1
|
Conti D, Valoriani J, Ballo P, Pazzi M, Gianesello L, Mengoni V, Criscenti V, Gemmi E, Stera C, Zoppi F, Galli L, Pavoni V. The clinical impact of pectoral nerve block in an 'enhanced recovery after surgery' program in breast surgery. Pain Manag 2023; 13:585-592. [PMID: 37937422 DOI: 10.2217/pmt-2023-0063] [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] [Indexed: 11/09/2023] Open
Abstract
Background: Pectoral nerve block (PECS) is increasingly performed in breast surgery. Aim: The study evaluated the clinical impact of these blocks in the postoperative course. Patients & methods: In this case-control study, patients undergoing breast surgery with 'enhanced recovery after surgery' pathways were divided into group 1 (57 patients) in whom PECS was performed before general anesthesia, and group 2 (57 patients) in whom only general anesthesia was effected. Results: Postoperative opioid consumption (p < 0.002), pain at 32 h after surgery (p < 0.005) and the length of stay (p < 0.003) were significantly lower in group 1. Conclusion: Reducing opioid consumption and pain after surgery, PECS could favor a faster recovery with a reduction in length of stay, ensuring a higher turnover of patients undergoing breast surgery.
Collapse
Affiliation(s)
- Duccio Conti
- Emergency Department & Critical Care Area, Anesthesia & Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, 50012, Italy
| | - Juri Valoriani
- Emergency Department & Critical Care Area, Anesthesia & Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, 50012, Italy
| | - Piercarlo Ballo
- Cardiology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, 50012, Italy
| | - Maddalena Pazzi
- Emergency Department & Critical Care Area, Anesthesia & Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, 50012, Italy
| | - Lara Gianesello
- Department of Anesthesia & Intensive Care, Orthopedic Anesthesia, University-Hospital Careggi, Florence, 50012, Italy
| | - Veronica Mengoni
- Breast Unit, S. Maria Annunziata Hospital, Florence, 50012, Italy
| | | | - Eleonora Gemmi
- Emergency Department & Critical Care Area, Anesthesia & Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, 50012, Italy
| | - Caterina Stera
- Emergency Department & Critical Care Area, Anesthesia & Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, 50012, Italy
| | - Federica Zoppi
- Emergency Department & Critical Care Area, Anesthesia & Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, 50012, Italy
| | - Lorenzo Galli
- Breast Unit, S. Maria Annunziata Hospital, Florence, 50012, Italy
| | - Vittorio Pavoni
- Emergency Department & Critical Care Area, Anesthesia & Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, 50012, Italy
| |
Collapse
|
2
|
Conti D, Valoriani J, Ballo P, Pazzi M, Cantini S, Pavoni V. Winged scapula following subpectoral plane blocks: myth or reality? Minerva Anestesiol 2023; 89:717-718. [PMID: 36884342 DOI: 10.23736/s0375-9393.23.17186-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Affiliation(s)
- Duccio Conti
- Unit of Anesthesia and Intensive Care, Emergency Department and Critical Care Area, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy -
| | - Juri Valoriani
- Unit of Anesthesia and Intensive Care, Emergency Department and Critical Care Area, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Piercarlo Ballo
- Department of Cardiology, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Maddalena Pazzi
- Unit of Anesthesia and Intensive Care, Emergency Department and Critical Care Area, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Silvio Cantini
- Unit of Anesthesia and Intensive Care, Emergency Department and Critical Care Area, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Vittorio Pavoni
- Unit of Anesthesia and Intensive Care, Emergency Department and Critical Care Area, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| |
Collapse
|
3
|
Conti D, Pandolfini L, Ballo P, Falsetto A, Zini C, Goti M, Cappelli V, Pissilli G, Laessig R, Scatizzi M, Pavoni V. The Role of the Recovery Room in Improving Adherence During an Enhanced Recovery After Surgery (ERAS) Implementation Program for Colorectal Surgery: A Single-Center Retrospective Analysis. J Perianesth Nurs 2023; 38:232-235. [PMID: 36241540 DOI: 10.1016/j.jopan.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/25/2022] [Accepted: 04/30/2022] [Indexed: 03/27/2023]
Abstract
PURPOSE The purpose of thisstudy was to evaluate the clinical impact of the Recovery Room (RR) in an Enhanced Recovery After Surgery (ERAS) pathway in colorectal surgery. DESIGN Single-center retrospective study. METHODS From November 2019 until September 2021, a total of 149 consecutive patients that underwent to colon-rectal surgery were enrolled. The patients were divided into two study groups: RR Group if admitted to RR after surgery, and no-Recovery Room (NRR) Group if monitored directly on the ward, bypassing the RR. The postoperative ERAS items adherence was assessed in the two study groups. FINDINGS Final analysis included 119 patients in the RR Group and 30 patients in NRR Group. Patients that started clear liquid oral intake within two hours postoperatively were 118 in the RR group and 19 in the NRR group (99.1% vs 63.3%, P < .001). A total of 98 patients and 18 patients were mobilized on day 0 in the RR group and in NRR group, respectively (84.4% vs 15.5%, P < .05). In the RR group, postoperative adherence to the ERAS protocol components was higher in comparison with the NRR group (P < .003); adherence to the all protocol components was also higher (P < .004). CONCLUSIONS Among patients undergoing colorectal surgery admitted to RR after surgery, the RR nurse guaranteed effective patient assistance and ensured appropriate compliance to the postoperative ERAS items.
Collapse
Affiliation(s)
- Duccio Conti
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy.
| | - Lorenzo Pandolfini
- General Surgery Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Piercarlo Ballo
- Cardiology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Alessandro Falsetto
- General Surgery Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Chiara Zini
- Department of Radiology, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Marta Goti
- Department of Clinical Nursing, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Valentina Cappelli
- Department of Clinical Nursing, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Gaia Pissilli
- Department of Clinical Nursing, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Romana Laessig
- General Surgery Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Marco Scatizzi
- General Surgery Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Vittorio Pavoni
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| |
Collapse
|
4
|
Conti D, Pandolfini L, Ballo P, Rollo S, Na'arani A, Valoriani J, Paroli GM, Pazzi M, Laessig R, Falsetto A, Pavoni V, Scatizzi M. The multidisciplinary audit in enhanced recovery after surgery (ERAS) colorectal surgery: experience in a single Italian center. Minerva Surg 2023:S2724-5691.22.09830-6. [PMID: 36762603 DOI: 10.23736/s2724-5691.22.09830-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Current literature underlines the role of periodical feed-back to improve Enhanced Recovery After Surgery (ERAS) path adherence during implementation program. The aim of this retrospective study was to evaluate the clinical impact of an audit program in an ERAS path. METHODS All elective patients submitted to elective colorectal surgery from November 2018 to January 2020 in our Institution were considered. The sample was divided into two study groups: group 1, including patients enrolled in the first sixth months of ERAS program until the first audit; group 2, patients enrolled in a time period of a six months after the first audit. RESULTS The final analysis included 46 patients in group 1 and 64 in group 2. Group 2 showed a higher ASA Score (P<0.03), a higher prevalence of right hemicolectomy, and a lower prevalence of left hemicolectomy and anterior rectum resection (RAR) (P<0.016). Group 2 also had a lower prevalence of anastomotic leakage (AL) (P<0.004). Intraoperative normothermia (T>36 C°) in this group was achieved in a larger number of patients in comparison with group 1 (39% vs. 19.5%) (P<0.01). Group 2 experienced a higher average body temperature at admission in recovery room (RR) when compared to Group 1 (35.8 vs. 35.1 C°, P<0.01). CONCLUSIONS Audit program may represent a useful tool to promote advantageous changes in clinical practice and to favor a better compliance to ERAS program.
