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Scheel PJ, Cartella I, Murray B, Gilotra NA, Ammirati E. Role of genetics in inflammatory cardiomyopathy. Int J Cardiol 2024; 400:131777. [PMID: 38218248 DOI: 10.1016/j.ijcard.2024.131777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
Traditional cardiomyopathy paradigms segregate inflammatory etiologies from those caused by genetic variants. An identified or presumed trigger is implicated in acute myocarditis or chronic inflammatory cardiomyopathy but growing evidence suggests a significant proportion of patients have an underlying cardiomyopathy-associated genetic variant often even when a clear inflammatory trigger is identified. Recognizing a possible genetic contribution to inflammatory cardiomyopathy may have major downstream implications for both the patient and family. The presenting features of myocarditis (i.e. chest pain, arrhythmia, and/or heart failure) may provide insight into diagnostic considerations. One example is isolated cardiac sarcoidosis, a distinct inflammatory cardiomyopathy that carries diagnostic challenges and clinical overlap; genetic testing has increasingly reclassified cases of isolated cardiac sarcoidosis as genetic cardiomyopathy, notably altering management. On the other side, inflammatory presentations of genetic cardiomyopathies are likewise underappreciated and a growing area of investigation. Inflammation plays an important role in the pathogenesis of several familial cardiomyopathies, especially arrhythmogenic phenotypes. Given these clinical scenarios, and the implications on clinical decision making such as initiation of immunosuppression, sudden cardiac death prevention, and family screening, it is important to recognize when genetics may be playing a role.
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Affiliation(s)
- Paul J Scheel
- Division of Cardiology, Department of Medicine, Johns Hopkins University, USA.
| | - Iside Cartella
- De Gasperis Cardio Center, Transplant Center, Niguarda Hospital, Milano, Italy; Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins University, USA
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University, USA
| | - Enrico Ammirati
- De Gasperis Cardio Center, Transplant Center, Niguarda Hospital, Milano, Italy; Department of Health Sciences, University of Milano-Bicocca, Monza, Italy.
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2
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La Vecchia G, Del Buono MG, Bonaventura A, Vecchiè A, Moroni F, Cartella I, Saponara G, Campbell MJ, Dagna L, Ammirati E, Sanna T, Abbate A. Cardiac Involvement in Patients With Multisystem Inflammatory Syndrome in Adults. J Am Heart Assoc 2024; 13:e032143. [PMID: 38348793 PMCID: PMC11010102 DOI: 10.1161/jaha.123.032143] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/20/2023] [Indexed: 02/21/2024]
Abstract
Multisystemic inflammatory syndrome in adults is a hyperinflammatory condition following (within 4-12 weeks) SARS-CoV-2 infection. Here, the dysregulation of the immune system leads to a multiorgan involvement often affecting the heart. Cardiac involvement in multisystemic inflammatory syndrome in adults has been described mainly in young men without other comorbidities and may present with different clinical scenarios, including acute heart failure, life-threatening arrhythmias, pericarditis, and myocarditis, with a nonnegligible risk of mortality (up to 7% of all cases). The heterogeneity of its clinical features and the absence of a clear case definition make the differential diagnosis with other postinfectious (eg, infective myocarditis) and hyperinflammatory diseases (eg, adult Still disease and macrophage activation syndrome) challenging. Moreover, the evidence on the efficacy of specific treatments targeting the hyperinflammatory response underlying this clinical condition (eg, glucocorticoids, immunoglobulins, and other immunomodulatory agents) is sparse and not supported by randomized clinical trials. In this review article, we aim to provide an overview of the clinical features and the diagnostic workup of multisystemic inflammatory syndrome in adults with cardiac involvement, highlighting the possible pathogenetic mechanisms and the therapeutic management, along with remaining knowledge gaps in this field.
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Affiliation(s)
- Giulia La Vecchia
- Department of Cardiovascular and Pulmonary SciencesCatholic University of the Sacred HeartRomeItaly
- Center of Excellence in Cardiovascular SciencesIsola Tiberina Hospital Gemelli IsolaRomeItaly
- Department of Cardiovascular MedicineFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Marco Giuseppe Del Buono
- Department of Cardiovascular and Pulmonary SciencesCatholic University of the Sacred HeartRomeItaly
- Department of Cardiovascular MedicineFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Aldo Bonaventura
- S.C. Medicina Generale 1Medical Center, Ospedale di Circolo e Fondazione Macchi, Department of Internal Medicine, ASST Sette LaghiVareseItaly
| | - Alessandra Vecchiè
- S.C. Medicina Generale 1Medical Center, Ospedale di Circolo e Fondazione Macchi, Department of Internal Medicine, ASST Sette LaghiVareseItaly
| | - Francesco Moroni
- Robert M. Berne Cardiovascular Research Center and Division of Cardiovascular Medicine, Department of Medicine, Heart and Vascular CenterUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Iside Cartella
- Department of Cardiology, De Gasperis Cardio Center, ASST GrandeOspedale Metropolitano NiguardaMilanItaly
| | - Gianluigi Saponara
- Department of Cardiovascular MedicineFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Michael J. Campbell
- Division of Pediatric Cardiology, Department of PediatricsDuke University Medical Center2301 Erwin Road, DUMC Box 3127DurhamNCUSA
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare DiseasesIRCCS San Raffaele Hospital, Vita‐Salute San Raffaele UniversityMilanItaly
| | - Enrico Ammirati
- Department of Cardiology, De Gasperis Cardio Center, ASST GrandeOspedale Metropolitano NiguardaMilanItaly
| | - Tommaso Sanna
- Department of Cardiovascular and Pulmonary SciencesCatholic University of the Sacred HeartRomeItaly
- Department of Cardiovascular MedicineFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center and Division of Cardiovascular Medicine, Department of Medicine, Heart and Vascular CenterUniversity of VirginiaCharlottesvilleVirginiaUSA
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3
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Rizza V, Maranta F, Cianfanelli L, Cartella I, Maisano F, Alfieri O, Cianflone D. Subacute postoperative atrial fibrillation after heart surgery: Incidence and predictive factors in cardiac rehabilitation. J Arrhythm 2024; 40:67-75. [PMID: 38333376 PMCID: PMC10848578 DOI: 10.1002/joa3.12956] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 02/10/2024] Open
Abstract
Background Postoperative atrial fibrillation (POAF) is the most common arrhythmia following cardiac surgery (CS). It may occur between the 1st and the 4th postoperative day as acute POAF or between the 5th and the 30th as subacute (sPOAF). sPOAF is associated with higher thromboembolic risk, which consistently increase patients' morbidity. Neutrophil-to-lymphocyte ratio (NLR) is a low-cost inflammatory index proposed as possible POAF predictor. Identification of patients' risk categories might lead to improved postoperative outcomes. Methods The aim was to assess the incidence of sPOAF and to identify possible predictors in patients performing cardiovascular rehabilitation (CR) after CS. A single-center cohort study was performed on 737 post-surgical patients admitted to CR on sinus rhythm. Continuous monitoring with 12-lead ECG telemetry was performed. We evaluated the predictive role of anamnestic, clinical, and laboratory data, including baseline NLR. Results Subacute POAF was documented in 170 cases (23.1%). At the multivariate analysis, age (OR 1.03; p = .001), mitral valve surgery (OR 1.77; p = .012), acute POAF (OR 2.97; p < .001), and NLR at baseline (OR 1.13; p = .042) were found to be independent predictive factors of sPOAF following heart surgery. Conclusions sPOAF is common after CS. Age, mitral valve procedures, acute POAF, and preoperative NLR were proved to increase sPOAF occurrence in CR. NLR is an affordable and reliable parameter which might be used to qualify the risk of arrhythmias at CR admission. Identification of new predictors of postoperative atrial fibrillation may allow to improve patients' prognosis.
