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Diana A, Polizzi AM, De Luisi A, Pantaleo MG, Leonetti G, Simonetti S, Bukvic N, Iacoviello M, Bucci R, Gentile M, Resta N. First report of whole CFTR gene duplication in a healthy newborn carrying R74W and V855I variants on the same allele. J Cyst Fibros 2024:S1569-1993(24)00013-4. [PMID: 38320874 DOI: 10.1016/j.jcf.2024.01.013] [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] [Received: 08/09/2023] [Revised: 11/16/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
Cystic fibrosis (CF) is the most common severe autosomal recessive genetic disorder among Caucasians. The improvement of genetic techniques has allowed the identification of an increasing number of genetic variants, including large rearrangements such as duplications. We report the first case of a whole CFTR gene duplication in a healthy newborn, who had normal sweat test, also carrying R74W and V855I variants on the same allele. Familial segregation analysis and the observed frequencies of all the CFTR gene variants, revealed that R74W and V855I were probably both present in a cis arrangement on the allele also containing the duplication (i.e., in a double complex allele). Since R74W is a "variant of varying clinical consequence" its arrangement in trans with one pathogenic variant may not be sufficient to cause a classic CF disease phenotype. Moreover, its duplication could even be an advantage that could compensate for the effect of the alteration.
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Affiliation(s)
- Anna Diana
- Medical Genetics Section, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Hospital Consortium Corporation Polyclinics of Bari, 70124 Bari, Italy
| | - Angela Maria Polizzi
- Medical Genetics Section, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Hospital Consortium Corporation Polyclinics of Bari, 70124 Bari, Italy
| | - Annunziata De Luisi
- Medical Genetics Section, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Hospital Consortium Corporation Polyclinics of Bari, 70124 Bari, Italy
| | - Maria Giuseppina Pantaleo
- Medical Genetics Section, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Hospital Consortium Corporation Polyclinics of Bari, 70124 Bari, Italy
| | - Giuseppina Leonetti
- Cystic Fibrosis Regional Center, University Hospital Consortium Corporation Polyclinics of Bari, 70124 Bari, Italy
| | - Simonetta Simonetti
- Clinical Patology and Neonatal Screening, Hospital "Giovanni XXIII", University Hospital Consortium Corporation Polyclinics of Bari, Bari, Italy
| | - Nenad Bukvic
- Medical Genetics Section, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Hospital Consortium Corporation Polyclinics of Bari, 70124 Bari, Italy
| | - Matteo Iacoviello
- Medical Genetics Section, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Hospital Consortium Corporation Polyclinics of Bari, 70124 Bari, Italy
| | - Roberta Bucci
- Medical Genetics Section, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Hospital Consortium Corporation Polyclinics of Bari, 70124 Bari, Italy; Medical Genetics Unit, Department of Human Reproductive Medicine, ASL Bari, Bari, Italy
| | - Mattia Gentile
- Medical Genetics Unit, Department of Human Reproductive Medicine, ASL Bari, Bari, Italy
| | - Nicoletta Resta
- Medical Genetics Section, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University Hospital Consortium Corporation Polyclinics of Bari, 70124 Bari, Italy.
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Luca M, Piglionica M, Bagnulo R, Cardaropoli S, Carli D, Turchiano A, Coppo P, Pantaleo A, Iacoviello M, Ferrero GB, Mussa A, Resta N. The somatic p.T81dup variant in AKT3 gene underlies a mild cerebral phenotype and expands the spectrum including capillary malformation and lateralized overgrowth. Genes Chromosomes Cancer 2023; 62:703-709. [PMID: 37395289 DOI: 10.1002/gcc.23188] [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: 04/22/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023] Open
Abstract
Heterozygous germline or somatic variants in AKT3 gene can cause isolated malformations of cortical development (MCDs) such as focal cortical dysplasia, megalencephaly (MEG), Hemimegalencephaly (HME), dysplastic megalencephaly, and syndromic forms like megalencephaly-polymicrogyria-polydactyly-hydrocephalus syndrome, and megalencephaly-capillary malformation syndrome. This report describes a new case of HME and capillary malformation caused by a somatic AKT3 variant that differs from the common p.E17K variant described in literature. The patient's skin biopsy from the angiomatous region revealed an heterozygous likely pathogenic variant AKT3:c.241_243dup, p.(T81dup) that may affect the binding domain and downstream pathways. Compared to previously reported cases with a common E17K mosaic variant, the phenotype is milder and patients showed segmental overgrowth, an uncommon characteristic in AKT3 variant cases. These findings suggest that the severity of the disease may be influenced not only by the level of mosaicism but also by the type of variant. This report expands the phenotypic spectrum associated with AKT3 variants and highlights the importance of genomic analysis in patients with capillary malformation and MCDs.
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Affiliation(s)
- Maria Luca
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Marilidia Piglionica
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Rosanna Bagnulo
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Simona Cardaropoli
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Diana Carli
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Antonella Turchiano
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Paola Coppo
- Pediatric Dermatology Unit, Regina Margherita Children's Hospital, Torino, Italy
| | - Antonino Pantaleo
- National Institute of Gastroenterology-IRCCS "Saverio de Bellis", Bari, Italy
| | - Matteo Iacoviello
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | | | - Alessandro Mussa
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
- Pediatric Clinical Genetics, Regina Margherita Children Hospital, Torino, Italy
| | - Nicoletta Resta
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
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Gazzin A, Leoni C, Viscogliosi G, Borgini F, Perri L, Iacoviello M, Piglionica M, De Pellegrin M, Ferrero GB, Bartuli A, Zampino G, Buonuomo PS, Resta N, Mussa A. Work-Up and Treatment Strategies for Individuals with PIK3CA-Related Disorders: A Consensus of Experts from the Scientific Committee of the Italian Macrodactyly and PROS Association. Genes (Basel) 2023; 14:2134. [PMID: 38136956 PMCID: PMC10742781 DOI: 10.3390/genes14122134] [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: 11/05/2023] [Revised: 11/23/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023] Open
Abstract
PIK3CA-related disorders encompass many rare and ultra-rare conditions caused by somatic genetic variants that hyperactivate the PI3K-AKT-mTOR signaling pathway, which is essential for cell cycle control. PIK3CA-related disorders include PIK3CA-related overgrowth spectrum (PROS), PIK3CA-related vascular malformations and PIK3CA-related non-vascular lesions. Phenotypes are extremely heterogeneous and overlapping. Therefore, diagnosis and management frequently involve various health specialists. Given the rarity of these disorders and the limited number of centers offering optimal care, the Scientific Committee of the Italian Macrodactyly and PROS Association has proposed a revision of the most recent recommendations for the diagnosis, molecular testing, clinical management, follow-up, and treatment strategies. These recommendations give insight on molecular diagnosis, eligible samples, preferable sequencing, and validation methods and management of negative results. The purpose of this paper is to promote collaboration between health care centers and clinicians with a joint shared approach. Finally, we suggest the direction of present and future research studies, including new systemic target therapies, which are currently under evaluation in several clinical trials, such as specific inhibitors that can be employed to downregulate the signaling pathway.
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Affiliation(s)
- Andrea Gazzin
- Clinical Pediatric Genetics Unit, Department of Public Health and Pediatrics, University of Torino, Regina Margherita Children’s Hospital, 10126 Torino, Italy; (A.G.); (A.M.)
- Postgraduate School of Pediatrics, University of Torino, 10126 Torino, Italy
| | - Chiara Leoni
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.V.); (L.P.); (G.Z.)
| | - Germana Viscogliosi
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.V.); (L.P.); (G.Z.)
| | - Federica Borgini
- Italian Macrodactyly and PROS Association, 27010 San Genesio ed Uniti (PV), Italy;
| | - Lucrezia Perri
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.V.); (L.P.); (G.Z.)
| | - Matteo Iacoviello
- Medical Genetics Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.I.); (M.P.); (N.R.)
| | - Marilidia Piglionica
- Medical Genetics Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.I.); (M.P.); (N.R.)
| | - Maurizio De Pellegrin
- Pediatric Orthopedic Unit, Piccole Figlie Hospital, 43125 Parma, Italy
- Department of Orthopedics, ASST Ospedale Papa Giovanni XXIII, 24127 Bergamo, Italy
| | | | - Andrea Bartuli
- Rare Disease and Medical Genetics Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (A.B.); (P.S.B.)
| | - Giuseppe Zampino
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.V.); (L.P.); (G.Z.)
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Paola Sabrina Buonuomo
- Rare Disease and Medical Genetics Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (A.B.); (P.S.B.)
| | - Nicoletta Resta
- Medical Genetics Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.I.); (M.P.); (N.R.)
| | - Alessandro Mussa
- Clinical Pediatric Genetics Unit, Department of Public Health and Pediatrics, University of Torino, Regina Margherita Children’s Hospital, 10126 Torino, Italy; (A.G.); (A.M.)
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Di Ciaula A, Iacoviello M, Bonfrate L, Khalil M, Shanmugam H, Lopalco G, Bagnulo R, Garganese A, Iannone F, Resta N, Portincasa P, Stella A. Genetic and clinical features of familial mediterranean fever (FMF) in a homogeneous cohort of patients from South-Eastern Italy. Eur J Intern Med 2023; 115:79-87. [PMID: 37183082 DOI: 10.1016/j.ejim.2023.05.015] [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: 03/27/2023] [Revised: 04/23/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
Familial Mediterranean Fever (FMF) is linked with the MEFV gene and is the commonest among monogenic autoinflammatory diseases, with high prevalence in the Mediterranean basin. Although the clinical presentation of FMF has a major role in diagnosis, genotype/phenotype correlations and the role of "benign" gene variants (as R202Q) appear highly variable and incompletely clear, making difficult to select the most effective strategy in the management of patients. Aim of the present study was to investigate the clinical presentation and the genetic background in a homogenous cohort of patients from Apulia (south eastern Italy). We investigated 217 patients with a clinical suspect of autoinflammatory diseases, who were characterized for the occurrence of specific symptoms and with next generation sequencing by a 4-gene panel including MEFV, MVK, NLRP3 and TNFRSF1A. A genetic change was identified in 122 (53.7%) patients, with 161 different MEFV variants recorded in 100 individuals, 10 variants in NLRP3, and 6 each in TNFRSF1A and MVK. The benign variant R202Q was largely prevalent (41.6% of all MEFV variants). When patients were selected according the number of pathogenic MEFV variants (0, 1, or 2 pathogenic variants), results failed to show significant links between the frequency of symptoms and the number of pathogenic variants. Only family history and Pras score (indicative for severity of disease) predicted the presence of pathogenic variants, as compared with carriers of variants considered of uncertain significance or benign. Fever >38 °C and arthralgias appeared more frequently in R202Q-positive patients than in non-R202Q carriers. These two subgroups showed comparable duration of fever, occurrence of myalgia, abdominal and chest pain, Pras, and IFFS scores. In conclusion, results confirm that FMF manifests in mild form in non-middle eastern patients. This possibility partly affects the reliability of clinical criteria/scores. Furthermore, the presence of the R202Q variant might not be completely neutral in selected groups of patients.
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Affiliation(s)
- Agostino Di Ciaula
- Clinica Medica "A. Murri", Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Matteo Iacoviello
- Laboratory of Medical Genetics, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Leonilde Bonfrate
- Clinica Medica "A. Murri", Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Mohamad Khalil
- Clinica Medica "A. Murri", Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Harshitha Shanmugam
- Clinica Medica "A. Murri", Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Rosanna Bagnulo
- Laboratory of Medical Genetics, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | | | - Florenzo Iannone
- Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Nicoletta Resta
- Laboratory of Medical Genetics, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy; Laboratory of Medical Genetics, AOU Hospital Policlinico, Bari, Italy
| | - Piero Portincasa
- Clinica Medica "A. Murri", Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Alessandro Stella
- Laboratory of Medical Genetics, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy; Laboratory of Medical Genetics, AOU Hospital Policlinico, Bari, Italy.
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5
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Turchiano A, Piglionica M, Martino S, Bagnulo R, Garganese A, De Luisi A, Chirulli S, Iacoviello M, Stasi M, Tabaku O, Meneleo E, Capurso M, Crocetta S, Lattarulo S, Krylovska Y, Lastella P, Forleo C, Stella A, Bukvic N, Simone C, Resta N. Impact of High-to-Moderate Penetrance Genes on Genetic Testing: Looking over Breast Cancer. Genes (Basel) 2023; 14:1530. [PMID: 37628581 PMCID: PMC10454640 DOI: 10.3390/genes14081530] [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] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
Breast cancer (BC) is the most common cancer and the leading cause of cancer death in women worldwide. Since the discovery of the highly penetrant susceptibility genes BRCA1 and BRCA2, many other predisposition genes that confer a moderate risk of BC have been identified. Advances in multigene panel testing have allowed the simultaneous sequencing of BRCA1/2 with these genes in a cost-effective way. Germline DNA from 521 cases with BC fulfilling diagnostic criteria for hereditary BC were screened with multigene NGS testing. Pathogenic (PVs) and likely pathogenic (LPVs) variants in moderate penetrance genes were identified in 15 out of 521 patients (2.9%), including 2 missense, 7 non-sense, 1 indel, and 3 splice variants, as well as two different exon deletions, as follows: ATM (n = 4), CHEK2 (n = 5), PALB2 (n = 2), RAD51C (n = 1), and RAD51D (n = 3). Moreover, the segregation analysis of PVs and LPVs into first-degree relatives allowed the detection of CHEK2 variant carriers diagnosed with in situ melanoma and clear cell renal cell carcinoma (ccRCC), respectively. Extended testing beyond BRCA1/2 identified PVs and LPVs in a further 2.9% of BC patients. In conclusion, panel testing yields more accurate genetic information for appropriate counselling, risk management, and preventive options than assessing BRCA1/2 alone.
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Affiliation(s)
- Antonella Turchiano
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Marilidia Piglionica
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Stefania Martino
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Rosanna Bagnulo
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Antonella Garganese
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Annunziata De Luisi
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Stefania Chirulli
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Matteo Iacoviello
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Michele Stasi
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Ornella Tabaku
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Eleonora Meneleo
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Martina Capurso
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Silvia Crocetta
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Simone Lattarulo
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Yevheniia Krylovska
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Patrizia Lastella
- Rare Disease Center, Internal Medicine Unit “C. Frugoni”, AOU Policlinico di Bari, 70124 Bari, Italy;
| | - Cinzia Forleo
- Cardiology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Alessandro Stella
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Nenad Bukvic
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
| | - Cristiano Simone
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
- Medical Genetics, National Institute of Gastroenterology, “S. de Bellis” Research Hospital, Via Turi 27, Castellana Grotte, 70013 Bari, Italy
| | - Nicoletta Resta
- Medical Genetic, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.T.); (M.P.); (S.M.); (R.B.); (A.G.); (A.D.L.); (S.C.); (M.I.); (M.S.); (O.T.); (E.M.); (M.C.); (S.C.); (S.L.); (Y.K.); (A.S.); (N.B.); (C.S.)
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6
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Ferrante F, Graves S, Iacoviello M. The inflationary effects of sectoral reallocation. J Monet Econ 2023:S0304-3932(23)00030-2. [PMID: 37363635 PMCID: PMC10022469 DOI: 10.1016/j.jmoneco.2023.03.003] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 06/28/2023]
Abstract
The COVID-19 pandemic has led to an unprecedented shift of consumption from services to goods. We study this demand reallocation in a multi-sector model featuring sticky prices, input-output linkages, and labor reallocation costs. Reallocation costs hamper the increase in the supply of goods, causing inflationary pressures. These pressures are amplified by the fact that goods prices are more flexible than services prices. We estimate the model allowing for demand reallocation, sectoral productivity, and aggregate labor supply shocks. The demand reallocation shock explains a large portion of the rise in U.S. inflation in the aftermath of the pandemic.
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7
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Mussa A, Leoni C, Iacoviello M, Carli D, Ranieri C, Pantaleo A, Buonuomo PS, Bagnulo R, Ferrero GB, Bartuli A, Melis D, Maitz S, Loconte DC, Turchiano A, Piglionica M, De Luisi A, Susca FC, Bukvic N, Forleo C, Selicorni A, Zampino G, Onesimo R, Cappuccio G, Garavelli L, Novelli C, Memo L, Morando C, Della Monica M, Accadia M, Capurso M, Piscopo C, Cereda A, Di Giacomo MC, Saletti V, Spinelli AM, Lastella P, Tenconi R, Dvorakova V, Irvine AD, Resta N. Genotypes and phenotypes heterogeneity in PIK3CA-related overgrowth spectrum and overlapping conditions: 150 novel patients and systematic review of 1007 patients with PIK3CA pathogenetic variants. J Med Genet 2023; 60:163-173. [PMID: 35256403 DOI: 10.1136/jmedgenet-2021-108093] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 02/18/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Postzygotic activating PIK3CA variants cause several phenotypes within the PIK3CA-related overgrowth spectrum (PROS). Variant strength, mosaicism level, specific tissue involvement and overlapping disorders are responsible for disease heterogeneity. We explored these factors in 150 novel patients and in an expanded cohort of 1007 PIK3CA-mutated patients, analysing our new data with previous literature to give a comprehensive picture. METHODS We performed ultradeep targeted next-generation sequencing (NGS) on DNA from skin biopsy, buccal swab or blood using a panel including phosphatidylinositol 3-kinase/AKT/mammalian target of rapamycin pathway genes and GNAQ, GNA11, RASA1 and TEK. Additionally, 914 patients previously reported were systematically reviewed. RESULTS 93 of our 150 patients had PIK3CA pathogenetic variants. The merged PROS cohort showed that PIK3CA variants span thorough all gene domains, some were exclusively associated with specific PROS phenotypes: weakly activating variants were associated with central nervous system (CNS) involvement, and strongly activating variants with extra-CNS phenotypes. Among the 57 with a wild-type PIK3CA allele, 11 patients with overgrowth and vascular malformations overlapping PROS had variants in GNAQ, GNA11, RASA1 or TEK. CONCLUSION We confirm that (1) molecular diagnostic yield increases when multiple tissues are tested and by enriching NGS panels with genes of overlapping 'vascular' phenotypes; (2) strongly activating PIK3CA variants are found in affected tissue, rarely in blood: conversely, weakly activating mutations more common in blood; (3) weakly activating variants correlate with CNS involvement, strong variants are more common in cases without; (4) patients with vascular malformations overlapping those of PROS can harbour variants in genes other than PIK3CA.