Collapse
Affiliation(s)
- Duccio Conti
- Anesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Lorenzo Pandolfini
- Unit of General Surgery, Santa Maria Annunziata Hospital, Florence, Italy -
| | - Piercarlo Ballo
- Unit of Cardiology, Santa Maria Annunziata Hospital, Florence, Italy
| | - Silvia Rollo
- Unit of General Surgery, Santa Maria Annunziata Hospital, Florence, Italy
| | - Ahmad Na'arani
- Unit of General Surgery, Santa Maria Annunziata Hospital, Florence, Italy
| | - Juri Valoriani
- Anesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Gian M Paroli
- Unit of General Surgery, Santa Maria Annunziata Hospital, Florence, Italy
| | - Maddalena Pazzi
- Anesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Romana Laessig
- Unit of General Surgery, Santa Maria Annunziata Hospital, Florence, Italy
| | | | - Vittorio Pavoni
- Anesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Marco Scatizzi
- Unit of General Surgery, Santa Maria Annunziata Hospital, Florence, Italy
| |
Collapse
|
5
|
Ballo P, Fibbi V, Conti D, Zuppiroli A, Dattolo P. Incorporation of estimated glomerular filtration rate into the GRACE score improves its prognostic performance for 10-year outcome prediction in non-ST segment elevation acute coronary syndrome treated with percutaneous coronary intervention. Eur J Intern Med 2023; 108:122-124. [PMID: 36270933 DOI: 10.1016/j.ejim.2022.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/13/2022] [Accepted: 09/28/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Piercarlo Ballo
- Cardiology Unit, Santa Maria Annunziata Hospital, Via dell'Antella 58, Florence 50012, Italy.
| | - Veronica Fibbi
- Cardiology Unit, Santa Maria Annunziata Hospital, Via dell'Antella 58, Florence 50012, Italy
| | - Duccio Conti
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | | | - Pietro Dattolo
- Nephrology and Dialysis Unit, S. Maria Annunziata Hospital, Florence, Italy
| |
Collapse
|
6
|
Conti D, Valoriani J, Gianesello L, Zini C, Ballo P, Pavoni V. Bilateral erector spinae plane block as part of an opioid-free anesthesia in enhanced recovery after surgery program in an unplanned open colorectal surgery. Minerva Anestesiol 2022; 88:873-874. [PMID: 36254698 DOI: 10.23736/s0375-9393.22.16626-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Duccio Conti
- Unit of Anesthesia and Intensive Care, Emergency Department and Critical Care Area, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy -
| | - Juri Valoriani
- Unit of Anesthesia and Intensive Care, Emergency Department and Critical Care Area, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Lara Gianesello
- Department of Anesthesia and Intensive Care, Orthopedic Anesthesia, Careggi University Hospital, Florence, Italy
| | - Chiara Zini
- Department of Radiology, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Piercarlo Ballo
- Department of Cardiology, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Vittorio Pavoni
- Unit of Anesthesia and Intensive Care, Emergency Department and Critical Care Area, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| |
Collapse
|
7
|
Pavoni V, Gianesello L, Conti D, Ballo P, Dattolo P, Prisco D, Görlinger K. "In Less than No Time": Feasibility of Rotational Thromboelastometry to Detect Anticoagulant Drugs Activity and to Guide Reversal Therapy. J Clin Med 2022; 11:1407. [PMID: 35268498 PMCID: PMC8911211 DOI: 10.3390/jcm11051407] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 01/06/2022] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 02/04/2023] Open
Abstract
Anticoagulant drugs (i.e., unfractionated heparin, low-molecular-weight heparins, vitamin K antagonists, and direct oral anticoagulants) are widely employed in preventing and treating venous thromboembolism (VTE), in preventing arterial thromboembolism in nonvalvular atrial fibrillation (NVAF), and in treating acute coronary diseases early. In certain situations, such as bleeding, urgent invasive procedures, and surgical settings, the evaluation of anticoagulant levels and the monitoring of reversal therapy appear essential. Standard coagulation tests (i.e., activated partial thromboplastin time (aPTT) and prothrombin time (PT)) can be normal, and the turnaround time can be long. While the role of viscoelastic hemostatic assays (VHAs), such as rotational thromboelastometry (ROTEM), has successfully increased over the years in the management of bleeding and thrombotic complications, its usefulness in detecting anticoagulants and their reversal still appears unclear.
Collapse
Affiliation(s)
- Vittorio Pavoni
- Anesthesia and Intensive Care Unit, Emergency Department and Critical Care Area, Santa Maria Annunziata Hospital, Bagno a Ripoli, 50012 Florence, Italy; (V.P.); (D.C.)
| | - Lara Gianesello
- Department of Anesthesia and Intensive Care, Orthopedic Anesthesia, University-Hospital Careggi, 50134 Florence, Italy
| | - Duccio Conti
- Anesthesia and Intensive Care Unit, Emergency Department and Critical Care Area, Santa Maria Annunziata Hospital, Bagno a Ripoli, 50012 Florence, Italy; (V.P.); (D.C.)
| | - Piercarlo Ballo
- Cardiology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, 50012 Florence, Italy;
| | - Pietro Dattolo
- Nephrology Unit Florence 1, Santa Maria Annunziata Hospital, Bagno a Ripoli, 50012 Florence, Italy;
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
| | - Klaus Görlinger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
- Medical Department, Tem Innovations, 81829 Munich, Germany
| |
Collapse
|
8
|
Dini FL, Ballo P, Pugliese NR, Bytyçi I, D'Agostino A, Bajraktari G, Pedrinelli R, Henein MY. Improved diastolic dysfunction is associated with higher forward flow and better prognosis in chronic heart failure. Int J Cardiovasc Imaging 2021; 38:10.1007/s10554-021-02457-z. [PMID: 34727251 DOI: 10.1007/s10554-021-02457-z] [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] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/25/2021] [Indexed: 02/05/2023]
Abstract
The benefit of repeat assessment of left ventricular (LV) systolic and diastolic function in heart failure (HF) remains uncertain. We assessed the prognostic value of repeat echocardiographic assessment of LV filling pressure (LVFP) and its interaction with cardiac index (CI) in ambulatory patients with chronic HF and reduced ejection fraction (HFrEF). We enrolled 357 patients (age 68 ± 11 years; 22% female) with chronic HFrEF. Patients underwent a clinical and echocardiographic examination at baseline. LVFP as assessed by the 2016 Guidelines and Doppler-derived CI were estimated. After the second echocardiographic examination, patients were followed for a median time of 30 months. The study endpoint included all-cause death and hospitalization for worsening HF. Patients who normalized LVFP or showed persistently normal LVFP at the follow-up examination had a significantly lower mortality rate than those with worsening or persistently raised LVFP (p < 0.0001). After stratification by CI, patients with elevated LVFP and CI < 2.0 l/min/m2 had a further worse outcome than those with elevated LVFP and CI ≥ 2.0 l/min/m2 (p < 0.0001). Multivariate survival analysis confirmed an independent prognostic impact of changes in LVFP, incremental to that of established clinical, laboratory and echocardiographic predictors. Repeat assessment of LVFP and CI significantly improved risk stratification of chronic HFrEF outpatients compared to baseline evaluation.
Collapse
Affiliation(s)
- Frank Lloyd Dini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Piercarlo Ballo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
| | - Ibadete Bytyçi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Andreina D'Agostino
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Gani Bajraktari
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Roberto Pedrinelli
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Michael Y Henein
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| |
Collapse
|
9
|
Cirillo L, Somma C, Allinovi M, Bagalà A, Ferro G, Di Marcantonio E, Bellelli S, Dallari LA, Ballo P, Dattolo PC. Ferric carboxymaltose vs. ferrous sulfate for the treatment of anemia in advanced chronic kidney disease: an observational retrospective study and cost analysis. Sci Rep 2021; 11:7463. [PMID: 33811227 PMCID: PMC8018957 DOI: 10.1038/s41598-021-86769-z] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 03/15/2021] [Indexed: 01/02/2023] Open
Abstract
In non-dialysis-dependent chronic kidney disease (NDD-CKD), erythropoiesis-stimulating agents (ESAs) and iron supplementation are essential for anemia management. Ferric carboxymaltose (FCM) is a relatively novel intravenous iron formulation used in different clinical settings, although scarce data exist in NDD-CKD patients. Primary objective of this study was to retrospectively evaluate the efficacy of FCM compared with oral ferrous sulfate for the treatment of iron-deficiency anemia in a cohort of NDD-CKD patients, considering also the treatment costs. This was a monocentric, retrospective observational study reviewing 349 NDD-CKD patients attending an outpatient clinic between June 2013 and December 2016. Patients were treated by either FCM intravenous infusion or oral ferrous sulfate. We collected serum values of hemoglobin, ferritin and transferrin saturation (TSAT) and ESAs doses at 12 and 18 months. The costs related to both treatments were also analysed. 239 patients were treated with FCM intravenous infusion and 110 patients with oral ferrous sulfate. The two groups were not statistically different for age, BMI and eGFR values. At 18 months, hemoglobin, serum ferritin and TSAT values increased significantly from baseline in the FCM group, compared with the ferrous sulfate group. ESAs dose and rate of infusion decreased only in the FCM group. At 18 months, the treatment costs, analysed per week, was higher in the ferrous sulfate group, compared with the FCM group, and this was mostly due to a reduction in ESAs prescription in the FCM group. Routine intravenous FCM treatment in an outpatient clinic of NDD-CKD patients results in better correction of iron-deficiency anemia when compared to ferrous sulfate. In addition to this, treating NDD-CKD patients with FCM leads to a significant reduction of the treatment costs by reducing ESAs use.