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Affiliation(s)
- Vincenzo Rizza
- Vita‐Salute San Raffaele UniversityMilanItaly
- Cardiac Rehabilitation UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Francesco Maranta
- Cardiac Rehabilitation UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Lorenzo Cianfanelli
- Cardiac Rehabilitation UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Iside Cartella
- School of Medicine and SurgeryMilano‐Bicocca UniversityMilanItaly
| | - Francesco Maisano
- Cardiac Surgery UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Ottavio Alfieri
- Cardiac Surgery UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Domenico Cianflone
- Vita‐Salute San Raffaele UniversityMilanItaly
- Cardiac Rehabilitation UnitIRCCS San Raffaele Scientific InstituteMilanItaly
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4
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Rizza V, Maranta F, Cianfanelli L, Cartella I, Alfieri O, Cianflone D. Imaging of the Diaphragm Following Cardiac Surgery: Focus on Ultrasonographic Assessment. J Ultrasound Med 2023; 42:2481-2490. [PMID: 37357908 DOI: 10.1002/jum.16291] [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] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/19/2023] [Accepted: 06/04/2023] [Indexed: 06/27/2023]
Abstract
Diaphragm dysfunction is a common complication following cardiac surgery. Its clinical impact is variable, ranging from the absence of symptoms to the acute respiratory failure. Post-operative diaphragm dysfunction may negatively affect patients' prognosis delaying the weaning from the mechanical ventilation (MV), extending the time of hospitalization and increasing mortality. Ultrasonography is a valid tool to evaluate diaphragmatic impairment in different settings, like the Intensive Care Unit, to predict successful weaning from the MV, and the Cardiovascular Rehabilitation Unit, to stratify patients in terms of risk of functional recovery failure. The aim of this review is to describe the pathophysiology of post-cardiac surgery diaphragm dysfunction, the techniques used for its diagnosis and the potential applications of diaphragm ultrasound.
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Affiliation(s)
| | - Francesco Maranta
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Cianfanelli
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Ottavio Alfieri
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Domenico Cianflone
- Vita-Salute San Raffaele University, Milan, Italy
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
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5
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Airale L, Borrelli F, Arrivi A, Baracchi A, Bertacchini F, Cartella I, Curcio R, Izzo R, Lembo M, Mancusi C, Manzi MV, Milani M, Moreo A, Paini A, Pucci G, Ruscelli F, Salvetti M, Soldati M, Milan A. Ascending aorta dilatation is associated to hard cardiovascular events, follow-up from multicentric ARGO-Perspective project. Hypertens Res 2023; 46:2016-2023. [PMID: 37328694 DOI: 10.1038/s41440-023-01340-9] [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: 01/23/2023] [Revised: 04/30/2023] [Accepted: 05/18/2023] [Indexed: 06/18/2023]
Abstract
Aortic root dilatation has been proposed as hypertension-mediated organ damage (HMOD). Nevertheless, the role of the aortic root dilatation as a possible additional HMOD is still unclear since studies conducted so far are quite heterogeneous regarding the type of population analyzed, the aortic tract considered, and the type of outcomes accounted for. The aim of the present study is to assess whether the presence of aortic dilatation is associated with strong cardiovascular (CV) events (MACE: heart failure, CV death, stroke, acute coronary syndrome, myocardial revascularization) in a population of patients affected by essential hypertension. Four hundred forty-five hypertensive patients from six Italian hospitals were recruited as part of ARGO-SIIA study1. For all centers, follow-up was obtained by re-contacting all patients by telephone and through the hospital's computer system. Aortic dilatation (AAD) was defined through absolute sex-specific thresholds as in previous studies (41 mm for males, 36 mm for females). Median follow-up was 60 months. AAD was found to be associated with the occurrence of MACE (HR = 4.07 [1.81-9.17], p < 0.001). This result was confirmed after correction for main demographic characteristics such as age, sex and BSA (HR = 2.91 [1.18-7.17], p = 0.020). At penalized Cox regression, age, left atrial dilatation, left ventricular hypertrophy and AAD were identified as best predictor of MACEs and AAD resulted a significant predictor of MACEs even after correction for these confounders (HR = 2.43 [1.02-5.78], p = 0.045). The presence of AAD was found to be associated with an increased risk of MACE independently of for major confounders, including established HMODs. AAD ascending aorta dilatation, LAe left atrial enlargement, LVH left ventricular hypertrophy, MACEs major adverse cardiovascular events, SIIA Società Italiana dell'Ipertensione Arteriosa (Italian Society for Arterial Hypertension).