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Affiliation(s)
- Alessandro Mussa
- Department of Public Health and Pediatric Sciences, Università degli Studi di Torino, Torino, Italy.,Pediatric Clinical Genetics, Regina Margherita Children's Hospital, Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Leoni
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Matteo Iacoviello
- Department of Biomedical Sciences and Human Oncology, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Diana Carli
- Department of Public Health and Pediatric Sciences, Università degli Studi di Torino, Torino, Italy.,Pediatric Onco-Hematology, Stem Cell Transplantation and Cell Therapy Division, Regina Margherita Children's Hospital, Città Della Salute e Della Scienza di Torino, Torino, Italy
| | - Carlotta Ranieri
- Department of Biomedical Sciences and Human Oncology, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Antonino Pantaleo
- Department of Biomedical Sciences and Human Oncology, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Paola Sabrina Buonuomo
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children's Hospital IRCCS, Roma, Italy
| | - Rosanna Bagnulo
- Department of Biomedical Sciences and Human Oncology, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | | | - Andrea Bartuli
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children's Hospital IRCCS, Roma, Italy
| | - Daniela Melis
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Fisciano, Italy
| | - Silvia Maitz
- Clinical Pediatric Genetics Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Daria Carmela Loconte
- Department of Biomedical Sciences and Human Oncology, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Antonella Turchiano
- Department of Biomedical Sciences and Human Oncology, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Marilidia Piglionica
- Department of Biomedical Sciences and Human Oncology, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Annunziata De Luisi
- Department of Biomedical Sciences and Human Oncology, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Francesco Claudio Susca
- Department of Biomedical Sciences and Human Oncology, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Nenad Bukvic
- Department of Biomedical Sciences and Human Oncology, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Cinzia Forleo
- Cardiology Unit, Department of Emergency and Organ Transplantation, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | | | - Giuseppe Zampino
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Roberta Onesimo
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Gerarda Cappuccio
- Department of Translational Medicine, Federico II University Hospital, Napoli, Italy
| | - Livia Garavelli
- Medical Genetics Unit, Mother and Child Health Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Novelli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Luigi Memo
- Department of Pediatrics, Neonatal Intensive Care Unit, San Bortolo Hospital of Vicenza, Vicenza, Italy
| | - Carla Morando
- Department of Pediatrics, Neonatal Intensive Care Unit, San Bortolo Hospital of Vicenza, Vicenza, Italy
| | | | - Maria Accadia
- Medical Genetics Unit, Hospital "Cardinale G. Panico", Tricase, Italy
| | - Martina Capurso
- Department of Biomedical Sciences and Human Oncology, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Carmelo Piscopo
- Medical Genetics Unit, Cardarelli Hospital, Napoli, Italy, Italy
| | - Anna Cereda
- Pediatric Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Veronica Saletti
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Patrizia Lastella
- Centro Sovraziendale di Assistenza e Ricerca per le Malattie Rare, Internal Medicine Unit 'C. Frugoni', Ospedale Consorziale Policlinico di Bari, Bari, Italy
| | - Romano Tenconi
- Department of Pediatrics, Clinical Genetics, Universita degli Studi di Padova, Padova, Italy
| | - Veronika Dvorakova
- Dermatology Clinic, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Alan D Irvine
- Dermatology Clinic, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Nicoletta Resta
- Department of Biomedical Sciences and Human Oncology, Università degli Studi di Bari "Aldo Moro", Bari, Italy
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8
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Abstract
Sympathetic activation has been long appreciated exclusively as a fundamental compensatory mechanism of the failing heart and, thus, welcome and to be supported. In the initial clinical phases of heart failure (HF), the sympathetic nervous system overdrive plays a compensatory function aimed at maintaining an adequate cardiac output despite the inotropic dysfunction affecting the myocardium. However, when the sympathetic reflex response is exaggerated it triggers a sequence of unfavourable remodelling processes causing a further contractile deterioration that unleashes major adverse cardiovascular consequences, favouring the HF progression and the occurrence of fatal events. Eventually, the sympathetic nervous system in HF was demonstrated to be a ‘lethality factor’ and thus became a prominent therapeutic target. The existence of an effective highly specialized intracardiac neuronal network immediately rules out the old concept that sympathetic activation in HF is merely the consequence of a drop in cardiac output. When a cardiac damage occurs, such as myocardial ischaemia or a primary myocardial disorder, the adaptive capability of the system may be overcame, leading to excessive sympatho-excitation coupled with attenuation till to abolishment of central parasympathetic drive. Myocardial infarction causes, within a very short time, both a functional and anatomical remodelling with a diffuse up-regulation of nerve growth factor (NGF). The subsequent nerve sprouting signal, facilitated by a rise in the levels of NGF in the left stellate ganglion and in the serum, triggers an increase in cardiac nerve density in both peri-infarct and non-infarcted areas. Finally, NFG production decreases over time, supposedly as an adaptative response to the prolonged exposure to sympathetic overactivity, leading in the end to a reduction in sympathetic nerve density. Accordingly, NGF levels were markedly reduced in patients with severe congestive heart failure. The kidney is the other key player of the sympathetic response to HF as it indeed reacts to under-perfusion and to loop diuretics to preserve filtration at the cost of many pathological consequences on its physiology. This vicious loop ultimately participates to the chronic and disruptive sympathetic overdrive. In conclusion, sympathetic activation is the natural physiological consequence to life stressors but also to any condition that may harm our body. It is the first system of reaction to any potential life-threatening event. However, in any aspect of life over reaction is never effective but, in many instances, is, actually, life threatening. One for all is the case of ischaemia-related ventricular fibrillation which is, strongly facilitated by sympathetic hyperactivity. The take home message? When, in a condition of harm, everybody is yelling failure is just around the corner.
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Affiliation(s)
- E Gronda
- U.O.C. Nefrologia, Dialisi e Trapianto Renale dell’Adulto, Programma Cardiorenale, Dipartimento di Medicina e Specialità Mediche, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico , Milano , Italy
- Area Cardiorenale Metabolica Associazione nazionale Medici Cardiologi Ospedalieri Italia
| | - V Dusi
- Cardiology Division, Department of Medical Sciences, University of Turin , Torino , Italy
| | - E D’Elia
- Cardiovascular Department, Papa Giovanni XXIII Hospital , Bergamo , Italy
| | - M Iacoviello
- Area Cardiorenale Metabolica Associazione nazionale Medici Cardiologi Ospedalieri Italia
- S.C. Cardiologia, AOU Policlinico Riuniti di Foggia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi , Foggia , Italy
| | - E Benvenuto
- Area Cardiorenale Metabolica Associazione nazionale Medici Cardiologi Ospedalieri Italia
- U.O.C. di Cardiologia-UTIC-Emodinamica PO ‘G. Mazzini’ Teramo , Italy
| | - E Vanoli
- Department of Molecular Medicine, University of Pavia , Pavia , Italy
- Department of Medicine, Cardiology and Rehabilitation Sacra Famiglia Hospital , Erba , Italy
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9
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Mussa A, Turchiano A, Cardaropoli S, Coppo P, Pantaleo A, Bagnulo R, Ranieri C, Iacoviello M, Garganese A, Stella A, Vallero SG, Bertin D, Santoro F, Carli D, Ferrero GB, Resta N. Lateralized overgrowth with vascular malformation caused by a somatic PTPN11 pathogenic variant: another piece added to the puzzle of mosaic RASopathies. Genes Chromosomes Cancer 2022; 61:689-695. [PMID: 35778969 PMCID: PMC9542063 DOI: 10.1002/gcc.23086] [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: 03/28/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Lateralized/segmental overgrowth disorders (LOs) encompass a heterogeneous group of congenital conditions with excessive body tissue growth. Documented molecular alterations in LOs mostly consist of somatic variants in genes of the PI3KCA/AKT/mTOR pathway or of chromosome band 11p15.5 imprinted region anomalies. In some cases, somatic pathogenic variants in genes of the RAS/MAPK pathway have been reported. We present the first case of a somatic pathogenic variant (T507K) in PTPN11 causing a LO phenotype characterized by severe lateralized overgrowth, vascular proliferation, and cerebral astrocytoma. The T507K variant was detected in DNA from overgrown tissue in a leg with capillary malformation. The astrocytoma tissue showed a higher PTPN11 variant allele frequency. A pathogenic variant in FGFR1 was also found in tumor tissue, representing a second hit on the RAS/MAPK pathway. These findings indicate that RAS/MAPK cascade overactivation can cause mosaic overgrowth phenotypes resembling PIK3CA‐related overgrowth disorders (PROS) with cancer predisposition and are consistent with the hypothesis that RAS/MAPK hyperactivation can be involved in the pathogenesis of astrocytoma. This observation raises the issue of cancer predisposition in patients with RAS/MAPK pathway gene variants and expands genotype spectrum of LOs and the treatment options for similar cases through inhibition of the RAS/MAPK oversignaling.
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Affiliation(s)
- Alessandro Mussa
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy.,Pediatric Clinical Genetics Unit, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Torino, Italy
| | - Antonella Turchiano
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Simona Cardaropoli
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Paola Coppo
- Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonino Pantaleo
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Rosanna Bagnulo
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Carlotta Ranieri
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Matteo Iacoviello
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Antonella Garganese
- Unit of Medical Genetics, Ospedale Consorziale Policlinico di Bari, Bari, Italy
| | - Alessandro Stella
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Stefano Gabriele Vallero
- Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Daniele Bertin
- Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Federica Santoro
- Pathology Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Diana Carli
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy.,Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Nicoletta Resta
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
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10
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Di Terlizzi V, Barone R, Manuppelli V, Correale M, Casavecchia G, Goffredo G, Pellegrino P, Puteo A, Ieva R, Di Biase M, Brunetti N, Iacoviello M. P237 INFLUENCE OF HEART RATE ON LEFT AND RIGHT VENTRICULAR LONGITUDINAL STRAIN IN PATIENTS WITH CHRONIC HEART FAILURE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.229] [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
Myocardial deformation evaluated by two–dimensional speckle tracking echocardiography (STE) is a useful tool to evaluate both left and right ventricular function. However, there are no conclusive data about the relationship between strain measures and heart rate (HR).
Aim of the Study
To analyse changes in left (LV) and right ventricular (RV) longitudinal strain associated with variations of HR in patients with and without chronic heart failure (CHF). Methods. We enrolled 45 patients. Of the 38 patients diagnosed with CHF, 21 were carrying an ICD (Group 1), and 17 an ICD with CRT (Group 2). Group 3 included 7 participants without CHF with sinus node dysfunction that were carrying a pacemaker. The frequency of atrial stimulation was increased to 90 beats/min and an echocardiogram was performed at each increase of 10 beats/min. Global LV and RV longitudinal strain (LVGLS and RVGLS, respectively) and RV free wall longitudinal strain (RVfwLS) were calculated at each HR, together with other echocardiographic parameters. Worsening or improvement of strain measures was defined as a relative change from baseline of 10%.
Results
The reproducibility of strain measurements was assessed in all the images obtained at the different HRs for 19 of the study participants. A high degree of reproducibility was observed for LVGLS (ICC = 0.96; 95% CI, 0.93 – 0.97) as well as for RVGLS (ICC = 0.91; 95%CI, 0.86 – 0.94) and RVfwLS (ICC = 0.91; 95%CI, 0.85 – 0.94). When analysed as continuous variables, significant reductions in LVGLS were detected at higher HRs, whereas improvements in both RVGLS and RVfwLS were observed (left panels of the figure). Patients with worsening of LVGLS (76% overall) were more likely to present lower baseline LV function and maximum relative changes of LVGLS correlated significantly with the E/e’ ratios (r = –0.56; p < 0.001). Only few patients (18% for RVGLS and 16% for RVfwLS) exhibited HR–related worsening of RV strain measures, which was associated with lower levels of baseline RV function and higher pulmonary systolic pressures. Finally, 21 (47%) and 25 (56%) of the participants responded with improvements in RVGLS and RVfwLS, respectively. Right panels of the figure show the trend of left and right measures in the different groups.
Conclusions
Our findings revealed heterogeneous RV and LV responses to increases in HR. These findings might ultimately be used to optimize cardiac functionality at rest in patients diagnosed with CHF.
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Affiliation(s)
| | | | | | | | | | | | | | | | - R Ieva
- POLICLINICO RIUNITI, FOGGIA
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11
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De Gennaro L, Donadeo V, Ruggero M, Tota F, Sergio M, De Laura D, Cavallari D, Resta M, Ricci G, Licurgo L, Buquicchio F, Corriero F, Citarelli G, Parisi G, Campanella C, Mancini L, Locuratolo N, Sublimi Saponetti L, Rutigliano D, Palumbo V, Basso P, Correale M, Brunetti N, Iacoviello M, Caldarola P. C23 HOW TO IMPROVE ADHERENCE TO ESC HF GUIDELINES THE PONTE (PDTA FOR INTEGRATED FOLLOW–UP TERRITORY HOSPITAL OF THE PATIENT WITH CARDIAC HEART FAILURE) PROJECT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.022] [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
Background
A careful and integrated follow up after hospitalization for heart failure (HF) may represent a feasible strategy to optimize the adherence to ESC guidelines and reduce the occurrence of adverse events (mortality, re–hospitalizations).
Methods
A strict integration between hospital and local health district proximity office cardiologist through an integrated clinical data sharing software has been implemented in Apulia region, Italy, in order to optimize the management of the HF patient after an hospitalization: the PONTE (PDTA FOR INTEGRATED FOLLOW–UP TERRITORY HOSPITAL OF THE PATIENT WITH CARDIAC HEART FAILURE) (bridge) project. As until December 2021, 1200 patients with HF have been enrolled in the project, both with reduced (HFrEF) and preserved ejection fraction (HFpEF). Adherence to ESC HF guidelines in HFrEF patients before vs after December 2020 was compared.
Results
In the HFrEF population (56%) the mean age was 63 years, 38% were hypertensive, 15% diabetic, 40% had ischemic heart disease, 42% were previously treated with coronary angioplasty, 56% had an ICD/CRT, 22% had atrial fibrillation. Mean NYHA class was 2.2, mean LVEF 30%, mean NT–proBNP values 4027 pg/mL, mean serum creatinine 1 mg/dL, 91% were taking beta–blockers (BB), 86% mineral corticoid receptor antagonists (MRA), 98% ACE–inhibitors/angiotensin–receptor–antagonists/neprilysin and angiotensin receptor antagonists (ACE/ARB/ARNI), and 13% ARNI. Compared to patients enrolled before 2020, ARNI prescription increased in 2021 (60% vs 13%, p < 0.001); in 30% ARNI were prescribed in hospital before discharge. Furthermore, in 10% of the population (most diabetics), sodium glucose cotransporter type 2 inhibitors (SGLT2i) have been prescribed as indicated by the latest ESC 2021 guidelines.
Conclusions
The implementation the PONTE project shows an improved adherence to ESC HF guidelines.
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Affiliation(s)
- L De Gennaro
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - V Donadeo
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - M Ruggero
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - F Tota
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - M Sergio
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - D De Laura
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - D Cavallari
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - M Resta
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - G Ricci
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - L Licurgo
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - F Buquicchio
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - F Corriero
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - G Citarelli
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - G Parisi
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - C Campanella
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - L Mancini
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - N Locuratolo
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | | | - D Rutigliano
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - V Palumbo
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - P Basso
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - M Correale
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - N Brunetti
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - M Iacoviello
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
| | - P Caldarola
- OSPEDALE SAN PAOLO BARI, BARI; OSPEDALE SAN PAOLO, BARI; SAN PAOLO, BARI
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12
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Barone R, Goffredo G, Di Terlizzi V, Correale M, Casavecchia G, Ieva R, Cuculo A, Brunetti N, Iacoviello M. P243 RELEVANCE OF RENAL RESISTANCE INDEX INCREASE AFTER CORONARY ANGIOGRAPHY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.235] [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
Renal resistance index is a Doppler derived measure which is able to reflect the pathophysiological background of Cardiorenal Syndrome (CS). There are no data about the influence of the intravascular administration of contrast media on RRI and its relationship with worsening of renal function (WRF).
