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Cappa M, Pozzobon G, Orso M, Maghnie M, Patti G, Spandonaro F, Granato S, Novelli G, La Torre D, Salerno M, Polistena B. The economic burden of pediatric growth hormone deficiency in Italy: a cost of illness study. J Endocrinol Invest 2024:10.1007/s40618-023-02277-z. [PMID: 38198073 DOI: 10.1007/s40618-023-02277-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE Growth hormone deficiency (GHD) is a rare condition with a worldwide prevalence of 1 patient in 4000 to 10,000 live births, placing a significant economic burden on healthcare systems. The aim of this study is to generate evidence on the economic burden of children and adolescents with GHD treated with rhGH and their parents in Italy. METHODS A cost of illness analysis, adopting the prevalence approach, has been developed, producing evidence on the total annual cost sustained by the Italian National Health System (NHS) and by the society. The study is based on original data collected from a survey conducted among Italian children and adolescents with GHD and their parents. RESULTS 143 children/adolescents with GHD and their parents participated to the survey, conducted from May to October 2021. Patients had a mean age of 12.2 years (SD: 3.1) and were mostly males (68.5%). The average direct healthcare cost sustained by the NHS was € 8,497.2 per patient/year; adding the out-of-pocket expenses (co-payments and expenses for private healthcare service), the total expense was € 8,568.6. The indirect costs, assessed with the human capital approach, were € 847.9 per patient/year. The total of direct and indirect cost is € 9,345.1 from the NHS perspective, and € 9,416.5 from a social perspective. The total cost incurred by the Italian NHS for children with GHD (range: 5,708-8,354) was estimated in € 48.5-71.0 million, corresponding to 0.04-0.06% of the total Italian public health expense in the year 2020. CONCLUSIONS The total annual cost for GHD children is close to € 10,000, and is mainly due to the cost of rhGH treatment. This cost is almost entirely sustained by the NHS, with negligible out-of-pocket expenses. The economic burden on the Italian NHS for the health care of established GHD children is fourfold higher than the prevalence of the disease in the overall Italian population.
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Affiliation(s)
- M Cappa
- Research Area for Innovative Therapies in Endocrinopathies, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - G Pozzobon
- IRCCS San Raffaele Hospital, Pediatric Unit-Università Vita-Salute, Milan, Italy
| | - M Orso
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy.
| | - M Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - G Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - F Spandonaro
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- University of Rome Tor Vergata, Rome, Italy
| | - S Granato
- Medical Department, Pfizer Italia, Rome, Italy
| | - G Novelli
- Health and Value, Pfizer Italia, Rome, Italy
| | - D La Torre
- Global Medical Affairs, Pfizer Rare Disease, Rome, Italy
| | - M Salerno
- Department of Translational Medical Sciences, Paediatric Endocrinology Unit, University of Naples 'Federico II', Naples, Italy
| | - B Polistena
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- University of Rome Tor Vergata, Rome, Italy
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Segala FV, Patti G, Olal L, De Vita E, Olung N, Papagni R, Amone J, Totaro V, Onapa E, Novara R, Ngole B, L'Episcopia M, Okori S, Dall'Oglio G, Ictho J, Severini C, Putoto G, Lochoro P, Di Gennaro F, Saracino A. COVID Perceptions among Pregnant Women Living in a Malaria Hyperendemic Rural Region in Uganda: A Cross-Sectional Study. Am J Trop Med Hyg 2023; 109:1363-1367. [PMID: 37931305 DOI: 10.4269/ajtmh.23-0464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/23/2023] [Indexed: 11/08/2023] Open
Abstract
Both SARS-CoV2 and Plasmodium falciparum infection during pregnancy increases the risk for adverse maternal and fetal outcomes, including abortion, severe disease, and death. Indeed, although malaria and COVID-19 show an overlapping clinical presentation, they require a profoundly different approach. The aim of this study was to explore COVID-19 awareness among pregnant women living in a P. falciparum hyperendemic region in rural Uganda. This cross-sectional, prospective study was conducted in one Hospital and two Health Centers (HC) in Lango region, Uganda, from July 14, 2022, to March 14, 2023. Data about demographics, COVID-19 history, and COVID-19 and malaria perceptions were collected using RedCap mobile app platform. Study endpoint was a context-specific COVID-19 awareness score, accounting for the most common disease misconceptions. Association between study variables and good COVID-19 awareness was assessed by χ2 and t test, as appropriate, and variables found to be statistically significant were further explored in multivariate logistic regression analysis. A total of 888 pregnant women were recruited. Median age was 24 (interquartile range: 20-29) years, whereas 79% (n = 704) attained only primary education and 66.6% (n = 591) were used in agriculture. SARS-CoV2 vaccination rate was 92%. In multivariate analysis (Table 3), variables associated with high COVID knowledge were presenting at antenatal care visit in Atipe HC (adjusted odds ratio [aOR]: 8.1, 95% CI: 4.1-16.48) having a previous good knowledge about malaria (aOR: 1.76, 95% CI: 1.21-2.56). Among pregnant women living in rural Uganda, COVID-19 awareness relies on the overall educational level, malaria knowledge and reference HC. Among pregnant women living in P. falciparum endemic areas, community-level malaria awareness might guide educational interventions during future pandemics.
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Affiliation(s)
- Francesco Vladimiro Segala
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro," Bari, Italy
| | - Giulia Patti
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro," Bari, Italy
| | | | - Elda De Vita
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro," Bari, Italy
| | | | - Roberta Papagni
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro," Bari, Italy
| | - James Amone
- St. John's XXIII Hospital Aber, Jaber, Uganda
| | - Valentina Totaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro," Bari, Italy
| | | | - Roberta Novara
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro," Bari, Italy
| | | | | | | | | | | | - Carlo Severini
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | | | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro," Bari, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro," Bari, Italy
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Maghnie M, Orso M, Polistena B, Cappa M, Pozzobon G, d'Angela D, Patti G, Spandonaro F, Granato S, Di Virgilio R, La Torre D, Salerno M. Quality of life in children and adolescents with growth hormone deficiency and their caregivers: an Italian survey. J Endocrinol Invest 2023; 46:2513-2523. [PMID: 37209402 PMCID: PMC10632207 DOI: 10.1007/s40618-023-02106-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/30/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE The aim of this study was to produce evidence on quality of life (QoL) among Italian growth hormone deficiency (GHD) children and adolescents treated with growth hormone (GH) and their parents. METHODS A survey was conducted among Italian children and adolescents aged 4-18 with a confirmed diagnosis of GHD and treated with GH therapy and their parents. The European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) and the Quality of Life in Short Stature Youth (QoLISSY) questionnaires were administered between May and October 2021 through the Computer-Assisted Personal Interview (CAPI) method. Results were compared with national and international reference values. RESULTS The survey included 142 GHD children/adolescents and their parents. The mean EQ-5D-3L score was 0.95 [standard deviation (SD) 0.09], while the mean visual analogue scale (VAS) score was 86.2 (SD 14.2); the scores are similar to those of a reference Italian population aged 18-24 of healthy subjects. As for the QoLISSY child-version, compared to the international reference values for GHD/ idiopathic short stature (ISS) patients, we found a significantly higher score for the physical domain, and lower scores for coping and treatment; compared to the specific reference values for GHD patients, our mean scores were significantly lower for all domains except the physical one. As for the parents, we found a significantly higher score for the physical domain, and a lower score for treatment; compared to reference values GHD-specific, we found lower score in the social, emotional, treatment, parental effects, and total score domains. CONCLUSIONS Our results suggest that the generic health-related quality of life (HRQoL) in treated GHD patients is high, comparable to that of healthy people. The QoL elicited by a disease specific questionnaire is also good, and comparable with that of international reference values of GHD/ISS patients.
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Affiliation(s)
- M Maghnie
- Paediatric Clinic and Endocrinology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - M Orso
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy.
| | - B Polistena
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- University of Rome Tor Vergata, Rome, Italy
| | - M Cappa
- Unit of Endocrinology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - G Pozzobon
- Pediatric Clinic, IRCCS San Raffaele Hospital, Università Vita-Salute San Raffaele, Milan, Italy
| | - D d'Angela
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- University of Rome Tor Vergata, Rome, Italy
| | - G Patti
- Paediatric Clinic and Endocrinology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - F Spandonaro
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- San Raffaele University, Rome, Italy
| | - S Granato
- Medical Department, Pfizer Italia, Rome, Italy
| | | | - D La Torre
- Global Medical Affairs, Pfizer Rare Disease, Rome, Italy
| | - M Salerno
- Department of Translational Medical Sciences, Paediatric Endocrinology Unit, University of Naples 'Federico II', Naples, Italy
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Abstract
Summary Background. Kounis syndrome (KS) is defined as a rare cause of an acute coronary syndrome associated with systemic allergic reactions. To establish the prevalence of KS among the patients with diagnosis of anaphylaxis, we described clinical features, cardiological and allergological outcomes of patients evaluated in our allergy outpatient clinic. Methods. A retrospective study was carried out in the Allergy Unit of Novara hospital, from January 2008 to March 2020. Skin tests and in vitro tests were performed with suspected etiological agents. Results. We found 9 adults with KS (2%) out of 444 subjects who had experienced anaphylactic reactions (4/9 to Hymenoptera stings, 5/9 to drugs). Conclusions. The present study highlights the importance of suspicion of KS that appears not so uncommon in patients with anaphylaxis. KS seems to be a rare disease because unrecognized in diagnosis of anaphylaxis.
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Affiliation(s)
- G Zisa
- Allergy Unit, Department of Internal Medicine, Hospital Maggiore della Carità, Novara, Italy
| | - A Panero
- Department of Medicine, Hospital of Biella, Biella, Italy
| | - A Re
- Department of Medicine, Hospital Maggiore della Carità, Novara, Italy
| | - M G Mennuni
- Division of Cardiology, Hospital Maggiore della Carità, Novara, Italy
| | - G Patti
- Division of Cardiology, Hospital Maggiore della Carità, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - M Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Division of Internal Medicine, Hospital Maggiore della Carità, Novara, Italy
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Segala FV, Ictho J, L'Episcopia M, Onapa E, De Vita E, Novara R, Olung N, Totaro V, Olal L, Patti G, Bingom C, Farina U, Papagni R, Agaro C, Bavaro DF, Amone J, Dall'Oglio G, Ngole B, Marotta C, Okori S, Zarcone M, Ogwang J, Severini C, Lochoro P, Putoto G, Saracino A, Di Gennaro F. Impact of the COVID-19 pandemic on malaria in pregnancy indicators in Northern Uganda: a joinpoint regression analysis. Pathog Glob Health 2023:1-9. [PMID: 37872763 DOI: 10.1080/20477724.2023.2273023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Pregnancy is both a risk factor for P. falciparum infection and development of severe malaria. In low- and middle-income countries, the COVID-19 pandemic severely impacted health systems, including utilization of maternal services. This study aimed to assess trends in delivering malaria in pregnancy-related health-care services before and during COVID-19 in Northern Uganda. METHODS An interrupted time-series study comparing pre-COVID-19 (January 2018 to April 2020) and COVID-19 (May to December 2021) periods, based on the date the first COVID case was detected. The study involved 30 health facilities in Northern Uganda with 22,650 estimated pregnancies per year, 14% of which took place in hospital. Monthly data were sourced from District routinely collected indicators. Trends were analyzed by joinpoint regression models. RESULTS From the onset of the COVID pandemic in Uganda (May 2020), we found a significant reduction in the number of women accessing a fourth antenatal care visit (from APC + 183.5 to + 4.98; p < 0.001) and taking at least three doses of intermittent preventive treatment in pregnancy (IPTp, from APC + 84.28 to -63.12; p < 0.001). However, we found no significant change in the trend of the total number of pregnant women managed as outpatients or hospitalized for malaria, as well as in the number of women attending their first antenatal visit and in the number of institutional deliveries. CONCLUSIONS In our study, the COVID-19 pandemic significantly reduced access to ANC visits and IPTp uptake. However, the healthcare system maintained its capacity for managing malaria cases, first antenatal visits, and institutional deliveries.Trial registration: This study has been registered on the ClinicalTrials.gov public website on 26 April 2022. ClinicalTrials.gov Identifier: NCT05348746.
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Affiliation(s)
- Francesco Vladimiro Segala
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Jerry Ictho
- Health Service Management, Doctors with Africa CAUMM, Kampala, Uganda
| | | | - Emmanuel Onapa
- Operational Research Unit, St. John's XXIII Hospital Aber, Jaber, Uganda
| | - Elda De Vita
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Roberta Novara
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Nelson Olung
- Operational Research Unit, St. John's XXIII Hospital Aber, Jaber, Uganda
| | - Valentina Totaro
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Lameck Olal
- Operational Research Unit, African Network for Change, Kampala, Uganda
| | - Giulia Patti
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | | | - Umberto Farina
- Hygiene Unit, Policlinico Riuniti Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Roberta Papagni
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Caroline Agaro
- Health Office, Oyam District Local Government, Loro, Uganda
| | - Davide Fiore Bavaro
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - James Amone
- Operational Research Unit, St. John's XXIII Hospital Aber, Jaber, Uganda
| | | | - Benedict Ngole
- Operational Research Unit, African Network for Change, Kampala, Uganda
| | - Claudia Marotta
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | - Samuel Okori
- Operational Research Unit, St. John's XXIII Hospital Aber, Jaber, Uganda
| | - Maurizio Zarcone
- Unità Operativa Complessa di Epidemiologia Clinica con Registro Tumori, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Palermo, Italy
| | - Joseph Ogwang
- Operational Research Unit, St. John's XXIII Hospital Aber, Jaber, Uganda
| | - Carlo Severini
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Peter Lochoro
- Health Service Management, Doctors with Africa CAUMM, Kampala, Uganda
| | - Giovanni Putoto
- Health Service Management, Doctors with Africa CAUMM, Kampala, Uganda
| | - Annalisa Saracino
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Di Gennaro
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
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La Valle A, d'Annunzio G, Campanello C, Tantari G, Pistorio A, Napoli F, Patti G, Crocco M, Bassi M, Minuto N, Piccolo G, Maghnie M. Are glucose and insulin levels at all time points during OGTT a reliable marker of diabetes mellitus risk in pediatric obesity? J Endocrinol Invest 2023:10.1007/s40618-023-02030-6. [PMID: 36763246 DOI: 10.1007/s40618-023-02030-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE Childhood overweight and obesity associated with insulin resistance and metabolic syndrome represent the new global pandemic and the main causative factors for dysglycemia, prediabetes, and Type 2 Diabetes Mellitus (T2DM). Predictors, such as HOMA-IR, HOMA-β%, and QUICKI lack specific reference values in children. OGTT is a gold standard for glycometabolic assessment. Recently, a glycemic level higher than 155 mg/dl at + 60' after glucose ingestion has been defined as a risk factor for T2DM in obese adolescents. We aim to analyze and correlate fasting insulin-resistance markers with OGTT results in overweight/obese children and adolescents. METHODS We retrospectively evaluated glucose and insulin values during a 2-h OGTT every 30 min in 236 overweight/obese patients. Glucose values and insulin sum during OGTT were compared to glycometabolic indexes and different cut-off values for insulin sum. RESULTS A 1-h glucose > 155 mg/dl and insulin sum > 535 microU/ml at all times during OGTT are the best predictors of diabetes risk in obese youths. A1-h glucose > 155 mg/dl is significantly associated with HbA1c > 5.7%, while no association was observed between HbA1c > 5.7% and glucose levels at baseline and 2 h. The ability of the standardized HOMA-IR to predict the prediabetes status is clearly lower than the total insulin sum at OGTT. CONCLUSION Our study demonstrates that also 1-h post-OGTT glucose, together with HbA1c, is an effective diabetes predictor.
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Affiliation(s)
- A La Valle
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G d'Annunzio
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - C Campanello
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Tantari
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - A Pistorio
- Epidemiology and Biostatistics Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - F Napoli
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Patti
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - M Crocco
- Gastroenterology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Bassi
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - N Minuto
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Piccolo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.
- Neurooncology Unit, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy.
| | - M Maghnie
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
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Panfili FM, Convertino A, Grugni G, Mazzitelli L, Bocchini S, Crinò A, Campana G, Cappa M, Delvecchio M, Faienza MF, Licenziati MR, Mariani M, Osimani S, Pajno R, Patti G, Rutigliano I, Sacco M, Scarano E, Fintini D. Multicentric Italian case-control study on 25OH vitamin D levels in children and adolescents with Prader-Willi syndrome. J Endocrinol Invest 2023:10.1007/s40618-022-01990-5. [PMID: 36708456 DOI: 10.1007/s40618-022-01990-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/09/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE 25OHD levels in patients with Prader-Willi Syndrome (PWS), the most frequent cause of genetic obesity with a peculiar fat mass distribution, are still debated. Insulin resistance (IR), Body Mass Index-SDS (BMI-SDS), Growth Hormone Therapy (GHT), and puberty onset seem to interact with 25OHD levels. The objectives of the study are: (1) To analyze 25OHD levels in pediatric PWS patients in comparison with a control group (CNT) (2) To evaluate a possible correlation between BMI-SDS, HOMA-IR, puberty, GHT, and 25OHD levels. METHODS This is a retrospective case-control, multicenter study. Data were collected among 8 different Italian Hospitals (outpatient clinics), over a period of four years (2016-2020). We included 192 genetically confirmed PWS and 192 CNT patients, aged 3-18 years, matched 1:1 for age, gender, BMI-SDS, Tanner stage, sun exposure, and month of recruitment. RESULTS No statistically significant differences in 25OHD levels were observed between the PWS population and the CNT (PWS 24.0 ng/mL vs CNT 22.5 ng/mL, p > 0.05), OR = 0.89 (95% CI 0.58-1.35). We observed a slight, although non-significant, reduction in 25OHD levels comparing NW and OB populations. HOMA-IR, puberty onset, genotype and GHT (previous or ongoing) did not show statistically significant correlation with 25OHD levels. CONCLUSIONS Our findings could be useful for clinicians to optimize the therapeutic management as well as to increase awareness of PWS.