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Affiliation(s)
- Lorenzo Airale
- Department of Medical Sciences, Hypertension Center-University of Torino-AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesco Borrelli
- Department of Medical Sciences, Hypertension Center-University of Torino-AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessio Arrivi
- SC Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
| | - Alessandro Baracchi
- Cardiothoracic and Vascular Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Fabio Bertacchini
- Department of Internal Medicine, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Iside Cartella
- Echo Lab, Cardiologia IV, De Gasperis Department, ASST Niguarda Ca Granda e Dip Medicina e Chirurgia, Università Milano Bicocca, Milano, Italy
| | - Rosa Curcio
- SC Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University Hospital, Napoli, Italy
| | - Maria Lembo
- Hypertension Research Center, Federico II University Hospital, Napoli, Italy
| | - Costantino Mancusi
- Hypertension Research Center, Federico II University Hospital, Napoli, Italy
| | - Maria Virgina Manzi
- Hypertension Research Center, Federico II University Hospital, Napoli, Italy
| | - Martina Milani
- Echo Lab, Cardiologia IV, De Gasperis Department, ASST Niguarda Ca Granda e Dip Medicina e Chirurgia, Università Milano Bicocca, Milano, Italy
| | - Antonella Moreo
- Echo Lab, Cardiologia IV, De Gasperis Department, ASST Niguarda Ca Granda e Dip Medicina e Chirurgia, Università Milano Bicocca, Milano, Italy
| | - Anna Paini
- Department of Internal Medicine, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Giacomo Pucci
- SC Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
| | - Federico Ruscelli
- Cardiothoracic and Vascular Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Massimo Salvetti
- Department of Internal Medicine, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Mario Soldati
- Cardiothoracic and Vascular Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alberto Milan
- Department of Medical Sciences, Hypertension Center-University of Torino-AOU Città della Salute e della Scienza di Torino, Torino, Italy.
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Galasso M, Cartella I, Soriano F, Nava S, Tavoletta P, De Chiara B, Oliva F, Bruschi G, Oreglia JA, Giannattasio C, Mangieri A, Montalto C. Bi-Caval Valve Implantation to Palliate Symptoms in a Case of Massive Tricuspid Regurgitation. Cardiovasc Revasc Med 2023; 53S:S139-S143. [PMID: 36709089 DOI: 10.1016/j.carrev.2023.01.014] [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: 12/14/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023]
Abstract
Severe tricuspid regurgitation is associated with the occurrence of right failure and increased morbidity and mortality. Transcatheter heterotopic bi-caval valve implantation might offer symptom relief in these patients that are often at prohibitive surgical risk.
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Affiliation(s)
- Michele Galasso
- Interventional Cardiology, 1st Department of Cardiology, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Iside Cartella
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Francesco Soriano
- Interventional Cardiology, 1st Department of Cardiology, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Stefano Nava
- Interventional Cardiology, 1st Department of Cardiology, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Pasquale Tavoletta
- Interventional Cardiology, 1st Department of Cardiology, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Benedetta De Chiara
- 4th Department of Cardiology, De Gasperis, Cardio Center, Niguarda Hospital, Milan, Italy
| | - Fabrizio Oliva
- Interventional Cardiology, 1st Department of Cardiology, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Giuseppe Bruschi
- Cardiac Surgery, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Jacopo A Oreglia
- Interventional Cardiology, 1st Department of Cardiology, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Cristina Giannattasio
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy; 4th Department of Cardiology, De Gasperis, Cardio Center, Niguarda Hospital, Milan, Italy
| | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, 20089 Rozzano-Milan, Italy
| | - Claudio Montalto
- Interventional Cardiology, 1st Department of Cardiology, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy.
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7
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Maloberti A, Giannattasio C, Rebora P, Occhino G, Ughi N, Rizzo J, Fabbri S, Leidi F, Cartella I, Rossetti C, Epis OM, Molon G, Bonfanti P, Valsecchi MG, Genovesi S. 85 ATRIAL FIBRILLATION INCIDENCE IN SARS-COV-2 INFECTED PATIENTS: PREDICTORS AND RELATIONSHIP WITH IN-HOSPITAL MORTALITY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.390] [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: 12/23/2022]
Abstract
Abstract
Background
Among the different CardioVascular (CV) manifestation of the COronaVIrus-related Disease (COVID) particular attention has been paid to arrhythmia and particularly to Atrial fibrillation (AF). The aim of our study was to assess the incidence of AF episodes in patients hospitalized for COVID and to evaluate its predictors and its relationship with in-hospital all-cause mortality.
Methods
We enrolled 3435 cases of SARS-CoV2 infection admitted in four hospitals in Northern Italy. We collected data on clinical history, vital signs, Intensive Care Unit (ICU) admission, laboratory tests and pharmacological treatment. AF incident and all-cause in-hospital mortality were considered as outcomes.
Results
145 (4.2%) patients develop AF during hospitalization, with a median time of 3 days (IQR: 0, 11.5) from admission. Incident AF patients were older and had lower eGFR, lower platelet and lymphocytes count and higher C-Reactive Protein (CRP), were admitted more frequently to ICU and more frequently died compared to subjects that didn't present AF. At the Cox regression model significant determinants of incident AF were older age (HR 1.070; 95% CI: 1.048, 1.092), history of AF (HR 2.800; 95% CI: 1.465, 5.351), ischemic heart disease (HR 0.324; 95% CI: 0.130, 0.811) and ICU admission (HR 8.030; 95% CI: 4.511, 14.292). Incident AF was a predictor of all-cause mortality (HR 1.679; 95% CI: 1.170, 2.410), together with age (HR 1.053; 95% CI: 1.042, 1.065), dementia (HR 1.553; 95% CI 1.151, 2.095), platelet count (HR 0.997; 95% CI: 0.996, 0.999) higher CRP (HR 1.004; 95% CI: 1.003, 1.005) and eGFR (HR: 0.991; 95% CI: 0.986, 0.996)
Conclusion
AF present as the main arrhythmia in COVID-19 patients and its development during the hospitalization strongly relates with in-hospital mortality.