Aim of the Study
To evaluate changes in renal resistance index (RRI) after coronary angiography in patients with and without WRF. METHODS We enrolled 115 patients (mean age 64 years, 73% males, 84% hypertensive, 43% diabetic, 30% with acute coronary syndrome, 21% affected by chronic heart failure, CHF, with a mean left ventricular ejection fraction, LVEF, of 51±11) with suspected coronary artery disease, stable angina, or acute coronary syndromes who have been referred for coronary angiography (with or without pre–existing renal impairment). Renal arterial echo–color Doppler was used to calculate RRI before and 48 hours after coronary angiography. WRF was defined as an increase of creatinine >0.3 mg/dl and of at least 25% from baseline 24–48 hours after coronary angiography.
Results
Fourteen (12%) among the enrolled patients showed WRF. As expected, a significant increase of creatinine serum levels was observed in patients with WRF (from 1.14±0.40 to 1.71±0.49, p < 0.001) but not those without (from 0.89±0.27 to 0.92±0.28, p n.s.) WRF. On the other hand, RRI significantly increased both in patients with (from 72.8±4.3 to 76.4±5.2, p < 0.05) and without (from 63.1±7.2 to 65.4±7.1, p < 0.05). However, both at baseline and after angiography, patients with WRF showed RRI values significantly greater when compared with those without. At ROC curve analyses for WRF, the baseline and after angiography RRI sowed similar AUC (0.88 and 0.90, respectively) and for both RRI values the best cut–off was 70% (sensitivity of 79% and 93% and Specificity of 93% and 82%, respectively). As shown in the figure, the high predictive accuracy of RRI values was due to the fact that, although increased after angiography, the proportion of patients without WRF and with RRI>70% remained very low.
Conclusion
After coronary angiography RRI significantly increase both in patients with and without WRF. However, a larger proportion of patients with WRF present a critically increased RRI, i.e. equal or above 70%, before and after angiography probably because reflecting the pathophysiological background underlying the progression of cardiorenal syndrome.
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Affiliation(s)
| | | | | | | | | | - R Ieva
- POLICLINICO RIUNITI, FOGGIA
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13
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Diomede N, Terazzi E, Correale M, Di Terlizzi V, Barone R, Manuppelli V, Brunetti N, Iacoviello M. P235 CLINICAL AND INSTRUMENTAL CORRELATES OF LEFT AND RIGHT ATRIAL TWO–DIMENSIONAL STRAIN MEASUREMENTS IN PATIENTS WITH HEART FAILURE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.227] [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
The two–dimensional strain obtained through Speckle Tracking Imaging (STI) represents an innovative, rapid and semi–automatic echocardiographic method to study systolic and diastolic function. By analyzing the deformation of cardiac segments, it provides an indirect index of myocardial contractility and relaxation of left and right ventricles, but also of both left and right atria.
Purpose of the Study
The aim of this study was to evaluate the clinical and instrumental correlates of the different measures of right and left atrial strain in a group of patients with chronic heart failure (CHF). Method. We enrolled 165 out patients with CHF (63 ± 14 years, 76% male, 39 ± 11% ejection fraction). All patients underwent a cardiological examination, ECG and echocardiogram. The echocardiographic images were analyzed using an innovative software (TomTec, Philips) able to semi–automatically analyze both the ventricular and atrial strain. For each patient, both for the left atrium (LA) and the right atrium (RA), the measures related to all atrial functional phases were calculated: reservoir (r), conduit (cd) and contraction (ct).
Results
At univariate and multivariate logistic regression models, the main determinants of atrial strain measurements were evaluated. As shown in the Table, both for the RA and LA the reservoir and conduit were more closely associated with ventricular systolic function and age. LA contraction was associated only with E/e‘ and heart rate, whereas for the RA one there was no independent statistical association with the parameters studied.
Conclusions
The Strain parameters that evaluate right and left atrial function have an independent association with different clinical and instrumental variables. These results support the hypothesis that the reservoir and conduit measurements express a different physiological and pathophysiological substrate than the contraction measures.
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Affiliation(s)
- N Diomede
- CARDIOLOGIA UNIVERSITARIA – OSPEDALI RIUNITI DI FOGGIA, FOGGIA
| | - E Terazzi
- CARDIOLOGIA UNIVERSITARIA – OSPEDALI RIUNITI DI FOGGIA, FOGGIA
| | - M Correale
- CARDIOLOGIA UNIVERSITARIA – OSPEDALI RIUNITI DI FOGGIA, FOGGIA
| | - V Di Terlizzi
- CARDIOLOGIA UNIVERSITARIA – OSPEDALI RIUNITI DI FOGGIA, FOGGIA
| | - R Barone
- CARDIOLOGIA UNIVERSITARIA – OSPEDALI RIUNITI DI FOGGIA, FOGGIA
| | - V Manuppelli
- CARDIOLOGIA UNIVERSITARIA – OSPEDALI RIUNITI DI FOGGIA, FOGGIA
| | - N Brunetti
- CARDIOLOGIA UNIVERSITARIA – OSPEDALI RIUNITI DI FOGGIA, FOGGIA
| | - M Iacoviello
- CARDIOLOGIA UNIVERSITARIA – OSPEDALI RIUNITI DI FOGGIA, FOGGIA
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14
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Terazzi E, Diomede N, Correale M, Di Terlizzi V, Barone R, Manuppelli V, Brunetti N, Iacoviello M. P233 ASSOCIATIONS BETWEEN LEFT AND RIGHT ATRIAL BIDIMENSIONAL STRAIN AND HEART FAILURE PROGRESSION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.225] [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
Two dimensional speckle tracking is an innovative echocardiographic method which analyses myocardial deformation thus allowing the evaluation of both atrial and ventricular function. Recently, new software are available to measure it by semiautomatic analyses.
Aim of the Study
To evaluate the association between left and right atrial Strain and the occurrence of clinical events related to the heart failure (HF) progression. Method. We enrolled 165 outpatients with chronic HF (76% males, NYHA 2.2 ± 0.69, ejection fraction 39±11%). All underwent a clinical and echocardiographic evaluation. An innovative software (TomTec, Philips) was used to analyse the images in order to semi–automatically calculate of atrial Strain. For each patient all the measures relative to the different phases of atrial deformation were considered both for the left atrium (LA) and the right one (RA), i.e. reservoir (r), conduit (cd) and contraction (ct). During the follow–up, we defined the HF progression as hospitalization due to HF worsening and/or heart transplantation and/or cardiovascular death.
Results
During a median follow–up of 5 months, at least one event related to HF progression occurred in 22 patients: all underwent at least one hospitalization, 7 patients died because of cardiovascular reasons and 2 underwent heart transplantation. At Cox univariate analysis, LASr (HR: 0,93; 95%CI: 0,88–0,97, p: 0.004; C–index 0,7), LAScd (HR: 1,09; 95%CI: 1,01–1,19; p: 0,023; C–index: 0,64), RASr (HR: 0,95; 95%CI: 0,90–0,99; p: 0,031; C–index: 0,68), RAScd (HR: 1,08; 95%CI: 1,01–1,15; p: 0,021; C–index: 0,67), but not LASct (HR: 1,04; 95%CI: 0,99–1,09; p 0,094; C–index 0,62) and RASct (HR: 1,02; 95%CI: 0,96–1,09; p: 0,61; C–index: 0,55), were significantly associated to HF progression. LASr and RASr showed the higher accuracy in predicting the events by the estimation of C index. At ROC curve analysis, for LASr the best cut–off was 16.1% (Sensitivity 83%, Specificity 56%) and for RASr 17.3% (Sensitivity 79%, Specificity 60%). Figure shows Kaplan–Meier curves for the considered end–point according with these cut–offs.
Conclusions
The preliminary results of this study have showed the association between LA and RA Strain variables and the HF progression. The prosecution of this study will be finalised to demonstrate the prognostic independent and incremental significance.
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Affiliation(s)
- E Terazzi
- CARDIOLOGIA UNIVERSITARIA – OSPEDALI RIUNITI DI FOGGIA, FOGGIA
| | - N Diomede
- CARDIOLOGIA UNIVERSITARIA – OSPEDALI RIUNITI DI FOGGIA, FOGGIA
| | - M Correale
- CARDIOLOGIA UNIVERSITARIA – OSPEDALI RIUNITI DI FOGGIA, FOGGIA
| | - V Di Terlizzi
- CARDIOLOGIA UNIVERSITARIA – OSPEDALI RIUNITI DI FOGGIA, FOGGIA
| | - R Barone
- CARDIOLOGIA UNIVERSITARIA – OSPEDALI RIUNITI DI FOGGIA, FOGGIA
| | - V Manuppelli
- CARDIOLOGIA UNIVERSITARIA – OSPEDALI RIUNITI DI FOGGIA, FOGGIA
| | - N Brunetti
- CARDIOLOGIA UNIVERSITARIA – OSPEDALI RIUNITI DI FOGGIA, FOGGIA
| | - M Iacoviello
- CARDIOLOGIA UNIVERSITARIA – OSPEDALI RIUNITI DI FOGGIA, FOGGIA
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15
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Goffredo G, Barone R, Di Terlizzi V, Correale M, Casavecchia G, Ieva R, Cuculo A, Brunetti N, Iacoviello M. P216 RENAL RESISTANCE INDEX IS INDEPENDENTLY ASSOCIATED WITH THE WORSENING OF RENAL FUNCTION AFTER CORONARY ANGIOGRAPHY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.208] [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
Background
The term Cardiorenal Syndrome (CS) has been recently introduced to indicate the close relationship between cardiovascular and renal diseases, which are able to reciprocally influence the each other progression. In this setting the renal resistance index (RRI) has been demonstrated to be a useful parameter able to detect patients at higher risk of CS. However, there are no data about its role in predicting worsening of renal function (WRF) mediated by the intravascular administration of contrast.
Aim of the Study
To evaluate the role of RRI in predicting WRF after coronary angiography. METHODS We enrolled 115 patients (mean age 64 years, 73% males, 84% hypertensive, 43% diabetic, 30% with acute coronary syndrome, 21% affected by chronic heart failure, CHF, with a mean left ventricular ejection fraction, LVEF, of 51±11) with suspected coronary artery disease, stable angina, or acute coronary syndromes who have been referred for coronary angiography (with or without pre–existing renal impairment). All patients underwent medical examination, electrocardiogram, echocardiographic and chemical evaluation, and renal arterial echo–color Doppler used to calculate RRI. WRF was defined as an increase of creatinine >0.3 mg/dl and of at least 25% from baseline 24–48 hours after coronary angiography.
Results
After coronary angiography, 14 (12%) of the enrolled patients showed WRF. As shown in the Table, at univariate regression analysis baseline RRI was associated with WRF as well as age, peripheral artery disease, CHF, atrial fibrillation, NYHA class, LVEF, mitral regurgitation (MR), central venous pressure (CVP), tricuspid regurgitation (TR), estimated glomerular filtration rate (GFR). In a multivariate forward stepwise regression model, including all univariate predictors, history of CHF, high CVP and RRI were the only parameters significantly associated with WRF.
Conclusion
Our findings demonstrate that in patients undergoing coronary angiography, history of CHF, high CVP and RRI are independent predictors of WRF. RRI, but not GFR, is independently associated with WRF probably because providing additional relevant information about cardiorenal pathophysiological factors reflecting the hemodynamic status and kidney flow reserve.
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Affiliation(s)
| | | | | | | | | | - R Ieva
- POLICLINICO RIUNITI, FOGGIA
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16
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Mazzeo P, Correale M, Magnesa M, Fortunato M, Mallardi A, Leopizzi A, Tricarico L, Mennella R, Iacoviello M, Brunetti ND. Right ventricle function improvement after six month of therapy with Sacubitril/Valsartan in a real-life population of patients with chronic heart failure with reduced ejection fraction. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.384] [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
Observational studies have demonstrated that treatment with sacubitril/valsartan may improve left ventricular (LV) systolic and diastolic function in subjects with reduced LV ejection fraction (LVEF) in real-world studies. Subjects with heart failure and reduced EF (HFrEF), however, are also characterized by an impaired right ventricular (RV) function. We therefore aimed to evaluate whether also RV function may improve after S/V therapy and possible predictors of RV improvement could be identified at echocardiography and tissue Doppler imaging.
Methods
Fifty consecutive patients (67 ± 8 years, LVEF 28 ± 6%, male 86%) with chronic HFrEF and NYHA class II-III were followed up for 6 months after therapy with S/V. L&RV function was assessed at baseline and after 6 months of therapy.
Results
After 6-month therapy with S/V a significant improvement was shown in the following echocardiography parameters assessing RV function: PAsP(31 ± 11vs 35 ± 10mmHg,p < 0.001),
TAPSE(19 ± 3vs18 ± 3mm,p < 0.001),RVFAC(38 ± 7 vs 34 ± 6 mm,p < 0.001), RVS’(12 ± 2vs10 ± 2cm/sec,p < 0.001), RVFWGLS(-20 ± 5vs-18 ± 5%,p < 0.001), RV4ChGLS (-16 ± 5vs-14 ± 5%,p < 0.001). At multivariable analysis improvement in RVFWGLS was associated to baseline levels of RV S’ (r 0.75, p < 0.01) and RAV (r–0.32,p < 0.05).
Conclusions
In a real-world scenario, 6-month therapy with S/V was associated with an improved RV function in HFrEF. RV function improvement may be predicted by assessing baseline RV S’ and right atrial volume values.
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Affiliation(s)
- P Mazzeo
- University of Foggia, Foggia, Italy
| | - M Correale
- University Hospital Ospedali Riuniti, Foggia, Italy
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17
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Magnesa M, Correale M, Correale M, Correale M, Mazzeo P, Mazzeo P, Mazzeo P, Fortunato M, Fortunato M, Fortunato M, Leopizzi A, Leopizzi A, Leopizzi A, Mallardi A, Mallardi A, Mallardi A, Tricarico L, Tricarico L, Tricarico L, Mennella R, Mennella R, Mennella R, Iacoviello M, Iacoviello M, Iacoviello M, Brunetti ND, Brunetti ND, Brunetti ND. Left atrial functional reverse remodeling assessed by speckle tracking echocardiography in a real-life population of patients with chronic heart failure after therapy with sacubitril/valsartan. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.050] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Left atrial (LA) enlargement has been demonstrated to be a predictor of adverse cardiovascular outcomes, such as atrial fibrillation (AF), heart failure (HF), and cardiovascular death (1). Previous studies showed left atrial structural reverse remodeling (LARR), defined as >15% reduction in LA end-systolic volume index (LAESVi) (2), can be achieved after therapy with Sacubitril/Valsartan (S/V) in real-world settings. On the other hand, LA functional reverse remodeling is not well defined.
Purpose
We sought to investigate the association between left atrial (LA) structural and functional remodelling in patients with chronic heart failure after therapy with S/V.
Methods
Patients with chronic HF, LV dysfunction (EF < 35%), NYHA class II-III were followed up between September 2019 and March 2020. All patients underwent clinical and echocardiography follow up at baseline and after 6 months of therapy with S/V. Measures of LA structure [LA end-systolic volume index (LAESVi)] and function [left atrial ejection fraction (LAEF), peak atrial longitudinal strain (PALS), LA conduit strain, and peak atrial contraction strain (PACS)] were calculated. We divided our population into two subgroups based on whether reverse remodeling was achieved (LARR+) or not (LARR-).
Results
Forty-seven consecutive outpatients (mean age 66 ± 8 years; 85% males) were enrolled in the study. At follow-up visit, a positive LARR was found in nearly half of patients treated with S/V, resulting in line with previous studies (3). Furthermore, global PALS was significantly improved in both groups compared to baseline (15 ± 7 vs 19 ± 8 %, p < 0.001), but the LARR+ group showed an improvement that was twice higher (55 ± 66 vs 25 ± 26, p = 0.039), supporting the potential role of PALS as marker of functional LARR.
Conclusions
Treatment with S/V in patients with systolic dysfunction is associated with an improvement in LA structural and functional remodelling in a real-world scenario. Therefore, PALS could be the benchmark for the assessment of left atrial functional reverse remodeling.
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Affiliation(s)
- M Magnesa
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - M Correale
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - M Correale
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - M Correale
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - P Mazzeo
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - P Mazzeo
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - P Mazzeo
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - M Fortunato
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - M Fortunato
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - M Fortunato
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - A Leopizzi
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - A Leopizzi
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - A Leopizzi
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - A Mallardi
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - A Mallardi
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - A Mallardi
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - L Tricarico
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - L Tricarico
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - L Tricarico
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - R Mennella
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - R Mennella
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - R Mennella
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - M Iacoviello
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - M Iacoviello
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - M Iacoviello
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - ND Brunetti
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - ND Brunetti
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
| | - ND Brunetti
- UTIC Universitaria Ospedali Riuniti OO.RR , Foggia, Italy
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18
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Mallardi A, Santoro F, Leopizzi A, Vitale E, Iacoviello M, Brunetti ND. Cognitive disorders in takotsubo syndrome: incidence, short and long-term outcome. Results from a prospective multi-center registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1822] [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
Takotsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction, whose pathophysiological mechanisms are not completely known. There are evidence suggesting a possible link between neurological disease and TTS. Aim of the study was to evaluate incidence and prognostic value of cognitive neurological disorders among TTS patients.
