we compared the diagnostic/clinical profiles of these 3 types of systemic cardiac amyloidosis. METHODS AND RESULTS We conducted a longitudinal study of 233 patients with clear-cut diagnosis by type of cardiac amyloidosis (AL, n=157; ATTRm, n=61; ATTRwt, n=15) at 2 large Italian centers providing coordinated amyloidosis diagnosis/management facilities since 1990. Average age at diagnosis was higher in AL than in ATTRm patients; all ATTRwt patients except 1 were elderly men. At diagnosis, mean left ventricular wall thickness was higher in ATTRwt than in ATTRm and AL. Left ventricular ejection fraction was moderately depressed in ATTRwt but not in AL or ATTRm. ATTRm patients less often displayed low QRS voltage (25% versus 60% in AL; P<0.0001) or low voltage-to-mass ratio (1.1+/-0.5 versus 0.9+/-0.5; P<0.0001). AL patients appeared to have greater hemodynamic impairment. On multivariate analysis, ATTRm was a strongly favorable predictor of survival, and ATTRwt predicted freedom from major cardiac events. CONCLUSIONS AL, ATTRm, and ATTRwt should be considered 3 different cardiac diseases, probably characterized by different pathophysiological substrates and courses. Awareness of the diversity underlying the cardiac amyloidosis label is important on several levels, ranging from disease classification to diagnosis and clinical management.
Collapse
Affiliation(s)
- Claudio Rapezzi
- Istituto di Cardiologia, Policlinico S. Orsola-Malpighi, Via Massarenti n 9, 40125 Bologna, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Perlini S, Salinaro F, Fonte ML. Direct renin inhibition: another weapon to modulate the renin-angiotensin system in postinfarction remodeling? Hypertension 2008; 52:1019-21. [PMID: 18955659 DOI: 10.1161/hypertensionaha.108.121590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
37
|
De Francesco MA, Gargiulo F, Schreiber C, Ciravolo G, Salinaro F, Manca N. Comparison of the AMPLICOR Human Papillomavirus Test and the Hybrid Capture 2 Assay for detection of high-risk human papillomavirus in women with abnormal PAP smear. J Virol Methods 2008; 147:10-7. [PMID: 17854914 DOI: 10.1016/j.jviromet.2007.07.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Revised: 07/25/2007] [Accepted: 07/30/2007] [Indexed: 12/01/2022]
Abstract
Infection with human papillomavirus (HPV) is a necessary step in the progression to cervical cancer. Many methods for HPV testing are currently available, mostly developed to detect pools of HPV types. Hybrid Capture 2 (HC2) is one of the most widely used. A new PCR-based assay, the Roche AMPLICOR HPV test, has been recently developed. Both assays recognize a group of 13 HR HPV types contemporaneously. This study evaluated the performance of both methods for detecting high-grade cervical lesions as a part of management for abnormal PAP smears. The study population was composed of 213 women, all referred to colposcopy and histologic diagnosis following an abnormal PAP test. Biopsy-confirmed high-grade cervical intraepithelial neoplasia was used as a gold standard. Overall agreement was 84.9% with a kappa value of 0.6. When comparing the ability to detect moderate cervical intraepithelial neoplasia (CIN2+) and high-grade cervical intraepithelial neoplasia (CIN3+/cancer), AMPLICOR proved slightly more sensitive than HC2, a finding that is important when HPV testing is used in a triage of borderline smear results. Genotyping of discordant results showed a prevalence of LR-HPV types in HC2 positive/AMPLICOR negative samples, and a similar prevalence of HR- and LR-HPV types in AMPLICOR positive/HC2 negative samples. In conclusion, the study shows that the AMPLICOR assay is more sensitive than HC2, which makes it a valid alternative for routine clinical use.
Collapse
Affiliation(s)
- M A De Francesco
- Institute of Microbiology and Virology, Spedali Civili, University of Brescia, Brescia, Italy.
| | | | | | | | | | | |
Collapse
|
38
|
Gargiulo F, De Francesco MA, Schreiber C, Ciravolo G, Salinaro F, Valloncini B, Manca N. Prevalence and distribution of single and multiple HPV infections in cytologically abnormal cervical samples from Italian women. Virus Res 2007; 125:176-82. [PMID: 17257705 DOI: 10.1016/j.virusres.2006.12.017] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 12/16/2006] [Accepted: 12/22/2006] [Indexed: 10/23/2022]
Abstract
The prevalence of single and multiple HPV infections was assessed over a cohort of 213 women with cytological abnormalities and its association with cervical neoplasia established. Roche linear array HPV genotyping test was used to identify HPV genotypes. The most prevalent HPV genotypes in cervical cancer samples were HPV16 (61.2%), HPV52 (16.1%), HPV18 (12.9%) and HPV 31 (9.6%). Multiple HR and LR HPV infections, comprising between two and 5+ HPV types, were identified in 49.7% of samples, with a significantly lower number in severe dysplasia and cervical cancer samples (p<0.05). These results seem to indicate that detection of multiple HPV infection with HR-HPV types is not significantly better as a predictor of cervical cancer than single HR-HPV infection, though further longitudinal studies are needed to better clarify the relevance of these infections to the progression of cervical neoplasia.