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Affiliation(s)
| | | | | | | | | | | | - Saverio Fabbri
- Ospedale Metropolitano Niguarda
- Universita Di Milano Bicocca
| | - Filippo Leidi
- Ospedale Metropolitano Niguarda
- Universita Di Milano Bicocca
| | - Iside Cartella
- Ospedale Metropolitano Niguarda
- Universita Di Milano Bicocca
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8
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Maloberti A, Giannattasio C, Rebora P, Occhino G, Ughi N, Fabbri S, Cartella I, Algeri M, Scarpellini S, Rossetti C, Epis OM, Molon G, Bonfanti P, Valsecchi MG, Genovesi S. Atrial fibrillation incidence in SARS-CoV-2 infected patients: predictors and relationship with in-hospital mortality. Eur Heart J 2022. [PMCID: PMC9619513 DOI: 10.1093/eurheartj/ehac544.500] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Among the different CardioVascular (CV) manifestation of the COronaVIrus-related Disease (COVID) particular attention has been paid to arrhythmia and particularly to Atrial fibrillation (AF). The aim of our study was to assess the incidence of AF episodes in patients hospitalized for COVID and to evaluate its predictors and its relationship with in-hospital all-cause mortality. Methods We enrolled 3435 cases of SARS-CoV2 infection admitted in four hospitals in Northern Italy. We collected data on clinical history, vital signs, Intensive Care Unit (ICU) admission, laboratory tests and pharmacological treatment. AF incident and all-cause in-hospital mortality were considered as outcomes. Results 145 (4.2%) patients develop AF during hospitalization, with a median time of 3 days (IQR: 0, 11.5) from admission. Incident AF patients were older and had lower eGFR, lower platelet and lymphocytes count and higher C-Reactive Protein (CRP), were admitted more frequently to ICU and more frequently died compared to subjects that didn't present AF. At the Cox regression model significant determinants of incident AF were older age (HR 1.070; 95% CI: 1.048, 1.092), history of AF (HR 2.800; 95% CI: 1.465, 5.351), ischemic heart disease (HR 0.324; 95% CI: 0.130, 0.811) and ICU admission (HR 8.030; 95% CI: 4.511, 14.292). Incident AF was a predictor of all-cause mortality (HR 1.679; 95% CI: 1.170, 2.410), together with age (HR 1.053; 95% CI: 1.042, 1.065), dementia (HR 1.553; 95% CI 1.151, 2.095), platelet count (HR 0.997; 95% CI: 0.996, 0.999) higher CRP (HR 1.004; 95% CI: 1.003, 1.005) and eGFR (HR: 0.991; 95% CI: 0.986, 0.996) Conclusion AF present as the main arrhythmia in COVID-19 patients and its development during the hospitalization strongly relates with in-hospital mortality. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): ASST GOM Niguarda Ca' Granda, Milan, Italy
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Affiliation(s)
- A Maloberti
- Niguarda Ca' Granda Hospital, Cardiology 4 , Milan , Italy
| | - C Giannattasio
- Niguarda Ca' Granda Hospital, Cardiology 4 , Milan , Italy
| | - P Rebora
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine , monza , Italy
| | - G Occhino
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine , monza , Italy
| | - N Ughi
- ASST Great Metropolitan Niguarda, Rheumatology, Multispecialist Medical Department , Milan , Italy
| | - S Fabbri
- Niguarda Ca' Granda Hospital, Cardiology 4 , Milan , Italy
| | - I Cartella
- Niguarda Ca' Granda Hospital, Cardiology 4 , Milan , Italy
| | - M Algeri
- Niguarda Ca' Granda Hospital, Cardiology 4 , Milan , Italy
| | - S Scarpellini
- Niguarda Ca' Granda Hospital, Cardiology 4 , Milan , Italy
| | - C Rossetti
- ASST Great Metropolitan Niguarda, Nuclear Medicine , Milan , Italy
| | - O M Epis
- ASST Great Metropolitan Niguarda, Rheumatology, Multispecialist Medical Department , Milan , Italy
| | - G Molon
- ASST Great Metropolitan Niguarda, Nuclear Medicine , Milan , Italy
| | - P Bonfanti
- Niguarda Ca' Granda Hospital, Cardiology 4 , Milan , Italy
| | - M G Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine , monza , Italy
| | - S Genovesi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine , monza , Italy
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9
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Cartella I, Tavecchia GA, Quattrocchi G, Giannattasio C, Volpato E, Palazzini M, Garascia A, Cipriani M, Frigerio M, Ammirati E, Pedrotti P. A heart of iron: juvenile haemochromatosis presents with cardiac failure. Lancet 2022; 400:616. [PMID: 35988570 DOI: 10.1016/s0140-6736(22)01285-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/24/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Iside Cartella
- Department of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; University of Milano Bicocca, Milan, Italy.