Methods
379 consecutive patients were enrolled in a prospective multicenter registry. History, clinical features, echocardiographic parameters, in-hospital complications and long-term follow up events of all patients were recorded. Cognitive neurological disorders included Alzheimer disease, old age dementia and cognitive impairment for other causes.
Results
Prevalence of cognitive neurological disorders among TTS patients was 5.5% (num=21). Among this subset of patients 48% (num=10) had Alzheimer syndrome, 24% (num=5) old age dementia and 28% (num=6) cognitive impairment for other causes.
Compared to the control group, these patients were older (81±5 vs 71±12, p=0.01) and predominantly men (24% vs 9%, p=0.01). No differences in term of cardiovascular risk factors and left ventricular ejection fraction at admission and discharge were found among the two groups.
TTS patients with cognitive neurological disorders experienced higher rate of in-hospital complications (62% vs 28% p=0.01), that were mainly driven by higher rate of pulmonary edema (14% vs 9% p=0.01), cardiogenic shock (29% vs 8%, p=0.01), death (24% vs 4% p=0.01), ischemic stroke (10% vs 4% p=0.01) and left ventricular thrombi (10% vs 3%, p=0.01).
At long term follow up patients with cognitive neurological disorders when compared to those without, experienced higher rate of mayor cardiovascular events (48% vs 16%, p=0.01), cardiovascular re-hospitalization (14% vs 10%, p=0.01) and death (43% vs 9%, p=0.01).
Conclusion
TTS patients with cognitive neurological disorders had an increased risk of in and out of hospital mayor cardiac adverse events and mortality at short and long-term follow-up.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Ospedali Riuniti di Foggia-Università di Foggia
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Affiliation(s)
- A Mallardi
- OO RR FOGGIA University Hospital, Foggia, Italy
| | - F Santoro
- OO RR FOGGIA University Hospital, Foggia, Italy
| | - A Leopizzi
- OO RR FOGGIA University Hospital, Foggia, Italy
| | - E Vitale
- OO RR FOGGIA University Hospital, Foggia, Italy
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19
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Leopizzi A, Santoro F, Mallardi A, Vitale E, Iacoviello M, Brunetti ND. Cerebrovascular events in takotsubo syndrome: short and long-term outcome. Results from a multicenter-prospective registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1823] [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
Several studies have shown that Takotsubo syndrome (TTS) secondary to neurological disorders is associated with higher rate of in-hospital complications. Imaging brain studies found that atrophy or damage of some regions and their altered connectivity with other brain regions are typical features of TTS patients.
Aim of the study
To evaluate rates of in hospital and long-term follow up events in TTS patients with history or acute cerebrovascular events (CVE).
Methods
395 consecutive patients were enrolled in a multicenter prospective registry. History, clinical data, echocardiographic parameters and in-hospital and long-term follow up events of all patients were evaluated.
Results
Prevalence of CVE among TTS patients was 9.4% (N=37). Compared to the control group, these patients were older (80±7 vs 71±12 years, p=0.01) and predominantly men (24% vs 9%, p=0.01). No differences in terms of cardiovascular risk factors and left ventricular ejection fraction at admission and discharge were found between the two groups. The prevalence of physical stressors was higher in the CVE group (67% vs 44% p=0.01).
The incidence of in-hospital adverse events was higher in the CVE group (70% vs 29%), mainly driven by higher rates of cardiogenic shock (19 vs 8%, p=0.01) and in-hospital death (19 vs 4%, p=0.01).
At long-term follow-up, patients in the CVE group had higher mortality rates (38% vs 20%, p=0.01).
Patients presenting with acute CVE, 10 out of 37 patients (27%), when compared with chronic CVE had higher in-hospital mortality rates (40% vs 11%, p=0.01).
Conclusion
TTS patients with history or CVE had higher rates of in-hospital events and death at long-term follow-up. Acute CVEs in the setting of TTS are associated with a worse prognosis.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Ospedali Riuniti di Foggia. Università di Foggia
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Affiliation(s)
- A Leopizzi
- UTIC Universitaria Ospedali Riuniti OO.RR, Foggia, Italy
| | - F Santoro
- UTIC Universitaria Ospedali Riuniti OO.RR, Foggia, Italy
| | - A Mallardi
- UTIC Universitaria Ospedali Riuniti OO.RR, Foggia, Italy
| | - E Vitale
- UTIC Universitaria Ospedali Riuniti OO.RR, Foggia, Italy
| | - M Iacoviello
- UTIC Universitaria Ospedali Riuniti OO.RR, Foggia, Italy
| | - N D Brunetti
- UTIC Universitaria Ospedali Riuniti OO.RR, Foggia, Italy
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20
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Delvecchio M, Iacoviello M, Pantaleo A, Resta N. Clinical Spectrum Associated with Wolfram Syndrome Type 1 and Type 2: A Review on Genotype-Phenotype Correlations. Int J Environ Res Public Health 2021; 18:ijerph18094796. [PMID: 33946243 PMCID: PMC8124476 DOI: 10.3390/ijerph18094796] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 12/27/2022]
Abstract
Wolfram syndrome is a rare neurodegenerative disorder that is typically characterized by diabetes mellitus and optic atrophy. Other common features are diabetes insipidus and hearing loss, but additional less-frequent findings may also be present. The phenotype spectrum is quite wide, and penetrance may be incomplete. The syndrome is progressive, and thus, the clinical picture may change during follow-up. Currently, two different subtypes of this syndrome have been described, and they are associated with two different disease-genes, wolframin (WFS1) and CISD2. These genes encode a transmembrane protein and an endoplasmic reticulum intermembrane protein, respectively. These genes are detected in different organs and account for the pleiotropic features of this syndrome. In this review, we describe the phenotypes of both syndromes and discuss the most pertinent literature about the genotype–phenotype correlation. The clinical presentation of Wolfram syndrome type 1 suggests that the pathogenic variant does not predict the phenotype. There are few papers on Wolfram syndrome type 2 and, thus, predicting the phenotype on the basis of genotype is not yet supported. We also discuss the most pertinent approach to gene analysis.
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Affiliation(s)
- Maurizio Delvecchio
- Metabolic Diseases, Clinical Genetics and Diabetology Unit, Giovanni XXIII Children’s Hospital, 70126 Bari, Italy
- Correspondence: ; Tel.: +39-08-0559-6771
| | - Matteo Iacoviello
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.I.); (A.P.); (N.R.)
| | - Antonino Pantaleo
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.I.); (A.P.); (N.R.)
| | - Nicoletta Resta
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.I.); (A.P.); (N.R.)
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21
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Rampino A, Torretta S, Gelao B, Veneziani F, Iacoviello M, Marakhovskaya A, Masellis R, Andriola I, Sportelli L, Pergola G, Minelli A, Magri C, Gennarelli M, Vita A, Beaulieu JM, Bertolino A, Blasi G. Evidence of an interaction between FXR1 and GSK3β polymorphisms on levels of Negative Symptoms of Schizophrenia and their response to antipsychotics. Eur Psychiatry 2021; 64:e39. [PMID: 33866994 PMCID: PMC8260562 DOI: 10.1192/j.eurpsy.2021.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Genome-Wide Association Studies (GWASs) have identified several genes associated with Schizophrenia (SCZ) and exponentially increased knowledge on the genetic basis of the disease. In addition, products of GWAS genes interact with neuronal factors coded by genes lacking association, such that this interaction may confer risk for specific phenotypes of this brain disorder. In this regard, fragile X mental retardation syndrome-related 1 (FXR1) gene has been GWAS associated with SCZ. FXR1 protein is regulated by glycogen synthase kinase-3β (GSK3β), which has been implicated in pathophysiology of SCZ and response to antipsychotics (APs). rs496250 and rs12630592, two eQTLs (Expression Quantitative Trait Loci) of FXR1 and GSK3β, respectively, interact on emotion stability and amygdala/prefrontal cortex activity during emotion processing. These two phenotypes are associated with Negative Symptoms (NSs) of SCZ suggesting that the interaction between these SNPs may also affect NS severity and responsiveness to medication. METHODS To test this hypothesis, in two independent samples of patients with SCZ, we investigated rs496250 by rs12630592 interaction on NS severity and response to APs. We also tested a putative link between APs administration and FXR1 expression, as already reported for GSK3β expression. RESULTS We found that rs496250 and rs12630592 interact on NS severity. We also found evidence suggesting interaction of these polymorphisms also on response to APs. This interaction was not present when looking at positive and general psychopathology scores. Furthermore, chronic olanzapine administration led to a reduction of FXR1 expression in mouse frontal cortex. DISCUSSION Our findings suggest that, like GSK3β, FXR1 is affected by APs while shedding new light on the role of the FXR1/GSK3β pathway for NSs of SCZ.
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Affiliation(s)
- Antonio Rampino
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Azienda Ospedaliero-Universitaria Consorziale Policlinico, Bari, Italy
| | - Silvia Torretta
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Barbara Gelao
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Federica Veneziani
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Matteo Iacoviello
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | | | - Rita Masellis
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Ileana Andriola
- Azienda Ospedaliero-Universitaria Consorziale Policlinico, Bari, Italy
| | - Leonardo Sportelli
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giulio Pergola
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, Maryland, USA
| | - Alessandra Minelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Chiara Magri
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Massimo Gennarelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Antonio Vita
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Alessandro Bertolino
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Azienda Ospedaliero-Universitaria Consorziale Policlinico, Bari, Italy
| | - Giuseppe Blasi
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Azienda Ospedaliero-Universitaria Consorziale Policlinico, Bari, Italy
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22
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Carli D, Ferrero GB, Fusillo A, Coppo P, La Selva R, Zinali F, Cardaropoli S, Ranieri C, Iacoviello M, Resta N, Mussa A. A new case of Smith-Kingsmore syndrome with somatic MTOR pathogenic variant expands the phenotypic spectrum to lateralized overgrowth. Clin Genet 2021; 99:719-723. [PMID: 33506498 DOI: 10.1111/cge.13931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/08/2021] [Accepted: 01/25/2021] [Indexed: 12/13/2022]
Abstract
Smith-Kingsmore syndrome (SKS) is a rare autosomal dominant disorder caused by heterozygous germline activating pathogenic variants in mammalian target of rapamycin (MTOR) on chromosome 1p36. A few patients with disseminated mosaicism have been described so far and they seem to display a different phenotype when compared to germline cases. Here we report the sixth case with a disseminated mosaic MTOR pathogenic variant, a 7-year-old boy with hemimegalencephaly, epilepsy, developmental delay, hypomelanosis of Ito, and lateralized overgrowth. Genetic testing revealed a pathogenic variant (c.4448G > A, p.Cys1483Tyr) in MTOR with a frequency of 32% in the DNA extracted from a skin sample, 3% in saliva and 0.46% in blood. The clinical features observed in our patient further corroborate the existence of differences in phenotypic presentation of germline and mosaic SKS cases. Moreover, lateralized overgrowth, a finding never described so far in SKS, further expands the phenotypic spectrum of SKS and allows the inclusion of MTOR pathogenic variants among the several causes of asymmetric body overgrowth.
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Affiliation(s)
- Diana Carli
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, University of Torino and Regina Margherita Children's Hospital, Città della Salute e della Scienza, Torino, Italy
| | | | - Anna Fusillo
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, University of Torino and Regina Margherita Children's Hospital, Città della Salute e della Scienza, Torino, Italy
| | - Paola Coppo
- Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Roberta La Selva
- Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Federica Zinali
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, University of Torino and Regina Margherita Children's Hospital, Città della Salute e della Scienza, Torino, Italy
| | - Simona Cardaropoli
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, University of Torino and Regina Margherita Children's Hospital, Città della Salute e della Scienza, Torino, Italy
| | - Carlotta Ranieri
- Department of Biomedical Sciences and Human Oncology (DIMO), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Matteo Iacoviello
- Department of Biomedical Sciences and Human Oncology (DIMO), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Nicoletta Resta
- Department of Biomedical Sciences and Human Oncology (DIMO), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Alessandro Mussa
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, University of Torino and Regina Margherita Children's Hospital, Città della Salute e della Scienza, Torino, Italy
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23
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Iacoviello M, Marini M, Gori M, Gonzini L, Benvenuto M, Cassaniti L, Municino' A, Navazio A, Ammirati E, Catalano M, Floresta M, Scopelliti G, Nassiacos D, Gorini M, De Maria R. Chronic heart failure in younger patients: temporal trends in clinical characteristics, treatment and outcomes over two decades in a nationwide cardiology registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0965] [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
Aim of the study
We analyzed the temporal trends in characteristics, therapy and outcomes over two decades of younger chronic heart failure (CHF) patients enrolled in our nationwide registry.
Methods
Among the 14823 CHF patients enrolled in the registry since January 1999 through May 2018, 5465 (37%) were aged<65 years (78% men, 54+9 years, left ventricular ejection fraction (LVEF) 36+11%). Patients were divided into 3 cohorts according with the recruitment epoch: 1999–2005; 2006–2011; 2012–2018. We analyzed trends over time of clinical characteristics, therapy, one-year all-cause mortality, all-cause mortality and/or all-cause hospitalization, all-cause mortality and/or CV hospitalization, and all-cause mortality and/or HF hospitalization.
Results
From 1999 to 2018 the proportion of patients <65 years declined: 42% in first (2288/5404), 37% in second (1464/3971), 31% in third period (1713/5448).
As shown in the Table, the proportion of women, diabetes, ischemic etiology and renin-angiotensin system inhibitor prescription did not change significantly among the three enrollment epochs, whereas preserved LVEF phenotype and prevalence of its driving risk factors increased. The proportion of guideline-recommended drug & device therapies significantly rose over time. All-cause mortality at 1-year follow-up decreased significantly across the 3 epochs studied (Figure).
Conclusions
During 20 years, the clinical characteristics, the implementation of recommended treatments and prognosis of patients <65 years enrolled in a nationwide cardiology registry have deeply changed. These modifications reflect the evolution of cardiovascular risk factors and improved management strategies of CV disease.
Figure 1
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Fondazione per il Tuo cuore – HCF onlus
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Affiliation(s)
| | - M Marini
- University Hospital Riuniti of Ancona, Ancona, Italy
| | - M Gori
- Ospedale Papa Giovanni XXIII, Cardiology Unit, Bergamo, Italy
| | - L Gonzini
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy
| | - M Benvenuto
- G. Mazzini Hospital, Cardiology Unit, Teramo, Italy
| | | | - A Municino'
- Padre A Micone Hospital ASL3, Cardiology Unit, Genoa, Italy
| | - A Navazio
- Santa Maria Nuova Hospital, Cardiology Unit, Reggio Emilia, Italy
| | - E Ammirati
- ASST Great Metropolitan Niguarda, Cardiology 2 - Heart Failure and Transplantation, Milan, Italy
| | - M Catalano
- Cannizzaro Hospital, Cardiology Unit, Catania, Italy
| | - M Floresta
- Ospedale Cervello-Villa Sofia, Cardiology Unit, Palermo, Italy
| | - G Scopelliti
- Alta Val d'Elsa Hospital, Cardiology Unit, Poggibonsi, Italy
| | - D Nassiacos
- Saronno General Hospital, Cardiology Unit, Saronno, Italy
| | - M Gorini
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy
| | - R De Maria
- CNR Institute of Clinical Physiology, ASST Metropolitan Hospital Niguarda, Milan, Italy
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24
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De Maria R, Gori M, Marini M, Gonzini L, Benvenuto M, Cassaniti L, Municino' A, Navazio A, Ammirati E, Gorini M, Leonardi G, Pagnoni N, Montagna L, Midi P, Iacoviello M. Chronic heart failure in octogenarians. Temporal trends in clinical characteristics, treatment and outcomes over two decades in a nationwide cardiology registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0942] [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
Elderly >80 years represent the most rapidly expanding population segment in Europe. Chronic heart failure (CHF) affects over 10% of this group and generates a major M&M burden. We analyzed the temporal trends in characteristics, therapy and outcomes over two decades in octogenarians enrolled in our nationwide registry.
Methods
According to the recruitment epoch, among 14.283 CHF patients first enrolled in the registry since 1–1999 through 5–2018, we divided those aged 80+ (2520,17.6%) into 3 cohorts: 1999–2005 (547, 10%); 2006–2011 (659, 16.5%); 2012–2018 (1314, 14.1%). We analyzed trends over time in characteristics, therapy, 1-year all-cause mortality and proportion admitted to hospital.
Results
From 1999 to 2018 the proportion of 80+ CHF patients (60% men, 84±3 years, LVEF 41±1%, HFrEF 49%) rose from 10% to 24%. Across the 3 epochs (Table 1) we observed a shift towards the HFpEF phenotype with an increase in its driving factors (obesity, diabetes, hypertension, AFib). At the same time, the proportion treated with recommended therapies rose. Cumulative 1-year mortality did not differ across the 3 epochs (Fig.1 top), whereas the proportion of 80+ hospitalized overall, for CV causes and for decompensated HF, declined (Fig. 1 bottom).