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Affiliation(s)
| | - A Convertino
- Prader Willi Reference Center, Endocrinology Unit, Pediatric University Department, Bambino Gesù Children Hospital, Via Torre di Palidoro, 00050, Palidoro, Rome, Italy
| | - G Grugni
- Auxology Division, Istituto Auxologico Italiano IRCCS, Piancavallo di Oggebbio, Verbania, Italy
| | - L Mazzitelli
- Prader Willi Reference Center, Endocrinology Unit, Pediatric University Department, Bambino Gesù Children Hospital, Via Torre di Palidoro, 00050, Palidoro, Rome, Italy
| | - S Bocchini
- Prader Willi Reference Center, Endocrinology Unit, Pediatric University Department, Bambino Gesù Children Hospital, Via Torre di Palidoro, 00050, Palidoro, Rome, Italy
| | - A Crinò
- Prader Willi Reference Center, Endocrinology Unit, Pediatric University Department, Bambino Gesù Children Hospital, Via Torre di Palidoro, 00050, Palidoro, Rome, Italy
| | - G Campana
- Prader Willi Reference Center, Endocrinology Unit, Pediatric University Department, Bambino Gesù Children Hospital, Via Torre di Palidoro, 00050, Palidoro, Rome, Italy
| | - M Cappa
- Prader Willi Reference Center, Endocrinology Unit, Pediatric University Department, Bambino Gesù Children Hospital, Via Torre di Palidoro, 00050, Palidoro, Rome, Italy
| | - M Delvecchio
- Metabolic and Genetic Disease Unit, Pediatric Hospital Giovanni XXIII, Bari, Italy
| | - M F Faienza
- Department of Biomedical Science and Human Oncology Department, A. Moro University, Bari, Italy
| | - M R Licenziati
- Obesity and Endocrine Diseases Unit, Neuroscience and Rehabilitation Department, Santobono-Pausilipon Hospital, Naples, Italy
| | - M Mariani
- Prader Willi Reference Center, Endocrinology Unit, Pediatric University Department, Bambino Gesù Children Hospital, Via Torre di Palidoro, 00050, Palidoro, Rome, Italy
| | - S Osimani
- Pediatric Unit, IRCCS San Raffaele, Milan, Italy
| | - R Pajno
- Pediatric Unit, IRCCS San Raffaele, Milan, Italy
| | - G Patti
- Pediatric Department, Gaslini Hospital, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health-University of Genova, Genoa, Italy
| | - I Rutigliano
- Pediatric Unit, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy
| | - M Sacco
- Pediatric Unit, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy
| | - E Scarano
- Rare Disease Unit, Pediatric Unit, Sant'Orsola Hospital, Bologna, Italy
| | - D Fintini
- Prader Willi Reference Center, Endocrinology Unit, Pediatric University Department, Bambino Gesù Children Hospital, Via Torre di Palidoro, 00050, Palidoro, Rome, Italy.
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Totaro V, Patti G, Segala FV, Laforgia R, Raho L, Falanga C, Schiavone M, Frallonardo L, Panico GG, Spada V, De Santis L, Pellegrino C, Papagni R, D’Argenio A, Novara R, Marotta C, Laforgia N, Bavaro DF, Putoto G, Saracino A, Di Gennaro F. HIV-HCV Incidence in Low-Wage Agricultural Migrant Workers Living in Ghettos in Apulia Region, Italy: A Multicenter Cross Sectional Study. Viruses 2023; 15:249. [PMID: 36680288 PMCID: PMC9861079 DOI: 10.3390/v15010249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/06/2023] [Accepted: 01/14/2023] [Indexed: 01/17/2023] Open
Abstract
Migrant populations are more susceptible to viral hepatitis and HIV due to the epidemiology from their country of origin or their social vulnerability when they arrive in Europe. The aims of the study are to explore the incidence of HIV and HCV in low-wage agricultural migrant workers and their knowledge, attitude, and practice with regard to HIV and HCV, as well as their sexual behaviour and risk factors. As part of the mobile clinic services, we performed a screening campaign for HIV-HCV involving migrants living in three Apulian establishments. Results: Between January 2020 and April 2021, 309 migrants (n. 272, 88% male, mean age 28.5 years) were enrolled in the study. Most of the migrants interviewed (n = 297, 96%) reported a stopover in Libya during their trip to Italy. Only 0.9% (n. 3) of migrants reported having been tested for HCV, while 30.7% (n. 95) reported being tested for HIV. Furthermore, screening tests found four migrants (1.3%) to be HIV positive and nine (2.9%) to be HCV positive. The median knowledge score was 1 (IQR 0-3; maximum score: 6 points) for HCV and 3 (IQR 1-4; maximum score: 7 points) for HIV and low use of condoms was 5% (n. 16), while more than 95% show an attitude score of 5 (IQR 5-6; maximum score:6 points) on HIV-HCV education campaigns. In a multivariate analysis, being male (OR = 1.72; 95% CI 1.28−1.92), being single (OR = 1.63; 95% CI 1.20−2.03), being of low educational status (OR = 2.09; 95% CI 1.29−2.21), living in shantytowns for >12 months (OR = 1.95; 95% CI 1.25−2.55), and originating from the African continent (OR = 1.43; 95% CI 1.28−2.01) are significant predictors of poor knowledge on HCV. Our data show low knowledge, especially of HCV, confirming migrants as a population with a higher risk of infection. To develop education programmes, integrated care and screening among migrants could be an effective strategy, considering the high attitude toward these items shown in our study.
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Affiliation(s)
- Valentina Totaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Giulia Patti
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Francesco Vladimiro Segala
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | | | - Lucia Raho
- Doctors with Africa CUAMM, 70123 Bari, Italy
| | | | | | - Luísa Frallonardo
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Gianfranco Giorgio Panico
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Vito Spada
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Laura De Santis
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Carmen Pellegrino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Roberta Papagni
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Angelo D’Argenio
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Roberta Novara
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Claudia Marotta
- Operational Research Unit, Doctors with Africa CUAMM, 35121 Padua, Italy
| | | | - Davide Fiore Bavaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa CUAMM, 35121 Padua, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
- Operational Research Unit, Doctors with Africa CUAMM, 35121 Padua, Italy
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9
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Frallonardo L, Di Gennaro F, Panico GG, Novara R, Pallara E, Cotugno S, Guido G, De Vita E, Ricciardi A, Totaro V, Camporeale M, De Iaco G, Bavaro DF, Lattanzio R, Patti G, Brindicci G, Papagni R, Pellegrino C, Santoro CR, Segala FV, Putoto G, Nicastri E, Saracino A. Onchocerciasis: Current knowledge and future goals. Front Trop Dis 2022. [DOI: 10.3389/fitd.2022.986884] [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: 11/18/2022] Open
Abstract
Human Onchocerciasis, caused by infection by the filarial nematode Onchocerca volvulus, is a neglected public health disease that affects millions of people in the endemic regions of sub-Saharan Africa and Latin America. It is also called river blindness because the Blackflies that transmit infection breeds in rapidly flowing fresh water streams and rivers. This review features state-of-the-art data on the parasite, its endobacteria Wolbachia, the prevalence of the infection and its geographical distribution, its diagnostics, the interaction between the parasite and its host, and the pathology of Onchocerciasis. By development and optimization of the control measures, transmission by the vector has been interrupted in foci of countries in the Americas (Colombia, Ecuador, Mexico, and Guatemala)and inSudan, followed by Onchocerciasis eliminations. The current state and future perspectives for vector control and elimination strategy are described.
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Altobelli E, Angeletti PM, Marzi F, D'Ascenzo F, Petrocelli R, Patti G. Hospital admissions and mortality for STEMI and NSTEMI during COVID-19 outbreak: a meta-analysis. Eur J Public Health 2022. [PMCID: PMC9593630 DOI: 10.1093/eurpub/ckac131.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background During SARS-CoV-2 pandemic, various studies have shown a significant reduction of Emergency Department (ED) presentations for acute cardiac diseases requiring in-hospital management. The aim of our study was to quantify hospital admission and mortality, comparing pandemic period and pre-pandemic period in different countries. Methods We performed an updated meta-analysis of observational studies to quantify on a large basis the impact of the SARS-CoV-2 outbreak on patients admitted to the ED for STEMI and NSTEMI. The literature research was conducted on PubMed, EMBASE, Scopus, Science Direct, Web of Science and Cochrane database registry on 6 January 2022. We performed a random-effect model meta-analysis. Results A total of 61 studies were included: came from Italy, China, Germany, Israel, Turkey, France, Helvetic Confederation, India, Poland, Spain, US, UK, Albania, Austria, Egypt, Greece, Iran, Ireland, Japan, Pakistan, Portugal, Saudi Arabia and Canada. Hospital admissions for STEMI decreased in most country. The countries with the high levels of reduction were Italy (IRR = 0.68) and Germany (IRR = 0.69). Mortality rates for STEMI increased differently among countries analyzed: p = 0.003. The highest mortality rate was in Serbia (OR = 2.15), followed by Italy (OR = 1.97), Pakistan (OR = 1.69) and France (OR = 1.55). Among the High-Income countries, the highest mortality rate was in Italy (OR = 3.71), the highest among the Upper-Middle-Income was in Serbia (OR = 2.15) and the highest among Low- Middle-Income was in Pakistan (OR = 1.69). Regarding NSTEMI, hospital admissions showed that Italy had the lowest value for with IRR = 0.59. Among countries, the meta-regression subgroups analysis, showed statistical difference (p < 0.001). Conclusions Our meta-analysis may represent a robust snapshot that might help healthcare systems manage and assist an expected higher number of people coming to the hospitals for severe, post-acute cardiological issues in the future. Key messages • The study shows hospital admission and mortality, comparing pandemic period and pre-pandemic period in different countries. • Epidemiological data suggests that one-fourth to one-third of MI patients, in large areas of the globe, during the COVID-19 pandemic in 2020, remained at home and did not have access to ED.
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Affiliation(s)
- E Altobelli
- Department of Life, Public Health and Environmental Sciences, University of L’Aquila , L'Aquila, Italy
| | - PM Angeletti
- Department of Life, Public Health and Environmental Sciences, University of L’Aquila , L'Aquila, Italy
- Cardiac Surgical Intensive Care Unit, Giuseppe Mazzini Hospital , Teramo, Italy
| | - F Marzi
- Department of Life, Public Health and Environmental Sciences, University of L’Aquila , L'Aquila, Italy
| | - F D'Ascenzo
- Cardiovascular and Thoracic Department, Division of Cardiology, University of Turin , Turin, Italy
| | - R Petrocelli
- San Timoteo Hospital, ASREM Molise , Termoli, Italy
| | - G Patti
- Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont , Novara, Italy
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11
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Pastore MC, Mandoli GE, Ghionzoli N, Stefanini A, D'Ascenzi F, Lisi M, Cavigli L, Carrucola C, Focardi M, Mondillo S, Patti G, Valente S, Cameli M. Prediction of congestive state and prognosis in acute and chronic heart failure: the association between NT-proBNP and left atrial strain. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In acute and chronic heart failure (HF), the relief of congestion is one of the pivotal elements to improve patient's quality of life and prognosis. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-known marker of cardiovascular congestion in HF, although with limited specificity. Peak atrial longitudinal strain (PALS) by speckle tracking echocardiography is emerging as an index of left ventricular (LV) filling pressure and prognosis in HF, however, its role as a marker of congestion should be further elucidated.
Purpose
the aim of our study was to determine the association between NT-proBNP and PALS and their prognostic implications in patients acute and chronic HF.
Methods
patients hospitalized for de-novo or recurrent acute HF and patients with chronic HF referred to our echo-labs for follow-up evaluation were included in this retrospective study. Patients with missing data, previous cardiac surgery, heart transplant and/or left ventricular assist device implantation, non-feasible speckle tracking analysis were excluded. Clinical characteristics, laboratory examinations, transthoracic echocardiography data were collected. Speckle tracking analysis was performed offline on the echocardiographic records. Follow up data were obtained via electronical records or phone-calls. The primary clinical endpoint was a combination of all-cause death and HF hospitalization.
Results
the overall study cohort included 388 patients, of which 172 with acute HF and 216 with chronic HF. Mean age was 65±12, 37% were female. The majority of patients had reduced LV systolic function (mean LV ejection fraction = 30±10%; mean LV global longitudinal strain = −8.3±3.9%). Patients with acute HF presented higher values of NT-proBNP than those with chronic HF (median [interquartile range] = 6039 [2989; 13535]pg/ml vs. 544[200; 1533] pg/ml) and lower global PALS (10.4 [6.3; 16.45] vs. 15.6 [10.6; 21]%). Global PALS showed a significant inverse correlation with NT-proBNP both in acute and chronic HF (Fig. 1; all p<0.001) and to be a significant predictor of NT-proBNP with linear regression analysis (R2=0.2; p<0.001). During a median follow-up of 1 year, 98 patients reached the combined endpoint (49 all-cause deaths, 16 cardiovascular deaths, 62 HF hospitalizations). With ROC curves, both NT-proBNP and global PALS showed to be good predictors of the combined endpoint (AUC=0.87 and 0.82 respectively, Fig. 2). Kaplan-Meier analysis showed a good risk stratification for the composite endpoint for ROC-derived cut-off of PALS ≤15% and NTproBNP ≥874.5%, and above all for their combination (Fig. 1B)
Conclusions
global PALS is associated with NT-proBNP in acute and chronic HF and may be used as additional index of congestion to optimize therapeutic management in these patients. The combination of global PALS and NT-proBNP could enhance the prognostic stratification of HF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | | | | | | | - M Lisi
- University of Siena , Siena , Italy
| | | | | | | | | | - G Patti
- University of Eastern Piedmont , Novara , Italy
| | | | - M Cameli
- University of Siena , Siena , Italy
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12
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Pastore MC, Fusini L, Mandoli GE, Carrucola C, Vigna M, Muratori M, Pepi M, Cavigli L, D'Ascenzi F, Focardi M, Valente S, Mondillo S, Pontone G, Patti G, Cameli M. Prognostic value of left and right ventricular strain in heart failure with reduced and preserved ejection fraction: a meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The association of speckle tracking echocardiography measures of left ventricular (LV) and right ventricular (RV) strain with clinical outcome in heart failure with reduced and preserved ejection fraction (HFrEF and HFpEF) has been extensively investigated. In fact, while the contribute of LV ejection fraction (LVEF) for prognosis is controversial, myocardial strain has proven to be a strong and independent prognostic predictor in many HF studies.
Purpose
The aim of this meta-analysis was to assess the prognostic value of LV global longitudinal strain (GLS) and free wall RV longitudinal strain (fwRVLS) by 2-dimensional speckle tracking echocardiography in patients with HFrEF, HF with mildly-reduced ejection fraction (HFmrEF) and HFpEF.
Methods
A systematic literature search of medical databases including Pubmed, Scopus, Ovid Online, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Scopus was performed using PRISMA principles. All relevant studies in English language reporting the predictive value of LV GLS and/or fwRVLS for mortality and/or cardiovascular events in HFrEF, HFmrEF and HFpEF, with follow up >6 months, were identified. Case reports/series and abstract congresses were excluded (Fig. 1). All-cause mortality and a composite endpoint of cardiovascular death, re-hospitalization for HF, cardiac transplantation, ventricular assist device implantation were analyzed. Hazard ratios (HR) were extracted from univariate and multivariate random-effects models reporting on the association of LV GLS and fwRVLS and outcome and described as pooled estimates with 95% confidence intervals (CI).
Results
Fifty studies (n=18276 patients) satisfied the inclusion criteria (35 studies in chronic HF, 15 studies in acute HF). Most studies (n=36) included patients with HFrEF, while 14 studies included patients with HFmrEF (n=3) and with HFpEF (n=11); thus HFmrEF and HFpEF were grouped together for the analysis. Overall, 48 studies included LV GLS (median value = −9% [from −17% to −11%], 17 studies included fwRVLS (median value = −18% [from −24% to −14%]). Over a median follow up of 32 [from 7 to 67] months follow up, 5618 (31%) had a cardiovascular event or died. LV GLS and fwRVLS were independently associated with all-cause mortality and the composite outcome, regardless of LVEF (Fig. 2), both in HFrEF (HR 1.26; 95% CI [1.15; 1.37]; p<0.01 for LV GLS and HR 1.06; 95% CI [1.03; 1.09]; p<0.01 for fwRVLS) and in HFpEF (HR 1.07; 95% CI [1.03; 1.12]; p<0.01 for LV GLS and HR 1.08; 95% CI [0.96; 1.21]; p<0.01 for fwRVLS).
Conclusions
These meta-analysis data demonstrate that LV and RV strain are associated with mortality and cardiovascular events in patients with HF, HFmrEF and HFpEF and may provide important additive prognostic information. These findings emphasize the potential usefulness of LV GLS and fwRVLS in clinical practice to improve the risk stratification and management of patients with HF regardless of LVEF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - L Fusini
- IRCCS Monzino Cardiology Center , Milan , Italy
| | | | | | - M Vigna
- University of Siena , Siena , Italy
| | - M Muratori
- IRCCS Monzino Cardiology Center , Milan , Italy
| | - M Pepi
- IRCCS Monzino Cardiology Center , Milan , Italy
| | | | | | | | | | | | | | - G Patti
- University of Eastern Piedmont , Novara , Italy
| | - M Cameli
- University of Eastern Piedmont , Novara , Italy
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13
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Patti G, Pecen L, Casalnuovo G, Kirchhof P, De Caterina R. Clinical outcomes in patients with atrial fibrillation with or without concomitant diabetes after two years of edoxaban treatment: ETNA-AF-Europe registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Concomitant diabetes mellitus (DM) in patients with atrial fibrillation (AF) has been associated with a higher risk of stroke/systemic embolic events (SEE), and higher mortality.
Purpose
To evaluate effectiveness and safety outcomes in AF patients with different types of concomitant DM vs those without concomitant DM after 2 years of edoxaban treatment in a sub-analysis of the prospective ETNA-AF-Europe registry.
Methods
Patients with AF who received edoxaban once daily were enrolled across 825 centres in 10 European countries. This sub-analysis is based on a data snapshot from 26th October 2020. Patients were grouped by DM status (with or without DM; insulin-treated or non-insulin-treated DM). Baseline characteristics are summarised descriptively. Kaplan-Meier (KM) survival curves of outcomes were constructed; annualised event rates (AERs; %/year) and comparisons between patients with or without DM by univariate analysis are presented. Comparisons of patients with insulin- vs non-insulin-treated DM were made by multivariate analysis adjusted for HbA1c.