| | - Giovanni A Tavecchia
- Department of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; University of Milano Bicocca, Milan, Italy
| | - Giuseppina Quattrocchi
- Department of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Cristina Giannattasio
- Department of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; University of Milano Bicocca, Milan, Italy
| | - Elisabetta Volpato
- Department of Oncology and Haematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Palazzini
- Department of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Garascia
- Department of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Manlio Cipriani
- Department of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Frigerio
- Department of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Enrico Ammirati
- Department of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Patrizia Pedrotti
- Department of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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10
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Maloberti A, Giannattasio C, Rebora P, Occhino G, Ughi N, Rizzo J, Fabbri S, Leidi F, Cartella I, Algeri M, Scarpellini S, Rossetti C, Epis O, Molon G, Bonfanti P, Valsecchi M, Genovesi S. Atrial fibrillation incidence in SARS-CoV-2 infected patients: Predictors and relationship with in-hospital mortality. Atherosclerosis 2022. [PMCID: PMC9425751 DOI: 10.1016/j.atherosclerosis.2022.06.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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11
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Maranta F, Cianfanelli L, Rizza V, Cartella I, Pistoni A, Avitabile M, Meloni C, Castiglioni A, De Bonis M, Alfieri O, Cianflone D. Diaphragm Dysfunction after Cardiac Surgery: Insights from Ultrasound Imaging during Cardiac Rehabilitation. Ultrasound Med Biol 2022; 48:1179-1189. [PMID: 35351317 DOI: 10.1016/j.ultrasmedbio.2022.02.011] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
Diaphragm dysfunction is common after cardiac surgery and can be evaluated with ultrasonography (US). We aimed at assessing with US the incidence of diaphragmatic dysfunction and the impact of cardiovascular rehabilitation (CR) on its recovery. A single-center cohort study was performed. Patients were enrolled after cardiac surgery. The 6-min walking test (6MWT) and diaphragm US were performed at CR admission and after 10 rehabilitative sessions. One hundred eighty-five patients were eligible for final analysis. One hundred thirty-one patients (70.8%) were found to have diaphragm dysfunction (excursion <2 cm). After CR, 68 patients regained normal diaphragmatic function; those with persistent dysfunction had a lower level of functional performance on the 6MWT (metabolic equivalents of tasks: 3.3 vs. 3.6, p = 0.013). The patients who underwent combined surgery (adjusted odds ratio [aOR] = 4.09, p = 0.001) and those with post-operative pneumothorax (aOR = 3.02, p = 0.042) were at increased risk of failure to improve diaphragmatic excursion. US parameters were more powerful tools in predicting diaphragmatic evolution compared with the 6MWT indexes: baseline diaphragm excursion and thickening fraction were associated with complete diaphragmatic functional recovery after CR (aOR = 9.101, p < 0.001, and aOR = 1.058, p = 0.020 respectively). US is a valuable tool for the assessment of post-operative diaphragmatic dysfunction and can identify patients at risk of diaphragmatic recovery failure.
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Affiliation(s)
- Francesco Maranta
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy.
| | - Lorenzo Cianfanelli
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Iside Cartella
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Anna Pistoni
- General Practitioner Lombardy Training Program, Pavia, Italy
| | - Maria Avitabile
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Meloni
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Castiglioni
- Vita-Salute San Raffaele University, Milan, Italy; Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Michele De Bonis
- Vita-Salute San Raffaele University, Milan, Italy; Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Domenico Cianflone
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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12
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Maloberti A, Giannattasio C, Rebora P, Occhino G, Ughi N, Rizzo J, Fabbri S, Leidi F, Cartella I, Algeri M, Scarpellini S, Rossetti C, Epis O, Molon G, Bonfanti P, Valsecchi MG, Genovesi S. ATRIAL FIBRILLATION INCIDENCE IN SARS-COV-2 INFECTED PATIENTS: PREDICTORS AND RELATIONSHIP WITH IN-HOSPITAL MORTALITY. J Hypertens 2022. [DOI: 10.1097/01.hjh.0000835888.39220.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Tedeschi A, Camilli M, Ianni U, Tavecchia G, Palazzini M, Cartella I, Gentile P, Quattrocchi G, Maria Spanò F, Cipriani M, Garascia A, Ammirati E. Takotsubo syndrome after BNT162b2 mRNA Covid-19 vaccine: Emotional or causative relationship with vaccination? IJC Heart & Vasculature 2022; 40:101002. [PMID: 35340274 PMCID: PMC8934733 DOI: 10.1016/j.ijcha.2022.101002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 01/24/2023]
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14
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Maloberti A, Giannattasio C, Rebora P, Occhino G, Ughi N, Rizzo J, Fabbri S, Leidi F, Cartella I, Algeri M, Scarpellini S, Rossetti C, Epis O, Molon G, Bonfanti P, Valsecchi M, Genovesi S. P16 ATRIAL FIBRILLATION INCIDENCE IN SARS–COV–2 INFECTED PATIENTS: PREDICTORS AND RELATIONSHIP WITH IN–HOSPITAL MORTALITY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.014] [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: 11/13/2022]
Abstract
Abstract
Background
Among the different CardioVascular (CV) manifestation of the COronaVIrus–related Disease (COVID) particular attention has been paid to arrhythmia and particularly to Atrial fibrillation (AF). The aim of our study was to assess the incidence of AF episodes in patients hospitalized for COVID and to evaluate its predictors and its relationship with in–hospital all–cause mortality.
Methods
We enrolled 3435 cases of SARS–CoV2 infection admitted in four hospitals in Northern Italy. We collected data on clinical history, vital signs, Intensive Care Unit (ICU) admission, laboratory tests and pharmacological treatment. AF incident and all–cause in–hospital mortality were considered as outcomes.
Results
145 (4.2%) patients develop AF during hospitalization, with a median time of 3 days (IQR: 0, 11.5) from admission. Incident AF patients were older and had lower eGFR, lower platelet and lymphocytes count and higher C–Reactive Protein (CRP), were admitted more frequently to ICU and more frequently died compared to subjects that didn’t present AF. At the Cox regression model significant determinants of incident AF were older age (HR 1.070; 95% CI: 1.048, 1.092), history of AF (HR 2.800; 95% CI: 1.465, 5.351), ischemic heart disease (HR 0.324; 95% CI: 0.130, 0.811) and ICU admission (HR 8.030; 95% CI: 4.511, 14.292). Incident AF was a predictor of all–cause mortality (HR 1.679; 95% CI: 1.170, 2.410), together with age (HR 1.053; 95% CI: 1.042, 1.065), dementia (HR 1.553; 95% CI 1.151, 2.095), platelet count (HR 0.997; 95% CI: 0.996, 0.999) higher CRP (HR 1.004; 95% CI: 1.003, 1.005) and eGFR (HR: 0.991; 95% CI: 0.986, 0.996)
Conclusion
AF present as the main arrhythmia in COVID–19 patients and its development during the hospitalization strongly relates with in–hospital mortality.