Conclusions
During 20 years, the clinical characteristics of octogenarians enrolled in a nationwide CHF registry have deeply changed, reflecting demographic variations, the evolution of CV risk factors and improved management. There was a consistent implementation of BB, MRA and devices. Survival of 80+ remained stable, but the proportion of those hospitalized for CV causes, and specifically decompensated HF, declined. These data suggest that cardiologists' input may contribute to decrease the socioeconomic burden of CHF in the elderly.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Fondazione per il Tuo cuore – Heart Care Foundation (HCF) ONLUS
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Affiliation(s)
- R De Maria
- CNR Institute of Clinical Physiology, Milan, Italy
| | - M Gori
- Ospedale Papa Giovanni XXIII, Cardiologia 1, Bergamo, Italy
| | - M Marini
- University Hospital Riuniti of Ancona, Cardiologia Ospedaliera Emodinamica e UTIC, Ancona, Italy
| | - L Gonzini
- ANMCO Foundation For Your Heart, ANMCO Research Center, Florence, Italy
| | - M Benvenuto
- Teramo Hospital, Cardiologia UTIC ed Emodinamica, Teramo, Italy
| | - L Cassaniti
- Ospedale E. Muscatello, Cardiologia - UTIC, Augusta, Italy
| | - A.M Municino'
- Ospedale Padre Antero Micone, Cardiologia – UTIC, Genova, Italy
| | - A Navazio
- Santa Maria Nuova Hospital, Cardiologia, Reggio Emilia, Italy
| | - E Ammirati
- ASST Great Metropolitan Niguarda, Cardiologia 2 -Insufficienza Cardiaca e Trapianto, Milan, Italy
| | - M Gorini
- ANMCO Foundation For Your Heart, ANMCO Research Center, Florence, Italy
| | - G Leonardi
- University Policlinic of Catania, PO Rodolico SSD Scompenso Cardiaco Grave, Catania, Italy
| | - N Pagnoni
- Hospital San Giovanni Addolorata, Cardiologia e Riabilitazione Cardiologica, Rome, Italy
| | - L Montagna
- San Luigi Gonzaga University Hospital, Cardiologia, Orbassano, Italy
| | - P Midi
- Hospital dei Castelli, Cardiologia UTIC, Ariccia, Italy
| | - M Iacoviello
- Polyclinic Hospital of Bari, Cardiologia Universitaria, Bari, Italy
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25
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Mallardi A, Santoro F, Leopizzi A, Vitale E, Zimotti T, Ieva R, Caldarola P, Iacoviello M, Cannone M, Brunetti N. Prognostic value of acute mitral insufficiency among patients admitted with Takotsubo syndrome. Preliminary data from a prospective multicenter registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2155] [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
Takotsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction, whose pathophysiological mechanisms are not completely known. Aim of the study is to evaluate the incidence and prognostic value of acute mitral insufficiency among TTS patients.
Methods
Three hundred sixteen consecutive patients admitted for TTS were enrolled from July 2007 to December 2019 in a prospective registry among four hospitals. Clinical features, laboratory data, ECG and echocardiographic parameters and in-hospital complications were recorded.
Results
Eighty-five (27%) patients, mean age 76±8 years, presented with moderate/severe mitral insufficiency (msMI). Compared to the control group, patients that presented with msMI were older (76±8 vs 71±12 years, p<0.01), had lower LVEF (34±7% vs 37±9% p=0.02) and experienced higher rate of in-hospital complications (42 vs 32% p=0.04).
The incidence of in-hospital adverse events was higher in case of both msMI and LVEF <35% than in one of the two previous conditions or neither (69%, 42%, 23% respectively, p<0.05). Differences remained statistically significant even after correction for age and gender in the multivariate analysis.
There was a reduction of mitral insufficiency from moderate/severe into mild in 30 out of 87 (34%) pts after 48h from admission and in 52 out of 87 pts at discharge (60%).
Left ventricular outflow tract obstruction (LVOTO) was found in 13 out of 87 (15%) pts with msMI at admission and was transient in 11 out of 13 pts (84%).
At long term follow up (650 days) patients with msIM when compared to those without, experienced higher rate of mayor cardiovascular events (31.7% vs 20% p=0.03).
Conclusions
Patients with TTS and moderate/severe mitral insufficiency at admission have an increased risk of in and out-of hospital mayor cardiac adverse events.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Mallardi
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - F Santoro
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - A Leopizzi
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - E Vitale
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - T Zimotti
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - R Ieva
- University of Foggia, Department of Cardiology, Foggia, Italy
| | | | - M Iacoviello
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - M Cannone
- Ospedale L.Bonomo, Deparment of Cardiology, Andria, Italy
| | - N.D Brunetti
- University of Foggia, Department of Cardiology, Foggia, Italy
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26
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Santoro F, Mallardi A, Leopizzi A, Vitale E, Zimotti T, Ieva R, Iacoviello M, Brunetti N. Neoplastic markers in Takotsubo syndrome. Results from a prospective registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Takotsubo syndrome (TTS) is an acute heart failure syndrome with significant rate of in and out-of hospital mayor cardiac adverse events (MACE).
Aim of this study
Evaluate the possible role of neoplastic biomarkers (CA 15.3, CA-19.9 and Carcinoembryonic Antigen (CEA)) as prognostic marker at short- and long-term follow-up in subjects with TTS.
Methods
Ninety consecutive subjects with TTC were enrolled and followed for a median of 3 years. Circulating levels of CA-15.3, CA-19.9, CEA were evaluated at admission, after 72 h and at discharge. Incidence of MACE during hospitalization and follow-up were recorded.
Results
Forty-three (46%) patients experienced MACE during hospitalization. These patients were older (78±9 vs 72±12 p=0.01), had lower LVEF (32±7 vs 38±8 p=0,01) and increased levels of CEA (4.3±6.2 vs 2.2±1.5 ng/ml p=0.03). CEA and CA 19.9 levels at admission were statistically correlated with CRP and NT-proBNP levels (both p<0.05).
At long term follow-up CEA and CA 19.9 levels (higher than median) were associated with increased risk of death (log rank p<0.01 (both) RR=5.3 CI 95% 1.9–14.8 p<0.01; RR=7.8 CI 95% 2.4–25.1 p<0.01 respectively). At multivariate analysis including age, sex and admission LVEF, CEA and CA 19.9 levels higher than median were an independent predictor of MACE at long term (p<0.01 RR 3.5 CI 1.6–7.3).
Conclusion
CEA and CA 19.9 serum levels are associated with higher risk of in-hospital MACE and death at long-term.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- F Santoro
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - A Mallardi
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - A Leopizzi
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - E Vitale
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - T Zimotti
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - R Ieva
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - M Iacoviello
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - N.D Brunetti
- University of Foggia, Department of Cardiology, Foggia, Italy
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27
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Ruocco G, Evangelista I, Brazzi A, Luschi L, Feola M, Iacoviello M, Passantino A, Palazzuoli A. Effects on congestion, natriuretic peptides, diuretic efficiency, and renal function during different dose and administration of intravenous loop diuretic: preliminary data of DIUR-AHF Trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1224] [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
Although loop diuretic is the cornerstone of treatment in acute heart failure (AHF) there is no consensus about the best modality and amount to be used during acute phase. Current Guidelines do not provide specific insights regarding timing course and target dose. Usually physicians double the oral domestic amount when they start intravenous infusion, but a precise algorithm does not exist.
Aims
To compare admission and pre discharge clinical congestion and BNP trend in relation to furosemide amount and modality administration; 2- to evaluate diuretic efficiency and renal function in the four arms and the potential effects on outcome.
Methods
This is a multicentre prospective Trial (DIUR-AHF) designed in order to clarify the correct loop diuretic target avoiding potential side effects. The study enrolled patients with AHF BNP level >100 pg/ml and congestion signs. Patients were divided in four arms in accordance with modality administration: Continuous (Ci) vs Bolus (Bi) and dose administered Low (LD) vs High (HD) considering a cutoff 125 mg/die. All patients executed a clinical congestion evaluation and Chest radiography at admission and pre discharge, BNP sample and renal function were measured during the first 12 hours and before discharge. Diuretic efficiency (DE) defined as weight change per 40 mg of furosemide during infusional period. DE was estimated as the net fluid output produced per 40 mg of furosemide equivalents, Follow up were obtained by direct visit or phone contact at 30 and 60 days after discharge
Results
We included 268 hospitalized patients with a mean BNP level 987±440 pg /ml, mean congestion score (3.5±2) creatinine and GFR value were 1.6±0.7 mg/dl; and 48±20 ml/min/m2 respectively. At admission BNP and Creatinine were modestly increased in HD (P<0.01) compared with all other groups. Pre discharge Congestion score were increased in Bi and HD groups (2.5±1 vs 1±1), similarly BNP levels were increased in Bi and HD with respect to Ci and LD (454±215 and 413±223 vs 288±170 and 312±248 p<0.05). Whereas DE were significantly increased in Ci compared with the other arms (−1.23 vs −0.55 p<0.01). In all groups, low DE, residual congestion and BNP reduction <30% resulted in escalation of diuretic strategies and impaired outcome (HR 1.88 [1.16–204]; 2.1 [1.4–2.8]; 1.3 [0.88–2.1]). A significant correlation between poor DE and residual congestion was recruited (r=0.76). Worsening Renal function (WRF) occurred much more in HD and Ci compared to LD and Bi (HD 44%, Ci 35% vs LD 33% and Bi 23% p<0.01) without significant effects on outcome.
Conclusions
HD and Bi of furosemide are both related with reduced congestion and invreased BNP level before discharge. In all groups low DE residual congestion and poor BNP reduction appear associated with higher rate of adverse events. Current data provide additional features for AHF patients during intravenous loop diuretic administration
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Ruocco
- Regina Montis Regalis Hospital, ASL-CN1, Cardiology Section, Mondovì, Italy
| | - I Evangelista
- University of Siena, Cardiovascular Diseases Unit, Department of Internal Medicine, Siena, Italy
| | - A Brazzi
- University of Siena, Cardiovascular Diseases Unit, Department of Internal Medicine, Siena, Italy
| | - L Luschi
- University of Siena, Cardiovascular Diseases Unit, Department of Internal Medicine, Siena, Italy
| | - M Feola
- Regina Montis Regalis Hospital, ASL-CN1, Cardiology Section, Mondovì, Italy
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De Maria R, Macera F, Gorini M, Battistoni I, Iacoviello M, Iacovoni A, Palmieri V, Pasqualucci D, Leonardi G, Pagnoni N, Montagna L, Floresta M, Midi P, Pulignano G, Mortara A. P320Heart failure with mid-range (HFmrEF) or recovered (HFrecEF) ejection fraction: differential determinants of transition. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Heart failure with mid-range ejection fraction (HFmrEF) has been identified as a multi-faceted phenotype that may encompass both patients with mild disease or those who from previous HFrEF recover EF (HFrecEF)
Purpose
To describe clinical characteristics and factors associated with phenotype transition at follow-up.
Methods
From 2009 to 2016, 1194 patients with baseline EF<50% and a second echocardiographic determination during clinically stability at a median of 6 months were enrolled in the IN-CHF Registry. Based on EF at enrollment, 335 (28%) had HFmrEF and 859 (72%) had HFrEF. We compared baseline clinical characteristics and predictors associated with follow-up reclassification to HFmrEF or full EF recovery
Results
When compared to HFrEF patients, those with HFmrEF had less often an ischemic etiology, advanced symptoms and a HF admission in the previous year. No other differences were found in clinical characteristics and drug therapy (Table).
At a median follow-up of 6 months, 30% of HFrEF patients improved EF by 14 (9) units: 21% showed partial EF recovery (transition to HFmrEF) and 9% had full EF recovery. Conversely among HFmrEF patients 22% improved EF, by 9 (5) units, to full recovery, and 18% deteriorated by 1.5 (5.5) units sloping to HFrEF.
By multivariable logistic regression analysis, variables associated with EF recovery at 6-month follow-up differed between baseline phenotypes. Within HFrEF, ischemic etiology (OR 0.46, 95% CI 0.33–0.64) and NYHA class III-IV symptoms (OR 0.57, 95% CI 0.38–0.68) were associated with a lower likelihood of EF recovery, while a history of HF<6 month correlated with a higher likelihood of EF recovery (OR 2.44, 95% CI 1.76–3.39). Within HFmrEF, while ischemic etiology (OR 0.66, 95% CI 0.19–0.68) was also associated with a lower likelihood of EF recovery, a history of atrial fibrillation at enrollment correlated with higher likelihood of EF recovery (OR 2.66, 95% CI 1.37–5.17) by 6 month-follow-up.
At a median follow-up of 36+28 months mortality was 4.6% vs 6.9% in HFrecEF vs non-recovered patients (log rank p=0.08).
Baseline characteristics HFrEF vs HFmrEF
Conclusions
HFmrEF patients showed a less severe clinical picture than HFrEF patients, but had EF recovery less often. EF improvement is negatively associated with ischemic etiology in both phenotypes, and positively associated with atrial fibrillation in HFmrEF and a short history of HF in HFrEF.
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Affiliation(s)
- R De Maria
- CNR Institute of Clinical Physiology, Milan, Italy
| | - F Macera
- Niguarda Ca' Granda Hospital, De Gasperis CardioCenter, Milan, Italy
| | - M Gorini
- ANMCO Study Center, Florence, Italy
| | - I Battistoni
- University Hospital Riuniti of Ancona, Ancona, Italy
| | | | - A Iacovoni
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - V Palmieri
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | | | - G Leonardi
- Polyclinic Hospital “Rodolico”, Catania, Italy
| | - N Pagnoni
- Hospital San Giovanni Addolorata, Rome, Italy
| | - L Montagna
- University Hospital San Luigi Gonzaga, Orbassano, Italy
| | - M Floresta
- Ospedale Cervello-Villa Sofia, Palermo, Italy
| | - P Midi
- Albano-Genzano Hospital, ASL Rome 6, Albano Laziale, Italy
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Scicchitano P, Massari F, Iacoviello M, Valle R, Sanasi M, Piscopo A, Sasanelli P, De Palo M, Guida P, Mastropasqua F, Caldarola P, Ciccone MM. P4547Serum biochemical determinants of peripheral congestion assessed by bioimpedance vector analysis in acute heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0938] [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 pathophysiology of peripheral congestion is poorly investigated in patients with acute heart failure (AHF).
Purpose
This study evaluated the relative contribution of serum colloid osmotic pressure (COP), relative plasma volume status (PVS), biomarkers of renal function, electrolytes, haemoglobin, and brain natriuretic peptide (BNP) in peripheral fluid overload using bioimpedance vector analysis (BIVA).
Methods
We retrospectively analysed data from 485 patients with AHF. Hydration status was evaluated by semiquantitative and quantitative approach using BIVA (R/Xc graph) and Hydration Index (HI), respectively. COP was calculated from albumin and total protein concentration, while relative PVS was calculated from validated equations.
Results
Congestion assessed by BIVA was observed in 304 (63%) patients and classified as mild (30%), moderate (42%), and severe (28%). On univariate analysis, HI was inversely correlated with COP (P<0.01), glomerular filtration rate (P<0.01), and haemoglobin (P<0.01), while positive correlations were found for relative PVS (P<0.05), BNP (P<0.01), and blood urea nitrogen (BUN; P<0.01). On stepwise multivariate analysis, COP explained 12% of the total variability, while BUN, PVS, haemoglobin, and BNP added a further 6%, 4%, 2%, and 1%, respectively, to the final explanatory model.
Conclusions
COP was the major determinant of the presence and entity of peripheral congestion assessed by BIVA. BUN, PVS, haemoglobin, and BNP revealed reduced influence on congestion as compared with COP. Routine laboratory testing could be useful in peripheral fluid accumulation. Future studies should evaluate the relationship between COP and pharmacological target therapies for the fluid management of AHF patients.