Collapse
Affiliation(s)
- Luigi Cirillo
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Chiara Somma
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Marco Allinovi
- Nephrology, Dialysis and Transplant Unit, Careggi University Hospital, Florence, Italy
| | - Alfredo Bagalà
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Giuseppe Ferro
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Elio Di Marcantonio
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Stefania Bellelli
- Health Technology Assessment and Management (HTAM) Research Area, IRES Piemonte, Torino, Italy
| | - Lorenzo Antonio Dallari
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Piercarlo Ballo
- Cardiology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Pietro Claudio Dattolo
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy.
| |
Collapse
|
10
|
Setti M, Benfari G, Mele D, Rossi A, Ballo P, Galderisi M, Henein M, Nistri S. Discrepancies in Assessing Diastolic Function in Pre-Clinical Heart Failure Using Different Algorithms-A Primary Care Study. Diagnostics (Basel) 2020; 10:diagnostics10100850. [PMID: 33092136 PMCID: PMC7589762 DOI: 10.3390/diagnostics10100850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/16/2020] [Accepted: 10/18/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Current guidelines on diastolic function (DF) by the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) have been disputed and two alternative algorithms have been proposed by Johansen et al. and Oh et al. We sought (a) to assess the concordance of ASE/EACVI guidelines on DF using these proposed alternative approaches and (b) to evaluate the prevalence of indeterminate diastolic dysfunction (DD) by each method, exploring means for reducing their number. Methods: We retrospectively analyzed the echocardiographic reports of 1158 outpatients including subjects at risk of heart failure without (n = 644) or with (n = 241) structural heart disease, and 273 healthy individuals. Concordance was calculated using the k coefficient and overall proportion of DD reclassification rate. The effectiveness of pulmonary vein flow (PVF), Valsalva maneuver, and left atrial volume index/late diastolic a’-ratio (LAVi/a’) over indeterminate grading was assessed. Results: The DD reclassification rate was 30.1% (k = 0.35) for ASE/EACVI and OH, 36.5% (k = 0.27) for ASE/EACVI and JOHANSEN and 31.1% (k = 0.37) for OH and JOHANSEN (p < 0.0001 for all comparisons). DF could not be graded only by ASE/EACVI and OH in 9% and 11% patients, respectively. The majority of patients could be reclassified using PVF or Valsalva maneuver or LAVi/a’, with the latter being the single most effective parameter. Conclusion: Inconsistencies between updated guidelines and independent approaches to assess and grade DF impede their interchangeable clinical use. The inconclusive diagnoses can be reconciled by conventional echocardiography in most patients, and LAVi/a’ emerges as a simple and effective approach to this aim.
Collapse
Affiliation(s)
- Martina Setti
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (M.S.); (G.B.); (A.R.)
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (M.S.); (G.B.); (A.R.)
| | - Donato Mele
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy;
| | - Andrea Rossi
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (M.S.); (G.B.); (A.R.)
| | - Piercarlo Ballo
- Santa Maria Annunziata Hospital, Cardiology Unit, 50012 Florence, Italy;
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy;
| | - Michael Henein
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden;
| | - Stefano Nistri
- CMSR Veneto Medica-Cardiology Service, 36077 Altavilla Vicentina (VI), Italy
- Correspondence: ; Tel.: +39-0444225111
| |
Collapse
|
11
|
Profili F, Ballo P, Balzi D, Bellini B, Bartalocci S, Zuppiroli A, Voller F, Francesconi P. [Chronic diseases and risk of symptomatic COVID-19: results of a case-population study on a sample of patients in the Local Health Unit 'Toscana Centro' (Tuscany Region, Central Italy)]. Epidemiol Prev 2020; 44:308-314. [PMID: 33412823 DOI: 10.19191/ep20.5-6.s2.131] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND the COVID-19 pandemic represents a challenge for health systems around the world, with just under 10,000 cases in Tuscany Region (Central Italy) and about 4,500 in the Local Health Unit (LHU) 'Toscana Centro', updated on 11 May 2020. The risk factors reported are several, including age, being male, and some chronic diseases such as hypertension, diabetes, respiratory and cardiovascular diseases. However, the relative importance of chronic diseases is still to be explored. OBJECTIVES to evaluate the role of chronic diseases on the risk to develop clinically evident (at least mild symptomatic) forms of SARS-CoV-2 infection in the population of the LHU Toscana Centro. DESIGN case-population study. SETTING AND PARTICIPANTS 'case' is a subject with SARS-CoV-2 positive swab with at least mild clinical status, who lives in the LHU Toscana Centro area; 'controls' are all people residing in the LHU Toscana Centro area at 1 January 2020. People aged under 30 and patients living in nursing care homes are excluded from the analysis. MAIN OUTCOME MEASURES the analysis assesses the effect of gender, age, neoplasm, and the main chronic diseases on the onset of an infection with at least mild symptoms by calculating odds ratios (OR) by multivariate logistic regression models (to produce adjusted OR by potential confounders). RESULTS among the 1,840 cases, compared to the general population, the presence of males and over-60-year-old people is greater. Almost all the considered chronic diseases are more frequent among the cases, compared to the general population. A chronic patient has a 68% greater risk to be positive with at least mild symptoms. Many of the considered diseases show an effect on the risk of getting COVID-19 in a symptomatic form, which remains even adjusting by other comorbidities. The main ones include heart failure, psychiatric disorders, Parkinson's disease, and rheumatic diseases. CONCLUSIONS these results confirm evidence already shown in other studies on COVID-19 patients and add information on the chronic diseases attributable risk in the population, referred to the symptomatic forms and adjusted by age, gender or the possible copresence of more diseases. These risk estimates should guide prevention interventions by health services in order to protect the chronic patients affected by the pathologies most at risk.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Fabio Voller
- Agenzia regionale di Sanità della Toscana, Firenze
| | | |
Collapse
|
12
|
Conti D, Ballo P, Ruggiano P, Boccalini R, Pavoni V, Sarti A. Very early postoperative troponin increase and clinical outcome in patients admitted to the recovery room after noncardiac surgery with suspected cardiac events. Indian Heart J 2020; 72:197-199. [PMID: 32768022 PMCID: PMC7411100 DOI: 10.1016/j.ihj.2020.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/29/2019] [Revised: 04/12/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022] Open
Abstract
We assessed the prognostic meaning of very early (<6 h) troponin increase after noncardiac surgery in a population of patients admitted to the recovery room, for whom troponin measurements were taken because of a suspected cardiac event. Among a total of 296 patients, abnormal troponin was found in 24 (8.1%). Ten patients in this group (41.7%) and 27 among those with normal troponin (9.9%) experienced cardiovascular death, myocardial infarction, or decompensated heart failure at one month (p < 0.0001). Troponin was independently associated with a two-fold risk of events (p < 0.0001). In these patients, very early troponin measurement in the recovery room may help to identify patients at risk of cardiovascular events.
Collapse
Affiliation(s)
- Duccio Conti
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Florence, Italy.
| | - Piercarlo Ballo
- Cardiology Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Peggy Ruggiano
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Rossana Boccalini
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Vittorio Pavoni
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Armando Sarti
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Florence, Italy
| |
Collapse
|
13
|
Nistri S, Mazzone C, Cioffi G, Barbati G, Gentile P, Ballo P, Borca EC, Faganello G, Cherubini A, Bussani R, Sinagra G, Di Lenarda A. Tissue Doppler indices of diastolic function as prognosticator in patients without heart failure in primary care. J Cardiol 2020; 76:18-24. [PMID: 32094011 DOI: 10.1016/j.jjcc.2020.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 12/28/2019] [Accepted: 01/20/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Tissue Doppler imaging (TDI) indices of left ventricular (LV) diastolic function provide incremental prognostic information on mortality and morbidity in the general population and in several clinical scenarios. Their independent, additional role in outpatients with normal LV ejection fraction (LVEF) and without heart failure (HF) is undefined. METHODS We reviewed clinical and echocardiographic records of 2628 consecutive outpatients 52.8% male, median age 71 years) with LVEF > 50% without concurrent or prior HF, from the Cardiovascular Center of Trieste. We analyzed septal early mitral annular velocity (e') and its combination with mitral peak early filling velocity (E/e') in relation to the composite end-point of death and cardiovascular hospitalizations. RESULTS During follow-up of 26 months (interquartile range: 12-41), 392 (15%) patients experienced the endpoint (88 deaths). Increasing E/e' showed an overall association with the clinical end-point (log rank p < 0.02), but with no prognostic difference between the middle and upper tertile. Decreasing e' also showed an association with the end-point, with a more balanced stepwise risk increase for increasing tertiles (log rank p < 0.01 for all contrasts). At multivariable analysis, E/e' (either in tertiles or dichotomized according to the threshold of 15) was no longer associated with clinical outcome, whereas e' independently predicted the combined endpoint [hazard ratio 0.73 (0.53-0.94), p = 0.04]. The prognostic value of e' was incremental to that of other clinical and echocardiographic variables (p = 0.04). CONCLUSIONS In outpatients with normal LVEF and without HF, e' and E/e' are both associated with clinical end-points, though only e' is an independent and incremental predictor of outcome. These findings suggest a potential role for e' as a prognosticator, and spread a cautionary word about the utilization of septal E/e' alone as a surrogate for a comprehensive assessment of diastolic function in this context.