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Affiliation(s)
- A Maloberti
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - C Giannattasio
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - P Rebora
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - G Occhino
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - N Ughi
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - J Rizzo
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - S Fabbri
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - F Leidi
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - I Cartella
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - M Algeri
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - S Scarpellini
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - C Rossetti
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - O Epis
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - G Molon
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - P Bonfanti
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - M Valsecchi
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - S Genovesi
- OSPEDALE NIGUARDA, MILANO; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MONZA; UNIVERSITÀ DEGLI STUDI DI MILANO BICOCCA, MILANO; OSPEDALE SAN GERARDO, MONZA; ISTITUTO AUXOLOGICO ITALIANO, MILANO
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15
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Scaglione A, Panzarino C, Modica M, Tavanelli M, Pezzano A, Grati P, Racca V, Toccafondi A, Bordoni B, Verde A, Cartella I, Castiglioni P. Short- and long-term effects of a cardiac rehabilitation program in patients implanted with a left ventricular assist device. PLoS One 2021; 16:e0259927. [PMID: 34851984 PMCID: PMC8635401 DOI: 10.1371/journal.pone.0259927] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022] Open
Abstract
The efficacy of cardiac rehabilitation in heart-failure patients who received a left-ventricular assist device (LVAD) instead of heart transplantation (HTx) is still unclear. This study aims to evaluate whether cardiac rehabilitation is beneficial in LVAD as HTx patients in the short term and whether its effects in LVAD patients persist over time. Twenty-five LVAD patients were evaluated by functional and psychological tests at admission (T0) and discharge (T1) of a 4-week inpatient structured rehabilitation program, and follow-ups 3 (T2), 6 (T3), and 12 months (T4) after discharge. Twenty-five matched HTx patients were also studied from T0 to T1 to compare the improvements in the six-minute walk test (6MWT). The quality-of-life scores substantially improved in LVAD patients and the 6MWT showed the same functional recovery as in HTx patients from T0 to T1. After T1, numerous LVAD patients withdrew from the study. However, the 6MWT outcome increased further from T1 to T3, with a positive trend during the follow-ups. Hemoglobin and the ventilatory performance increased, and the psychological perception of heart-failure symptoms and pain further improved at T2. In conclusion, exercise-based rehabilitation programs provide similar beneficial effects in LVAD and HTx patients, without deterioration in LVAD patients up to 12 months after discharge.
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Affiliation(s)
- Anna Scaglione
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Claudia Panzarino
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Maddalena Modica
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Monica Tavanelli
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Antonio Pezzano
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Paola Grati
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Vittorio Racca
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Anastasia Toccafondi
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Bruno Bordoni
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Alessandro Verde
- Heart Failure and Heart Transplant Program, CardioThoracic and Vascular Department, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Iside Cartella
- Heart Failure and Heart Transplant Program, CardioThoracic and Vascular Department, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
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16
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Maloberti A, Bombelli M, Vallerio P, Milani M, Cartella I, Tavecchia G, Tognola C, Grasso E, Sun J, De Chiara B, Riccobono S, Grassi G, Giannattasio C. Metabolic syndrome is related to vascular structural alterations but not to functional ones both in hypertensives and healthy subjects. Nutr Metab Cardiovasc Dis 2021; 31:1044-1052. [PMID: 33549437 DOI: 10.1016/j.numecd.2020.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/01/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Metabolic Syndrome (MS) has been related to an impairment in arterial structural and functional properties with heterogeneous results. In this paper we focused on the effects of MS on arterial carotid-femoral PWV and common carotid IMT in two different populations, one of hypertensive patients and one of healthy controls. METHODS AND RESULTS We enrolled 816 consecutive HT and 536 healthy controls. Vascular structural (IMT) and functional (PWV) properties were evaluated. NCEP-ATP-III criteria were used for diagnosis of MS. MS was diagnosed in 26.9% and 6.9% in hypertensive and control subjects, respectively. PWV was similar in controls with and without MS (7.7 ± 1.9 vs 7.6 ± 1.1 m/s, p = 0.69), while IMT was higher in controls with than those without MS (0.64 ± 0.18 vs 0.57 ± 0.13 mm, p = 0.02). Hypertensives with MS were older (57.9 ± 12.2 vs 52.7 ± 14.1 years, p < 0.001) and showed higher PWV (9.0 ± 2.3 vs 8.4 ± 2.1 m/s, p = 0.001) and IMT (0.72 ± 0.22 vs 0.65 ± 0.17 mm, p < 0.001) than those without MS, however at the age-adjusted analysis only the difference in IMT was confirmed (p = 0.007). Regression models showed that MS was an independent determinant of IMT in both controls (β = 0.08, p = 0.03) and hypertensives (β = 0.08, p = 0.01), but not of PWV either in controls (β = 0.006, p = 0.886 and β = 0.04, p = 0.19, respectively). CONCLUSIONS the main finding of our work is that MS is a significant determinant of IMT while this is not the case for PWV. This result have been confirmed both in hypertensive subjects and in healthy controls.
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Affiliation(s)
- Alessandro Maloberti
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy; Health Science Department, Milano-Bicocca University, Milan, Italy.
| | - Michele Bombelli
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Paola Vallerio
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Martina Milani
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Iside Cartella
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | | | - Chiara Tognola
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Enzo Grasso
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Jinwei Sun
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Benedetta De Chiara
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Salvatore Riccobono
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Guido Grassi
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Cristina Giannattasio
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy; Health Science Department, Milano-Bicocca University, Milan, Italy
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17
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Maloberti A, Qualliu E, Occhi L, Sun J, Grasso E, Tognola C, Tavecchia G, Cartella I, Milani M, Vallerio P, Signorini S, Brambilla P, Casati M, Bombelli M, Grassi G, Giannattasio C. Hyperuricemia prevalence in healthy subjects and its relationship with cardiovascular target organ damage. Nutr Metab Cardiovasc Dis 2021; 31:178-185. [PMID: 32994122 DOI: 10.1016/j.numecd.2020.08.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Heterogeneous results have been obtained in the relationship between Uric Acid (UA) and Target Organ Damage (TOD). In the present study we sought to assess the prevalence of hyperuricemia in healthy subjects as well as the role of UA in determining TOD. We evaluated vascular, cardiac and renal TODs in the whole population as well as sub-grouped by gender. METHODS AND RESULTS As many as 379 blood donors participated at the present analysis. TOD was evaluated as Pulse Wave Velocity (PWV), Left Ventricular Mass Index (LVMI) and carotid Intima-Media Thickness (IMT). Hyperuricemia was defined with the classic cut-off (>7.0 in men and >6.0 mg/dL in women) but also with a most recently defined one (5.6 mg/dL for both sex). Hyperuricemia was present in 6.3% of the whole population (7.3% males, 2.8% females) considering the classic cut-off, while, with the recently identified one, it was present in 28.2% of the whole population (37.3% males, 4.7% females). Despite all the evaluated TODs significantly correlated with UA, linear multivariate regression analysis showed that none of them, except for GFR, displayed UA as a significant covariate. Similar figures were found also when both correlation and linear regression analyses were repeated in the two genders separately. CONCLUSIONS Hyperuricemia is an important problem also in healthy subjects and its prevalence could further increase if lower cut-off will be used. In this specific population UA is significantly associated with renal impairment while this was not the case for cardiac and vascular damage.