Acknowledgement/Funding
None
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Affiliation(s)
| | - F Massari
- F. Perinei Hospital, Altamura, Italy
| | - M Iacoviello
- Polyclinic Hospital of Bari, Cardiology, Bari, Italy
| | - R Valle
- Chioggia Hospital, Cardiology, Chioggia, Italy
| | - M Sanasi
- F. Perinei Hospital, Altamura, Italy
| | - A Piscopo
- F. Perinei Hospital, Altamura, Italy
| | | | - M De Palo
- Città di Bari Hospital CBH, Cardiac Surgery, Bari, Italy
| | - P Guida
- Institute of Cassano Murge, Rehabilitation Cardiology, Bari, Italy
| | - F Mastropasqua
- Institute of Cassano Murge, Rehabilitation Cardiology, Bari, Italy
| | | | - M M Ciccone
- Polyclinic Hospital of Bari, Cardiology, Bari, Italy
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Bossone E, Arcopinto M, Iacoviello M, Triggiani V, Cacciatore F, Maiello C, Limongelli G, Masarone D, Perticone F, Sciacqua A, Perrone-Filardi P, Mancini A, Volterrani M, Vriz O, Castello R, Passantino A, Campo M, Modesti PA, De Giorgi A, Monte I, Puzzo A, Ballotta A, Caliendo L, D'Assante R, Marra AM, Salzano A, Suzuki T, Cittadini A. Multiple hormonal and metabolic deficiency syndrome in chronic heart failure: rationale, design, and demographic characteristics of the T.O.S.CA. Registry. Intern Emerg Med 2018; 13:661-671. [PMID: 29619769 DOI: 10.1007/s11739-018-1844-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 12/06/2017] [Accepted: 03/24/2018] [Indexed: 12/20/2022]
Abstract
Recent evidence supports the concept that progression of chronic heart failure (CHF) depends upon an imbalance of catabolic forces over the anabolic drive. In this regard, multiple hormonal deficiency syndrome (MHDS) significantly has impacts upon CHF progression, and is associated with a worse clinical status and increased mortality. The T.O.S.CA. (Trattamento Ormonale nello Scompenso CArdiaco; Hormone Therapy in Heart Failure) Registry (clinicaltrial.gov = NCT02335801) tests the hypothesis that anabolic deficiencies reduce survival in a large population of mild-to-moderate CHF patients. The T.O.S.CA. Registry is a prospective multicenter observational study coordinated by "Federico II" University of Naples, and involves 19 centers situated throughout Italy. Thyroid hormones, insulin-like growth factor-1, total testosterone, dehydroepiandrosterone , and insulin are measured at baseline and every year for a patient-average follow-up of 3 years. Subjects with CHF are divided into two groups: patients with one or no anabolic deficiency, and patients with two or more anabolic deficiencies at baseline. The primary endpoint is the composite of all-cause mortality and cardiovascular hospitalization. Secondary endpoints include the composite of all-cause mortality and hospitalization, the composite of cardiovascular mortality and cardiovascular hospitalization, and change of VO2 peak. Patient enrollment started in April 2013, and was completed in July 2017. Demographics and main clinical characteristics of enrolled patients are provided in this article. Detailed cross-sectional results will be available in late 2018. The T.O.S.CA. Registry represents the most robust prospective observational trial on MHDS in the field of CHF. The study findings will advance our knowledge with regard to the intimate mechanisms of CHF progression and hopefully pave the way for future randomized clinical trials of single or multiple hormonal replacement therapies in CHF.
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Affiliation(s)
- E Bossone
- Heart Department, Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, University of Salerno, Salerno, Italy
| | - M Arcopinto
- Department of Translational Medical Sciences, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - M Iacoviello
- Cardiology Unit, Cardiothoracic Department, University of Bari "Aldo Moro", Bari, Italy
| | - V Triggiani
- Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "A. Moro", Bari, Italy
| | - F Cacciatore
- Heart Transplantation Unit, Monaldi Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - C Maiello
- Heart Transplantation Unit, Monaldi Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - G Limongelli
- Division of Cardiology SUN, Monaldi Hospital, Azienda Ospedaliera dei Colli, Second University of Naples, Naples, Italy
| | - D Masarone
- Division of Cardiology SUN, Monaldi Hospital, Azienda Ospedaliera dei Colli, Second University of Naples, Naples, Italy
| | - F Perticone
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - A Sciacqua
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - P Perrone-Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - A Mancini
- Operative Unit of Endocrinology, Catholic University of the Sacred Heart, Rome, Italy
| | - M Volterrani
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - O Vriz
- Heart Center Department, King Faisal Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - R Castello
- Division of General Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - A Passantino
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Cassano Murge, Bari, Italy
| | - M Campo
- Unit of Endocrinology and Metabolic Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - P A Modesti
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
| | - A De Giorgi
- Department of Medical Sciences, School of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - I Monte
- Department of General Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | - A Puzzo
- IRCSS. Oasi Maria SS, Troina, Italy
| | - A Ballotta
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - L Caliendo
- Ospedale Santa Maria della Pietà, Nola, Naples, Italy
| | | | | | - A Salzano
- Department of Translational Medical Sciences, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | - T Suzuki
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | - A Cittadini
- Department of Translational Medical Sciences, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
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Terlizzese P, Grande D, Rizzo C, Parisi G, Gioia M, Leopizzi T, Segreto A, Lattarulo M, Licchelli B, Triggiani V, Iacoviello M. P3239Poor outcome in chronic heart failure patients with thyroid hormones deficiencies. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Puzzovivo A, Ciccone MM, Iacoviello M, Doronzo A, Antoncecchi V, Monitillo F, Citarelli G, Paradies V, Corrieri N, Favale S. Renal resistance index: a new marker reflecting cardiorenal syndrome independently associated with heart failure progression. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p637] [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: 11/15/2022] Open
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33
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Antoncecchi V, Ciccone MM, Iacoviello M, Puzzovivo A, Doronzo A, Monitillo F, Citarelli G, Paradies V, Corrieri N, Favale S. Renal arterial resistance index: a marker of renal dysfunction with an incremental role in predicting heart failure progression. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3837] [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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34
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Doronzo A, Ciccone MM, Iacoviello M, Puzzovivo A, Monitillo F, Antoncecchi V, Citarelli G, Paradies V, Corrieri N, Favale S. Renal arterial resistance index is independently associate to high diuretic dose in chronic heart failure outpatients. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p636] [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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35
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Giagulli V, Moghetti P, Kaufman J, Guastamacchia E, Iacoviello M, Triggiani V. Managing Erectile Dysfunction in Heart Failure. Endocr Metab Immune Disord Drug Targets 2013; 13:125-34. [DOI: 10.2174/1871530311313010015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 11/22/2022]
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Totzeck M, Hendgen-Cotta U, Rammos C, Petrescu A, Stock P, Goedecke A, Shiva S, Kelm M, Rassaf T, Duerr GD, Heuft T, Klaas T, Suchan G, Roell W, Zimmer A, Welz A, Fleischmann BK, Dewald O, Luedde M, Carter N, Lutz M, Sosna J, Jacoby C, Floegel U, Hippe HJ, Adam D, Heikenwaelder M, Frey N, Sobierajski J, Luedicke P, Hendgen-Cotta U, Lue H, Totzeck M, Dewor M, Kelm M, Bernhagen J, Rassaf T, Cortez-Dias N, Costa M, Carrilho-Ferreira P, Silva D, Jorge C, Robalo Martins S, Fiuza M, Pinto FJ, Nunes Diogo A, Enguita FJ, Tsiachris D, Tsioufis C, Kasiakogias A, Flessas D, Antonakis V, Kintis K, Giakoumis M, Hatzigiannis P, Katsimichas T, Stefanadis C, Andrikou E, Tsioufis C, Thomopoulos C, Kasiakogias A, Tzamou V, Andrikou I, Bafakis I, Lioni L, Kintis K, Stefanadis C, Lazaros G, Tsiachris D, Tsioufis C, Vlachopoulos C, Brili S, Chrysohoou C, Tousoulis D, Stefanadis C, Santos De Sousa CI, Pires S, Nunes A, Cortez Dias N, Belo A, Cabrita I, Pinto FJ, Benova T, Radosinska J, Viczenczova C, Bacova B, Knezl V, Dosenko V, Navarova J, Zeman M, Tribulova N, Maceira Gonzalez AM, Cosin Sales J, Igual B, Ruvira J, Diago JL, Aguilar J, Lopez Lereu MP, Monmeneu JV, Estornell J, Choi JC, Cha KS, Lee HW, Yun EY, Ahn JH, Oh JH, Choi JH, Lee HC, Hong TJ, Manzano Fernandez S, Lopez-Cuenca A, Januzzi JL, Mateo-Martinez A, Sanchez-Martinez M, Parra-Pallares S, Orenes-Pinero E, Romero-Aniorte AI, Valdes-Chavarri M, Marin F, Bouzas Mosquera A, Peteiro J, Broullon FJ, Alvarez Garcia N, Couto Mallon D, Bouzas Zubeldia B, Martinez Ruiz D, Yanez Wonenburger JC, Fabregas Casal R, Castro Beiras A, Backus BE, Six AJ, Cullen L, Greenslade J, Than M, Kameyama T, Sato T, Noto T, Nakadate T, Ueno H, Yamada K, Inoue H, Albrecht-Kuepper B, Kretschmer A, Kast R, Baerfacker L, Schaefer S, Kolkhof P, Andersson C, Kober L, Christensen SB, Nguyen CD, Nielsen MB, Olsen AMS, Gislason GH, Torp-Pedersen C, Shigekiyo M, Harada K, Lieu H, Neutel J, Maddock S, Goldsmith S, Koren M, Antwerp BV, Burnett J, Christensen SB, Charlot MG, Madsen M, Andersson C, Kober L, Gustafsson F, Torp-Pedersen C, Gislason GH, Cavusoglu Y, Mert KU, Nadir A, Mutlu F, Gencer E, Ulus T, Birdane A, Lim HS, Tahk SJ, Yang HM, Kim JW, Seo KW, Choi BJ, Choi SY, Yoon MH, Hwang GS, Shin JH, Russ MA, Wackerl C, Hochadel M, Brachmann J, Mudra H, Zeymer U, Weber MA, Menozzi A, Saia F, Valgimigli M, Belotti LM, Casella G, Manari A, Cremonesi A, Piovaccari G, Guastaroba P, Marzocchi A, Kuramitsu S, Iwabuchi M, Haraguchi T, Domei T, Nagae A, Hyodo M, Takabatake Y, Yokoi H, Toyota F, Nobuyoshi M, Kaitani K, Hanazawa K, Izumi C, Nakagawa Y, Ando K, Arita T, Nobuyoshi M, Shizuta S, Kimura T, Isshiuki T, Trucco ME, Tolosana JM, Castel MA, Borras R, Sitges M, Khatib M, Arbelo E, Berruezo A, Brugada J, Mont L, Romanov A, Pokushalov E, Prokhorova D, Chernyavskiy A, Shabanov V, Goscinska-Bis K, Bis J, Bochenek A, Gersak B, Karaskov A, Linde C, Daubert C, Bergemann TL, Abraham WT, Gold MR, Van Boven N, Bogaard K, Ruiter JH, Kimman GP, Kardys I, Umans VA, Cipriani M, Lunati M, Landolina M, Vittori C, Vargiu S, Ghio S, Petracci B, Campo C, Bisetti S, Frigerio M, Bongiorni MG, Soldati E, Segreti L, Zucchelli G, Di Cori A, De Lucia R, Viani S, Paperini L, Boem A, Levorato D, Kutarski A, Malecka B, Zabek A, Czajkowski M, Chudzik M, Kutarski A, Mitkowski P, Maciag A, Kempa M, Golzio PG, Fanelli A, Vinci M, Pelissero E, Morello M, Grosso Marra W, Gaita F, Kutarski A, Czajkowski M, Pietura R, Golzio PG, Vinci M, Pelissero E, Fanelli A, Ferraris F, Gaita F, Cuypers JAAE, Menting ME, Opic P, Utens EMWJ, Van Domburg RT, Helbing WA, Witsenburg M, Van Den Bosch AE, Bogers AJJC, Roos-Hesselink JW, Van Der Linde D, Takkenberg JJM, Rizopoulos D, Heuvelman HJ, Witsenburg M, Budts W, Van Dijk APJ, Bogers AJJC, Oechslin EN, Roos-Hesselink JW, Diller GP, Kempny A, Liodakis E, Alonso-Gonzalez R, Orwat S, Dimopoulos K, Swan L, Li W, Gatzoulis MA, Baumgartner H, Andrade AC, Voges I, Jerosch-Herold M, Pham M, Hart C, Hansen T, Kramer HH, Rickers C, Kempny A, Wustmann K, Borgia F, Dimopoulos K, Uebing A, Piorkowski A, Yacoub MH, Gatzoulis MA, Swan L, Diller GP, Mueller J, Weber R, Pringsheim M, Hoerer J, Hess J, Hager A, Hu K, Liu D, Niemann M, Herrmann S, Cikes M, Stoerk S, Knob S, Ertl G, Bijnens B, Weidemann F, Mornos C, Cozma D, Dragulescu D, Ionac A, Mornos A, Petrescu L, Mingo S, Ruiz Bautista L, Monivas Palomero V, Prados C, Maiz L, Giron R, Martinez M, Cavero Gibanel MA, Segovia J, Pulpon L, Kato H, Kubota S, Takasawa Y, Kumamoto T, Iacoviello M, Puzzovivo A, Forleo C, Lattarulo MS, Monitillo F, Antoncecchi V, Malerba G, Marangelli V, Favale S, Ruiz Bautista L, Mingo S, Monivas V, Segovia J, Prados C, Maiz L, Giron R, Martinez MT, Gonzalez Estecha M, Alonso Pulpon LA, Ren B, De Groot-De Laat L, Mcghie J, Vletter W, Ten Cate F, Geleijnse M, Looi JL, Lam YY, Yu CM, Lee PW, Apor A, Sax B, Huttl T, Nagy A, Kovacs A, Merkely B, Vecera J, Bartunek J, Vanderheyden M, Mertens P, Bodea O, Penicka M, Biaggi P, Gaemperli O, Corti R, Gruenenfelder J, Felix C, Bettex D, Datta S, Jenni R, Tanner F, Herzog B, Fattouch K, Murana G, Castrovinci S, Sampognaro R, Bertolino EC, Caccamo G, Ruvolo G, Speziale G, Lancellotti P. Saturday, 25 August 2012. Eur Heart J 2012. [DOI: 10.1093/eurheartj/ehs280] [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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Deshmukh A, Sharma SS, Gobal FG, Singla SS, Hebbar PH, Paydak HP, Igarashi M, Tada H, Sekiguchi Y, Yamasaki H, Kuroki K, Machino T, Yoshida K, Aonuma K, Shavadia J, Otieno H, Yonga G, Jinah A, Qvist JF, Soerensen PH, Dixen U, Ramirez-Marrero MA, Perez-Villardon B, Gaitan-Roman D, Jimenez-Navarro M, Delgado-Prieto JL, De Teresa-Galvan E, De Mora-Martin M, Deshmukh A, Hebbar PB, Wei WX, Gobal FG, Singla SS, Sharma SS, Paydak HP, Bardari S, Zecchin M, Salame' R, Vitali Serdoz L, Di Lenarda A, Guerrini N, Barbati G, Sinagra G, Hanazawa K, Kaitani K, Nakagawa Y, Lenaerts I, Driesen R, Hermida N, Heidbuchel H, Janssens S, Balligand JL, Sipido KR, Willems R, Sehra R, Krummen D, Briggs C, Narayan S, Tanaka Y, Hirao K, Nakamura T, Inaba O, Yagishita A, Higuchi K, Hachiya H, Isobe M, Kallergis E, Kanoupakis EM, Mavrakis HE, Goudis CA, Maliaraki NE, Vardas PE, Sehra R, Krummen D, Briggs C, Narayan S, Kiuchi K, Piorkowski C, Kircher S, Gaspar T, Watanabe N, Bollmann A, Hindricks G, Wauters K, Grosse A, Raffa S, Brunelli M, Geller JC, Maggioni AP, Gonzini L, Gussoni G, Vescovo G, Gulizia M, Pirelli S, Mathieu G, Di Pasquale G, Zecchin M, Bardari S, Vitali Serdoz L, Salame R, Buja G, Rovai N, Gargaro A, Sperzel J, Knops RE, Meine M, Speca G, Santini L, Haarbo J, Dubin K, Di Lenarda A, Carlson M, Garcia Quintana A, Mendoza-Lemes H, Garcia Perez L, Led Ramos S, Caballero Dorta E, Matinez De Espronceda M, Piro Mastracchio V, Serrano Arriezu L, Sciarra L, Barbati G, Marziali M, Marras E, Rebecchi M, Allocca G, Lioy E, Delise P, Calo' L, Santobuono VE, Iacoviello M, Nacci F, Magnani S, Luzzi G, Puzzovivo A, Memeo M, Quadrini F, Favale S, Trucco ME, Arce M, Palazzolo J, Uribe W, Baranchuk A, Sinagra G, Femenia F, Maggi R, Furukawa T, Croci F, Solano A, Brignole M, Lebreiro A, Sousa A, Correia AS, Lourenco P, Sakamoto T, Oliveira S, Paiva M, Freitas J, Maciel MJ, Linker N, Rieger G, Garutti C, Edvardsson N, Salguero Bodes R, De Riva Silva M, Kumagai K, Fontenla Cerezuela A, Lopez