Collapse
Affiliation(s)
- Stefano Nistri
- CMSR Veneto Medica, Cardiology Service, Altavilla Vicentina, Italy.
| | - Carmine Mazzone
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Giovanni Cioffi
- Villa Bianca Hospital, Department of Cardiology, Trento, Italy
| | - Giulia Barbati
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Piero Gentile
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Piercarlo Ballo
- Santa Maria Annunziata Hospital, Cardiology Unit, Florence, Italy
| | | | - Giorgio Faganello
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | | | | | | | - Andrea Di Lenarda
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| |
Collapse
|
14
|
Francesconi P, Ballo P, Profili F, Policardo L, Roti L, Zuppiroli A. Chronic Care Model for the Management of Patients with Heart Failure in Primary Care. Health Serv Insights 2019; 12:1178632919866200. [PMID: 31456642 PMCID: PMC6702766 DOI: 10.1177/1178632919866200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 04/18/2019] [Indexed: 11/26/2022] Open
Abstract
We recently investigated the prognostic impact of a Chronic Care Model (CCM)-based healthcare program applied in primary care in Tuscany Region mainly run by multidisciplinary teams composed of general practitioners (GPs) and nurses. The project included proactively planned follow-up visits for each patient, individualized counselling to optimize lifestyle modifications and adherence to appropriate diagnostic and therapeutic pathways. 1761 patients with Chronic heart failure (CHF) directly enrolled by the GPs were matched with 3522 CHF controls not involved in the project. Over a 4-year follow-up in the CCM group a higher CHF hospitalization rate was found (12.1 vs 10.3 events/100 patient-years; incidence rate ratio [IRR] 1.15, p=0.0030), whereas mortality was lower (10.8 vs 12.6 events/100 patient-years; IRR 0.82, p<0.0001). The CCM status was independently associated with a 34% increase in the risk of CHF hospitalization and a 18% reduction in the risk of death (p<0.0001 for both). The CCM status was associated with a 50% increase in the rate of planned Heart failure (HF) hospitalizations whereas the rate of 1-month CHF readmissions showed no differences. Such a divergent trend could be explained by the direct involvement of GPs in the CCM program, leading them to a better awareness of patients’ clinical status, and then to a more frequent use of clinical pathways and facilities, including hospitalization. It is reasonable to argue that not all hospitalizations must necessarily be considered as a poor outcome, as they often provide additional opportunities to improve therapies, optimize patient education, or define follow-up strategies. The evidence of a divergent trend between mortality and hospitalization in our population might support the clinical importance of a multidisciplinary approach for the management of patients with HF.
Collapse
Affiliation(s)
- Paolo Francesconi
- Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Piercarlo Ballo
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy
| | - Francesco Profili
- Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Laura Policardo
- Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Lorenzo Roti
- Primary Healthcare Unit, Regional Health Authority, Florence, Italy
| | - Alfredo Zuppiroli
- Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy
| |
Collapse
|
15
|
Ballo P, Nistri S, Cameli M, Zuppiroli A, Mondillo S. Reply to "Comparison of Accuracy of Left Atrial Area and Volume by Two-Dimensional Transthoracic Echocardiography Versus Computed Tomography". Am J Cardiol 2019; 124:461-463. [PMID: 31182212 DOI: 10.1016/j.amjcard.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 05/06/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Piercarlo Ballo
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy.
| | - Stefano Nistri
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy
| | - Matteo Cameli
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy
| | | | - Sergio Mondillo
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy
| |
Collapse
|
16
|
Bonizzoli M, Cipani S, Lazzeri C, Chiostri M, Ballo P, Sarti A, Peris A. Speckle tracking echocardiography and right ventricle dysfunction in acute respiratory distress syndrome: A pilot study. Echocardiography 2018; 35:1982-1987. [DOI: 10.1111/echo.14153] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 08/23/2018] [Accepted: 09/03/2018] [Indexed: 12/24/2022] Open
Affiliation(s)
- Manuela Bonizzoli
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - Simone Cipani
- Intensive Care Unit; Ospedale Santa Maria Nuova; Florence Italy
| | - Chiara Lazzeri
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - Marco Chiostri
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | | | - Armando Sarti
- Intensive Care Unit; Ospedale Santa Maria Nuova; Florence Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| |
Collapse
|
17
|
Ballo P, Fibbi V, Granelli M, Fusco F, Abbondanti A, Fantini A, Bartalini M, Consalvo M, Fazi A, Santoro GM. Giant isolated intracardiac thrombus presenting as acute heart failure secondary to right ventricular outflow tract obstruction in a patient with renal carcinoma. Oxf Med Case Reports 2018; 2018:omy019. [PMID: 29977577 PMCID: PMC6007396 DOI: 10.1093/omcr/omy019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/31/2018] [Accepted: 04/19/2018] [Indexed: 11/13/2022] Open
Abstract
Right-sided intracardiac thrombi are potential causes of right ventricular (RV) failure, particularly when tricuspid or pulmonary obstruction occurs. In most cases, RV thrombus develops in patients with RV dysfunction and concomitant thrombosis in the systemic veins. However, RV thrombosis can rarely present as an isolated mass and despite preserved RV function, particularly in patients with thrombophilic states. In this report, we describe an unusual case of giant isolated RV thrombus presenting with acute RV failure secondary to dynamic RV outflow tract obstruction in a patient with renal carcinoma. Bedside echocardiography allowed a rapid assessment of the hemodynamic effects of the mass. The possibility of a thrombotic RV outflow obstruction should be considered in patients with acute RV failure, even in those with no evidence of thrombosis in the venous district. This may be particularly important in patients with prothrombotic states, where the effectiveness of routine thromboembolic prophylaxis could be reduced.
Collapse
Affiliation(s)
- Piercarlo Ballo
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy
| | - Veronica Fibbi
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy
| | - Massimo Granelli
- Emergency Department, S. Maria Annunziata Hospital, Florence, Italy
| | - Francesca Fusco
- Radiology Unit, S. Maria Annunziata Hospital, Florence, Italy
| | | | - Andrea Fantini
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy
| | - Mattia Bartalini
- Emergency Department, S. Maria Annunziata Hospital, Florence, Italy
| | - Matteo Consalvo
- Radiology Unit, S. Maria Annunziata Hospital, Florence, Italy
| | - Antonio Fazi
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy
| | | |
Collapse
|
18
|
Cipani S, Bartolozzi C, Ballo P, Sarti A. Blood flow maintenance by cardiac massage during cardiopulmonary resuscitation: Classical theories, newer hypotheses, and clinical utility of mechanical devices. J Intensive Care Soc 2018; 20:2-10. [PMID: 30792756 DOI: 10.1177/1751143718778486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The mechanisms by which closed chest cardiac massage produces and maintains blood flow during cardiopulmonary resuscitation are still debated. To date, two main theories exist: the "cardiac pump", which assumes that blood flow is driven by direct cardiac compression and the "chest pump", which hypothesizes that blood flow is caused by changes in intrathoracic pressure. Newer hypotheses including the "atrial pump", the "lung pump", and the "respiratory pump" were also proposed. We reviewed studies supporting these different theories as well as the clinical evidences on the utility of mechanical devices proposed to optimize cardiopulmonary resuscitation, in view of their pathophysiological assumptions with regard to the underlying theory. On the basis of current evidence, a single theory is probably not sufficient to explain how cardiac massage produces blood flow. This suggests that different simultaneous mechanism might be involved. The relative importance of these mechanisms depends on several factors, including delay from collapse to starting of resuscitation, compression force and rate, body habitus, airway pressure, and presenting electrocardiogram. The complexity of the physiologic events occurring during cardiopulmonary resuscitation, together with the need of adequate training for a correct and prompt utilization of mechanical devices, might also partially explain the disappointing results of these devices in most clinical studies.