Results
Patients' demographics and baseline characteristics are shown in Table 1. Of 13,133 patients with AF, 2885 (22.0%) had DM. Among patients with DM, 2756 (95.6%) received treatment: 605 (22.0%) with insulin and 2151 (78.0%) with non-insulin treatments. KM curves for effectiveness and safety outcomes are shown in Figure 1. AERs (%/year) of ischaemic stroke/transient ischaemic attack (TIA)/SEE were 0.86% in patients with AF and no DM, 0.87% with non-insulin-treated DM (p=0.9216 vs no DM) and 1.81% with insulin-treated DM (p=0.0022 vs no DM; p=0.0014 vs non-insulin-treated DM). AERs of myocardial infarction (MI) were 0.40%, 0.43% (p=0.7454 vs no DM), and 1.04% (p=0.0033 vs no DM) respectively; of major bleeding were 0.90%, 1.10% (p=0.2427 vs no DM), and 1.71% (p=0.0106 vs no DM), respectively; and of all-cause death were 3.36%, 5.02% (p<0.0001 vs no DM), and 8.91% (p<0.0001 vs no DM) respectively. In a multivariate analysis of DM patients adjusted for HbA1c (patients with AF and DM with HbA1c measured, n=1869), patients with AF and insulin-treated DM had a higher risk of stroke/TIA/SEE (HbA1c adjusted HR [95% CI]: 2.13 [1.12–4.05], p=0.0205) and all-cause death (1.83 [1.35–2.49], p=0.0001) vs those with non-insulin-treated DM; no significant difference in the risk of MI (2.10 [0.78–5.66], p=0.1448) or major bleeding (1.81 [0.95–3.44], p=0.0706) was detected between the groups.
Conclusion
In patients with AF and DM, risk of stroke/TIA/SEE, MI and major bleeding was confined to insulin-treated DM patients only. These patients also had poorer survival rates vs those without DM and those with non-insulin-treated DM, reinforcing previously published data showing a strong association between insulin treatment and poorer outcomes, and a mild/absent association between non-insulin treatments and poorer outcomes in patients with AF and DM.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This research was funded by Daiichi Sankyo Europe.
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Affiliation(s)
- G Patti
- Maggiore della Carità Hospital, Department of Thoracic and Cardiovascular Diseases , Novara , Italy
| | - L Pecen
- The Czech Academy of Science, Institute of Computer Science , Prague , Czechia
| | | | - P Kirchhof
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - R De Caterina
- University of Pisa, Chair of Cardiology , Pisa , Italy
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14
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Pallara E, Cotugno S, Guido G, De Vita E, Ricciardi A, Totaro V, Camporeale M, Frallonardo L, Novara R, Panico GG, Puzo P, Alessio G, Sablone S, Mariani M, De Iaco G, Milano E, Bavaro DF, Lattanzio R, Patti G, Papagni R, Pellegrino C, Saracino A, Di Gennaro F. Loa loa in the Vitreous Cavity of the Eye: A Case Report and State of Art. Am J Trop Med Hyg 2022; 107:tpmd220274. [PMID: 35914685 PMCID: PMC9490677 DOI: 10.4269/ajtmh.22-0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/06/2022] [Indexed: 11/20/2022] Open
Abstract
Loa loa is a filarial nematode responsible for loiasis, endemic to West-Central Africa south of the Sahara and transmitted by flies. This study reports a case of L. loa in the vitreous cavity of the eye of a young patient, along with an in-depth literature review. A 22-year-old woman from Cameroon who migrated from Cameroon to Italy was referred to the Emergency Ophthalmology Department at Policlinico di Bari in July 2021 with the presence of a moving parasite in the subconjunctiva of the left eye. A recent onset of a papular lesion on the dorsal surface of the right wrist and a nodular lesion in the scapular region were detected. L. loa filariasis was diagnosed based on anamnestic data, clinical and paraclinical signs, and a parasitological test confirming the presence of microfilariae in two blood samples collected in the morning of two different days. Because of the unavailability of diethylcarbamazine (DEC), albendazole (ALB) 200 mg twice daily was administered for 21 days. A mild exacerbation of pruritus occurred during treatment, but resolved with the use of an antihistamine. A single dose of 12 mg ivermectin was prescribed at the end of the treatment with albendazole. Unlike other endemic parasite infections, L. loa is not included in the Global Program to Eliminate Lymphatic Filariasis, because it is not mentioned in the WHO and CDC list of neglected tropical diseases. This can result in an overall risk of lack of attention and studies on loiasis, with lack of data on global burden of the disease.
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Affiliation(s)
- Elisabetta Pallara
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Sergio Cotugno
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Giacomo Guido
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Elda De Vita
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Aurelia Ricciardi
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Valentina Totaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Michele Camporeale
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Luisa Frallonardo
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Roberta Novara
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Gianfranco G. Panico
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Pasquale Puzo
- Section of Ophthalmology, Department of Medical Science, Neuroscience and Senso Organs, Bari Policlinico Hospital University of Bari, Bari, Italy
| | - Giovanni Alessio
- Section of Ophthalmology, Department of Medical Science, Neuroscience and Senso Organs, Bari Policlinico Hospital University of Bari, Bari, Italy
| | - Sara Sablone
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro,” Bari, Italy
| | - Michele Mariani
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Giuseppina De Iaco
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Eugenio Milano
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Davide F. Bavaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Rossana Lattanzio
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Giulia Patti
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Roberta Papagni
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Carmen Pellegrino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
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15
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Spinoni E, Ghiglieno C, Costantino S, Battistini E, Dell’era G, Porcellini S, Santagostino M, De Vecchi F, Patti G. Access site bleeding complications comparing oral anticoagulation therapy with NOACs and VKAs in patients with atrial fibrillation undergoing cardiac implantable device intervention. Europace 2022. [DOI: 10.1093/europace/euac053.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Atrial fibrillation is frequent in patients undergoing cardiac implantable electronic device (CIED) intervention. Such population require oral anticoagulation therapy, which increases risk of procedure related bleeding. There is a lack on data on procedure-related bleeding outcome with non-vitamin K antagonist anticoagulants (NOACs) vs vitamin K antagonist anticoagulants (VKAs) in patients with AF undergoing CIED intervention.
Study purpose
Aim of the present stud was to evaluate whether NOACs have a safety benefit compared to VKAs in terms of fewer hemorrhagic complications at the site of CIED implant.
Methods
Consecutive AF patients receiving NOACs or VKAs at the time of CIED procedure were included in this observational, retrospective, monocentric investigation. Primary endpoint was the incidence of post-intervention clinically significant pocket hematoma. Multivariate analysis was performed to investigate the association between covariates and the primary endpoint.
Results
A total of 311 patients were enrolled, 146 on NOACs and 165 on VKAs. The incidence of pocket hematoma was 3.4% in the NOAC vs 13.3% in the VKA group (p=0.002) (Figure 1). Primary outcome-free survival at 30-days was 96.6 % in patients on NOACs and 86.0% in those on VKAs (p=0.019) (Figure 2). Multivariate analysis, adjusted by propensity-score calculation of inverse-probability-weighting, showed a significantly lower occurrence of pocket hematoma in patients receiving NOACs vs VKAs (HR 0.35, 95% CI 0.13-0.96, p=0.042). Such NOACs benefit was confirmed vs patients on VKAs without peri-procedural bridging with low-molecular weight heparin (HR 0.34, 95% CI 0.11-0.99, p=0.048). The incidence of pocket infection, surgical pocket evacuation, ischemic events and major bleeding complications at 30 days (secondary endpoints) was similar in the two groups.
Conclusion
Among patients with AF undergoing implantable cardiac defibrillator or pace-maker intervention, the use of NOACs vs VKAs is associated with significant reduction of post-procedural pocket hematoma, regardless of bridging with low molecular-weight heparin in the VKA group.
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Affiliation(s)
- E Spinoni
- University of Eastern Piedmont, Novara, Italy
| | - C Ghiglieno
- University of Eastern Piedmont, Novara, Italy
| | | | | | - G Dell’era
- Hospital Maggiore Della Carita, Novara, Italy
| | | | | | - F De Vecchi
- Hospital Maggiore Della Carita, Novara, Italy
| | - G Patti
- University of Eastern Piedmont, Novara, Italy
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16
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Ghiglieno C, Dell’ Era G, Palmisano P, Floris R, Pimpini L, Coluccia G, Delogu G, Colombo C, Marconetto C, De Zan G, D’amico A, Mazzoleni F, Patti G. Long-term incidence of cardiac device complications with intrathoracic versus extrathoracic venous access: results from the PLACE (Planning Lead Access for Cardiac Electrostimulation) study. Europace 2022. [DOI: 10.1093/europace/euac053.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Optimal venous access is crucial in successful cardiac device implantation. Most commonly used accesses are subclavian or axillary vein puncture and cephalic vein cutdown. The extrathoracic access has the advantage of reducing the risk of pneumothorax and lead disfunction; thus, this approach is recommended as the first choice approach.
Purpose
The aim of our retrospective registry was to evaluate the incidence of long-term device complications (pneumothorax, lead rupture or displacement, hematoma, infection or bleeding) with different venous approaches in four high-volume centers in Italy.
Methods
We collected data from implantation and device complications during follow up using available electronic records from each center.
Results
We included 4443 patients, mean age 73±11 years. Median follow up was 118 months (IC range 59-198 months). The incidence of any complication was 7.7 %, without difference between intrathoracic and extrathoracic access (7.8% vs 7.7% respectively, p=0.70). However, lead rupture was more frequent in the intrathoracic group (5.3% vs 1.4%, p=0.04).
Conclusion
In experienced, high-volume centers, the use of intrathoracic vein puncture in the case of unsuitable extrathoracic access may represent a safe alternative of venous access in patients undergoing cardiac device implantation, although associated with a higher occurrence of lead rupture.
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Affiliation(s)
- C Ghiglieno
- Hospital Maggiore Della Carita - University of Eastern Piedmont, Novara, Italy
| | - G Dell’ Era
- Hospital Maggiore Della Carita, Novara, Italy
| | - P Palmisano
- Cardinale G. Panico Hospital, Tricase, Italy
| | - R Floris
- ASSL Sanluri - Our Lady of Bonaria Hospital, San Gavino Monreale, Italy
| | - L Pimpini
- Italian National Research Centre on Aging, Ancona, Italy
| | - G Coluccia
- Cardinale G. Panico Hospital, Tricase, Italy
| | - G Delogu
- ASSL Sanluri - Our Lady of Bonaria Hospital, San Gavino Monreale, Italy
| | - C Colombo
- Hospital Maggiore Della Carita - University of Eastern Piedmont, Novara, Italy
| | - C Marconetto
- Hospital Maggiore Della Carita - University of Eastern Piedmont, Novara, Italy
| | - G De Zan
- Hospital Maggiore Della Carita - University of Eastern Piedmont, Novara, Italy
| | - A D’amico
- Hospital Maggiore Della Carita - University of Eastern Piedmont, Novara, Italy
| | - F Mazzoleni
- Hospital Maggiore Della Carita - University of Eastern Piedmont, Novara, Italy
| | - G Patti
- Hospital Maggiore Della Carita - University of Eastern Piedmont, Novara, Italy
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17
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Spinoni E, Funes M, Dell’era G, Cumitini L, Porcellini S, Santagostino M, De Vecchi F, Pisterna A, Patti G. Comparison of infective complications with two different antibiotic prophylaxis at two-years follow up in patients undergoing cardiac implantable electronic device procedure: a prospective study. Europace 2022. [DOI: 10.1093/europace/euac053.529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiac implantable electronic device (CIED) infective complications are associated with high morbidity and mortality. Selection of proper antibiotic prophylaxis therapy is mandatory, as it can decrease the infective risk.
Purpose of the Study
Aim of the present study was to compare two different antibiotic strategy in term of procedural-related infective complications in a two-years follow-up.
Material and Methods
Patients undergoing CIED procedure (implant, replacement, or revision), with cefuroxime antibiotic prophylaxis during 2009 were consecutively enrolled as study group, with the purpose to have a long follow-up available (10 years). Patients undergoing CIED procedure (implant, replacement, or revision), with cefazolin antibiotic prophylaxis during 2020 were consecutively enrolled as control group. Primary endpoint was the evaluation of infective complications in the first 2 years follow-up (pocket infection, endocarditis and infective complication requiring CIED complete extraction). Multivariate analysis was performed to evaluate association between covariates resulted significantly different between the two study groups and study endpoint. Long-term follow-up incidence of infective complications was evaluated in the cefuroxime group.
Results
340 patients were enrolled in the cefuroxime prophylaxis group and 239 patients in the cefazolin prophylaxis group. There was no significative difference of median age between the two study groups. Patients in the cefazolin prophylaxis group compared to the cefuroxime group showed higher rate of diabetes (33.1% vs 22.1%, p=0.003), dyslipidemia (46.4% vs 36.5%, p=0.02) and higher rate of antiplatelet (45.2% vs 40.6%, p<0.001) and anticoagulation therapy (36.8% vs 31.8%, p<0.001) (Figure 1). ICD and CRT implant was more frequent in patients in the cefazolin group (33.3% vs 25.06%, p=0.05) (Figure 2). There was no significant difference of the primary endpoint in the two study groups: pocket infection (cefazolin group n=4, 1.7%, vs cefuroxime group n=5, 1.5%, p=0.85), endocarditis (cefazolin group n=1, 0.4%, vs cefuroxime group n=1, 0.3%, p=0.8) and infection requiring complete device extraction (cefazolin group n=2, 0.8%, vs cefuroxime group n=2, 0.6%, p=0.95). At multivariate analysis, there was an observed trend in reduction of infective complications in patients undergoing pacemaker (odds ratio 0.23) and CRT (odds ratio 0.82) implant.
At 10 years follow-up, 11 (3.2%) infective procedure-related complications were recorded in the cefuroxime group, 5 pocket infection, 5 pocket infection with erosion and 1 endocarditis.
Conclusion
Cefazolin antibiotic prophylaxis is effective as cefuroxime prophilaxis in reducing CIED procedure-related infections, even if patients in the cefazolin group showed higher prevalence of comorbidities and more complex device procedure (ICD and CRT implant).
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Affiliation(s)
- E Spinoni
- University of Eastern Piedmont, Novara, Italy
| | - M Funes
- University of Eastern Piedmont, Novara, Italy
| | - G Dell’era
- Hospital Maggiore Della Carita, Novara, Italy
| | - L Cumitini
- University of Eastern Piedmont, Novara, Italy
| | | | | | - F De Vecchi
- Hospital Maggiore Della Carita, Novara, Italy
| | - A Pisterna
- University of Eastern Piedmont, Novara, Italy
| | - G Patti
- University of Eastern Piedmont, Novara, Italy
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18
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Carassia C, Mennuni M, Degiovanni A, De Vecchi S, Erbetta R, Patti G. P219 IS DISPROPORTIONALITY ENOUGH TO IDENTIFY CANDIDATES FOR PERCUTANEOUS MITRAL VALVE REPAIR? A CLINICAL CASE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Functional mitral regurgitation (FMR) is defined as regurgitation with structurally normal leaflets secondary to the distortion of the LV in the context of dilated cardiopathy. The conflicting results emerged from the MITRA–FR and COAPT trials have raised a new interest in the individuation of “primary–like” components of MR. In this scenario, a binary classification in proportionate and disproportionate FMR has been proposed by Garland et al. When the MR is completely due to LV remodeling, they observed a linear relationship between ERO and LVEDV, defining a proportionate FMR; on the other side, when the ERO is superior to the expected one, the FMR is considered as disproportionate, and it may benefit from TEER on top of GMDT. However, the Garland’s model may not explain the full complexity of MV apparatus and FMR. We present the case of a 75–years–old woman diagnosed with dilated cardiopathy of ischemic origin, known since 2008. In 2021 she started receiving multiple hospitalizations for acute decompensation of HF with dyspnoea and symptoms of hypoperfusion, such as AKI on top of CKD and hypotension. The TOE showed a severe LV dysfunction and a moderate dilation of the left ventricle (EF 19%, LVEDVi 90 ml/m2), with a severe FMR secondary to annular dilation and retraction with tethering of the posterior leaflet (MR ERO 0,27 cm2, VC 0,67 cm, RV 45 ml). In order to improve symptoms she underwent TEER with implantation of one Edwards Pascal device at the level of A2–P2, with good results and a mild residual MR. Basing on the Garland’s model our patient would have been classified as proportionate FMR, with no benefit from TEER. However, removing MR component from the heart disease, she improved her stroke volume and her systolic function, allowing a better peripheral perfusion, as showed by an increase in renal function and in arterial pressure during follow–up, which allowed an introduction ad up–titration of Sacubitril/Valsartan, impossible before TEER. At the same time TEER decreased pulmonary pressures improving dyspnoea and functional status (she was NYHA II–III at the 6 month follow–up). In conclusion, the binary model of proportionality has the strength of being easy–to–use and of easily recognizing a primary–like MR that can benefit from TEER; however, proportionate FMR probably includes different pathophysiological mechanisms of disease, requiring an ultra stratification to better identify cases where TEER may increase survival.
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Affiliation(s)
| | | | | | | | | | - G Patti
- AOU MAGGIORE DELLA CARITÀ, NOVARA
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19
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Gallone G, Burrello J, Burrello A, Iannaccone M, De Luca L, Patti G, Cerrato E, Venuti G, De Filippo O, Mattesini A, Muscoli S, Trabattoni D, Giammaria M, Truffa A, Cortese B, Conrotto F, Mulatero P, Monticone S, Escaned J, Usmiani T, D‘ascenzo F, De Ferrari G, Breviario S. C25 PREDICTION OF ALL–CAUSE MORTALITY FOLLOWING PERCUTANEOUS CORONARY INTERVENTION IN BIFURCATION LESIONS USING MACHINE LEARNING ALGORITHMS – THE RAIN–ML PREDICTION MODEL. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Stratifying prognosis following coronary bifurcation percutaneous coronary intervention (PCI) is an unmet need. Machine learning (ML) may identify patterns from multidimensional, non–linear relationships to make outcome predictions. We sought to develop a ML–based risk stratification model built on clinical, anatomical and procedural features to predict all–cause mortality following contemporary bifurcation PCI.
Methods and Results
Multiple ML models to predict all–cause mortality were tested on a cohort of 2,393 patients (training, n = 1,795; internal validation, n = 598) undergoing bifurcation PCI with contemporary stents from the real–world RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) registry. Among 38 commonly available features, 25 (13 patient–related, 12 lesion–related) were selected to train ML models. The best performing model (the RAIN–ML prediction model) was validated in an external validation cohort of 1,701 patients undergoing bifurcation PCI from the DUTCH PEERS (DUrable polymer–based sTent CHallenge of Promus ElemEnt versus ReSolute integrity: TWENTE II) trial and the BIO–RESORT trial cohorts. The area under the receiver operating characteristic curves for the prediction of 2–year mortality was 0.786 (0.74–0.83) in the overall population, 0.736 (0.72–0.847) at internal validation and 0.706 (0.6919–0.794) at external validation. Performance at risk ranking analysis, k–center cross validation, and with continual learning confirmed the generalizability of the models, available also as an online interface.
Conclusions
The RAIN–ML prediction model represents the first tool combining clinical, anatomical and procedural features to predict all–cause mortality among patients undergoing contemporary bifurcation PCI with a good discriminative performance.