Gil M, Mejia Martinez E, Jurado Roman A, Garcia Alvarez S, Arribas Ynsaurriaga F, Petix NR, Del Rosso A, Guarnaccia V, Zipoli A, Fuke E, Rabajoli F, Foglia Manzillo G, Tolardo C, Checchinato C, Chiaravallotti S, Santarone M, Spinnler MT, Podoleanu C, Maggi R, Brignole M, Nishiuchi S, Frigy A, Dobreanu D, Ginghina C, Carasca E, Hayashi T, Miki Y, Naito S, Oshima S, Hof IE, Vonken E, Velthuis BK, Meine M, Hauer RNW, Loh KP, Na JO, Choi CU, Kim EJ, Rha SW, Park CG, Seo HS, Oh DJ, Lim HE, Igarashi M, Tada H, Sekiguchi Y, Yamasaki H, Kuroki K, Machino T, Yoshida K, Aonuma K, Wichterle D, Bulkova V, Fiala M, Chovancik J, Simek J, Peichl P, Cihak R, Kautzner J, Glick A, Viskin S, Belhassen B, Navarrete A, Conte F, Ishti A, Sai D, Moran M, Chitovova Z, Ahmed H, Mares K, Skoda J, Sediva L, Petru J, Reddy VY, Neuzil P, Schmidt M, Dorwarth U, Leber A, Wankerl M, Krieg J, Straube F, Reif S, Hoffmann E, Mikhaylov E, Tikhonenko V, Lebedev D, Lim HE, Shin SY, Yong HS, Choi CU, Choi JI, Kim SH, Kim EJ, Na JO, Matsuo S, Yamane T, Hioki M, Ito K, Narui R, Date T, Sugimoto K, Yoshimura M, Rolf S, Piorkowski C, Gaspar T, Sommer P, Hindricks G, Batalov R, Popov S, Antonchenko I, Suslova T, Fichtner S, Czudnochowsky U, Estner HL, Ammar S, Reents T, Jilek C, Hessling G, Deisenhofer I, Pokushalov E, Romanov A, Corbucci G, Artemenko S, Losik D, Shabanov V, Turov A, Elesin D, Mikhaylov E, Abramov M, Lebedev D, Piorkowski C, Sanders P, Jais P, Roberts-Thomson K, Hindricks G, Fukumoto K, Takatsuki S, Kimura T, Nishiyama N, Aizawa Y, Sato T, Miyoshi S, Fukuda K, Roux Y, Tenkorang J, Carroz P, Schlaepfer J, Pascale P, Forclaz A, Fromer M, Pruvot E, Fiala M, Wichterle D, Bulkova V, Sknouril L, Nevralova R, Chovancik J, Dorda M, Januska J, Brunelli M, Grosse A, Santi R, Wauters K, Geller C, Kumagai K, Nakamura K, Hayashi T, Kasseno K, Naito S, Sakamoto T, Oshima S, Taniguchi K, Wutzler A, Rolf S, Huemer M, Parwani A, Boldt LH, Blaschke D, Dietz R, Haverkamp W, Coutu B, Malanuk R, Ait Said M, Vicentini A, Schade S, Ando K, Rousseauplasse A, Deering T, Picarra BC, Santos AR, Dionisio P, Semedo P, Matos R, Leitao M, Jacinto A, Trinca M, Wan C, Glad J, Szymkiewicz S, Habibovic M, Versteeg H, Pelle AJM, Theuns DAMJ, Jordaens L, Pedersen SS, Pakarinen S, Toivonen L, Reif S, Schade S, Taggeselle J, Frey A, Birkenhagen A, Kohler S, Schmidt M, Maier SKG, Lobitz N, Paule S, Becher J, Mustafa G, Ibrahim A, King G, Foley B, Wilkoff B, Freedman R, Hayes D, Kalbfleisch S, Kutalek S, Schaerf R, Fazal IA, Tynan M, Plummer CJ, Mccomb JM, Oto A, Aytemir K, Yorgun H, Canpolat U, Kaya EB, Tokgozoglu L, Kabakci G, Ozkutlu H, Greenberg S, Hamati F, Styperek R, Alonso J, Peress D, Bolanos O, Augostini R, Pelini M, Zhang S, Stoycos S, Witsaman S, Mowrey K, Bremer J, Oza A, Ciconte G, Mazzone P, Paglino G, Marzi A, Vergara P, Sora N, Gulletta S, Della Bella P, Nagashima M, Goya M, Soga Y, Hiroshima K, Andou K, Hayashi K, An Y, Nobuyoshi M, Kutarski A, Malecka B, Pietura R, Osmancik P, Herman D, Stros P, Kocka V, Tousek P, Linkova H, Bortnik M, Occhetta E, Dell'era G, Degiovanni A, Plebani L, Marino PN, Gorev MV, Alimov DG, Raju P, Kully S, Ugni S, Furniss S, Lloyd G, Patel NR, Richards MW, Warren CE, Anderson MH, Hero M, Rey JL, Ouali S, Azzez S, Kacem S, Hammas S, Ben Salem H, Neffeti E, Remedi F, Boughzela E, Kronborg MB, Mortensen PT, Poulsen SH, Nielsen JC, Simantirakis EN, Kontaraki JE, Arkolaki EG, Chrysostomakis SI, Nyktari EG, Patrianakos AP, Vardas PE, Funck RC, Harink C, Mueller HH, Koelsch S, Maisch B, Bortnik M, Occhetta E, Dell'era G, Degiovanni A, Bolzani V, Marino PN, Costandi P, Shehada RE, Butala N, Coppola B, Taborsky M, Heinc P, Fedorco M, Doupal V, Di Cori A, Zucchelli G, Soldati E, Segreti L, De Lucia R, Viani S, Paperini L, Bongiorni MG, Gutleben KJ, Kranig W, Barr C, Morgenstern MM, Simon M, Dalal YH, Landolina M, Pierantozzi A, Agricola T, Lunati M, Pisano' E, Lonardi G, Bardelli G, Zucchi G, Thibault B, Dubuc M, Karst E, Ryu K, Paiement P, Carlson MD, Farazi T, Alhous H, Mont L, Porres JM, Alzueta J, Beiras X, Fernandez-Lozano I, Macias A, Ruiz R, Brugada J, Viani SM, Segreti L, Di Cori A, Zucchelli G, Paperini L, Soldati E, De Lucia R, Bongiorni MG, Seifert M, Schau T, Moeller V, Meyhoefer J, Butter C, Ganiere V, Niculescu V, Domenichini G, Stettler C, Defaye P, Burri H, Stockburger M, De Teresa E, Lamas G, Desaga M, Koenig C, Cobo E, Navarro X, Wiegand U, Blich M, Carasso S, Suleiman M, Marai I, Gepstein L, Boulos M, Sasov M, Liska B, Margitfalvi P, Malacky T, Svetlosak M, Goncalvesova E, Hatala R, Takaya Y, Noda T, Yamada Y, Okamura H, Satomi K, Shimizu W, Aihara N, Kamakura S, Proclemer A, Boveda S, Oswald H, Scipione P, Rousseauplasse A, Da Costa A, Brzozowski W, Tomaszewski A, Kutarski A, Wysokinski A, Arbelo E, Tamborero D, Vidal B, Tolosana JM, Sitges M, Matas M, Brugada J, Mont L, Botto GL, Dicandia CD, Mantica M, La Rosa C, D' Onofrio A, Molon G, Raciti G, Verlato R, Foley PWX, Chalil S, Ratib K, Smith REA, Printzen F, Auricchio A, Leyva F, Abu Sham'a R, Buber J, Luria D, Kuperstein R, Feinberg M, Granit H, Eldar M, Glikson M, Osmancik P, Herman D, Stros P, Vondrak K, Abu Sham'a R, Nof E, Kuperstein R, Carasso S, Feinberg M, Lipchenca I, Eldar M, Glikson M, Vatasescu RG, Iorgulescu C, Caldararu C, Vasile A, Bogdan S, Constantinescu D, Dorobantu M, Sakaguchi H, Miyazaki A, Yamamoto T, Fujimoto K, Ono S, Ohuchi H, Martinelli M, Martins S, Molina R, Siqueira S, Nishioka SAD, Peixoto GL, Alkmim-Teixeira R, Costa R, Versteeg H, Meine MM, Tuinenburg AE, Doevendans PA, Denollet J, Pedersen SS, Goscinska-Bis K, Zupan I, Van Der H, Anselme F, Hartog H, Block M, Borri A, Padeletti L, Toniolo M, Zanotto G, Rossi A, Raytcheva E, Tomasi L, Vassanelli C, Fernandez Lozano I, Mitroi C, Toquero Ramos J, Castro Urda V, Monivas Palomero V, Corona Figueroa A, Ruiz Bautista L, Alonso Pulpon L, Jadidi AS, Sacher F, Shah AS, Scherr D, Derval N, Hocini M, Haissaguerre M, Jais P, Castrejon Castrejon S, Largo-Aramburu C, Sachar J, Gang E, Estrada A, Doiny D, De Miguel E, Merino JL, Vergara P, Trevisi N, Ricco A, Petracca F, Baratto F, Bisceglie A, Maccabelli G, Della Bella P, El-Damaty A, Sapp J, Warren J, Macinnis P, Horacek M, Dinov B, Schoenbauer R, Piorkowski C, Bollmann A, Sommer P, Braunschweig F, Hindricks G, Arya A, Andreu D, Berruezo A, Ortiz JT, Silva E, Mont L, De Caralt TM, Fernandez-Armenta J, Brugada J, Castrejon Castrejon S, Estrada A, Doiny D, Perez-Silva A, Ortega M, Lopez-Sendon JL, Merino JL, Regoli F, Faletra F, Nucifora G, Pasotti E, Moccetti T, Klersy C, Auricchio A, Casella M, Dello Russo A, Moltrasio M, Zucchetti M, Fassini G, Di Biase L, Natale A, Tondo C, Sakamoto T, Kumagai K, Matsuhashi N, Nishiuchi S, Fuke E, Hayashi T, Naito S, Oshima S, Weig HJ, Kerst G, Weretk S, Seizer P, Gawaz MP, Schreieck J, Sarquella-Brugada G, Prada F, Brugada J, Reents T, Ammar S, Fichtner S, Salling CM, Jilek C, Kolb C, Hessling G, Deisenhofer I, Pytkowski M, Maciag A, Farkowski M, Jankowska A, Kowalik I, Kraska A, Szwed H, Maury P, Hocini M, Sacher F, Duparc A, Mondoly P, Rollin A, Jais P, Haissaguerre M, Pap R, Kohari M, Bencsik G, Makai A, Saghy L, Forster T, Ebrille E, Scaglione M, Raimondo C, Caponi D, Di Donna P, Blandino A, Delcre SDL, Gaita F, Roca Luque I, Dos LDS, Rivas NRG, Pijuan APD, Perez J, Casaldaliga J, Garcia-Dorado DGD, Moya AMM, Sato H, Yagi T, Yambe T, Streitner F, Dietrich C, Mahl E, Schoene N, Veltmann C, Borggrefe M, Kuschyk J, Sadarmin PP, Wong KCK, Rajappan K, Bashir Y, Betts TR, Svetlosak M, Leclercq C, Martins R, Hatala R, Daubert JC, Mabo P, Koide M, Hamano G, Taniguchi T, Yamato M, Sasaki N, Hirooka K, Ikeda Y, Yasumura Y, Dichtl W, Wolber T, Paoli U, Bruellmann S, Berger T, Stuehlinger M, Duru F, Hintringer F, Kanoupakis E, Mavrakis H, Kallergis E, Koutalas E, Saloustros I, Goudis C, Chlouverakis G, Vardas P, Herre JM, Saeed M, Saberi L, Neuman S, An Y, Ando K, Goya M, Nagashima M, Yamaji K, Soga Y, Iwabuchi M, Nobuyoshi M, Baranchuk A, Femenia F, Miranda Hermosilla R, Lopez Diez JC, Serra JL, Valentino M, Retyk E, Galizio N, Kwasniewski W, Filipecki A, Orszulak W, Urbanczyk-Swic D, Trusz - Gluza M, Piot O, Degand B, Da Costa A, Donofrio A, Scanu P, Quesada A, Rousseauplasse A, Padeletti L, Kloppe A, Mijic D, Bogossian H, Zarse M, Lemke B, Tyler J, Comfort G, Kalbfleisch S, Deering TF, Epstein AE, Greenberg SMG, Goldman DS, Rhude J, Majewski JP, Lelakowski J, Tomala I, Santos CM, Miranda RS, Sousa PJ, Cavaco DM, Adragao PP, Knops RE, Wilde AA, Da Costa A, Belhameche M, Hermida JS, Dovellini E, Frohlig G, Siot P, Degand B, Duray GZ, Israel CW, Brachmann J, Seidl KH, Foresti M, Birkenhauer F, Hohnloser SH, Ferreira C, Mateus P, Ribeiro H, Carvalho S, Ferreira A, Moreira J, Kadro W, Rahim H, Turkmani M, Abu Lebdeh M, Altabban A, Raimondo C, Scaglione M, Ebrille E, Caponi D, Di Donna P, Cerrato N, Delcre SDL, Gaita F, Rivera S, Scazzuso F, Albina G, Klein A, Laino R, Sammartino V, Giniger A, Kvantaliani T, Akhvlediani M, Namdar M, Steffel J, Jetzer S, Bayrak F, Chierchia GB, Jenni R, Duru F, Brugada P, Bakos Z, Medvedev M MM, Jonas Carlsson JC, Fredrik Holmqvist FH, Pyotr Platonov PP, Nurbaev T, Pirnazarov M, Nikishin A, Aagaard P, Sahlen A, Bergfeldt L, Braunschweig F, Simeonidou E, Kastellanos S, Varounis C, Michalakeas C, Koniari C, Nikolopoulou A, Anastasiou-Nana M, Furukawa Y, Yamada T, Morita T, Tanaka K, Iwasaki Y, Kawasaki M, Kuramoto Y, Fukunami M, Blanche C, Tran N, Rigamonti F, Zimmermann M, Okisheva E, Tsaregorodtsev D, Sulimov V, Novikova D, Popkova T, Udachkina E, Korsakova Y, Volkov A, Novikov A, Alexandrova E, Nasonov E, Arsenos P, Gatzoulis K, Manis G, Dilaveris P, Gialernios T, Kartsagoulis E, Asimakopoulos S, Stefanadis C, Marocolo M, Barbosa Neto O, Carvalho AC, Marques Neto SR, Mota GR, Barbosa PRB, Fernandez-Fernandez A, Manzano Fernandez S, Pastor-Perez FJ, Barquero-Perez O, Goya-Esteban R, Salar M, Rojo-Alvarez JL, Garcia-Alberola A, Takigawa M, Kawamura M, Aiba T, Kamakura S, Sakaguchi T, Itoh H, Horie M, Shimizu W, Miyazaki A, Sakaguchi H, Yamamoto T, Igarashi T, Negishi J, Toyota N, Ohuchi H, Yamada O, Arsenos P, Gatzoulis K, Manis G, Dilaveris P, Gialernios T, Papavasileiou M, Asimakopoulos S, Stefanadis C, Cabrera Bueno F, Molina Mora MJ, Alzueta Rodriguez J, Barrera Cordero A, De Teresa Galvan E, Revishvili AS, Dzhordzhikiya T, Sopov O, Simonyan G, Lyadzhina O, Fetisova E, Kalinin V, Balt JC, Steggerda RC, Boersma LVA, Wijffels MCEF, Wever EFD, Ten Berg JM, Ricci RP, Morichelli L, D'onofrio A, Zanotto G, Vaccari D, Calo' L. Poster Session 1. Europace 2011. [DOI: 10.1093/europace/eur220] [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: 11/14/2022] Open
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Mitro P, Kirsch P, Gajek J, Zysko D, Mazurek W, Ruiz GA, Chirife R, Tentori C, Nogues M, Grancelli H, Nur-Mammadova G, Mustafaev I, Gajek J, Zysko D, Mazurek W, Sredniawa B, Cebula S, Musialik-Lydka A, Kowalczyk J, Sliwinska A, Sedkowska A, Wozniak A, Kalarus Z, Pietrucha AZ, Wojewodka-Zak E, Bzukala I, Wnuk M, Mroczek-Czernecka D, Konduracka E, Piwowarska W, Peppes V, Kontomerkos D, Parisi T, Dimopoulos M, Antoniou A, Freitas JP, Santos RM, Boomsma F, Maciel MJ, Iacoviello M, Forleo C, Guida P, Ciccone MM, D'andria V, Sorrentino S, Panunzio M, Favale S, Candeias R, Silva J, Santos A, Marques N, Jesus I, Gomes V, Gajek J, Zysko D, Mazurek W, Olendrzynski LUK, Kramarz EK, Kubik LK, Zysko D, Gajek J, Mazurek W, Tahir T, Rose S, Garratt C, Clarke B, Cooper P, Fitzpatrick A, Petkar S, Fuca G, Dinelli M, Gianfranchi L, Corbucci G, Alboni P, Leiria TLL, Kus T, Godin B, Ayala-Paredes F, Lemieux A, Sturmer ML, Stanczyk A, Gatzoulis K, Karystinos G, Gialernios T, Sotiropoulos H, Sideris S, Dilaveris P, Arsenos P, Stefanadis C, Maggi R, Kohno R, Abe H, Otsuji Y. Poster Session 4: Syncope. Europace 2009. [DOI: 10.1093/europace/euq238] [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: 11/14/2022] Open
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Brady PA, Erne P, Val-Mejias J, Schwab J, Schimpf R, Orlov M, Mattioni T, Amlie J, Itou H, Igarashi M, Iga A, Tubota T, Yamazaki J, Yoshihara K, Santos De Sousa CI, Carpinteiro L, Marques P, Almeida MR, Miltemberger G, Correia MJ, Sousa J, Lopes M, Teixeira R, Ferreira MJ, Donato P, Ventura M, Cristovao J, Elvas L, Providencia LA, Chang D, Zhang S, Gao L, Yang D, Lin Y, Chu Z, Yang Y, Pecini R, Pehrson S, Chen X, Thoegersen AM, Kjaer A, Hastrup-Svendsen J, Sanchez-Munoz JJ, Garcia-Alberola A, Martinez-Sanchez J, Penafiel-Verdu P, Giner-Caro JA, Pastor-Perez FJ, Valdes-Chavarri M, Sorrentino S, Forleo C, Iacoviello M, Guida P, D'andria V, Favale S, Pasceri E, Curcio A, Achille F, De Serio D, Zinzi S, Torella D, Mastroroberto P, Indolfi C, Ozcan Celebi O, Canbay A, Aydogdu S, Diker E, De Sisti A, Tonet J, Benkaci A, Frank R, Sanchez-Munoz JJ, Garcia-Alberola A, Martinez-Sanchez J, Penafiel Verdu P, Giner Caro JA, Pastor-Perez FJ, Valdes-Chavarri M, Maroz-Vadalazhskaya N, Denissevich T, Ostrovskiy I, Sharashidze N, Pagava Z, Saatashvili G, Agladze R, Noda M, Yoshikawa S, Fujinami T, Yamamoto Y, Tashiro H, Usui M, Ichikawa K, Isobe M, Meyer C, Saygili E, Rana O, Floege J, Hennersdorf M, Rassaf T, Kelm M, Schauerte P, Sredniawa B, Cebula S, Kowalczyk J, Musialik-Lydka A, Wozniak A, Zakliczynski M, Zembala M, Kalarus Z, Gumenyuk OI, Chernenkov YV, Kosenkova IV, Bolotova NV, Averyanov AP. Poster Session 4: Miscellaneous. Europace 2009. [DOI: 10.1093/europace/euq239] [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: 11/13/2022] Open
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Iacoviello M, Guida P, Guastamacchia E, Triggiani V, Forleo C, Catanzaro R, Cicala M, Basile M, Sorrentino S, Favale S. Prognostic role of sub-clinical hypothyroidism in chronic heart failure outpatients. Curr Pharm Des 2009; 14:2686-92. [PMID: 19006851 DOI: 10.2174/138161208786264142] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND It has been suggested that low thyroid hormones levels may be associated with increased mortality in patients with cardiovascular disease. AIM To evaluate the prognostic role of thyroid function deficiency in patients with chronic heart failure (CHF). METHODS We evaluated 338 consecutive outpatients with stable CHF receiving conventional therapy, all of whom underwent a physical examination, electrocardiography and echocardiography. Blood samples were drawn to assess renal function, and Na+, hemoglobin, NT-proBNPs, fT3, fT4 and TSH levels. Patients with hyperthyroidism were excluded. RESULTS During the follow-up (15+/-8 months), heart failure progression was observed in 79 patients (including 18 who died of heart failure after hospitalisation and six who underwent transplantation). Univariate regression analysis showed that TSH (p<0.0001), fT3 (p<0.0001), fT4 (p=0.016) and fT3/fT4 (p<0.0001) were associated with heart failure progression but multivariate analysis showed that only TSH considered as a continuous variable (p = 0.001) as well as subclinical hypothyroidism (TSH > 5.5 mUI/l; p=0.014) remained significantly associated with the events. CONCLUSIONS In CHF patients TSH levels even slightly above normal range are independently associated with a greater likelihood of heart failure progression. This supports the need for prospective studies aimed at clarifying the most appropriate therapeutic approach to sub-clinical hypothyroidism in such patients.