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Affiliation(s)
- Alessandro Maloberti
- Cardiology IV, "A. De Gasperis" Department, ASTT GOM Niguarda Ca' Granda, Milan, Italy; University of Milano-Bicocca, Milan, Italy.
| | | | - Lucia Occhi
- Cardiology IV, "A. De Gasperis" Department, ASTT GOM Niguarda Ca' Granda, Milan, Italy; University of Milano-Bicocca, Milan, Italy
| | - Jinwei Sun
- University of Milano-Bicocca, Milan, Italy
| | | | | | | | | | | | | | | | | | - Marco Casati
- Laboratory Medicine, San Gerardo Hospital, ASST Monza, Italy
| | - Michele Bombelli
- University of Milano-Bicocca, Milan, Italy; Clinica Medica, University of Milano-Bicocca, Monza, Italy
| | - Guido Grassi
- University of Milano-Bicocca, Milan, Italy; Clinica Medica, University of Milano-Bicocca, Monza, Italy
| | - Cristina Giannattasio
- Cardiology IV, "A. De Gasperis" Department, ASTT GOM Niguarda Ca' Granda, Milan, Italy; University of Milano-Bicocca, Milan, Italy
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18
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Tognola C, Alessandro M, Milani M, Cartella I, Tavecchia G, Grasso E, Sun J, Giannattasio C. Nutraceuticals in Chronic Coronary Syndromes: Preclinical Data and Translational Experiences. High Blood Press Cardiovasc Prev 2021; 28:13-25. [PMID: 33125662 PMCID: PMC7864844 DOI: 10.1007/s40292-020-00416-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/10/2020] [Indexed: 12/13/2022] Open
Abstract
Non-pharmacological treatments have always been considered important in the management of Chronic Coronary Syndromes. Nutraceuticals ("Nutrition" + "Pharmaceutical") could fall both under the definition of non-pharmacological treatment and pharmacological one or, probably more correctly, in the middle of these two kinds of therapies. However, the word "nutraceuticals" never appears in the latest guidelines on this issue. This is probably determined by the fact that evidences on this topic are scarce and most of the published articles are based on preclinical data while translational experiences are available only for some molecules. In this review we will focus on nutraceutical strategies that act on the ischemic myocardium itself and not only on the cardiovascular risk factors. As demonstrated by the important number of papers published in recent years, this is an evolving topic and evaluated substances principally act on two mechanisms (cardiac energetics and ischemia-reperfusion damage) that will be also reviewed.
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Affiliation(s)
- Chiara Tognola
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Maloberti Alessandro
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.
| | - Martina Milani
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Iside Cartella
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Giovanni Tavecchia
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Enzo Grasso
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Jinwey Sun
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Cristina Giannattasio
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
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19
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Maranta F, Cartella I, Pistoni A, Cianfanelli L, Cerea P, Castiglioni A, De Bonis M, Alfieri O, Cianflone D. P4385Diaphragm dysfunction following cardiac surgery: role of ultrasound imaging for initial and follow-up assessment during cardiac rehabilitation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0790] [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
Diaphragm dysfunction is a common complication of cardiac surgery, often underdiagnosed. Ultrasonography (US) is a promising technique for diaphragmatic assessment. Few trials have been conducted using US after heart surgery and no clear data exist on the recovery of diaphragm function after cardiovascular rehabilitation (CR).
Purpose
The aim of this study is to evaluate post-cardiac surgery diaphragm dysfunction using US and to assess the impact of an inpatient CR programme on its functional recovery.
Methods
In a single-centre prospective cohort study 97 consecutive patients hospitalised in our CR Unit were enrolled. 14 patients underwent aortic valve replacement, 38 mitral valve repair or replacement, 14 coronary artery bypass grafting (CABG), 22 combined surgery, and 9 other surgical interventions. We performed diaphragm US at admission and after 10 rehabilitative sessions. The following parameters were assessed: thickening fraction (TF) in B-mode on the right intercostal projections, and excursion, time of inspiration, time of a respiratory cycle and contraction velocity in M-mode on right anterior subcostal projections.
Results
After cardiac surgery, the incidence of diaphragm dysfunction and paralysis were 60% and 1%, respectively. Patients with TF <20% at admission showed a significant improvement in TF (13.30%, IQR 8.69–17.39 vs 27.27%, IQR 21.05–31.58; p<0.001), excursion (1.67cm, IQR 1.3–2.1 vs 2.23cm, IQR 1.9–2.7; p<0.001), time of inspiration (0.9s, IQR 0.9–1.07 vs 1.01s, IQR 0.87–1.13; p=0.005), time of a respiratory cycle (2.67s, IQR 2.38–3.05 vs 3.07s, IQR 2.68–3.35; p<0.001) and velocity (1.81cm/s, IQR 1.14–2.33 vs 2.24cm/s, IQR 1.92–2.76; p<0.001). On the contrary, in patients with a TF>20%, no additional improvement was observed. In both groups, there was a significant improvement in the parameters of physical performance.