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Affiliation(s)
- G Gallone
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - J Burrello
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - A Burrello
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - M Iannaccone
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - L De Luca
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - G Patti
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - E Cerrato
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - G Venuti
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - O De Filippo
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - A Mattesini
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - S Muscoli
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - D Trabattoni
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - M Giammaria
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - A Truffa
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - B Cortese
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - F Conrotto
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - P Mulatero
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - S Monticone
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - J Escaned
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - T Usmiani
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - F D‘ascenzo
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - G De Ferrari
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - S Breviario
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
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20
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Pastore MC, Degiovanni A, Spinoni E, De Zan G, Carassia C, Patti G. Left atrial strain reduction in acute myocarditis and its association with incident atrial fibrillation. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The diagnostic and prognostic evaluation of acute myocarditis remains still challenging. Particularly, acute atrial involvement could be underdiagnosed due to its limited evaluation by cardiac magnetic resonance (CMR) and the lack of sensitive basic echocardiographic indices.
Purpose
Our aim was to assess left atrial strain in a cohort of patients with diagnosis of acute myocarditis, and its correlation with incident cardiovascular events at follow up.
Methods
30 patients with acute myocarditis diagnosed by CMR, performed within one week from admission, according to Lake-Louise criteria were retrospectively included. Patients with poor acoustic window or missing data related to hospitalization or follow-up were excluded. Clinical characteristics, laboratory examinations, transthoracic echocardiography data were collected. Speckle tracking analysis was performed offline on the echocardiographic records. Follow up data were obtained via electronical records or phone-calls. Clinical endpoints were the development of all-cause or cardiovascular death, cardiovascular hospitalization (including heart failure, major arrhythmias, acute coronary syndromes), atrial fibrillation or ventricular arrhythmias onset.
Results
The study cohort, composed of 30 patients with acute myocarditis (mean age 38 ±15 years, 33% (n = 10) female), showed raised C-reactive protein and cardiac troponin at admission, beside a mild reduction of left ventricular ejection fraction (Fig.1). Left ventricular strain was preserved in the majority of patients (57%, n = 17) or mildly reduced, while left atrial strain was significantly reduced (Table 1). At CMR, 57% (n = 17) of patients presented myocardial edema and 70% (n = 21) presented late gadolinium enhancement. Over a mean follow up of 2.3 ± 1.9 years, 5 patients had hospitalizations for cardiovascular reasons, one of whom for heart failure, 3 patients developed atrial fibrillation, 5 patients developed ventricular arrhythmias. Patients with cardiovascular events showed lower left atrial strain than those without events (Fig.2); global atrial reservoir strain reached a statistically significant difference in patients with incident atrial fibrillation vs those without (p = 0.02).
Conclusions
our findings suggest that patients with acute myocarditis may have a subtle atrial involvement which could be detected by speckle tracking echocardiography. Moreover, lower values of left atrial strain may characterize patients at higher risk of incident atrial fibrillation during follow-up. Abstract Figure. Fig.1 Abstract Figure. Fig.2
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Affiliation(s)
- MC Pastore
- University of Eastern Piedmont, Novara, Italy
| | | | - E Spinoni
- University of Eastern Piedmont, Novara, Italy
| | - G De Zan
- University of Eastern Piedmont, Novara, Italy
| | - C Carassia
- University of Eastern Piedmont, Novara, Italy
| | - G Patti
- University of Eastern Piedmont, Novara, Italy
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21
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Colombo C, Degiovanni A, Ghiglieno C, Maulini GM, Patti G. Early improvement of cardiac performance after atrial fibrillation direct current cardioversion. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Atrial fibrillation (AF) is the most common arrhythmia and one of the most prevalent cardiac disease. Restoring sinus rhythm improves long-term systolic and diastolic function, quality of life and relieve symptoms in patients with symptomatic AF.
Purpose
The aim of the study was to evaluate the early effects of AF direct current cardioversion on myocardial deformation using speckle-tracking echocardiography.
Methods
51 patients with persistent AF who underwent successful direct current cardioversion were enrolled (age: 70 ± 9 years; men: 72.5%). Patients with ischemic, dilatative, hypertrophic cardiomyopaties, valvular heart disease, previous cardiac interventions were excluded from the study. Left ventricular ejection fraction was 55.2 ± 7.0%. A transthoracic echocardiography was performed one day before the successful cardioversion and 6 hours after, employing 2d standard echocardiography and speckle-tracking technique to evaluate left atrial, left ventricular and free-wall right ventricular longitudinal strain.
Results
Restoration of sinus rhythm led to a reduction of the heart rate (83 ± 14 vs 70 ± 13 bpm, p < 0.001). After about six hours from successful AF direct current cardioversion, we highlighted an increase in left ventricular filling pressure estimated with the ratio E/E’ (8.19 ± 0.29 vs 9.34 ± 0.41, p = 0.0016). A significant increase in left atrial longitudinal strain (10.47 ± 0.64% vs 19.76 ± 1.01%, p < 0.001, Figure A) and in left ventricular longitudinal strain (-13.10 ± 0.60% vs -15.86 ± 0.51%, p < 0.001, Figure C) were noticed; also the free wall right ventricular longitudinal strain increased (-12.06 ± 1.16% vs -15.86 ± 1.29%, p = 0.047, Figure B).
Conclusion
Restoring sinus rhythm improves cardiac performance as evidenced by the increase in either left atrial and bi-ventricular longitudinal strain, suggesting an amelioration even if after early time. Abstract Figure
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Affiliation(s)
- C Colombo
- Hospital Maggiore Della Carita, Department of Thoracic, Heart and Vascular Diseases, Novara, Italy
| | - A Degiovanni
- Hospital Maggiore Della Carita, Department of Thoracic, Heart and Vascular Diseases, Novara, Italy
| | - C Ghiglieno
- Hospital Maggiore Della Carita, Department of Thoracic, Heart and Vascular Diseases, Novara, Italy
| | - GM Maulini
- University of Eastern Piedmont, Novara, Italy
| | - G Patti
- Hospital Maggiore Della Carita, Department of Thoracic, Heart and Vascular Diseases, Novara, Italy
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22
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Patti G, Pellegrino C, Ricciardi A, Novara R, Cotugno S, Papagni R, Guido G, Totaro V, De Iaco G, Romanelli F, Stolfa S, Minardi ML, Ronga L, Fato I, Lattanzio R, Bavaro DF, Gualano G, Sarmati L, Saracino A, Palmieri F, Di Gennaro F. Potential Role of Vitamins A, B, C, D and E in TB Treatment and Prevention: A Narrative Review. Antibiotics (Basel) 2021; 10:1354. [PMID: 34827292 PMCID: PMC8614960 DOI: 10.3390/antibiotics10111354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 12/26/2022] Open
Abstract
(1) Background: Tuberculosis (TB) is one of the world's top infectious killers, in fact every year 10 million people fall ill with TB and 1.5 million people die from TB. Vitamins have an important role in vital functions, due to their anti-oxidant, pro-oxidant, anti-inflammatory effects and to metabolic functions. The aim of this review is to discuss and summarize the evidence and still open questions regarding vitamin supplementation as a prophylactic measure in those who are at high risk of Mycobacterium tuberculosis (MTB) infection and active TB; (2) Methods: We conducted a search on PubMed, Scopus, Google Scholar, EMBASE, Cochrane Library and WHO websites starting from March 1950 to September 2021, in order to identify articles discussing the role of Vitamins A, B, C, D and E and Tuberculosis; (3) Results: Supplementation with multiple micronutrients (including zinc) rather than vitamin A alone may be more beneficial in TB. The WHO recommend Pyridoxine (vitamin B6) when high-dose isoniazid is administered. High concentrations of vitamin C sterilize drug-susceptible, MDR and extensively drug-resistant MTB cultures and prevent the emergence of drug persisters; Vitamin D suppresses the replication of mycobacterium in vitro while VE showed a promising role in TB management as a result of its connection with oxidative balance; (4) Conclusions: Our review suggests and encourages the use of vitamins in TB patients. In fact, their use may improve outcomes by helping both nutritionally and by interacting directly and/or indirectly with MTB. Several and more comprehensive trials are needed to reinforce these suggestions.
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Affiliation(s)
- Giulia Patti
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70123 Bari, Italy; (G.P.); (C.P.); (A.R.); (R.N.); (S.C.); (R.P.); (G.G.); (V.T.); (G.D.I.); (R.L.); (D.F.B.); (A.S.); (F.D.G.)
| | - Carmen Pellegrino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70123 Bari, Italy; (G.P.); (C.P.); (A.R.); (R.N.); (S.C.); (R.P.); (G.G.); (V.T.); (G.D.I.); (R.L.); (D.F.B.); (A.S.); (F.D.G.)
| | - Aurelia Ricciardi
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70123 Bari, Italy; (G.P.); (C.P.); (A.R.); (R.N.); (S.C.); (R.P.); (G.G.); (V.T.); (G.D.I.); (R.L.); (D.F.B.); (A.S.); (F.D.G.)
| | - Roberta Novara
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70123 Bari, Italy; (G.P.); (C.P.); (A.R.); (R.N.); (S.C.); (R.P.); (G.G.); (V.T.); (G.D.I.); (R.L.); (D.F.B.); (A.S.); (F.D.G.)
| | - Sergio Cotugno
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70123 Bari, Italy; (G.P.); (C.P.); (A.R.); (R.N.); (S.C.); (R.P.); (G.G.); (V.T.); (G.D.I.); (R.L.); (D.F.B.); (A.S.); (F.D.G.)
| | - Roberta Papagni
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70123 Bari, Italy; (G.P.); (C.P.); (A.R.); (R.N.); (S.C.); (R.P.); (G.G.); (V.T.); (G.D.I.); (R.L.); (D.F.B.); (A.S.); (F.D.G.)
| | - Giacomo Guido
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70123 Bari, Italy; (G.P.); (C.P.); (A.R.); (R.N.); (S.C.); (R.P.); (G.G.); (V.T.); (G.D.I.); (R.L.); (D.F.B.); (A.S.); (F.D.G.)
| | - Valentina Totaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70123 Bari, Italy; (G.P.); (C.P.); (A.R.); (R.N.); (S.C.); (R.P.); (G.G.); (V.T.); (G.D.I.); (R.L.); (D.F.B.); (A.S.); (F.D.G.)
| | - Giuseppina De Iaco
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70123 Bari, Italy; (G.P.); (C.P.); (A.R.); (R.N.); (S.C.); (R.P.); (G.G.); (V.T.); (G.D.I.); (R.L.); (D.F.B.); (A.S.); (F.D.G.)
| | - Federica Romanelli
- Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, 70124 Bari, Italy; (F.R.); (S.S.); (L.R.)
| | - Stefania Stolfa
- Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, 70124 Bari, Italy; (F.R.); (S.S.); (L.R.)
| | - Maria Letizia Minardi
- Infectious Diseases Clinic, University Hospital “Tor Vergata”, Department of Systems Medicine, University of Rome Tor Vergata, 00173 Rome, Italy; (M.L.M.); (I.F.); (L.S.)
| | - Luigi Ronga
- Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, 70124 Bari, Italy; (F.R.); (S.S.); (L.R.)
| | - Ilenia Fato
- Infectious Diseases Clinic, University Hospital “Tor Vergata”, Department of Systems Medicine, University of Rome Tor Vergata, 00173 Rome, Italy; (M.L.M.); (I.F.); (L.S.)
| | - Rossana Lattanzio
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70123 Bari, Italy; (G.P.); (C.P.); (A.R.); (R.N.); (S.C.); (R.P.); (G.G.); (V.T.); (G.D.I.); (R.L.); (D.F.B.); (A.S.); (F.D.G.)
| | - Davide Fiore Bavaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70123 Bari, Italy; (G.P.); (C.P.); (A.R.); (R.N.); (S.C.); (R.P.); (G.G.); (V.T.); (G.D.I.); (R.L.); (D.F.B.); (A.S.); (F.D.G.)
| | - Gina Gualano
- National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00161 Rome, Italy;
| | - Loredana Sarmati
- Infectious Diseases Clinic, University Hospital “Tor Vergata”, Department of Systems Medicine, University of Rome Tor Vergata, 00173 Rome, Italy; (M.L.M.); (I.F.); (L.S.)
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70123 Bari, Italy; (G.P.); (C.P.); (A.R.); (R.N.); (S.C.); (R.P.); (G.G.); (V.T.); (G.D.I.); (R.L.); (D.F.B.); (A.S.); (F.D.G.)
| | - Fabrizio Palmieri
- National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00161 Rome, Italy;
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70123 Bari, Italy; (G.P.); (C.P.); (A.R.); (R.N.); (S.C.); (R.P.); (G.G.); (V.T.); (G.D.I.); (R.L.); (D.F.B.); (A.S.); (F.D.G.)
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23
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Pastore MC, Cameli P, Mandoli GE, D'Alessandro M, De Carli G, Vigna M, Bergantini L, Patti G, Bargagli E, Cameli M. Speckle tracking echocardiography as a promising tool for the prognostic assessment of patients with sarcoidosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Sarcoidosis is a chronic granulomatous disease characterized by multiorgan inflammatory involvement and recurrent relapses with significant impact on morbidity and mortality. The prognostic assessment of these patients is still challenging. Although the international guidelines didn't recommend basic transthoracic echocardiography (TTE) for diagnostic and prognostic assessment of sarcoidosis, speckle tracking echocardiography (STE) has emerged as more sensitive for the early detection of cardiac sarcoidosis and outcome.
Purpose
This prospective study aimed to assess the potential value of STE parameters for the prediction of major adverse cardiac events (MACE) and sarcoidosis relapse.
Methods
Consecutive patients with confirmed diagnosis of sarcoidosis who underwent transthoracic echocardiography (TTE) and subsequent pulmonary function tests (PFTs) were enrolled. Patients with acute events or treatment escalation between TTE and PFTs and previous cardiac surgery were excluded. All patients were followed for sarcoidosis relapse requiring increase in step-up therapy and MACE (cardiovascular death, cardiovascular hospitalizations, arrhythmias).
Results
172 patients were included (111 females, 57.4±12.6 years); 56 patients showed extrapulmonary localizations of sarcoidosis; at baseline, 99 patients were on steroid and/or immunosuppressive therapy. During a median follow up of 2217 days, 8 deaths (3 cardiovascular deaths), 23 MACE and 36 sarcoidosis relapses were reported. Patients with MACE were older (p=0.0022), but didn't show significant differences in PFTs and sarcoidosis phenotype. LV global longitudinal strain (GLS) was the only echocardiographic index to show significant differences (lower values) in patients with MACE (p=0.025). LV GLS ≤17.13% (absolute value) was identified as a fair predictor of MACE both with ROC curves (AUC=0.64) and Kaplan Meier analysis (Fig. 1).
No significant differences of demographic, clinical, functional, and therapeutic data were observed between patients with/without sarcoidosis relapse. TTE revealed a significant reduction of LV ejection fraction (p=0.0432), tricuspid annular plane systolic excursion (TAPSE, p=0.0272) and global peak atrial longitudinal strain (PALS, p=0.0012) in patients with relapse. Among these 3 parameters, PALS ≤28.5% showed to be the best predictor of sarcoidosis relapse with ROC (AUC=0.7155) and Kaplan Meier curves (Fig. 2).
Conclusions
Our results highlight a potential role of LV GLS and PALS as prognostic markers in sarcoidosis, suggesting the use of STE in the clinical management of these patients, regardless the evidence or the suspect of cardiac localizations of the disease.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- M C Pastore
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - P Cameli
- University of Siena, Respiratory Diseases and Lung Transplantation, Siena, Italy
| | - G E Mandoli
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M D'Alessandro
- University of Siena, Respiratory Diseases and Lung Transplantation, Siena, Italy
| | - G De Carli
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M Vigna
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - L Bergantini
- University of Siena, Respiratory Diseases and Lung Transplantation, Siena, Italy
| | - G Patti
- University of Eastern Piedmont, Novara, Italy
| | - E Bargagli
- University of Siena, Respiratory Diseases and Lung Transplantation, Siena, Italy
| | - M Cameli
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
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24
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Marino P, Zanaboni J, Degiovanni A, Patti G, Fraser A. Left atrial conduit flow rate at baseline and during exercise: an index of impaired relaxation in patients with heart failure and preserved ejection fraction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In healthy subjects, adrenergic stimulation augments left ventricular (LV) long-axis shortening/lengthening, and increases left atrial (LA) to LV intracavitary pressure gradients in early diastole. Lower increments are observed in patients with heart failure with preserved ejection fraction (HFpEF).
Purpose
We hypothesized that exercise in HFpEF would similarly impair passive LV filling in early-mid diastole, during conduit flow from pulmonary veins.
Methods
Twenty HFpEF patients (67.8±9.8 years; 11 women), diagnosed according to 2007 ESC recommendations, underwent ramped semi-supine bicycle exercise to submaximal target heart rate (∼100) or symptoms. Seventeen asymptomatic subjects (64.3±8.9 years; 7 women) served as controls. Simultaneous LA and LV volumes were measured from pyramidal 3D echocardiographic full-volume datasets acquired from apical window at baseline and during stress, together with brachial arterial pressure. LA conduit function was computed, from minimum LV volume to ECG P wave, as [LV volume (time) – LV minimum volume] – [LA maximum volume – LA volume (time)] and expressed as average flow rate. The slope of the single-beat preload recruitable stroke work (PRSW) quantified LV inotropic state.
Results
There were divergent responses in conduit flow rate, which increased by 40% during exercise in control subjects (+17.8±37.3 ml/s) but decreased by 18% in patients with HFpEF (−9.6±42.3 ml/s) (p=0.046); increments during stress correlated with PRSW slope changes (p=0.003).
Conclusion
In HFpEF conduit flow rate decreases when diastolic dysfunction develops during exercise, in parallel with LV inotropic state changes, thereby contributing to impaired stroke volume reserve. Conduit flow can be measured as a marker of LV relaxation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Marino
- University of Eastern Piedmont, Novara, Italy
| | - J Zanaboni
- University of Eastern Piedmont, Novara, Italy
| | - A Degiovanni
- Maggiore Della Carita Hospital, Department of Cardiology, Novara, Italy
| | - G Patti
- University of Eastern Piedmont, Novara, Italy
| | - A Fraser
- University of Wales College of Medicine, Cardiff, United Kingdom
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25
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Cavallari I, Patti G, Maddaloni E, Veneziano F, Mangiacapra F, Ricottini E, Ussia GP, Grigioni F. Association between platelet reactivity and long-term bleeding complications following percutaneous coronary intervention in patients with and without diabetes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The association between diabetes mellitus (DM) and bleeding complications following percutaneous coronary intervention (PCI) is controversial. We hypothesized that on-treatment platelet reactivity may have a role in the bleeding risk stratification of such patients.