Collapse
Affiliation(s)
- Simone Cipani
- Department of Anaesthesia and Intensive Care, Santa Maria Nuova Hospital, Florence, Italy
| | - Carlo Bartolozzi
- Department of Health Sciences, Anaesthesiology and Intensive Care Unit, University of Florence, Careggi Hospital, Florence, Italy
| | - Piercarlo Ballo
- Department of Cardiology, Santa Maria Annunziata Hospital, Florence, Italy
| | - Armando Sarti
- Department of Anaesthesia and Intensive Care, Santa Maria Annunziata Hospital, Florence, Italy
| |
Collapse
|
19
|
Ballo P, Profili F, Policardo L, Roti L, Francesconi P, Zuppiroli A. Opposite trends in hospitalization and mortality after implementation of a chronic care model-based regional program for the management of patients with heart failure in primary care. BMC Health Serv Res 2018; 18:388. [PMID: 29848317 PMCID: PMC5975582 DOI: 10.1186/s12913-018-3164-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/30/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The chronic care model (CCM) is an established framework for the management of patients with chronic illness at the individual and population level. Its application has been previously shown to improve clinical outcome in several conditions, but the prognostic impact of CCM-based programs for the management of patients with chronic heart failure (HF) in primary care is still to be elucidated. METHODS We assessed the prognostic impact of a primary-care, CCM-based project applied in Tuscany, Italy, in 1761 patients with chronic HF enrolled in a retrospective matched cohort study. The project was based on predefined working teams including general practitioners and nurses, proactively scheduled regular follow-up visitations for each patient, counseling for therapy adherence and lifestyle modifications, appropriate diagnostic and therapeutic pathways according to international guidelines, and a key supporting role of the nurses, who were responsible for the practical coordination of the follow-up. A matched group of 3522 HF subjects assisted by general practitioners not involved in the project was considered as control group. The endpoints of this study were HF hospitalization and all-cause mortality. RESULTS Over a 4-year follow-up period, HF hospitalization rate was higher in the CCM group than the controls (12.1 vs 10.3 events/100 patient-years; incidence rate ratio 1.15[1.05-1.27], p = 0.0030). Mortality was lower in the CCM group than the controls (10.8 vs 12.6 events/100 patient-years; incidence rate ratio 0.82[0.75-0.91], p < 0.0001). In multivariable analysis, the CCM status was associated with a 34% higher risk of HF hospitalization and 18% lower risk of death (p < 0.0001 for both). The effect on HF hospitalization was mostly driven by a 50% higher rate of planned HF hospitalization. CONCLUSIONS Implementation of a CCM-based program for the management of HF patients in primary care led to reduced mortality and increased HF hospitalization. These findings support the hypothesis that the beneficial effects of CCM on survival might be extended to patients with chronic HF followed in primary care, but also support the need for further strategies aimed at improving the management of these patients in terms of hospitalizations.
Collapse
Affiliation(s)
- Piercarlo Ballo
- Cardiology Unit, S. Maria Annunziata Hospital, via dell’Antella 58, Florence, Italy
| | | | | | | | | | | |
Collapse
|
20
|
Venni A, Ioia F, Laviola S, Frigieri F, Pieri A, Marilli S, Balzi D, Ballo P, Gori S, Guarducci D. Clinical Utility of a Structured Program to Reduce the Risk of Health-Related Quality of Life Impairment after Discharge from Intensive Care Unit: A Real-World Experience. Crit Care Res Pract 2018; 2018:3838962. [PMID: 29854449 PMCID: PMC5964427 DOI: 10.1155/2018/3838962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/16/2018] [Accepted: 04/12/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Postdischarge deterioration in health-related quality of life (HRQoL) is a major clinical issue for patients after an intensive care unit (ICU) hospitalization. A significant proportion of these patients is known to develop a progressive worsening of mental and physical performance-the so-called post-intensive care syndrome (PICS). AIM We aimed at exploring the effects of a structured program for the management of ICU patients, aimed at improving postdischarge HRQoL and reducing the risk of PICS. METHODS A total of 159 patients hospitalized in our ICU with a length of stay >72 hours were enrolled in an institutional management protocol including specific recommendations: adequate sedation and analgesia protocols, to ensure a valid delirium prevention strategy, and to provide a planned midterm after discharge. The main endpoint was the occurrence of PICS at the 6-month follow-up visitation, defined as an abnormal physical or mental score in the SF-12 questionnaire in the presence of clinical evidence of new or worsening impairment in physical, cognitive, or mental health status. An additional questionnaire was administered, to assess the effects of ICU-related memories. RESULTS Most patients positively rated their health at the 6-month follow-up and had no significant impairment in physical or mental health status. The mean normalized values of the physical and mental component of the SF-12 score were 46 ± 11 and 48 ± 14, suggesting a normal physical and mental health status in most patients. Twenty-nine patients (18.2%) showed evidence of PICS. Similar good results were found by the questionnaire of memories. In multivariable analysis, no variable was found to predict the risk of PICS in our population. CONCLUSION In this real-world analysis that lacks a control group, patients who used a program aimed at minimizing the risk of HRQoL deterioration and PICS reported a good perception of their state of health with a relatively low prevalence of PICS.
Collapse
Affiliation(s)
- Angelica Venni
- Department of Intensive Care, S. Maria Annunziata Hospital, Florence, Italy
| | - Francesca Ioia
- Department of Intensive Care, S. Maria Annunziata Hospital, Florence, Italy
| | - Silvia Laviola
- Department of Intensive Care, S. Maria Annunziata Hospital, Florence, Italy
| | - Francesca Frigieri
- Department of Intensive Care, S. Maria Annunziata Hospital, Florence, Italy
| | - Alessandra Pieri
- Department of Intensive Care, S. Maria Annunziata Hospital, Florence, Italy
| | - Simona Marilli
- Department of Intensive Care, S. Maria Annunziata Hospital, Florence, Italy
| | - Daniela Balzi
- Department of Epidemiology, Local Health Authority, Florence, Italy
| | - Piercarlo Ballo
- Department of Cardiology, S. Maria Annunziata Hospital, Florence, Italy
| | - Stefano Gori
- Department of Intensive Care, S. Maria Annunziata Hospital, Florence, Italy
| | - Diletta Guarducci
- Department of Intensive Care, S. Maria Annunziata Hospital, Florence, Italy
| |
Collapse
|
21
|
Cameli M, Mondillo S, Galderisi M, Mandoli GE, Ballo P, Nistri S, Capo V, D'Ascenzi F, D'Andrea A, Esposito R, Gallina S, Montisci R, Novo G, Rossi A, Mele D, Agricola E. [Speckle tracking echocardiography: a practical guide]. G Ital Cardiol (Rome) 2017; 18:253-269. [PMID: 28492566 DOI: 10.1714/2683.27469] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Speckle tracking echocardiography (STE) has recently emerged as a quantitative technique to accurately estimate myocardial function. By the analysis of the motion of speckles in the two-dimensional ultrasonic image, this technique allows a non-Doppler angle-independent objective analysis of myocardial deformation, with the possibility to quantify thickening, shortening and rotation dynamics of cardiac function. Since this technique does not require Doppler imaging, the analysis is relatively angle-independent and is marginally affected by cardiac in-plane motion artifacts. Data regarding feasibility, reproducibility and diagnostic accuracy appear to be optimal in several clinical contexts. This review describes the fundamental concepts of deformation imaging, explains how to obtain myocardial deformation measurements in clinical practice and highlights current clinical applications of STE. In addition, in relation with the recent extension of STE to three-dimensional echocardiography with the potential for a more comprehensive analysis of global and segmental myocardial function, a window is also opened on the perspectives of three-dimensional STE.