Collapse
Affiliation(s)
- F Gargiulo
- Institute of Microbiology and Virology, P. le Spedali Civili 1, University of Brescia, 25123-Brescia, Italy.
| | | | | | | | | | | | | |
Collapse
|
39
|
De Francesco MA, Gargiulo F, Schreiber C, Ciravolo G, Salinaro F, Manca N. Detection and genotyping of human papillomavirus in cervical samples from Italian patients. J Med Virol 2005; 75:588-92. [PMID: 15714493 DOI: 10.1002/jmv.20306] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [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: 11/06/2022]
Abstract
Human papillomaviruses (HPVs) are etiological agents of cervical cancer. In order to assess the epidemiological incidence and frequency of different HPV types, we applied a polymerase chain reaction (PCR)-direct sequencing approach based on the use of MY09/MY11 primers as compared to Hybrid Capture assay. Cervical samples were taken from 1,500 women, both with normal and abnormal cytological smears, and we found an incidence of 6.6% of HPV infection in Brescia. Overall, 97 samples tested HPV-positive, yielding 18 HPV types. The four most frequent HPV types were: HPV 16, -31, -6, and -58. This approach could be used in ordinary laboratory settings for quick and reliable typing of known and novel HPVs from clinical specimens and it could also be applied to anti-cancer vaccine development.
Collapse
Affiliation(s)
- M A De Francesco
- Institute of Microbiology and Virology, Spedali Civili-University of Brescia, 1 Piazzale Spedali Civili, 25123 Brescia, Italy.
| | | | | | | | | | | |
Collapse
|
40
|
Decensi A, Bonanni B, Guerrieri-Gonzaga A, Gandini S, Robertson C, Johansson H, Travaglini R, Sandri MT, Tessadrelli A, Farante G, Salinaro F, Bettega D, Barreca A, Boyle P, Costa A, Veronesi U. Biologic activity of tamoxifen at low doses in healthy women. J Natl Cancer Inst 1998; 90:1461-7. [PMID: 9776411 DOI: 10.1093/jnci/90.19.1461] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.2] [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: 11/13/2022] Open
Abstract
BACKGROUND Results of a clinical trial recently completed in the United States indicate that administration of tamoxifen (20 mg/day) to women at risk can reduce breast cancer incidence by approximately 50% but is associated with an increased risk of developing endometrial cancer and venous thromboembolic events. Since these adverse effects may be dose related, we investigated the effect of tamoxifen on several biomarkers when the drug was given at doses lower than those currently in use. METHODS In two sequential experiments, 127 healthy hysterectomized women aged 35-70 years were randomly assigned to one of the following four treatment arms: placebo (n = 31) or tamoxifen at 20 mg/day (n = 30) (first experiment); or tamoxifen at 10 mg/day (n = 34) or tamoxifen at 10 mg/ alternate days (n = 32) (second experiment). Baseline and 2-month measurements of the following parameters were compared: 1) total cholesterol (primary end point) and other surrogate markers of cardiovascular disease, e.g., low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and lipoprotein(a); 2) blood cell count; 3) fibrinogen; 4) antithrombin III; 5) osteocalcin; and, 6) in a subgroup of 103 women, insulin-like growth factor-I (IGF-I), a possible surrogate marker for breast cancer. RESULTS After adjustment for the baseline values, there were reductions in circulating levels of total cholesterol and IGF-I of the same magnitude in all three tamoxifen treatment arms. A similar pattern was observed for most of the other parameters. In the placebo arm, fibrinogen level, which showed a decrease, was the only parameter exhibiting change. CONCLUSIONS Up to a 75% reduction in the conventional dose of tamoxifen (i.e., 20 mg/day) does not affect the activity of the drug on a large number of biomarkers, most of which are surrogate markers of cardiovascular disease. This study was hypothesis generating, and larger studies are warranted to assess the efficacy of tamoxifen at low doses.
Collapse
Affiliation(s)
- A Decensi
- Chemoprevention Unit, European Institute of Oncology, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Falsetti L, Salinaro F, Chiaramonte M. Adrenal androgen-secreting carcinoma in a fertile woman. Acta Eur Fertil 1995; 26:117-21. [PMID: 9098472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The article reports on a case of functioning adrenal carcinoma in a woman of 40 with concomitant in situ carcinoma of the portio (CIN 3). She had had amenorrhoea for 14 months and early menopause was suspected. Hirsutism and other signs of virilization such as clitoromegaly and voice changes were detected upon hospitalization.. The characteristic of the clinical case is given by hormone production involving not only androgens of prevalently adrenal genesis (dehydroepiandrosterone, dehydroepiandrosterone sulphate and androstenedione), but also testosterone, more suggestive of a gonadal neoplasm. The adrenal carcinoma only produced androgens, as plasma cortisol and aldosterone concentrations were normal. Diagnosis of adrenal carcinoma was first made with hormone assays and then with the adrenal block test using dexamethasone, with adrenal ecography and abdomino-pelvic computed tomography (CT). When amenorrhoea is present and hirsutism and other signs of virilization occur ex-novo in a short period, in a woman of fertile age, a thorough endocrine study must be carried out. According to the hormone profile, the next diagnostic step should be aimed at detecting a prospective ovarian or adrenal neoplasm.
Collapse
Affiliation(s)
- L Falsetti
- Department of Gynecological Endocrinology, University of Brescia
| | | | | |
Collapse
|