Purpose
To investigate the role of low platelet reactivity (LPR) in the long-term bleeding risk stratification among patients with and without diabetes undergoing PCI.
Methods
In this observational, retrospective single-center study, 472 patients undergoing PCI for stable coronary artery disease were included. All patients were treated with dual antiplatelet therapy with aspirin and clopidogrel. Platelet reactivity was assessed using the VerifyNow P2Y(12) assay and LPR was defined by values of platelet reactivity unit (PRU) ≤178. Primary endpoint was the occurrence of all bleeding events at 5 years stratified by DM status and LPR.
Results
Out of the study population included, 30.5% had DM (N=144). LPR was numerically less frequent in patients with DM compared to those without (29.2% vs 37.6%; p=0.077). Overall, 11.9% of patients experienced a bleeding complication at 5-year follow-up; 44.6% of events were classified as major bleedings. The incidence of bleeding events per 1000 patients-year was 34.5 (95% CI 22.3–53.5) in DM and 24.2 (95% CI 17.3–33.8) in no DM (p=0.24). A stepwise increase in the crude rates of bleeding complications was observed across patients with and without DM and LPR (log-rank p=0.004), with those having both conditions being at the highest risk of events (Figure). LPR had a similar value for stratifying the risk of bleeding in patients with and without diabetes (p value for interaction between diabetes and LPR status=0.45).
Conclusions
Approximately 1 out of 3 patients undergoing PCI for stable coronary artery disease on clopidogrel has LPR. The assessment of LPR provides a significant incremental value for the prediction of bleeding events irrespective from DM status. While the presence of DM per se does not increase the risk of bleeding complications, the coexistence of DM and LPR identifies the subgroup at the highest risk of events who could benefit from a short-term and less intensive antiplatelet regimen.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Cavallari
- University Campus Bio-Medico of Rome, Rome, Italy
| | - G Patti
- University of Eastern Piedmont, Novara, Italy
| | - E Maddaloni
- University Campus Bio-Medico of Rome, Rome, Italy
| | - F Veneziano
- University Campus Bio-Medico of Rome, Rome, Italy
| | | | - E Ricottini
- University Campus Bio-Medico of Rome, Rome, Italy
| | - G P Ussia
- University Campus Bio-Medico of Rome, Rome, Italy
| | - F Grigioni
- University Campus Bio-Medico of Rome, Rome, Italy
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Dell'Era G, Gravellone M, Scacchi S, Franzone PC, Pavarino LF, Boggio E, Prenna E, De Vecchi F, Occhetta E, Devecchi C, Patti G. A clinical-in silico study on the effectiveness of multipoint bicathodic and cathodic-anodal pacing in cardiac resynchronization therapy. Comput Biol Med 2021; 136:104661. [PMID: 34332350 DOI: 10.1016/j.compbiomed.2021.104661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/16/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022]
Abstract
Up to one-third of patients undergoing cardiac resynchronization therapy (CRT) are nonresponders. Multipoint bicathodic and cathodic-anodal left ventricle (LV) stimulations could overcome this clinical challenge, but their effectiveness remains controversial. Here we evaluate the performance of such stimulations through both in vivo and in silico experiments, the latter based on computer electromechanical modeling. Seven patients, all candidates for CRT, received a quadripolar LV lead. Four stimulations were tested: right ventricular (RVS); conventional single point biventricular (S-BS); multipoint biventricular bicathodic (CC-BS) and multipoint biventricular cathodic-anodal (CA-BS). The following parameters were processed: QRS duration; maximal time derivative of arterial pressure (dPdtmax); systolic arterial pressure (Psys); and stroke volume (SV). Echocardiographic data of each patient were then obtained to create an LV geometric model. Numerical simulations were based on a strongly coupled Bidomain electromechanical coupling model. Considering the in vivo parameters, when comparing S-BS to RVS, there was no significant decrease in SV (from 45 ± 11 to 44 ± 20 ml) and 6% and 4% increases of dPdtmax and Psys, respectively. Focusing on in silico parameters, with respect to RVS, S-BS exhibited a significant increase of SV, dPdtmax and Psys. Neither the in vivo nor in silico results showed any significant hemodynamic and electrical difference among S-BS, CC-BS and CA-BS configurations. These results show that CC-BS and CA-BS yield a comparable CRT performance, but they do not always yield improvement in terms of hemodynamic parameters with respect to S-BS. The computational results confirmed the in vivo observations, thus providing theoretical support to the clinical experiments.
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Affiliation(s)
- G Dell'Era
- Cardiologia 1, Azienda Ospedaliera Universitaria "Maggiore Della Carità", Novara, Italy
| | - M Gravellone
- Divisione di Cardiologia, Ospedale Degli Infermi, Biella, Italy
| | - S Scacchi
- Dipartimento di Matematica, Università Degli Studi di Milano, Via Saldini 50, 20133, Milano, Italy.
| | - P Colli Franzone
- Dipartimento di Matematica, Università Degli Studi di Pavia, Via Ferrata 1, 27100, Pavia, Italy
| | - L F Pavarino
- Dipartimento di Matematica, Università Degli Studi di Pavia, Via Ferrata 1, 27100, Pavia, Italy
| | - E Boggio
- Divisione di Cardiologia, Ospedale Degli Infermi, Biella, Italy
| | - E Prenna
- Cardiologia 1, Azienda Ospedaliera Universitaria "Maggiore Della Carità", Novara, Italy
| | - F De Vecchi
- Divisione di Cardiologia, Ospedale Sant'Andrea, Vercelli, Italy
| | - E Occhetta
- Divisione di Cardiologia, Ospedale Sant'Andrea, Vercelli, Italy
| | - C Devecchi
- Divisione di Cardiologia, Ospedale Sant'Andrea, Vercelli, Italy
| | - G Patti
- Cardiologia 1, Azienda Ospedaliera Universitaria "Maggiore Della Carità", Novara, Italy; Dipartimento di Medicina Traslazionale, Università Del Piemonte Orientale, Novara, Italy
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Gresele P, Guglielmini G, Del Pinto M, Calabrò P, Pignatelli P, Patti G, Pengo V, Antonucci E, Cirillo P, Fierro T, Palareti G, Marcucci R. Peripheral arterial disease has a strong impact on cardiovascular outcome in patients with acute coronary syndromes: from the START Antiplatelet registry. Int J Cardiol 2020; 327:176-182. [PMID: 33152418 DOI: 10.1016/j.ijcard.2020.10.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/24/2020] [Accepted: 10/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Peripheral arterial disease (PAD) was reported to increase the risk of new cardiovascular events in patients with acute coronary syndromes (ACS). However, most of the evidence comes from randomized clinical trials. We aimed to assess the impact of PAD on cardiovascular outcome and treatment decisions in ACS patients in a current real-life setting. METHODS START-ANTIPLATELET is a multicenter registry enrolling ACS patient. Baseline clinical characteristics and treatment at discharge were recorded and follow-up was repeated at 6-months and 1-year. PAD was defined as intermittent claudication and/or previous revascularization. RESULTS Among 1442 patients enrolled, 103 (7.1%) had PAD. PAD patients were older (71.8 ± 10.6vs66.2 ± 12.6 yrs., p < 0.0001), more frequently hypertensive (90.3vs68.6%, p< 0.0001), hypercholesterolemic (66vs52%, p= 0.037), diabetic (51.5vs24%, p= 0.0001), obese (28.2vs19.3%, p= 0.029) and with previous TIA (7.8vs2.8%, p= 0.005) or stroke (11.7vs3.1%, p< 0.0001). Clinical presentation and acute treatment were similar in non-PAD and PAD patients, but the latter were discharged significantly less frequently on dual antiplatelet therapy (DAPT) (68.9vs85%, p= 0.005). After a median follow-up time of 11.1 months, major cardio/cerebrovascular event-free survival [MACCE, including cardiovascular death, MI, TIA and stroke, target-vessel revascularization (TVR) and major arterial ischemic events] was significantly shorter (9.0vs11.2 months, p= 0.02; HR 3.2, 2.4-8.4) in PAD patients and net adverse cardiovascular events (NACE = MACCE plus major hemorrhages) were significantly more frequent (19.1%vs10.5%, p = 0.049). CONCLUSIONS PAD identifies a subgroup of ACS patients at significantly increased cardiovascular risk, but these patients tend to be undertreated. Patients admitted for ACS should be screened for PAD and optimal medical therapy at discharge should be implemented.
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Affiliation(s)
- P Gresele
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy.
| | - G Guglielmini
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - M Del Pinto
- Division of Cardiology, Perugia Hospital, Italy
| | - P Calabrò
- Department of Translational Medical Sciences University of Campania "Luigi Vanvitelli", Naples, Italy
| | - P Pignatelli
- Department of Clinical, Internistic, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - G Patti
- Department of Traslational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - V Pengo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - E Antonucci
- Arianna Anticoagulazione Foundation, Bologna, Italy
| | - P Cirillo
- Division of Cardiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - T Fierro
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - G Palareti
- Arianna Anticoagulazione Foundation, Bologna, Italy
| | - R Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Italy
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28
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Cavallari I, Sagazio E, Antonucci E, Calabro' P, Gragnano F, Cirillo P, Gresele P, Palareti G, Pengo V, Pignatelli P, Marcucci R, Patti G. Ischemic and bleeding risk stratification in diabetic patients after acute coronary syndrome based on insulin requirement. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Diabetes is a known risk factor for a first or recurrent cardiovascular event, however, its association with an increased risk of bleeding is controversial. To date, no study has explored the prognostic weight of insulin therapy in the setting of ACS.
Purpose
To investigate the differential role of insulin versus no insulin therapy on ischemic and bleeding risks in patients with diabetes and ACS.
Methods
START-ANTIPLATELET is a prospective, real-world multicenter registry including consecutive patients admitted for ACS. For the purpose of this analysis, patients were stratified according to diabetes status and insulin therapy. We compared 1-year rates of major adverse cardiovascular events, a composite of cardiovascular death, myocardial infarction and stroke, and of any bleeding, according to diabetes status (no diabetes, diabetes not on insulin therapy, diabetes on insulin therapy). In addition, we evaluated the net clinical benefit of dual antiplatelet therapy with the newer P2Y12 inhibitors (ticagrelor or prasugrel) vs dual antiplatelet therapy with clopidogrel according to diabetes status.
Results
In an overall population of 907 patients, 198 had diabetes, 10.6% of whom were on insulin. From non-diabetic patients to diabetic patients not on insulin and diabetic patients on insulin there was a stepwise decrease of MACE-free survival (log-rank p 0.039) with incidence of events at 1 year being 3.8%, 6.8% (adjusted p vs no diabetes 0.49) and 12.5% (adjusted p vs no diabetes 0.047), respectively (Figure, panel A). The rates of any bleeding were higher in patients on insulin (20.8% vs 8.8% in those without diabetes and 5.8% in diabetic patients not receiving insulin; log-rank p 0.028; Figure, panel B). Multivariable analysis demonstrated an almost 5-fold increase of any bleeding in diabetic patients with vs without insulin (OR 4.98, 95% CI 1.46–16.92; p=0.010). In the overall population, the incidence of the net composite endpoint including MACE or major bleeding with the use of ticagrelor/prasugrel on top of aspirin was significantly lower compared to use of clopidogrel (4.7% vs 8.4%; OR 0.54, 95% CI 0.30–0.94, p=0.031). This net clinical benefit in patients receiving a newer P2Y12 inhibitor was regardless of the diabetes status (p for interaction 0.48).
Conclusions
In this cohort of ACS patients, the presence of diabetes stratified by insulin therapy was associated with a graded increase in the 1-year rates of MACE. Conversely, insulin therapy significantly contributed to the overall increase of bleeding risk in diabetes.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- I Cavallari
- Campus Bio-Medico University of Rome, Cardiovascular Sciences, Rome, Italy
| | - E Sagazio
- University of Eastern Piedmont, Novara, Italy
| | - E Antonucci
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - P Calabro'
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - F Gragnano
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - P Cirillo
- Parthenope University of Naples, Naples, Italy
| | - P Gresele
- University of Perugia, Perugia, Italy
| | - G Palareti
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - V Pengo
- University of Padua, Padova, Italy
| | | | | | - G Patti
- University of Eastern Piedmont, Novara, Italy
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29
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Lio V, Pasceri V, Di Lullo L, Russo V, Fimiani F, Calabro' P, Petroni R, Grimaldi M, Renda G, Pignatelli P, Romano S, Penco M, Patti G. Clinical outcome with NOACs vs VKAs in patients with atrial fibrillation and severe chronic kidney disease: results of a retrospective, multicenter, real-world study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with atrial fibrillation (AF) and severe chronic kidney disease (CKD) are at higher risk of both bleeding and thromboembolic events. Non-vitamin K antagonist oral anticoagulants (NOACs) are licensed to be used in these patients, although they were excluded from phase III controlled randomized trials comparing NOACs vs warfarin in AF. Thus, current evidence on NOACs use in such setting of patients is not definitive.
Purpose
Aim of our multicenter study was to perform a real-world comparison of clinical outcome with NOACs vs vitamin K antagonist anticoagulants (VKAs) also in AF patients having an estimated glomerular filtration rate (eGFR) 15–29 mL/min.
Methods
We retrospectively included a total of 266 patients receiving NOACs (N=159) or VKAs (N=107). Primary outcome measure was the cumulative incidence of the net composite endpoint including ischemic stroke, systemic thromboembolism or any bleeding. Mean follow-up was 2.6 years.
Results
CHA2DS2-VASc and HAS-BLED scores at baseline were similar in the two groups (3.4±1.3 with NOACs vs 3.4±0.9 with VKAs and 3.1±1.0 vs 3.0±0.7, respectively); eGFR and hemoglobin values were also comparable (31.8±12.3 vs 32±11.9 mL/min and 10.2±2.1 vs 11.0±2.3 g/dL, respectively). NOACs were not inferior to VKAs for the primary net composite endpoint: incidence 20.7% vs 29.9%, p<0.01 for non-inferiority, p=0.11 for superiority. In proportional Cox regression model, hazard ratio for the primary outcome measure with NOACs use was 0.74 (95% CI 0.45–1.21, p=0.22). In the NOAC group there was a trend towards reduction in minor bleeding complications (p=0.08).
Conclusions
Our real-world data indicate that in patients with AF and severe renal failure NOACs are not inferior to VKAs for both safety and efficacy. The use of NOACs was associated with a numerically lower incidence of minor bleeding.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- V Lio
- University of Eastern Piedmont, Cardiology Department, Novara, Italy
| | - V Pasceri
- San Filippo Neri Hospital, Rome, Italy
| | - L Di Lullo
- L. Parodi - Delfino Hospital, Rome, Italy
| | - V Russo
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - F Fimiani
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - P Calabro'
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - R Petroni
- University della Campania Luigi Vanvitelli, Naples, Italy
| | | | - G Renda
- Regional General Hospital F. Miulli, Acquaviva Delle Fonti, Italy
| | | | - S Romano
- Sapienza University of Rome, Rome, Italy
| | - M Penco
- University of L'Aquila, L'Aquila, Italy
| | - G Patti
- University of Eastern Piedmont, Cardiology Department, Novara, Italy
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30
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Gravellone M, Dell' Era G, De Vecchi F, Boggio E, Prenna E, Devecchi C, Matta M, Barbonaglia L, Occhetta E, Patti G, Rametta F. Cathodic-anodal left ventricular stimulation during cardiac resynchronization therapy: haemodynamic evaluation and electrocardiographic analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac resynchronization therapy (CRT) is an established treatment for heart failure with reduced ejection fraction (HFrEF). However, one third of patients are “non responders”. Cathodic-anodal (CA) left ventricle (LV) capture is a multisite pacing occurring during CRT using both bipolar and quadripolar LV lead. It allows depolarization to arise simultaneously from the cathode and the anode of the bipole located on the LV epicardium, activating a larger volume of myocardium than cathodal pacing alone, thus potentially improving electromechanical synchrony (figure 1). We have previously proven that CA-LV stimulation is feasible and similar to bicathodic multipoint pacing (MPP) in terms of QRS wavefront activation.
Purpose
We aimed to evaluate both the acute intraprocedural haemodynamic and electrical effects of CA biventricular stimulation (CA-BS), comparing it with right-ventricle only pacing (Right Ventricle-Stimulation: RV-S), single-point CRT (Single Point-Biventricular Stimulation: SP-BS) and multipoint bicathodic biventricular stimulation (Multi Point-Biventricular Stimulation:MP-BS) in de novo CRT implants.
Methods
Ten patients candidates to CRT (LV ejection fraction ≤35% and left bundle branch block) received a quadripolar LV lead. Four pacing configurations were tested: RV-S, SP-BS, MP-BS and CA-BS, where cathode and the anode were the same electrodes used as cathodes in MP-BS. QRS duration by 12-lead ECG was defined as the time from the earliest ventricular deflection until the return to the isoelectric line. Haemodynamic assessment by radial artery catheterization using Pressure Recording Analytical Method processed the following parameters: dP/dT max (mmHg/msec), systolic arterial pressure (aPsys, mmHg), diastolic arterial pressure (aPdia, mmHg), mean arterial pressure (aPmean, mmHg), Cardiac Index (CI, l/min/m2), Stroke Volume Index (SVI, ml/min/m2).
Results
dP/dT max and aPmean increased significantly from RV-S to SP-BS (mean dP/dT max 0,82±0,28 versus 0,87±0,29 mmHg/msec, p=0,02; mean aPmean 89±19 versus 93±20 mmHg, p=0,01), but not from RV-S to MP-BS. Comparing RV-S to CA-BS, only aPmean exhibited a significant increase (mean aPmean 89±19 versus 92±20 mmHg, p=0,01). There were no haemodynamic differences between SP-BS, MP-BS and CA-BS. QRS duration reduced significantly from RV-S (167±10 msec) to each biventricular stimulation (135±14 msec, p=0,0002 for SP-BS; 130±17 msec, p=0,0001 for MP-BS; 129±18 msec, p=0,0002 for CA-BS) and from SP-BS to MP-BS and CA-BS (p=0,03 for both), whereas there were no difference comparing MP-BS and CA-BS.
Conclusions
CA-LV stimulation is not superior to single-point CRT in terms of acute haemodynamic performance, whereas it reduces the duration of ventricular electrical activation, showing an electrohaemodynamic mismatch. Long-term studies are needed to evaluate if acute electrical benefits of CA stimulation can predict chronic benefits, in terms of reverse cardiac remodelling.