Collapse
Affiliation(s)
- Matteo Cameli
- U.O. Cardiologia Universitaria, Università degli Studi, Siena
| | - Sergio Mondillo
- U.O. Cardiologia Universitaria, Università degli Studi, Siena
| | - Maurizio Galderisi
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli
| | | | | | - Stefano Nistri
- Servizio di Cardiologia, CMSR-Veneto Medica, Altavilla Vicentina (VI)
| | - Verdiana Capo
- U.O. Cardiologia Universitaria, Università degli Studi, Siena
| | | | - Antonello D'Andrea
- U.O.D. Diagnostica Cardiologica Integrata, Seconda Università degli Studi, AORN dei Colli-Monaldi, Napoli
| | - Roberta Esposito
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli
| | - Sabina Gallina
- Dipartimento di Scienze Cliniche e di Bioimmagini, Università degli Studi "G. d'Annunzio", Chieti
| | - Roberta Montisci
- Dipartimento di Scienze Mediche "Mario Aresu", Cardiologia Clinica, Università degli Studi, Cagliari
| | - Giuseppina Novo
- Divisione di Cardiologia, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli Studi, Palermo
| | - Andrea Rossi
- Sezione di Cardiologia, Dipartimento di Medicina, Università degli Studi, Verona
| | - Donato Mele
- S.S.D. Cardiologia Non Invasiva, Azienda Ospedaliero-Universitaria di Ferrara
| | | |
Collapse
|
22
|
D'Andrea A, Radmilovic J, Ballo P, Mele D, Agricola E, Cameli M, Rossi A, Esposito R, Novo G, Mondillo S, Montisci R, Gallina S, Bossone E, Galderisi M. Left ventricular hypertrophy or storage disease? the incremental value of speckle tracking strain bull's-eye. Echocardiography 2017; 34:746-759. [DOI: 10.1111/echo.13506] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
|
23
|
Ballo P, Nistri S, Mele D, Henein MY. Simplified vs comprehensive echocardiographic grading of left ventricular diastolic dysfunction in primary care. Int J Cardiol 2016; 214:243-5. [DOI: 10.1016/j.ijcard.2016.03.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/19/2016] [Indexed: 10/22/2022]
|
24
|
Ballo P, Nistri S, Galderisi M, Mele D, Rossi A, Dini FL, Olivotto I, Losi MA, D'Andrea A, Zuppiroli A, Santoro GM, Mondillo S, Gentile F. Determinants of discrepancies between two-dimensional echocardiographic methods for assessment of maximal left atrial volume. Eur Heart J Cardiovasc Imaging 2016; 18:584-602. [DOI: 10.1093/ehjci/jew067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 03/07/2016] [Indexed: 12/26/2022] Open
Affiliation(s)
- Piercarlo Ballo
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy
| | | | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Donato Mele
- Department of Cardiology, University of Ferrara, Ferrara, Italy
| | - Andrea Rossi
- Cardiology Division, Borgo Trento Hospital, Verona, Italy
| | - Frank L. Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Iacopo Olivotto
- Careggi University Hospital, Referral Center for Cardiomyopathies, Florence, Italy
| | - Maria Angela Losi
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University, Naples, Italy
| | | | | | | | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | | | | |
Collapse
|
25
|
Conti D, Ballo P, Boccalini R, Sarti A. Predictors of early postoperative troponin increase after noncardiac surgery: a pilot study in a real-world population admitted to the recovery room. Br J Anaesth 2016; 115:945-6. [PMID: 26582864 DOI: 10.1093/bja/aev394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
|
26
|
Ballo P, Nistri S, Bocelli A, Mele D, Dini FL, Galderisi M, Zuppiroli A, Mondillo S. A new method to estimate left ventricular circumferential midwall systolic function by standard echocardiography: Concordance between models and validation by speckle tracking. Int J Cardiol 2016; 203:947-58. [DOI: 10.1016/j.ijcard.2015.11.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 12/27/2022]
|
27
|
Toscani L, Guarducci D, Matà S, Furlan T, Ballo P. Association between acute motor axonal neuropathy and septic shock due to Acinetobacter baumannii. Infez Med 2015; 23:349-352. [PMID: 26700086] [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: 06/05/2023]
Abstract
In this report, we describe a case of acute motoral axonal neuropathy (AMAN) following septic shock due to Acinetobacter baumannii. The aetiology of AMAN is still not fully clarified. An association with a potential infection by Campylobacter jejuni, resulting in stimulation of autoimmune response against gangliosides mediated by a phenomenon of molecular mimicry, is believed to play a major role. Since the lipopolysaccharide of A. baumannii has a structure that is similar to that of C. jejuni, we hypothesise that the infection by A. baumannii in our patient may have had a pathogenic role in the development of the neurological picture via a mechanism of molecular mimicry.
Collapse
Affiliation(s)
- Lucia Toscani
- Department of Neurology, S. Maria Annunziata Hospital, Florence, Italy
| | - Diletta Guarducci
- Department of Anaesthesia and Intensive Care, S. Maria Annunziata Hospital, Florence, Italy
| | - Sabrina Matà
- Department of Immunology, Careggi Hospital, Florence, Italy
| | - Tiziana Furlan
- Department of Neurology, S. Maria Annunziata Hospital, Florence, Italy
| | - Piercarlo Ballo
- Department of Cardiology, S. Maria Annunziata Hospital, Florence, Italy
| |
Collapse
|
28
|
Ballo P, Balzi D, Barchielli A, Turco L, Franconi F, Zuppiroli A. Gender differences in statin prescription rates, adequacy of dosing, and association of statin therapy with outcome after heart failure hospitalization: a retrospective analysis in a community setting. Eur J Clin Pharmacol 2015; 72:311-9. [DOI: 10.1007/s00228-015-1980-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 11/09/2015] [Indexed: 12/12/2022]
|
29
|
Ballo P, Betti I, Barchielli A, Balzi D, Castelli G, De Luca L, Gheorghiade M, Zuppiroli A. Prognostic role of N-terminal pro-brain natriuretic peptide in asymptomatic hypertensive and diabetic patients in primary care: impact of age and gender. Clin Res Cardiol 2015; 105:421-31. [DOI: 10.1007/s00392-015-0937-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/27/2015] [Indexed: 01/27/2023]
|
30
|
Nistri S, Ballo P, Mele D, Papesso B, Galderisi M, Mondillo S, Zito GB, Henein MY. Effect of Echocardiographic Grading of Left Ventricular Diastolic Dysfunction by Different Classifications in Primary Care. Am J Cardiol 2015; 116:1144-52. [PMID: 26256581 DOI: 10.1016/j.amjcard.2015.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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] [Received: 05/03/2015] [Revised: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 12/14/2022]
Abstract
The presence of left ventricular (LV) diastolic dysfunction (DD) as characterized by Doppler echocardiography is associated with worse overall mortality both in symptomatic and asymptomatic patients. However, available data on this topic come from referral centers and have been obtained by different, validated algorithms for each single study. Thus, we aimed at determining the feasibility of comprehensive evaluation of LVDD in a primary care outpatient setting and at testing the concordance of different methodological approaches in grading diastolic dysfunction. Eight hundred eighty-five consecutive outpatients, in sinus rhythm, prospectively underwent Doppler echocardiography according to a predetermined protocol. Feasibility of each LV diastolic index and concordance between 3 methods to determine the degree of LVDD, namely the American Society of Echocardiography/European Association of Echocardiography (ASE/EAE) recommendations, the Olmstead County, and the Canberra Study protocols, were tested. Feasibility of all diastolic indexes was high, ranging from 93% of Valsalva maneuver to ≥99% for mitral inflow and tissue Doppler parameters. Diastolic function was not classifiable in 6% to 19% of patients. The concordance for LV diastolic dysfunction degree was fair when comparing the classification of the ASE/EAE with those from Olmstead County (κ = 0.25; reclassification rate 51%) and Canberra Study (κ = 0.27; reclassification rate 43.7%), and was good for the comparison between the Olmstead County and Canberra classifications (κ = 0.68, reclassification rate 27%). In conclusion, feasibility of LV diastolic function measurements is very high and grading diastolic dysfunction is possible in most patients in primary care settings. Substantial differences, however, exist when concordance is tested among 3 documented criteria, resulting in poor concordance of data interpretation and hence patient stratification and clinical management.
Collapse
Affiliation(s)
- Stefano Nistri
- Cardiology Service CMSR Veneto Medica, Altavilla Vicentina, Italy.
| | - Piercarlo Ballo
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy
| | - Donato Mele
- Department of Cardiology, University of Ferrara, Ferrera, Italy
| | - Barbara Papesso
- Cardiology Service CMSR Veneto Medica, Altavilla Vicentina, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | | | | |
Collapse
|
31
|
Giaccardi M, Del Rosso A, Guarnaccia V, Ballo P, Mascia G, Chiodi L, Colella A. Near-zero x-ray in arrhythmia ablation using a 3-dimensional electroanatomic mapping system: A multicenter experience. Heart Rhythm 2015; 13:150-6. [PMID: 26341606 DOI: 10.1016/j.hrthm.2015.09.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Radiation exposure related to conventional tachyarrhythmia radiofrequency catheter ablation (RFCA) carries small but not negligible stochastic and deterministic effects on health. These effects are cumulative and potentially more harmful in younger individuals. Nonfluoroscopic mapping systems can significantly reduce the radiological exposure and in some cases it can completely eliminate it. OBJECTIVE The aim of this study was to assess the safety, feasibility, and efficacy of a complete nonfluoroscopic approach for RFCA compared with ablation procedures performed under fluoroscopic guidance. METHODS RFCA was performed in 442 consecutive patients (mean age 58 ± 19 years). The first 145 patients (group 1) were treated only under fluoroscopic guidance, and the following 297 patients (group 2) were treated using a nonfluoroscopic electroanatomic mapping system (EnSite Velocity). RFCA was completely performed without fluoroscopy in 255 of 297 patients in group 2 (86%). RESULTS The acute success rate did not differ between group 1 and group 2 (97% vs 96%; P = .46), and there were no differences in either procedure time (87 ± 57 minutes vs 91 ± 52 minutes; P = .41) or complication rate. Fluoroscopic exposure in group 2 was significantly reduced in comparison with group 1 (14 ± 6 seconds vs 1159 ± 833 seconds; P < .0001). CONCLUSION Compared with the conventional fluoroscopic technique, the near-zero radiation (RX) approach provides similar outcomes and may significantly reduce or eliminate ionizing radiation exposure in RFCA. These reductions are achieved without altering the duration or compromising the safety and effectiveness of the procedure.