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Affiliation(s)
- M Iacoviello
- Cardiology Unit, Emergency and Organ Transplantation Department, University of Bari, Bari, Italy.
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Iacoviello M, Guida P, Forleo C, Sorrentino S, D'Alonzo L, Favale S. Impaired arterial baroreflex function before nitrate-induced vasovagal syncope during head-up tilt test. Europace 2008; 10:1170-5. [DOI: 10.1093/europace/eun217] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pitzalis MV, Massari F, Mastropasqua F, Iacoviello M, Rizzon P. [Cardiopulmonary sensitivity and chemosensitivity]. Ital Heart J Suppl 2001; 2:478-83. [PMID: 11388330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The autonomic control of the cardiovascular system plays an important role in maintaining the arterial pressure at the levels necessary for adequate tissue perfusion. In cardiovascular diseases, the impairment of the basic reflex mechanisms that are responsible for the moment-to-moment regulation could increase sympathetic activity and is correlated with an adverse outcome. The objective of the present review was to provide information about the methodological aspects exploring cardiopulmonary and chemoreceptor reflexes. Different techniques are available and all of them include assessment of reflexes through the activation or deactivation of either the cardiopulmonary baroreceptors or chemoreceptors. Intravenous saline load, head-down tilt, passive legs raising, head-out water immersion and the application of a lower body positive pressure are the principal methods utilized for activating cardiopulmonary baroreceptors; on the contrary deactivation could be achieved by acutely induced hypovolemia by furosemide or blood donation, inflation of a congestion cuff on the thighs or application of a negative pressure on the lower body. The transient exposure to a hypoxic or a hypercapnic gas mixture is frequently used to determine the peripheral and central chemoreflexes, respectively. The reflexes are quantified by the gain between output (i.e. heart rate, sympathetic activity, vascular resistance, ventilation) and input (oxygen saturation, end-tidal CO2 or changes in central venous pressure). One important limitation in assessing the cardiopulmonary baroreflex by using currently available techniques is that the involvement of the arterial baroreflex cannot be avoided. In addition, chemoreflexes cannot be interpreted unless the breathing rate is controlled. To date, several techniques are available for the quantification of cardiopulmonary baroreceptor and chemoreceptor reflexes and could provide new information on the abnormal autonomic mechanisms contributing to the pathophysiology of several cardiovascular diseases.
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Affiliation(s)
- M V Pitzalis
- Istituto di Cardiologia, Università degli Studi, Bari.
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Pitzalis MV, Iacoviello M, Todarello O, Fioretti A, Guida P, Massari F, Mastropasqua F, Russo GD, Rizzon P. Depression but not anxiety influences the autonomic control of heart rate after myocardial infarction. Am Heart J 2001; 141:765-71. [PMID: 11320364 DOI: 10.1067/mhj.2001.114806] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIMS It has been previously hypothesized that the adverse outcome observed in depressed patients after myocardial infarction might be due to an imbalance in autonomic nervous system activity. The aim of this study was to define the role of depressive and anxious symptoms in influencing autonomic control of heart rate after myocardial infarction. METHODS AND RESULTS The SD of RR intervals, baroreflex sensitivity, and depression and anxiety (Zung's scales) were assessed before discharge in 103 patients with acute myocardial infarction; 32 were found to be depressed. Among the patients who were not taking beta-blockers, those with depression had significantly lower SDs of RR intervals and baroreflex sensitivity than did those without depression (96.3 +/- 22.2 ms vs 119.5 +/- 37.7 ms, P =.016; 8.6 +/- 6.2 ms vs 11.8 +/- 6.5 ms/mm Hg, P =.01, respectively). No differences were found when anxiety was considered or when beta-blockers were given. Among the patients not taking beta-blockers, there was a significant correlation between depression levels and both the SD of RR intervals (r = -0.47) and baroreflex sensitivity (r = -0.40). CONCLUSIONS In patients with myocardial infarction, depression but not anxiety negatively influences autonomic control of heart rate. Beta-blockers modify these influences.
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Affiliation(s)
- M V Pitzalis
- Institute of Cardiology, University of Bari, Bari, Italy.
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Pitzalis MV, Grimaldi M, Anaclerio M, Iacoviello M, Luzzi G, Forleo C, Rizzon P. Usefulness of handgrip to improve ibutilide efficacy in organizing atrial electrical activity during atrial fibrillation. Am J Cardiol 2001; 87:798-801, A8-9. [PMID: 11249910 DOI: 10.1016/s0002-9149(00)01510-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We analyzed the effect of handgrip on atrial electrical activity during atrial fibrillation (AF) by recording right and left atrial activity in 15 patients with persistent AF under baseline conditions and after saline and ibutilide infusions. The handgrip test for 15 seconds, which was always associated with a significant increase in mean atrial cycle length, was recorded in both atria (right atrium: saline vs saline + handgrip 141 +/- 29 vs 171 +/- 24 ms, p <0.001; ibutilide vs ibutilide + handgrip: 197 +/- 43 vs 221 +/- 39 ms, p <0.005). Handgrip favorably modifies atrial electrophysiologic properties during AF.
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Affiliation(s)
- M V Pitzalis
- Institute of Cardiology, University of Bari, Italy.
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Pitzalis MV, Iacoviello M, Massari F, Guida P, Romito R, Forleo C, Vulpis V, Rizzon P. Influence of gender and family history of hypertension on autonomic control of heart rate, diastolic function and brain natriuretic peptide. J Hypertens 2001; 19:143-8. [PMID: 11204295 DOI: 10.1097/00004872-200101000-00019] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To verify in a unitary view whether autonomic control of heart rate and cardiac structure and function are modified early in offspring of hypertensive families. METHODS AND RESULTS We selected 87 age- and sex-matched young normotensive subjects with (n = 45) and without (n = 42) a family history of hypertension who underwent evaluations of arterial pressure, time-domain parameters of autonomic heart rate control (24-h ECG monitoring), spectral baroreflex sensitivity, left ventricular geometry and function (echo-Doppler) and plasma brain natriuretic peptide levels (BNP). The group with a family history of hypertension significantly differed from their counterparts for systolic pressure (119 +/- 11 versus 114 +/- 9 mmHg, P< 0.05), heart rate (RR interval, 766 +/- 64 versus 810 +/- 93 ms, P< 0.05), heart rate variability [the standard deviation of normal RR intervals (SDNN), 147 +/- 29 versus 171 +/- 33 ms, P < 0.051, diastolic function (isovolumetric relaxation time, 65 +/- 9 versus 60 +/- 8 ms, P< 0.05) and BNP (23 +/- 13 versus 37 +/- 10 pg/ml, P< 0.05). Baroreflex sensitivity values did not differ between the two groups. When gender was considered, all the above-mentioned measures, as well as baroreflex sensitivity, were significantly different between males with and without a family history of hypertension but not between females, except for BNP, which was lower in males and females with a history of hypertension (males, 24 +/- 11 versus 38 +/- 8 pg/ml, P< 0.01; females 21 +/- 14 versus 36 +/- 13 pg/ml, P < 0.05). CONCLUSIONS Male, but not female, hypertensive offspring have modified diastolic function and autonomic control of heart rate; BNP is the only parameter able to characterize hypertensive offspring independently from the influence of gender. This provides the hypothesis that the impaired production of this hormone could play a primary role in the pre-hypertensive state.
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Affiliation(s)
- M V Pitzalis
- Institute of Cardiology, University of Bari, Italy.
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Abstract
This article describes a new organelle found in the cytoplasm of the growth stage fish oocytes. In particular, we describe its organization at the morphological level and investigate its composition by different cytochemical and immunocytochemical approaches with both light and electron microscope. The conclusion is that the body is a peculiar protein scaffold functioning as a temporary trap for the storage of rRNA in the mid to late growth stage oocytes. Its presence would be related to the reorganization of the mass of amplified rDNA in micronucleoli and to the consequent temporary stop in the rRNA synthesis.
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Affiliation(s)
- S Fusco
- Department of Evolutive and Comparative Biology, University of Naples Federico II, Naples, Italy
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Iacoviello M, Massari F, De Laura D, Guida P, Mastropasqua F, Forleo C, Rizzon P, Pitzalis MV. Influence of hydrophilic and lipophilic beta-blockers on heart rate, ventricular repolarization and their interrelationship in normal subjects. Ital Heart J 2000; 1:331-5. [PMID: 10832808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND It has been hypothesized that hydrophilic and lipophilic beta-blockers have different antiarrhythmic properties because only the latter seem to reduce the rate of sudden death in post-myocardial infarction patients as well as animal models which seem to be independent of their effect on autonomic nervous system modulation. The aim of this study was to evaluate the different effects of a hydrophilic (nadolol) and lipophilic (metoprolol) beta-blocker on ventricular repolarization in normal subjects. METHODS Seventeen normal subjects entered this randomized, single-blind cross-over study designed to compare the effects of nadolol (80 mg/day) and slow-release metoprolol (200 mg/day) on dynamic ventricular repolarization. The RR intervals, the QT evaluated at the apex (QT apex) and at the end (QT end) of the T wave before and after correction for heart rate, the standard deviation of QT apex and QT end, and the slope of the QT/RR linear relationship (QTa-slope and QTe-slope) were studied using the ELATEC system (ELA Medical, Mountrouge, France), and an evaluation was made of their reproducibility and the effects of each beta-blocker. RESULTS The most reproducible parameters were QT apex, corrected QT apex and the QTe-slope. Nadolol was associated with a greater adrenergic blockade than metoprolol (lengthening of RR interval +25 +/- 7 and +17 +/- 8% respectively, p = 0.0003) and a lower effect on ventricular repolarization (reduction of corrected QT apex -0.6 +/- 3 and -2.5 +/- 2.1% respectively, p < 0.01; reduction of QTe-slope -5 +/- 16 and -15 +/- 15% respectively, p = 0.03). CONCLUSIONS At the dosages used in the study, metoprolol showed lower adrenergic blockade but greater effect on ventricular repolarization than nadolol.
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Affiliation(s)
- M Iacoviello
- Institute of Cardiology, University of Bari, Italy
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Gastaldi E, Benvenuti S, Mennini B, Iacoviello M, Caviglione M, Rucci E, Anselmi L, Traverso G. Classic Kaposi's sarcoma on the glans penis only: Case report. Urologia 1997. [DOI: 10.1177/039156039706400133] [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: 11/16/2022]
Abstract
The Authors report a case of Kaposi's sarcoma presenting on the glans penis only in a non-HIV positive patient, who had not been treated with immuno-suppressive drugs. In our experience and according to a review of specific literature, choice treatment would seem to be a radiotherapeutic approach followed by partial penectomy in the event of recurrence.
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Affiliation(s)
| | | | | | | | | | | | - L Anselmi
- Servizio di Anatomia ed Istologia Patologica - Azienda Ospedaliera “Villa Scassi” - Ospedale di Genova-Sampierdarena
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Gastaldi E, Benvenuti S, Mennini B, Iacoviello M, Caviglione M, Rucci E, Traverso G. Epidermoid Cysts of the Testis: A Clinical Case. Urologia 1996. [DOI: 10.1177/039156039606300225] [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: 11/16/2022]
Abstract
The Authors report their experience on a case of testicular epidermoid cyst. Pre-surgical sonographic assessment (a round-shaped mass of low-echogenous structure with concentrical layers of echogenous material without acoustic shadows) indicated the possibility of an epidermoid cyst and consequently a surgical approach aimed at both enucleation and saving of the testicle.
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Affiliation(s)
- E. Gastaldi
- Divisione Urologica - Ospedale Civile - Genova-Sampierdarena
| | - S. Benvenuti
- Divisione Urologica - Ospedale Civile - Genova-Sampierdarena
| | - B. Mennini
- Divisione Urologica - Ospedale Civile - Genova-Sampierdarena
| | - M. Iacoviello
- Divisione Urologica - Ospedale Civile - Genova-Sampierdarena
| | - M. Caviglione
- Divisione Urologica - Ospedale Civile - Genova-Sampierdarena
| | - E. Rucci
- Divisione Urologica - Ospedale Civile - Genova-Sampierdarena
| | - G.B. Traverso
- Divisione Urologica - Ospedale Civile - Genova-Sampierdarena
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Gastaldi E, Benvenuti S, Mennini B, Iacoviello M, Caviglione M, Rucci E, Traverso G. Correlation between atypical adenomatous hyperplasia, intraepithelial tumour and prostatic carcinoma. Urologia 1996. [DOI: 10.1177/039156039606300124] [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: 11/15/2022]
Abstract
— The Authors report their experience on early cancer lesions of the prostate: atypical adenomatous hyerplasia and intra-epithelial tumour. Even though such lesions could develop long-term into a prostatic tumour, the Authors do not justify handling and treating such patients as affected by prostatic tumour. Nevertheless, strict patient follow-up is useful, including rectal examination and PSA testing every 3 months and transrectal prostatic sonography with cytological testing or gland biopsy every 6 months.
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Affiliation(s)
- E. Gastaldi
- Divisione Urologica - Azienda Ospedaliera “Villa Scassi” - Ospedale Civile - Genova-Sampierdarena
| | - S. Benvenuti
- Divisione Urologica - Azienda Ospedaliera “Villa Scassi” - Ospedale Civile - Genova-Sampierdarena
| | - B. Mennini
- Divisione Urologica - Azienda Ospedaliera “Villa Scassi” - Ospedale Civile - Genova-Sampierdarena
| | - M. Iacoviello
- Divisione Urologica - Azienda Ospedaliera “Villa Scassi” - Ospedale Civile - Genova-Sampierdarena
| | - M. Caviglione
- Divisione Urologica - Azienda Ospedaliera “Villa Scassi” - Ospedale Civile - Genova-Sampierdarena
| | - E. Rucci
- Divisione Urologica - Azienda Ospedaliera “Villa Scassi” - Ospedale Civile - Genova-Sampierdarena
| | - G.B. Traverso
- Divisione Urologica - Azienda Ospedaliera “Villa Scassi” - Ospedale Civile - Genova-Sampierdarena
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