Cathodic-anodal left ventricular capture
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Gravellone
- Sant'Andrea Hospital, Division of Cardiology, Vercelli, Italy
| | - G Dell' Era
- Hospital Maggiore Della Carita, Division of Cardiology, Novara, Italy
| | - F De Vecchi
- Sant'Andrea Hospital, Division of Cardiology, Vercelli, Italy
| | - E Boggio
- Ospedale degli Infermi, Division of Cardiology, Biella, Italy
| | - E Prenna
- Hospital Maggiore Della Carita, Division of Cardiology, Novara, Italy
| | - C Devecchi
- Sant'Andrea Hospital, Division of Cardiology, Vercelli, Italy
| | - M Matta
- Sant'Andrea Hospital, Division of Cardiology, Vercelli, Italy
| | - L Barbonaglia
- Sant'Andrea Hospital, Division of Cardiology, Vercelli, Italy
| | - E Occhetta
- Sant'Andrea Hospital, Division of Cardiology, Vercelli, Italy
| | - G Patti
- Hospital Maggiore Della Carita, Division of Cardiology, Novara, Italy
| | - F Rametta
- Sant'Andrea Hospital, Division of Cardiology, Vercelli, Italy
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31
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Moscarella E, Calabro P, Gragnano F, Cesaro A, Pafundi P, Patti G, Cavallari I, Antonucci E, Cirillo P, Pignatelli P, Palareti G, Sasso F, Pengo V, Gresele P, Marcucci R. Effect of body mass index on ischemic and bleeding events in patients presenting with acute coronary syndromes: insights from the START-ANTIPLATELET registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The protective effect of obesity on mortality in acute coronary syndromes (ACS) patients remains debated. We aimed at evaluating the impact of obesity on ischemic and bleeding events as possible explanations to the obesity paradox in ACS patients.
Methods
For the purpose of this sub-study, patients enrolled in the START-ANTIPLATELET registry were stratified according to Body Mass Index (BMI) into three groups: normal, BMI <25kg/m2; overweight, BMI: 25–29.9kg/m2; obese, BMI ≥30kg/m2. The primary endpoint was net adverse clinical endpoints (NACE), defined as a composite of all-cause death, myocardial infarction (MI), stroke, and major bleeding.
Results
Patients were classified as follows: 410 (33.9%) normal, 538 (44.5%) overweight, 261 (21.6%) obese. Compared to the normal weight group, obese and overweight patients had a higher prevalence of cardiovascular risk factors, but were younger, with a better left ventricular ejection fraction (LVEF) and lower PRECISE-DAPT score. At one-year follow-up NACE was more frequently observed in normal than in overweight and obese patients (15.1%,8.6%,and9.6%, respectively; p=0.004), driven by a significantly higher rate of all-cause death (6.3%,2.6%, and 3.8%, respectively; p=0.008), while no significant differences were noted in terms of MI, stroke, and major bleeding. When correcting for confounding variables, BMI loses its power in independently predicting outcomes, failing to confirm the obesity paradox in a real-world ACS population.
Conclusions
Our study conflicts the obesity paradox in real-world ACS population, and suggest that the reduced mortality rate may be explained by a lower bleeding risk in obese patients allowing a more aggressive medical treatment, and by a better LVEF translating into a higher survival rate.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Moscarella
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - P Calabro
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - F Gragnano
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - A Cesaro
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - P.C Pafundi
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - G Patti
- University of L'Aquila, L'Aquila, Italy
| | | | | | | | | | | | - F.C Sasso
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - V Pengo
- General University Hospital of Alicante, Alicante, Spain
| | - P Gresele
- University of Perugia, Perugia, Italy
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32
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Gragnano F, Moscarella E, Calabro' P, Cesaro A, Pafundi P, Patti G, Antonucci E, Cirillo P, Pignatelli P, Palareti G, Pelliccia F, Sasso F, Pengo V, Gresele P, Marcucci R. Ticagrelor versus Clopidogrel in high bleeding risk patients presenting with Acute Coronary Syndromes: insights from the multicenter START-ANTIPLATELET registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Optimal dual antiplatelet therapy in high bleeding risk (HBR) patients with acute coronary syndromes (ACS) remains debated. Although current guidelines recommend the use of potent P2Y12 inhibitors in these patients (according to the labeled indications), clopidogrel is frequently used in clinical practice based on a perceived advantage in terms of safety in the HBR population.
Purpose
We sought to investigate the use of clopidogrel versus ticagrelor in consecutive HBR ACS patients and their impact on ischemic and bleeding events at 1 year.
Methods
ACS patients enrolled in the START-ANTIPLATELET registry with at least 1 HBR criterion were included in the present analysis and stratified according to DAPT type (clopidogrel versus ticagrelor). The primary endpoint was net adverse clinical endpoint (NACE), defined as a composite of all-cause death, myocardial infarction, stroke, and major bleeding. The secondary endpoints were major adverse cardiac and cerebral events (MACE), defined as a composite of all-cause death, myocardial infarction and stroke, each individual component of NACE and MACE, and target vessel revascularization.
Results
Among a total of 1,209 patients with 1-year follow-up in the registry, 383 patients were considered at HBR, of whom 174 (45.4%) were on clopidogrel and 209 (54.6%) on ticagrelor. Clopidogrel was more likely to be administered in patients at increased ischemic and bleeding risk, while ticagrelor in those undergoing percutaneous coronary intervention. Mean DAPT duration was longer in the ticagrelor group than in the clopidogrel group (10.40±4.29 versus 9.35±5.4; p-value=0.03). At 1-year follow-up, the risk of NACE and MACE events was significantly higher in the clopidogrel than in the ticagrelor group (NACE: HR 1.82; 95% CI 1.07–3.09; p-value=0.02; MACE: HR 1.83; 95% CI 1.04–3.24; p-value=0.03) (Figure). After multivariate adjustment for clinical and procedural characteristics, no difference in NACEs nor MACEs was observed between patients on clopidogrel versus ticagrelor (NACE: adjusted HR 1.27; 95% CI 0.71–2.27; p-value=0.42; MACE: adjusted HR 1.19; 95% CI 0.63–2.24; p-value=0.59) (Figure). Age, number of HBR criteria, and mean DAPT duration were independent predictors of NACEs.
Conclusions
In a real-world ACS registry, approximately 50% of patients are at HBR and frequently treated with clopidogrel. In HBR ACS patients, no difference was observed in ischemic and bleeding events between clopidogrel and ticagrelor after adjustment for potential confounders.
Kaplan-Meier curves at 1-year follow-up.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- F Gragnano
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - E Moscarella
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - P Calabro'
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - A Cesaro
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - P.C Pafundi
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - G Patti
- University of Eastern Piedmont, Novara, Italy
| | | | - P Cirillo
- Federico II University of Naples, Naples, Italy
| | | | | | | | - F.C Sasso
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - V Pengo
- University of Padova, Padua, Italy
| | - P Gresele
- University of Perugia, Perugia, Italy
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33
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Degiovanni A, Gravellone M, Erbetta R, Dell' Era G, Marino P, Patti G. Acute response to cardiac re-synchronization therapy: ventricular properties adaptation? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac re-synchronization therapy (CRT) reduces mortality and hospitalization in patients with heart failure, reduced left ventricular ejection fraction (LVEF) and left bundle branch block (LBBB). However, there is no conclusive evidence on baseline parameters able to discriminate responder vs non-responder patients.
Purpose
In this study, we tested whether echocardiographic parameters describing LV dyssynchrony and efficiency may predict an acute LV recovery after CRT and whether lead position can modify such relationship.
Methods
We enrolled 65 consecutive patients (75% males, aged 71.2±10.5 years) referred for CRT according to current guidelines; 45% had an underlying ischaemic cardiopathy and 1/3 of them presented diabetes mellitus. We performed a CRT-off and CRT–on 2D and 3D echocardiography during devices optimization (time between programming change 10/12 min). We evaluated ventricular dyssynchrony by speckle-tracking analysis based on temporary uniformity of strain (TUS) 3D longitudinal and circumferential. We also derived non-invasive myocardial efficiency (Effic) by interaction between pressure work index (PWI), representing an estimation of myocardial oxygen consumption, and mechanical external work. We indicated as concordant those patients presenting a LV lead position (defined from a chest X-ray using 2 orthogonal views) in the same segment as the latest systolic 3D circumferential strain curves.
Results
In the CRT-on phase, a non-statistically significant raise in LVEF was observed [from 0.37 (0.28–0.46) to 0.41 (0.34–0.47), p=0.27]. No improvement in both longitudinal and circumferential 3D TUS was demonstrated during CRT-on (p=0.44 and 0.47, respectively). Conversely, the gain in Effic from CRT-off to CRT-on phase was overall significant (from 0.43±0.14 to 0.50±0.16; p<0.001). After switching to CRT-on, the increase in longitudinal 3D TUS was higher in concordant compared to discordant patients (from 0.83±0.08 to 0.87±0.07 vs 0.88±0.11 to 0.87±0.12, respectively), but without significant interaction (interaction p 0.24). No interaction was also found between variations of PWI after switching to CRT-on and LV lead position (concordant: from 12.99±4.18 to 12.84±2.99 ml/min/100g; discordant: from 13.58±3.89 to 13.95±3.97 ml/min/100g; interaction p 0.75).
Conclusions
Effic was overall acutely augmented during CRT-on phase in patients with LV dysfunction undergoing cardiac re-synchronization. In the acute phase, no significant relationship between LV changes in speckle-tracking analyses after CRT and LV lead position was found.
2-way ANOVA for myocardial efficiency
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Degiovanni
- University of Eastern Piedmont, Department of Cardiology, Novara, Italy
| | | | - R Erbetta
- University of Eastern Piedmont, Department of Cardiology, Novara, Italy
| | - G Dell' Era
- University of Eastern Piedmont, Department of Cardiology, Novara, Italy
| | - P.N Marino
- University of Eastern Piedmont, Department of Cardiology, Novara, Italy
| | - G Patti
- University of Eastern Piedmont, Department of Cardiology, Novara, Italy
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Morrone D, Kroep S, Ricci F, Renda G, Patti G, Kirchhof P, Chuang L, Van Hout B, De Caterina R. Additive predictive power of the CHA2DS2-VASc and HAS-BLED scores for mortality in patients with atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and objectives
In atrial fibrillation (AF), assessment of thromboembolic and bleeding risks are recommended to prescribe anticoagulation for stroke prevention. However, AF also increases mortality, and predictors of death are less characterized than predictors for stroke. We investigated the predictive power for mortality of the CHA2DS2-VASc, the HAS-BLED score and their combination.
Methods
Individual patient data were analyzed from the PREvention oF thromboembolic events-European Registry in Atrial Fibrillation (PREFER AF), a prospective real-world registry with a 12-month follow-up, with a total of 7243 patients enrolled from 461 hospitals and 7 European countries (Austria, France, Germany, Italy, Spain, Switzerland, and United Kingdom). Logistic regression was used to analyze the relationship of the CHA2DS2-VASc and HAS-BLED scores, and their combinations with outcome events, including mortality, at one year. The predictive ability of the scores was analyzed by comparing c-statistics.
Results
The study sample consisted of 5,209 AF patients with complete information on both scores. Mean age was 71.8±10.46 years; 3145 subjects (60.4%) were male. Events rate of stroke/SEE and major bleeding at one-year were 2.3% (122 patients) and 2.9% (149 patients), respectively. At one year, 3.1% of patients died (160 out of 5,209). Both scores had broadly similar c-statistics; for CHA2DS2-VASc: 0.637, 0.656 and 0.616 for models predicting mortality, SSE and major bleeding, respectively; for HAS-BLED: 0.620, 0.647, and 0.627, respectively. When including the individual components of both scores separately, c-statistics increased to 0.715, 0.694 and 0.636 with CHA2DS2-VASc, and to 0.681, 0.697 and 0.680 with HAS-BLED. The predictive power with both scores combined, removing overlapping components, was higher, with a c-statistic of 0.74, 0.73 and 0.70 for mortality (Table), SSE and major bleeding, respectively.
Conclusion
Both the CHA2DS2-VASc and the HAS-BLED score predict mortality similarly in AF, and a combination of the score components increases prediction significantly. Such combination may thus be clinically useful.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - S Kroep
- Pharmerit International, Rotterdan, Netherlands (The)
| | - F Ricci
- G. d Annunzio University, Chieti, Italy
| | - G Renda
- G. d Annunzio University, Chieti, Italy
| | - G Patti
- University of Eastern Piedmont, torino, Italy
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - L.C Chuang
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - B Van Hout
- University of Sheffield, Sheffield, United Kingdom
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35
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Ricci F, Patti G, Di Martino G, Renda G, Hamrefors V, Melander O, Sutton R, Gallina S, Engstrom G, De Caterina R, Fedorowski A. P6223Relationship between platelet indices and future cardiovascular events: results from a population-based cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Studies evaluating the relationship between platelet indices and cardiovascular outcome yielded conflicting results. In particular, the evidence from large, population-based, prospective studies with extended follow-up duration is scarce.
Purpose
We investigated the incidence of major adverse events in relation to baseline values of platelet count, mean platelet volume (MPV) and platelet distribution width (PDW) in the prospective cohort of the Malmö Diet and Cancer Study.
Methods
A total of 30,314 middle-aged individuals (mean age 57±8 years; 40% men) were overall included and followed up for a median of 16 years (in total, 468,490 person-years). The following outcome measures were considered: all-cause death, myocardial infarction (MI) and ischemic stroke.
Results
There was no relationship between increase in MPV or PDW values and adverse events during follow-up. In particular, the incidence of all-cause death, MI and stroke in patients in the 4thquartile of MPV was 19.8% (vs. 20.7% in the 1stquartile; p=0.08), 8.5% (vs. 8.2%; p=0.78) and 7.9% (vs. 7.1%; p=0.09), respectively. The rates of all-cause death, MI and stroke in patients in the 4thquartile of PDW were 20.1% (vs. 20.7% in the 1stquartile; p=0.16), 8.7% (vs. 8.1%; p=0.30) and 8.1% (vs. 7.2%; p=0.09), respectively. There was a significant rise in mortality by platelet count increase (log-rank p<0.001). In multivariable analysis, patients in the 4thquartile of platelet count (>264 x 109/L) showed a significantly higher incidence of all-cause death (HR 1.17, 95% CI 1.07–1.28; p=0.001), MI (HR 1.24, 95% CI 1.08–1.43; p=0.003) and stroke (HR 1.20, 95% CI 1.04–1.39; p=0.014) vs the 1stquartile. The higher mortality in the 4thquartile of platelet count was independent of the history of previous stroke, was significant in patients without prior MI (HR 1.18, 95% CI 1.08–1.29; p<0.001) and non-significant in those with prior MI (HR 0.86, 95% CI 0.56–1.33; p=0.51). The risk of MI in the 4thquartile of platelet count was higher regardless of the history of previous MI (p for interaction=0.11). The risk of stroke in the 4thquartile of platelet count was higher regardless of the history of previous stroke (p for interaction=0.15).
Conclusions
In this population-based, prospective, cohort study there was no difference in the incidence of adverse events across various strata of baseline platelet morphology. However, patients with highest platelet count at baseline showed a significantly higher risk of all-cause death, MI and stroke. Whether or not these individuals should be targeted by more aggressive primary prophylactic measures including antiplatelet treatment, remains to be proven.
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Affiliation(s)
- F Ricci
- G. D'Annunzio University, Institute of Cardiology and Center of Excellence on Aging, Chieti, Italy
| | - G Patti
- University of L'Aquila, L'Aquila, Italy
| | | | - G Renda
- G. D'Annunzio University, Institute of Cardiology and Center of Excellence on Aging, Chieti, Italy
| | | | | | - R Sutton
- Imperial College London, London, United Kingdom
| | - S Gallina
- University of Chieti-Pescara, Chieti, Italy
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Cavallari I, Verolino G, Patti G. 3054Efficacy and safety of non-vitamin K oral anticoagulants in patients with atrial fibrillation and cancer. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Anticoagulation in patients with cancer and atrial fibrillation (AF) is particularly challenging given the higher risk of both thrombotic and bleeding complications in this setting. Data regarding the efficacy and safety of non-vitamin K oral anticoagulants (NOACs) in AF patients with malignancy remain unclear.
Purpose
In the present meta-analysis we further investigate the efficacy and safety of NOACs compared to warfarin in patients with AF and cancer assuming that available studies may be individually underpowered for endpoints at low incidence, i.e. stroke, major and intracranial bleeding.
Methods
We performed a systematic review and meta-analysis of studies comparing the use of NOACs vs. warfarin in AF patients with cancer. Efficacy outcome measures included stroke or systemic embolism, venous thromboembolism and mortality. Safety outcome measures were major bleeding and intracranial hemorrhage.
Results
We pooled data from 6 identified studies enrolling a total of 31,756 AF patients with cancer. Mean follow-up was 1.7 years. Patients with cancer had significantly increased annualized rates of venous thromboembolism (1.38% vs. 0.74%), major bleeding (9.01% vs. 5.13%), in particular major gastrointestinal bleeding (2.38% vs. 1.60%), and all-cause mortality (17.73% vs. 8.50%) vs. those without (all P values <0.001), whereas the incidence of stroke or systemic embolism and intracranial hemorrhage did not differ. Compared with warfarin, treatment with NOACs nominally decreased the risk of stroke or systemic embolism (5.41% vs. 2.70%; odds ratio, OR; 95% confidence intervals, CI 0.51, 0.26–1.01; P=0.05; Figure), mainly of ischemic stroke (OR 0.56; 95% CI 0.35–0.89; P=0.01), and the risk of venous thromboembolism (OR 0.51; 95% CI 0.42–0.61; P<0.001). In cancer patients receiving NOACs there was a significant reduction of major bleeding (3.95% vs. 4.66%; OR 0.66, 95% CI 0.46–0.94; P=0.02; Figure) and intracranial hemorrhage (0.26% vs. 0.66%; OR 0.25, 95% CI 0.08–0.82; P=0.02) vs. warfarin, with no difference in gastrointestinal major bleeding rates.
Conclusion
AF patients on oral anticoagulation and concomitant cancer are at higher risk of venous thromboembolism, major bleeding and all-cause mortality. NOACs may represent a safer and more effective alternative to warfarin also in this setting of patients.