In particular, in the group with a TF<20%, the distance covered during the 6MWT (300m, IQR 205–370 vs 555m, IQR 450–612; p<0.001) and the energy cost of physical activity (2.60, IQR 2.13–2.92 vs 4.09, IQR 3.44–4.50; p<0.001) increased while the perception of exertion (Borg Scale 11, IQR 11–13 vs 13, IQR 12–13; p=0.011) was reduced. At the 10th day assessment, 51.5% of the total population had a recovery of diaphragm function, whilst 48.5% had a failure of recovery (TF relative change between admission and discharge <60%). The multivariate analysis identified CABG as an independent predictor of failure of diaphragm recovery (OR 5.44; CI 1.10–26.84, p=0.037).
Conclusion
US might be a valuable part of routine clinical practice for initial and follow-up assessment of patients after open-heart surgery. CR showed to be an effective strategy to improve diaphragm parameters in patients with post-surgical dysfunction. Progressive evaluation of diaphragm function may drive personalised rehabilitation programmes.
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Affiliation(s)
- F Maranta
- San Raffaele Scientific Institute, Milan, Italy
| | - I Cartella
- University Vita-Salute San Raffaele, Milan, Italy
| | - A Pistoni
- University Vita-Salute San Raffaele, Milan, Italy
| | | | - P Cerea
- University of Milan-Bicocca, Cardiology, Milan, Italy
| | | | - M De Bonis
- University Vita-Salute San Raffaele, Milan, Italy
| | - O Alfieri
- San Raffaele Scientific Institute, Milan, Italy
| | - D Cianflone
- University Vita-Salute San Raffaele, Milan, Italy
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20
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Maranta F, Pistoni A, Cartella I, Cianfanelli L, Cerea P, De Bonis M, Castiglioni A, Alfieri O, Cianflone D. P2522A new scoring system to stratify post-surgical valvular patients during cardiovascular rehabilitation: derivation and validation study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0851] [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
Guidelines underline the importance of Cardiovascular Rehabilitation (CR) in post-surgical valvular patients both for the functional recovery and the monitoring of complications. However, there are no established indicators to better categorise their risk and to identify the real probability of recovery.
Purpose
The aim of this study is to propose and validate a scoring system to appropriately stratify post-surgical valvular patients in order to individualise CR programmes.
Methods
A retrospective study was conducted on 1480 post-surgical valvular patients hospitalized in our CR Unit (902 M – 578 F; median age of 64 years, IQR 53–73). 485 patients underwent single heart valve repair, 408 single heart valve replacement, 237 single heart valve surgery and additional interventions, 249 multiple valve interventions and 101 multiple heart valves and additional interventions. Subjects were randomised in two groups for data analysis: a Derivation (D; n=1000) and a Validation (V; n=480) group. Initially, in group D we assessed the predictive value of anamnestic, clinical and laboratory variables for major complications and functional recovery. We created two scoring systems for these outcomes and, subsequently, we validated them on group V. Finally, we interlaced them in an operative algorithm.
Results
Chronic kidney disease (OR 2.588; 95% CI 1.232–5.436; p=0.012), sternal surgical re-synthesis (OR 7.757; 95% CI 2.042–29.471; p=0.003), post-surgical transfusions (OR 2.419; 95% CI 1.407–4.161; p=0.001) and Troponin T peak >1400 μg/L (OR 2.441; 95% CI 1.418–4.200; p=0.001) were independent predictors for the occurrence of major complications in group D. Age (OR 0.958; 95% CI 0.9339–0.977; p<0.001), post- surgical transfusions (OR 1.981; 95% CI 1.160–3.380; p<0.001) and METS at admission (OR 0.032; 95% CI 0.017–0.061; p<0.001) were independent predictors of a higher functional recovery in group D. When the two scoring systems were validated on group V, we obtained a z score of 0.07 (p=0.941) for the major complications risk score and a z score of 1.23 (p=0.219) for the functional recovery stratification system, respectively, indicating a very reliable model. We proceeded to build an operative algorithm to stratify patients and propose personalised CR strategies.
Conclusions
We identified predictors to stratify the risk of complications and to define the probability of recovery in post-surgical valvular patients undergoing CR. The proposed final operative algorithm may be a unique tool to support the cardiologist to tailor rehabilitation programmes. This may lead to better outcomes and reduction of healthcare expenditure with optimisation in the use of available resources.
Acknowledgement/Funding
None
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Affiliation(s)
- F Maranta
- San Raffaele Scientific Institute, Milan, Italy
| | - A Pistoni
- University Vita-Salute San Raffaele, Milan, Italy
| | - I Cartella
- University Vita-Salute San Raffaele, Milan, Italy
| | | | - P Cerea
- University of Milan-Bicocca, Cardiology, Milan, Italy
| | - M De Bonis
- University Vita-Salute San Raffaele, Milan, Italy
| | | | - O Alfieri
- San Raffaele Scientific Institute, Milan, Italy
| | - D Cianflone
- University Vita-Salute San Raffaele, Milan, Italy
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21
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Maranta F, Fossati L, Cerea P, Cianfanelli L, Pagnesi M, Cartella I, Pistoni A, Negri S, Cianflone D. P1244Neutrophil to lymphocyte ratio: a new preoperative predictive index of postoperative atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1244] [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)
- F Maranta
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
| | - L Fossati
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
| | - P Cerea
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
| | - L Cianfanelli
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
| | - M Pagnesi
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
| | - I Cartella
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
| | - A Pistoni
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
| | - S Negri
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
| | - D Cianflone
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
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22
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Cerea P, Maranta F, Fossati L, Cianfanelli L, Pagnesi M, Cartella I, Pistoni A, Negri S, Cianflone D. P2558A novel scoring system and decisional algorithm to predict functional recovery after heart valve surgery. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2558] [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)
- P Cerea
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
| | - F Maranta
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
| | - L Fossati
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
| | - L Cianfanelli
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
| | - M Pagnesi
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
| | - I Cartella
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
| | - A Pistoni
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
| | - S Negri
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
| | - D Cianflone
- San Raffaele Hospital of Milan (IRCCS), Cardiovascular Rehabilitation, Milan, Italy
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