Collapse
Affiliation(s)
- Marzia Giaccardi
- Electrophysiology Unit, Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy.
| | - Attilio Del Rosso
- Electrophysiology Unit, Department of Internal Medicine, San Giuseppe Hospital, Empoli, Italy
| | - Vincenzo Guarnaccia
- Electrophysiology Unit, Department of Internal Medicine, San Giuseppe Hospital, Empoli, Italy
| | - Piercarlo Ballo
- Cardiology Unit, Department of Internal Medicine, Santa Maria Annunziata Hospital, Florence, Italy
| | - Giuseppe Mascia
- Cardiology Unit, Department of Internal Medicine, Santa Maria Nuova Hospital, Florence, Italy
| | - Leandro Chiodi
- Cardiology Unit, Department of Internal Medicine, Santa Maria Annunziata Hospital, Florence, Italy
| | - Andrea Colella
- Electrophysiology Unit, Department of Heart and Vessels, Careggi Hospital, Florence, Italy
| |
Collapse
|
32
|
Conti D, Ballo P, Buoncristiano U, Secchi S, Cecconi P, Buoncristiano M, Boccalini R, Mondaini N, Pedullà A. Clinical utility of an undersized nurse-operated recovery room in the postoperative course: results from an Italian community setting. J Perianesth Nurs 2015; 29:185-90. [PMID: 24856335 DOI: 10.1016/j.jopan.2013.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 05/22/2013] [Accepted: 07/15/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE In Europe, standardized criteria for recovery room (RR) requirements have not been established. The purpose of this study was to examine the clinical utility of an undersized nurse-operated RR in an Italian community hospital. DESIGN Single-center observational study. METHODS A total of 1,945 consecutive surgical patients admitted to the RR at the study institution between September 31, 2009, and August 31, 2011, were included in the study. A control group of surgical patients not admitted to the RR, matched for age, gender, American Society of Anesthesiologists score, and type of surgery were also considered. The prevalence of early adverse events occurring within 3 hours of the end of surgery was compared between the two groups. FINDINGS Patients admitted to the RR (mean age, 73.6 ± 14.2 years; 42.2% male; and 76.3% having major surgery) showed lower prevalences of hypotension (P < .0001), hypertensive response (P < .0001), new arrhythmias requiring intervention (P = .0036), and oxygen desaturation (P < .0001) in comparison with the control group. No differences in the proportions of patients experiencing postoperative nausea and vomiting, shivering, bleeding, and respiratory events were found. The Numeric Rating Scale for pain was also significantly lower at 2 hours in the study group as compared to the control group (1 [0 to 5] vs 3 [1 to 7]; P < .0001). CONCLUSION In this Italian community setting, an undersized nurse-operated RR contributed to a reduced prevalence of adverse postoperative events.
Collapse
|
33
|
Favilli S, Spaziani G, Ballo P, Fibbi V, Santoro G, Chiappa E, Arcangeli C. Advanced therapies in patients with congenital heart disease-related pulmonary arterial hypertension: results from a long-term, single center, real-world follow-up. Intern Emerg Med 2015; 10:445-50. [PMID: 25573622 DOI: 10.1007/s11739-014-1185-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/22/2014] [Indexed: 10/24/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a common finding in patients with congenital heart disease (CHD), and has relevant prognostic implications. The recent introduction of advanced therapies (AT) considerably improved the clinical outcome of these patients, but real-world data are still lacking. We aimed at reporting the results of a long-term follow-up of CHD patients with PAH undergoing AT, followed at a tertiary Center during the two last decades. The study population included a total of 34 patients with an established diagnosis of CHD-related PAH. In addition to conventional treatment, 97% of patients started AT during the follow-up. Over a median follow-up of 9 [3-31] years, 11 (32.4%) patients died: 7 of them were affected by Eisenmenger syndrome and the majority of patients were in NYHA class ≥3 at the time of death. Among the 23 patients who were alive at the last follow-up, the majority were in NYHA class I-II. Oxygen saturation and 6-min walking distance improved in all subjects within the first 6 months after starting of AT. One patient with ventricular septum defect and high pulmonary resistances was successfully treated with AT to lower resistances and underwent defect closure. A good clinical outcome was also observed in the subset (n = 8) with Down syndrome. The results of this real-world experience suggest that, despite a relatively high mortality rate mostly related to late commencement of AT, the clinical outcome of subjects with CHD-related PAH undergoing AT are characterized by a good quality of life and clinical improvement in most patients.
Collapse
Affiliation(s)
- Silvia Favilli
- Pediatric Cardiology, Meyer Hospital, Viale Pieraccini 24, 50134, Florence, Italy
| | | | | | | | | | | | | |
Collapse
|
34
|
Ballo P, Nistri S, Galderisi M, Mele D, Mondillo S, Henein MY. Impact of physical training on normal age-related changes in left ventricular longitudinal function. Int J Cardiol 2015; 184:68-70. [DOI: 10.1016/j.ijcard.2014.12.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/25/2014] [Indexed: 11/30/2022]
|
35
|
Tong L, Huang C, Ramalli A, Tortoli P, Luo J, D'hooge J, Tzemos N, Mordi I, Bishay T, Bishay T, Negishi T, Hristova K, Kurosawa K, Bansal M, Thavendiranathan P, Yuda S, Popescu B, Vinereanu D, Penicka M, Marwick T, Hamed W, Kamel M, Yaseen R, El-Barbary H, Nemes A, Kis O, Gavaller H, Kanyo E, Forster T, Angelis A, Vlachopoulos C, Ioakimidis N, Felekos I, Chrysohoou C, Aznaouridis K, Abdelrasoul M, Terentes D, Ageli K, Stefanadis C, Kurnicka K, Domienik-Karlowicz J, Lichodziejewska B, Goliszek S, Grudzka K, Krupa M, Dzikowska-Diduch O, Ciurzynski M, Pruszczyk P, Gual Capllonch F, Lopez Ayerbe J, Teis A, Ferrer E, Vallejo N, Junca G, Pla R, Bayes-Genis A, Schwaiger J, Knight D, Gallimore A, Schreiber B, Handler C, Coghlan J, Bruno RM, Giardini G, Malacrida S, Catuzzo B, Armenia S, Brustia R, Ghiadoni L, Cauchy E, Pratali L, Kim K, Lee K, Cho J, Yoon H, Ahn Y, Jeong M, Cho J, Park J, Cho S, Nastase O, Enache R, Mateescu A, Botezatu D, Popescu B, Ginghina C, Gu H, Sinha M, Simpson J, Chowienczyk P, Fazlinezhad A, Tashakori Behesthi A, Homaei F, Mostafavi H, Hosseini G, Bakaeiyan