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Affiliation(s)
- I Cavallari
- University Campus Bio-Medico of Rome, Rome, Italy
| | - G Verolino
- University Campus Bio-Medico of Rome, Rome, Italy
| | - G Patti
- University of L'Aquila, L'Aquila, Italy
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Ricottini E, Gatto L, Melfi R, Nusca A, Cavallaro C, Albano M, Giannone S, Patti G, Prati F, Pozzilli P, Di Sciascio G. P4766Hyperleptinemia as risk factor for high platelet reactivity and cardiovascular events in patients undergoing percutaneous coronary intervention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Ricottini
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - L Gatto
- Hospital San Giovanni Addolorata, Cardiology Unit, Rome, Italy
| | - R Melfi
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - A Nusca
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - C Cavallaro
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - M Albano
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - S Giannone
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - G Patti
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - F Prati
- Hospital San Giovanni Addolorata, Cardiology Unit, Rome, Italy
| | - P Pozzilli
- University Campus Bio-Medico of Rome, Unit of Endocrinology, Rome, Italy
| | - G Di Sciascio
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
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38
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Renda G, Ricci F, Patti G, Aung N, Petersen SE, Hamrefors V, Melander O, Engstrom G, De Caterina R, Fedorowski A. P2885The CHA2DS2VASc score as a predictor of cardiovascular events in patients without atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Renda
- G. d'Annunzio University, Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, Chieti, Italy
| | - F Ricci
- G. d'Annunzio University, Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, Chieti, Italy
| | - G Patti
- University Campus Bio-Medico of Rome, Department of Cardiovascular Science, Rome, Italy
| | - N Aung
- Queen Mary University of London, William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, London, United Kingdom
| | - S E Petersen
- Queen Mary University of London, William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, London, United Kingdom
| | - V Hamrefors
- Lund University, Department of Clinical Sciences in Malmö, Clinical Research Centre, Malmo, Sweden
| | - O Melander
- Lund University, Department of Clinical Sciences in Malmö, Clinical Research Centre, Malmo, Sweden
| | - G Engstrom
- Lund University, Department of Clinical Sciences in Malmö, Clinical Research Centre, Malmo, Sweden
| | - R De Caterina
- G. d'Annunzio University, Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, Chieti, Italy
| | - A Fedorowski
- Lund University, Department of Clinical Sciences in Malmö, Clinical Research Centre, Malmo, Sweden
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39
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Renda G, Ricci F, Patti G, Aung N, Petersen SE, Hamrefors V, Melander O, Engstrom G, Fedorowski A, De Caterina R. P2507The CHA2DS2VASc score as a predictor of new onset atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- G Renda
- G. d'Annunzio University, Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, Chieti, Italy
| | - F Ricci
- G. d'Annunzio University, Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, Chieti, Italy
| | - G Patti
- University Campus Bio-Medico of Rome, Department of Cardiovascular Science, Rome, Italy
| | - N Aung
- Queen Mary University of London, William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, London, United Kingdom
| | - S E Petersen
- Queen Mary University of London, William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, London, United Kingdom
| | - V Hamrefors
- Lund University, Department of Clinical Sciences in Malmö, Clinical Research Centre, Malmo, Sweden
| | - O Melander
- Lund University, Department of Clinical Sciences in Malmö, Clinical Research Centre, Malmo, Sweden
| | - G Engstrom
- Lund University, Department of Clinical Sciences in Malmö, Clinical Research Centre, Malmo, Sweden
| | - A Fedorowski
- Lund University, Department of Clinical Sciences in Malmö, Clinical Research Centre, Malmo, Sweden
| | - R De Caterina
- G. d'Annunzio University, Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, Chieti, Italy
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40
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Cavallari I, Patti G, Pecen L, Lucerna M, Huber K, Rohla M, Renda G, Siller-Matula J, Ricci F, Kirkhhof P, De Caterina R. P3837Net clinical benefit of NOACs vs. VKAs in elderly patients with atrial fibrillation: a pooled analysis from the real-world PREFER in AF and PREFER in AF PROLONGATION registries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- I Cavallari
- University Campus Bio-Medico of Rome, Rome, Italy
| | - G Patti
- University Campus Bio-Medico of Rome, Rome, Italy
| | - L Pecen
- Charles University of Pilsen, Pilsen, Czech Republic
| | - M Lucerna
- Daiichi Sankyo Europe, Munich, Germany
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - M Rohla
- Wilhelminen Hospital, Vienna, Austria
| | - G Renda
- G. d'Annunzio University, Chieti, Italy
| | | | - F Ricci
- G. d'Annunzio University, Chieti, Italy
| | - P Kirkhhof
- University of Birmingham, Birmingham, United Kingdom
| | - R De Caterina
- University of Birmingham, Birmingham, United Kingdom
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41
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Bressi E, Patti G, Pasceri V, Renda G, Ricci F, Melander O, Engstrom G, De Caterina R, Fedorowski A. 3138Predictive value of the CHA2DS2VASc score for adverse cardiovascular events in diabetic patients without atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Bressi
- University Campus Bio-Medico of Rome, Rome, Italy
| | - G Patti
- University Campus Bio-Medico of Rome, Rome, Italy
| | - V Pasceri
- San Filippo Neri Hospital, Rome, Italy
| | - G Renda
- G. d'Annunzio University, Chieti, Italy
| | - F Ricci
- G. d'Annunzio University, Chieti, Italy
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Cavallari I, Patti G, Lucerna M, Pecen L, Siller-Matula J, Kirchhof P, De Caterina R. P5153Net clinical benefit of oral anticoagulation in very elderly patients with atrial fibrillation: a sub-analysis from the PREFER in AF registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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43
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Castro G, Torrisi G, Celona L, Mascali D, Neri L, Sorbello G, Leonardi O, Patti G, Castorina G, Gammino S. A new H2 (+) source: Conceptual study and experimental test of an upgraded version of the VIS-Versatile ion source. Rev Sci Instrum 2016; 87:083303. [PMID: 27587109 DOI: 10.1063/1.4960564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The versatile ion source is an off-resonance microwave discharge ion source which produces a slightly overdense plasma at 2.45 GHz of pumping wave frequency extracting more than 60 mA proton beams and 50 mA He(+) beams. DAEδALUS and IsoDAR experiments require high intensities for H2 (+) beams to be accelerated by high power cyclotrons for neutrinos generation. In order to fulfill the new requirements, a new plasma chamber and injection system has been designed and manufactured for increasing the H2 (+) beam intensity. In this paper the studies for the increasing of the H2 (+)/p ratio and for the design of the new plasma chamber and injection system will be shown and discussed together with the experimental tests carried out at Istituto Nazionale di Fisica Nucleare-Laboratori Nazionali del Sud (INFN-LNS) and at Best Cyclotron Systems test-bench in Vancouver, Canada.
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Affiliation(s)
- G Castro
- INFN-Laboratori Nazionali del Sud, Via S. Sofia 62, 95123 Catania, Italy
| | - G Torrisi
- INFN-Laboratori Nazionali del Sud, Via S. Sofia 62, 95123 Catania, Italy
| | - L Celona
- INFN-Laboratori Nazionali del Sud, Via S. Sofia 62, 95123 Catania, Italy
| | - D Mascali
- INFN-Laboratori Nazionali del Sud, Via S. Sofia 62, 95123 Catania, Italy
| | - L Neri
- INFN-Laboratori Nazionali del Sud, Via S. Sofia 62, 95123 Catania, Italy
| | - G Sorbello
- INFN-Laboratori Nazionali del Sud, Via S. Sofia 62, 95123 Catania, Italy
| | - O Leonardi
- INFN-Laboratori Nazionali del Sud, Via S. Sofia 62, 95123 Catania, Italy
| | - G Patti
- INFN-Laboratori Nazionali del Sud, Via S. Sofia 62, 95123 Catania, Italy
| | - G Castorina
- INFN-Laboratori Nazionali del Sud, Via S. Sofia 62, 95123 Catania, Italy
| | - S Gammino
- INFN-Laboratori Nazionali del Sud, Via S. Sofia 62, 95123 Catania, Italy
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44
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Galatà A, Patti G, Celona L, Mascali D, Neri L, Torrisi G. Electromagnetic analysis of the plasma chamber of an ECR-based charge breeder. Rev Sci Instrum 2016; 87:02B505. [PMID: 26932058 DOI: 10.1063/1.4934209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The optimization of the efficiency of an ECR-based charge breeder is a twofold task: efforts must be paid to maximize the capture of the injected 1+ ions by the confined plasma and to produce high charge states to allow post-acceleration at high energies. Both tasks must be faced by studying in detail the electrons heating dynamics, influenced by the microwave-to-plasma coupling mechanism. Numerical simulations are a powerful tools for obtaining quantitative information about the wave-to-plasma interaction process: this paper presents a numerical study of the microwaves propagation and absorption inside the plasma chamber of the PHOENIX charge breeder, which the selective production of exotic species project, under construction at Legnaro National Laboratories, will adopt as charge breeder. Calculations were carried out with a commercial 3D FEM solver: first, all the resonant frequencies were determined by considering a simplified plasma chamber; then, the realistic geometry was taken into account, including a cold plasma model of increasing complexity. The results gave important information about the power absorption and losses and will allow the improvement of the plasma model to be used in a refined step of calculation reproducing the breeding process itself.
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Affiliation(s)
- A Galatà
- INFN-Laboratori Nazionali di Legnaro, Viale dell'Universitá 2, 35020 Legnaro, Padova, Italy
| | - G Patti
- INFN-Laboratori Nazionali di Legnaro, Viale dell'Universitá 2, 35020 Legnaro, Padova, Italy
| | - L Celona
- INFN-Laboratori Nazionali del Sud, Via S. Sofia 62, 95123 Catania, Italy
| | - D Mascali
- INFN-Laboratori Nazionali del Sud, Via S. Sofia 62, 95123 Catania, Italy
| | - L Neri
- INFN-Laboratori Nazionali del Sud, Via S. Sofia 62, 95123 Catania, Italy
| | - G Torrisi
- INFN-Laboratori Nazionali del Sud, Via S. Sofia 62, 95123 Catania, Italy
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Delahaye P, Galatà A, Angot J, Cam JF, Traykov E, Ban G, Celona L, Choinski J, Gmaj P, Jardin P, Koivisto H, Kolhinen V, Lamy T, Maunoury L, Patti G, Thuillier T, Tarvainen O, Vondrasek R, Wenander F. Optimizing charge breeding techniques for ISOL facilities in Europe: Conclusions from the EMILIE project. Rev Sci Instrum 2016; 87:02B510. [PMID: 26932063 DOI: 10.1063/1.4935229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The present paper summarizes the results obtained from the past few years in the framework of the Enhanced Multi-Ionization of short-Lived Isotopes for Eurisol (EMILIE) project. The EMILIE project aims at improving the charge breeding techniques with both Electron Cyclotron Resonance Ion Sources (ECRIS) and Electron Beam Ion Sources (EBISs) for European Radioactive Ion Beam (RIB) facilities. Within EMILIE, an original technique for debunching the beam from EBIS charge breeders is being developed, for making an optimal use of the capabilities of CW post-accelerators of the future facilities. Such a debunching technique should eventually resolve duty cycle and time structure issues which presently complicate the data-acquisition of experiments. The results of the first tests of this technique are reported here. In comparison with charge breeding with an EBIS, the ECRIS technique had lower performance in efficiency and attainable charge state for metallic ion beams and also suffered from issues related to beam contamination. In recent years, improvements have been made which significantly reduce the differences between the two techniques, making ECRIS charge breeding more attractive especially for CW machines producing intense beams. Upgraded versions of the Phoenix charge breeder, originally developed by LPSC, will be used at SPES and GANIL/SPIRAL. These two charge breeders have benefited from studies undertaken within EMILIE, which are also briefly summarized here.
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Affiliation(s)
- P Delahaye
- GANIL, CEA/DSM-CNRS/IN2P3, Blvd. Becquerel, BP 55027, 14076 Caen Cedex 05, France
| | - A Galatà
- INFN-Laboratori Nazionali di Legnaro, Viale dell'Università 2, 35020 Legnaro (Padova), Italy
| | - J Angot
- LPSC-Université Grenoble Alpes-CNRS/IN2P3, 53 rue des Martyrs, 38026 Grenoble Cedex, France
| | - J F Cam
- LPC Caen, 6 Blvd. Maréchal Juin, 14050 Caen Cedex, France
| | - E Traykov
- LPC Caen, 6 Blvd. Maréchal Juin, 14050 Caen Cedex, France
| | - G Ban
- LPC Caen, 6 Blvd. Maréchal Juin, 14050 Caen Cedex, France
| | - L Celona
- INFN-Laboratori Nazionali del Sud, via S. Sofia 62, 95125 Catania, Italy
| | - J Choinski
- Heavy Ion Laboratory, University of Warsaw, ul. Pasteura 5a, 02 093 Warsaw, Poland
| | - P Gmaj
- Heavy Ion Laboratory, University of Warsaw, ul. Pasteura 5a, 02 093 Warsaw, Poland
| | - P Jardin
- GANIL, CEA/DSM-CNRS/IN2P3, Blvd. Becquerel, BP 55027, 14076 Caen Cedex 05, France
| | - H Koivisto
- Department of Physics, University of Jyväskylä, PB 35 (YFL), 40351 Jyväskylä, Finland
| | - V Kolhinen
- Department of Physics, University of Jyväskylä, PB 35 (YFL), 40351 Jyväskylä, Finland
| | - T Lamy
- LPSC-Université Grenoble Alpes-CNRS/IN2P3, 53 rue des Martyrs, 38026 Grenoble Cedex, France
| | - L Maunoury
- GANIL, CEA/DSM-CNRS/IN2P3, Blvd. Becquerel, BP 55027, 14076 Caen Cedex 05, France
| | - G Patti
- INFN-Laboratori Nazionali di Legnaro, Viale dell'Università 2, 35020 Legnaro (Padova), Italy
| | - T Thuillier
- LPSC-Université Grenoble Alpes-CNRS/IN2P3, 53 rue des Martyrs, 38026 Grenoble Cedex, France
| | - O Tarvainen
- Department of Physics, University of Jyväskylä, PB 35 (YFL), 40351 Jyväskylä, Finland
| | - R Vondrasek
- Argonne National Laboratory, 9700 S. Cass Avenue, Argonne, Illinois 60439, USA
| | - F Wenander
- ISOLDE, CERN, 1211 Geneva 23, Switzerland
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Galatà A, Patti G, Roncolato C, Angot J, Lamy T. The new ECR charge breeder for the Selective Production of Exotic Species project at INFN--Laboratori Nazionali di Legnaro. Rev Sci Instrum 2016; 87:02B503. [PMID: 26932056 DOI: 10.1063/1.4933338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The Selective Production of Exotic Species (SPES) project is an ISOL facility under construction at Istituto Nazionale di Fisica Nucleare-Laboratori Nationali di Legnaro (INFN-LNL). 1+ radioactive ions, produced and extracted from the target-ion-source system, will be charge bred to high charge states by an ECR charge breeder (SPES-CB): the project will adopt an upgraded version of the PHOENIX charge breeder, developed since about twenty years by the Laboratoire de Physique Subatomique et de Cosmologie (LPSC). The collaboration between LNL and LPSC started in 2010 with charge breeding experiments performed on the LPSC test bench and led, in June 2014, to the signature of a Research Collaboration Agreement for the delivery of a complete charge breeder and ancillaries, satisfying the SPES requirements. Important technological aspects were tackled during the construction phase, as, for example, beam purity issues, electrodes alignment, and vacuum sealing. This phase was completed in spring 2015, after which the qualification tests were carried out at LPSC on the 1+/q+ test stand. This paper describes the characteristics of the SPES-CB, with particular emphasis on the results obtained during the qualification tests: charge breeding of Ar, Xe, Rb, and Cs satisfied the SPES requirements for different intensities of the injected 1+ beam, showing very good performances, some of which are "best ever" for this device.
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Affiliation(s)
- A Galatà
- INFN-Laboratori Nazionali di Legnaro, Viale dell'Università 2, 35020 Padova, Legnaro, Italy
| | - G Patti
- INFN-Laboratori Nazionali di Legnaro, Viale dell'Università 2, 35020 Padova, Legnaro, Italy
| | - C Roncolato
- INFN-Laboratori Nazionali di Legnaro, Viale dell'Università 2, 35020 Padova, Legnaro, Italy
| | - J Angot
- LPSC-Université Grenoble Alpes-CNRS/IN2P3, 53 rue des Martyrs, 38026 Grenoble CEDEX, France
| | - T Lamy
- LPSC-Université Grenoble Alpes-CNRS/IN2P3, 53 rue des Martyrs, 38026 Grenoble CEDEX, France
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C, Orosz A, Forster T, Bulbul Z, Issa Z, Al Sehly A, Pergola V, Oufi S, Conde Y, Cimino E, Rinaldi E, Ashurov R, Ricci S, Pergolini M, Vitarelli A, Lujan Valencia JE, Chaparro M, Garcia-Guerrero A, Cristo Ropero MJ, Izquierdo Bajo A, Madrona L, Recio-Mayoral A, Monmeneu JV, Igual B, Lopez Lereu P, Garcia MP, Selmi W, Jalal Z, Thambo JB, Kosuta D, Fras Z. Poster session 5The imaging examinationP1097Correlation between visual and quantitative assessment of left ventricle: intra- and inter-observer agreementP1099Incremental prognostic value of late gadolinium-enhanced by cardiac magnetic resonance in patients with heart failureAnatomy and physiology of the heart and great vesselsP1100Left ventricular geometry and diastolic performance in erectile dysfunction patients; a topic of differential arterial stiffness influenceAssessment of diameters, volumes and massP1101Impact of the percutaneous closure of atrial septal defect on the right heart "remodeling"P1102Left Ventricular Mass Indexation in Infants, Children and Adolescents: a Simplified Approach for the Identification of Left Ventricular Hypertrophy in Clinical PracticeP1103Impact of trabecules while quantifying cardiac magnetic resonance exams in patients with systemic right ventricleP1104Detection of subclinical atherosclerosis by carotid intima-media thickness: correlation with leukocytes telomere shorteningAssessments of haemodynamicsP1105Flow redirection towards the left ventricular outflow tract: vortex formation is not affected by variations in atrio-ventricular delayAssessment of systolic functionP1106Reproducibility and feasibility of cardiac MRI feature tracking in Fabry diseaseP1107Normal left ventricular strain values by two-dimensional strain echocardiography; result of normal (normal echocardiographic dimensions and functions in korean people) studyP1108Test-retest repeatability of global strain following st-elevation myocardial infarction - a comparison of tagging and feature trackingP1109Cardiotoxicity induced by tyrosine kinase inhibitors in patients with gastrointestinal stromal tumors (GIST)P1110Finite strain ellipses for the analysis of left ventricular principal strain directions using 3d speckle tracking echocardiographyP1111Antihypertensive therapy reduces time to peak longitudinal strainP1112Right ventricular systolic function as a marker of prognosis after inferior myocardial infarction - 5-year follow-upP1113Is artery pulmonary dilatation related with right but also early left ventricle dysfunction in pulmonary artery hypertension?P1114Right ventricular mechanics changes according to pressure overload increasing, a 2D-speckle tracking echocardiographic evaluationAssessment of diastolic functionP1115Paired comparison of left atrial strain from P-wave to P-wave and R-wave to R-waveP1116Diagnostic role of Tissue Doppler Imaging echocardiographic criteria in obese heart failure with preserved ejection fraction patientsP1117Evaluation of diastolic function of right ventricle in idiopathic pulmonary arterial hypertensionP1118Severity and predictors of diastolic dysfunction in a non-hypertensive non-ischemic cohort of Egyptian patients with documented systemic autoimmune disease; pilot reportP1119correlation between ST segment shift and cardiac diastolic function in patients with acute myocardial infarctionIschemic heart diseaseP1120Computed tomography coronary angiography verSus sTRess cArdiac magneTic rEsonance for the manaGement of sYmptomatic revascularized patients: a cost effectiveness study (STRATEGY study)P1121Utility of transmural myocardial mechanic for early infarct size prediction after primary percutaneous coronary intervention in STEMI patientsP1122Progressive Improvements of the echocardiographic deformation parameters in ST Elevation Myocardial Infarction after five years follow-upP1123Long-term prognostic value of left ventricular dyssynchrony as assessed by cardiac magnetic resonance feature-tracking imaging after a first st-segment elevation myocardial infarctionP1124Differences in mitral annulus remodeling in acute anterior ST elevation and acute inferior ST elevation myocardial infarctionP1125Reduction of microvascular injury using a novel theragnostic ultrasound strategy: a first in men feasibility and safety studyP1126Impact of focused echocardiography in clinical decision of patient presented with st elevation myocardial infarction underwent primary angioplastyHeart valve DiseasesP1127Aortic valve area calculation in aortic stenosis: a comparison among conventional and 3D-transesophageal echocardiography and computed tomographyP1128Myocardial fibrosis and microRNA-21 expression in patients with severe aortic valve stenosis and preserved ejection fraction: a 2D speckle tracking echocardiography, tissutal and plasmatic studyP1129Quantification of calcium amount in a new experimental model: a comparison between calibrated integrated backscatter of ultrasound and computed tomographyP1130Altered diffusion capacity in aortic stenosis: role of the right heartP1131Osteoprotegerin predicts all-cause mortality in calcific aortic stenosis patients with preserved left ventricle ejection fraction in long term observationP1132Mitral regurgitation as a risk factor for pulmonary hypertension in patients with aortic stenosisP1133The relationship between the level of plasma B-type natriuretic peptide and mitral stenosisP1134Aortic regurgitation, left ventricle mechanics and vascular load: a single centre 2d derived-speckle tracking studyP1135Feasibility and reproducibility issues limit the usefulness of quantitative colour Doppler parameters in the assessment of chronic aortic and mitral regurgitation severityP1136Predictors of postoperative outcome in degenerative mitral regurgitationP1137Left ventricular mechanical dyssynchrony in patients with severe mitral regurgitation of rheumatic etiology; three dimensional echocardiography studyP1138Functional mitral regurgitation and left atrial dysfunction concur in determining pulmonary hypertension and functional status in subjects with left ventricular systolic dysfunctionP11393D echocardiography allows more effective quantitative assessment of the severity of functional tricuspid regurgitation than conventional 2D/Doppler echocardiographyP1140Prosthetic valve thrombosis: still a severe disease? 10-years experience in a university hospitalP1141Validity of echocardiography in the hospital course of patients with feverP1142Do baseline 3DTEE characteristics of mitral valve apparatus predict long term result in patients undergoing percutaneous valve repair for degenerative regurgitation?P1143Influence of baseline aortic regurgitation on mitral regurgitation change after transcatheter aortic valve replacement for aortic stenosisP1144Prevalence of echocardiography detected significant valvular regurge in subclinical rheumatic carditis in assiut childrenCardiomyopathiesP1145Can we early detect left ventricular systolic dysfunction in patients with Duchenne muscular dystrophy using global longitudinal strain assessment?P1146Prevalence of isolated papillary muscle hypertrophy in young competitive athletesP1147Troponin release after exercise in patients with hypertrophic cardiomyopathy: associations with clinical and mr imaging characteristicsP1148Atrial fibrillation in hypertrophic cardiomyopathy: can we score the risk?P1149Impact of hypertrophy on multiple layer longitudinal deformation in hypertrophy cardiomyopathy and cardiac amyloidosis compared to controlsP1150Functional evaluation in hypertrophic cardiomyopathy combining cardiopulmonary exercise testing combined with exercise-echocardiographyP1151Refinement of the old diagnostic criteria of left ventricular noncompaction cardiomyopathy (LVNC) based on cardiac magnetic resonance (CMR)P1152Differences of clinical characteristics and outcomes between acute myocarditis with preserved and reduced left ventricular systolic functionP1153Value of longitudinal strain for distinguishing left ventricular non-compaction from idiopathic dilated cardiomyopathyP1154Speed of recovery of left ventricular function is not related to the prognosis of Takotsubo cardiomyopathy. A Portuguese multicentre studyP1155Predictors of in-hospital left ventricular systolic function recovery after admission with takotsubo cardiomyopathy. Portuguese multicentre studyP1156Mid-ventricular takotsubo detected by initial echocardiogram associates with recurrence of takotsubo cardiomyopathy - a portuguese multicentre studySystemic diseases and other conditionsP1157Relations between left ventricle remodelling and expression of angiotensin 2 AT2R1 geneP1158Impact of renal denervation on long-term blood pressure variability and surrogate markers of target organ damage in individuals with drug-resistant arterial hypertensionP1159Greater improvement of coronary artery function, left ventricular deformation and twisting by IL12/23 compared to TNF-a inhibition in psoriasisP1160Advanced glycation end products play a role in adverse LV remodeling following MIP1161Incidence of subclinical myocardial dysfunction in patients with systemic sclerosis and normal left ventricular systolic and diastolic functionP1162Left atrial remodeling and dysfunction occur early in patients with systemic sclerosis and normal left ventricular functionP1163Intrinsic vortex formation : a unique performance indicatorP1164P-wave morphology is unaffected by training-induced biatrial dilatation: a prospective, longitudinal study in healthy athletesP1165Usefulness of transthoracic echocardiography in diagnosis of young patients with ischemic strokeP1166Primary cardiac lymphoma: role of echocardiography in the clinical managementP1167Abnormal echocardiographic findings in cancer patients before chemotherapyMasses, tumors and sources of embolismP1168Three-dimensional transesophageal echocardiography of the left atrial appendage reduces rate of postpone electrical cardioversionP1169Detection of ventricular thrombus by cmr after reperfused st-segment elevation myocardial infarction correlated with echocardiographyP1170Clinical and transthoracic echocardiographic predictors of left atrial appendage thrombus in patients with atrial fibrillationStress echocardiographyP1171Pharmacological stress echocardiography complications: a 4-year single center experienceP1172Myocardial functional and perfusion reserve in type I diabetesP1173Feasibility of incorporating 3D Dobutamine stress echocardiography into routine clinical practiceP1174Right ventricular isovolumic acceleration at rest and during exercise in children after heart transplantP1175Right ventricular systolic and diastolic response to exercise in children after heart transplant -a bicycle exercise studyP1176Determinants of functional capacity in heart failure patients with reduced ejection fractionP1177Handgrip stress echocardiography with emotional component compared to conventional isometric exercise in coronary artery disease diagnosisP1178The relationship between resting transthoracic echocardiography and exercise capacity in patients with paroxysmal atrial fibrillationP1179Correlation between NT-proBNP and selected echocardiography parameters at rest and after exercise in patients with functional ischemic mitral regurgitation qualified for cardiosurgical treatmentReal-time three-dimensional TEEP1180Vena contracta area for severity grading in functional and degenerative mitral regurgitation: A study based on transesophageal 3D colour Doppler in 419 patientsP1181Proximal flow convergence by 3D echocardiography in the evaluation of mitral valve area in rheumatic mitral stenosisP1182Quantification of valve dimensions by transesophageal 3D echocardiography in patients with functional and degenerative mitral regurgitationTissue Doppler and speckle trackingP1183Automatic calculation of left ventricular volume changes over a cardiac cycle from echocardiography images by nonlinear dimensionality reductionP1184Effect of the mitral valve repairs on the left ventricular blood flow formationP1185Quantification of left atrial strain using cardiovascular magnetic resonance. a comparison between hypertrophic cardiomyopathy and healthy controlsP1186The role of early systolic lengthening in patients with non-ST elevation acute coronary syndrome and its relation to syntax scoreP1187Different standard two dimensional strain methods to quantity left ventricular mechanicsP1188Atrial function and electrocardiography caracteristics in sportsmen with or without paroxysmal atrial fibrillationP1189Right ventricular outflow premature contractions induce regional left ventricular dysfunctionP1190Ultrasound guided venous access for pacemaker and defibrillators. Randomized TrialP1191Atrial function analysis correlates with symptoms and quality of life of heart failure patientsP1192The use of tissue doppler echocardiography in myocardial iron overload in patients with thalassaemia majorP1193Independent association between pulse pressure and left ventricular global longitudinal strainP1194Global and regional longitudinal strain identifies the presence of coronary artery disease in patients with suspected reduction of coronary flow reserve and absence of wall motion abnormalitiesP1195Prognostic value of invasive and noninvasive parameters of right ventricular function in patients with pulmonary arterial hypertension receiving specific vasodilator therapyP1196Myocardial deformation analysis to improve arrhythmic risk stratificationP1197Quantitative assessment of regional systolic and diastolic function parameters for detecting prior transient ischemia in normokinetic segmentsP1198Left atrial function in patients with corrected tetralogy of Fallot - a three-dimensional speckle-tracking echocardiographic studyP1199Left atrial ejection force correlates with left atrial strain and volume-based functional properties as assessed by three-dimensional speckle tracking echocardiographyP1200Acute angulation of the aortic arch late after the arterial switch operation for transposition of the great arteries: impact on cardiac mechanicsP1201Circumferential deformation of the ascending thoracic aorta in hypertensive patients by three-dimensional speckle tracking echocardiographyCardiac Magnetic ResonanceP1202The incremental value of cardiac magnetic resonance on diagnosis myocardial infarction and non-obstructed coronary arteriesP1204Reference ranges of global and regional myocardial T1 values derived from MOLLI and shMOLLI at 3TComputed Tomography & Nuclear CardiologyP1205Deformation of the left atrial appendage after percutaneous closure with the Amplatzer cardiac plugP1206Prognostic impact of non-obstructive coronary artery disease on coronary computed tomographic angiography: A single-center study. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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De Luca L, Bolognese L, Valgimigli M, Ceravolo R, Danzi GB, Piccaluga E, Rakar S, Cremonesi A, Bovenzi FM, Abbate R, Andreotti F, Bolognese L, Biondi-Zoccai G, Bovenzi FM, Capodanno D, Caporale R, Capranzano P, Carrabba N, Casella G, Cavallini C, Ceravolo R, Colombo P, Conte MR, Cordone S, Cremonesi A, Danzi GB, Del Pinto M, De Luca G, De Luca L, De Servi S, Di Lorenzo E, Di Pasquale G, Esposito G, Farina R, Fiscella A, Formigli D, Galli S, Giudice P, Gonzi G, Greco C, Grieco NB, La Vecchia L, Lazzari M, Lettieri C, Lettino M, Limbruno U, Lupi A, Macchi A, Marini M, Marzilli M, Montinaro A, Musumeci G, Navazio A, Olivari Z, Oltrona Visconti L, Oreglia JA, Ottani F, Parodi G, Pasquetto G, Patti G, Perkan A, Perna GP, Piccaluga E, Piscione F, Prati F, Rakar S, Ravasio R, Ronco F, Rossini R, Rubboli A, Saia F, Sardella G, Satullo G, Savonitto S, Sbarzaglia P, Scorcu G, Signore N, Tarantini G, Terrosu P, Testa L, Tubaro M, Valente S, Valgimigli M, Varbella F, Vatrano M. ANMCO/SICI-GISE paper on antiplatelet therapy in acute coronary syndrome. Eur Heart J Suppl 2014. [DOI: 10.1093/eurheartj/suu030] [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: 02/05/2023]
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Neri L, Celona L, Gammino S, Mascali D, Castro G, Torrisi G, Cheymol B, Ponton A, Galatà A, Patti G, Gozzo A, Lega L, Ciavola G. Improved design of proton source and low energy beam transport line for European Spallation Source. Rev Sci Instrum 2014; 85:02A723. [PMID: 24593457 DOI: 10.1063/1.4832135] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The design update of the European Spallation Source (ESS) accelerator is almost complete and the construction of the prototype of the microwave discharge ion source able to provide a proton beam current larger than 70 mA to the 3.6 MeV Radio Frequency Quadrupole (RFQ) started. The source named PS-ESS (Proton Source for ESS) was designed with a flexible magnetic system and an extraction system able to merge conservative solutions with significant advances. The ESS injector has taken advantage of recent theoretical updates and new plasma diagnostics tools developed at INFN-LNS (Laboratori Nazionali del Sud, Istituto Nazionale di Fisica Nucleare). The design strategy considers the PS-ESS and the low energy beam transport line as a whole, where the proton beam behaves like an almost neutralized non-thermalized plasma. Innovative solutions have been used as hereinafter described. Thermo-mechanical optimization has been performed to withstand the chopped beam and the misaligned focused beam over the RFQ input collimator; the results are reported here.
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Affiliation(s)
- L Neri
- Laboratori Nazionali del Sud, Istituto Nazionale di Fisica Nucleare, Via S. Sofia 62, 95123 Catania, Italy
| | - L Celona
- Laboratori Nazionali del Sud, Istituto Nazionale di Fisica Nucleare, Via S. Sofia 62, 95123 Catania, Italy
| | - S Gammino
- Laboratori Nazionali del Sud, Istituto Nazionale di Fisica Nucleare, Via S. Sofia 62, 95123 Catania, Italy
| | - D Mascali
- Laboratori Nazionali del Sud, Istituto Nazionale di Fisica Nucleare, Via S. Sofia 62, 95123 Catania, Italy
| | - G Castro
- Laboratori Nazionali del Sud, Istituto Nazionale di Fisica Nucleare, Via S. Sofia 62, 95123 Catania, Italy
| | - G Torrisi
- Laboratori Nazionali del Sud, Istituto Nazionale di Fisica Nucleare, Via S. Sofia 62, 95123 Catania, Italy
| | - B Cheymol
- European Spallation Source ESS AB, Lund, Sweden
| | - A Ponton
- European Spallation Source ESS AB, Lund, Sweden
| | - A Galatà
- Laboratori Nazionali di Legnaro, Istituto Nazionale di Fisica Nucleare, Viale dell'università 2, 35020 Legnaro, Italy
| | - G Patti
- Laboratori Nazionali del Sud, Istituto Nazionale di Fisica Nucleare, Via S. Sofia 62, 95123 Catania, Italy
| | - A Gozzo
- Laboratori Nazionali del Sud, Istituto Nazionale di Fisica Nucleare, Via S. Sofia 62, 95123 Catania, Italy
| | - L Lega
- Laboratori Nazionali del Sud, Istituto Nazionale di Fisica Nucleare, Via S. Sofia 62, 95123 Catania, Italy
| | - G Ciavola
- Laboratori Nazionali del Sud, Istituto Nazionale di Fisica Nucleare, Via S. Sofia 62, 95123 Catania, Italy
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Koivisto H, Tarvainen O, Toivanen V, Komppula J, Kronholm R, Lamy T, Angot J, Delahaye P, Maunoury L, Galata A, Patti G, Standylo L, Steczkiewicz O, Choinski J. Ionization efficiency studies with charge breeder and conventional electron cyclotron resonance ion source. Rev Sci Instrum 2014; 85:02B917. [PMID: 24593622 DOI: 10.1063/1.4854215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Radioactive Ion Beams play an increasingly important role in several European research facility programs such as SPES, SPIRAL1 Upgrade, and SPIRAL2, but even more for those such as EURISOL. Although remarkable advances of ECRIS charge breeders (CBs) have been achieved, further studies are needed to gain insight on the physics of the charge breeding process. The fundamental plasma processes of charge breeders are studied in the frame of the European collaboration project, EMILIE, for optimizing the charge breeding. Important information on the charge breeding can be obtained by conducting similar experiments using the gas mixing and 2-frequency heating techniques with a conventional JYFL 14 GHz ECRIS and the LPSC-PHOENIX charge breeder. The first experiments were carried out with noble gases and they revealed, for example, that the effects of the gas mixing and 2-frequency heating on the production of high charge states appear to be additive for the conventional ECRIS. The results also indicate that at least in the case of noble gases the differences between the conventional ECRIS and the charge breeder cause only minor impact on the production efficiency of ion beams.
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Affiliation(s)
- H Koivisto
- Department of Physics, University of Jyväskylä (JYFL), Jyväskylä, Finland
| | - O Tarvainen
- Department of Physics, University of Jyväskylä (JYFL), Jyväskylä, Finland
| | - V Toivanen
- Department of Physics, University of Jyväskylä (JYFL), Jyväskylä, Finland
| | - J Komppula
- Department of Physics, University of Jyväskylä (JYFL), Jyväskylä, Finland
| | - R Kronholm
- Department of Physics, University of Jyväskylä (JYFL), Jyväskylä, Finland
| | - T Lamy
- LPSC, Université Joseph Fourier Grenoble 1, Grenoble INP, 53 rue des martyrs, 38026 Grenoble Cedex, France
| | - J Angot
- LPSC, Université Joseph Fourier Grenoble 1, Grenoble INP, 53 rue des martyrs, 38026 Grenoble Cedex, France
| | - P Delahaye
- GANIL, CEA/DSM-CNRS/IN2P3, Caen Cedex 05, France
| | - L Maunoury
- GANIL, CEA/DSM-CNRS/IN2P3, Caen Cedex 05, France
| | - A Galata
- INFN-Laboratori Nazionali di Legnaro, Legnaro, Padova, Italy
| | - G Patti
- INFN-Laboratori Nazionali del Sud, Catania, Italy
| | - L Standylo
- Heavy Ion Laboratory, University of Warsaw, Warsaw, Poland
| | - O Steczkiewicz
- Heavy Ion Laboratory, University of Warsaw, Warsaw, Poland
| | - J Choinski
- Heavy Ion Laboratory, University of Warsaw, Warsaw, Poland
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