M, Boutsikou M, Petrou E, Dimopoulos A, Dritsas A, Leontiadis E, Karatasakis G, Sahin ST, Yurdakul S, Yilmaz N, Cengiz B, Cagatay Y, Aytekin S, Yavuz S, Karlsen S, Dahlslett T, Grenne B, Sjoli B, Smiseth O, Edvardsen T, Brunvand H, Nasr G, Nasr A, Eleraki A, Elrefai S, Mordi I, Sonecki P, Tzemos N, Gustafsson U, Naar J, Stahlberg M, Cerne A, Capotosto L, Rosato E, D'angeli I, Azzano A, Truscelli G, De Maio M, Salsano F, Terzano C, Mangieri E, Vitarelli A, Renard S, Najih H, Mancini J, Jacquier A, Haentjens J, Gaubert J, Habib G, Caminiti G, D'antoni V, D'antoni V, Cardaci V, Cardaci V, Conti V, Conti V, Volterrani M, Volterrani M, Ahn J, Kim D, Lee H, Iliuta L, Lo Iudice F, Esposito R, Lembo M, Santoro C, Ballo P, Mondillo S, De Simone G, Galderisi M, Hwang Y, Kim J, Kim J, Moon K, Yoo K, Kim C, Tagliamonte E, Rigo F, Cirillo T, Caruso A, Astarita C, Cice G, Quaranta G, Romano C, Capuano N, Calabro' R, Zagatina A, Zhuravskaya N, Guseva O, Huttin O, Benichou M, Voilliot D, Venner C, Micard E, Girerd N, Sadoul N, Moulin F, Juilliere Y, Selton-Suty C, Baron T, Christersson C, Johansson K, Flachskampf F, Lee S, Lee J, Hur S, Park J, Yun J, Song S, Kim W, Ko J, Nyktari E, Bilal S, Ali S, Izgi C, Prasad S, Aly M, Kleijn S, Kandil H, Kamp O, Beladan C, Calin A, Rosca M, Craciun A, Gurzun M, Calin C, Enache R, Mateescu A, Ginghina C, Popescu B, Mornos C, Mornos A, Ionac A, Cozma D, Crisan S, Popescu I, Ionescu G, Petrescu L, Camacho S, Gamaza Chulian S, Carmona R, Diaz E, Giraldez A, Gutierrez A, Toro R, Benezet J, Antonini-Canterin F, Vriz O, La Carrubba S, Poli S, Leiballi E, Zito C, Careri S, Caruso R, Pellegrinet M, Nicolosi G, Kong W, Kyu K, Wong R, Tay E, Yip J, Yeo T, Poh K, Correia M, Delgado A, Marmelo B, Correia E, Abreu L, Cabral C, Gama P, Santos O, Rahman M, Borges IP, Peixoto E, Peixoto R, Peixoto R, Marcolla V, Okura H, Kanai M, Murata E, Kataoka T, Stoebe S, Tarr A, Pfeiffer D, Hagendorff A, Generati G, Bandera F, Pellegrino M, Alfonzetti E, Labate V, Guazzi M, Kuznetsov V, Yaroslavskaya E, Pushkarev G, Krinochkin D, Zyrianov I, Carigi S, Baldazzi F, Bologna F, Amati S, Venturi P, Grosseto D, Biagetti C, Fabbri E, Arlotti M, Piovaccari G, Rahbi H, Bin Abdulhaq A, Tleyjeh I, Santoro C, Galderisi M, Costantino M, Tarsia G, Innelli P, Dores E, Esposito G, Matera A, De Simone G, Trimarco B, Capotosto L, Azzano A, Mukred K, Ashurov R, Tanzilli G, Mangieri E, Vitarelli A, Merlo M, Gigli M, Stolfo D, Pinamonti B, Antonini Canterin F, Muca M, D'angelo G, Scapol S, Di Nucci M, Sinagra G, Behaghel A, Feneon D, Fournet M, Thebault C, Martins R, Mabo P, Leclercq C, Daubert C, Donal E, Davinder Pal S, Prakash Chand N, Sanjeev A, Rajeev M, Ankur D, Ram Gopal S, Mzoughi K, Zairi I, Jabeur M, Ben Moussa F, Ben Chaabene A, Kamoun S, Mrabet K, Fennira S, Zargouni A, Kraiem S, Demkina A, Hashieva F, Krylova N, Kovalevskaya E, Potehkina N, Zaroui A, Ben Said R, Smaali S, Rekik B, Ben Hlima M, Mizouni H, Mechmeche R, Mourali M, Malhotra A, Sheikh N, Dhutia H, Siva A, Narain R, Merghani A, Millar L, Walker M, Sharma S, Papadakis M, Siam-Tsieu V, Mansencal N, Arslan M, Deblaise J, Dubourg O, Zaroui A, Rekik B, Ben Said R, Boudiche S, Larbi N, Tababi N, Hannachi S, Mechmeche R, Mourali M, Mechmeche R, Zaroui A, Chalbia T, Ben Halima M, Rekik B, Boussada R, Mourali M, Lipari P, Bonapace S, Valbusa F, Rossi A, Zenari L, Lanzoni L, Targher G, Canali G, Molon G, Barbieri E, Novo G, Giambanco S, Sutera M, Bonomo V, Giambanco F, Rotolo A, Evola S, Assennato P, Novo S, Budnik M, Piatkowski R, Kochanowski J, Opolski G, Chatzistamatiou E, Mpampatseva Vagena I, Manakos K, Moustakas G, Konstantinidis D, Memo G, Mitsakis O, Kasakogias A, Syros P, Kallikazaros I, Marketou M, Parthenakis F, Kalyva N, Pontikoglou C, Maragkoudakis S, Zacharis E, Patrianakos A, Maragoudakis F, Papadaki H, Vardas P, Rodrigues A, Perandini L, Souza T, Sa-Pinto A, Borba E, Arruda A, Furtado M, Carvalho F, Bonfa E, Andrade J, Hlubocka Z, Malinova V, Palecek T, Danzig V, Kuchynka P, Dostalova G, Zeman J, Linhart A, Chatzistamatiou E, Konstantinidis D, Memo G, Mpampatzeva Vagena I, Moustakas G, Manakos K, Trachanas K, Vergi N, Feretou A, Kallikazaros I, Corut H, Sade L, Ozin B, Atar I, Turgay O, Muderrisoglu H, Ledakowicz-Polak A, Polak L, Krauza G, Zielinska M, Szulik M, Streb W, Wozniak A, Lenarczyk R, Sliwinska A, Kalarus Z, Kukulski T, Nogueira M, Branco L, Agapito A, Galrinho A, Borba A, Teixeira P, Monteiro A, Ramos R, Cacela D, Cruz Ferreira R, Guala A, Camporeale C, Tosello F, Canuto C, Ridolfi L, Chatzistamatiou E, Moustakas G, Memo G, Konstantinidis D, Mpampatzeva Vagena I, Manakos K, Traxanas K, Vergi N, Feretou A, Kallikazaros I, Hristova K, Marinov R, Stamenov G, Mihova M, Persenska S, Racheva A, Plaskota K, Trojnarska O, Bartczak A, Grajek S, Ramush Bejiqi R, Retkoceri R, Bejiqi H, Beha A, Surdulli S, Dreyfus J, Durand-Viel G, Cimadevilla C, Brochet E, Vahanian A, Messika-Zeitoun D, Jin C, Fang F, Meng F, Kam K, Sun J, Tsui G, Wong K, Wan S, Yu C, Lee A, Cho IJ, Chung H, Heo R, Ha S, Hong G, Shim C, Chang H, Ha J, Chung N, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Alexopoulos A, Dawson D, Nihoyannopoulos P, Zainal Abidin HA, Ismail J, Arshad K, Ibrahim Z, Lim C, Abd Rahman E, Kasim S, Peteiro J, Barrio A, Escudero A, Bouzas-Mosquera A, Yanez J, Martinez D, Castro-Beiras A, Scali M, Simioniuc A, Mandoli G, Lombardo A, Massaro F, Di Bello V, Marzilli M, Dini F, Adachi H, Tomono J, Oshima S, Merchan Ortega G, Bravo Bustos D, Lazaro Garcia R, Sanchez Espino A, Macancela Quinones J, Ikuta I, Ruiz Lopez M, Valencia Serrano F, Bonaque Gonzalez J, Gomez Recio M, Romano G, D'ancona G, Pilato G, Di Gesaro G, Clemenza F, Raffa G, Scardulla C, Sciacca S, Lancellotti P, Pilato M, Addetia K, Takeuchi M, Maffessanti F, Weinert L, Hamilton J, Mor-Avi V, Lang R, Sugano A, Seo Y, Watabe H, Kakefuda Y, Aihara H, Nishina H, Ishizu T, Fumikura Y, Noguchi Y, Aonuma K, Luo X, Fang F, Lee A, Shang Q, Yu C, Sammut EC, Chabinok R, Jackson T, Siarkos M, Lee L, Carr-White G, Rajani R, Kapetanakis S, Byrne D, Walsh J, Ellis L, Mckiernan S, Norris S, King G, Murphy R, Hristova K, Katova T, Simova I, Kostova V, Shuie I, Ferferieva V, Bogdanova V, Castelon X, Nemes A, Sasi V, Domsik P, Kalapos A, Lengyel C, Orosz A, Forster T, Grapsa J, Demir O, Dawson D, Sharma R, Senior R, Nihoyannopoulos P, Pilichowska E, Zaborska B, Baran J, Stec S, Kulakowski P, Budaj A, Kosmala W, Kaye G, Saito M, Negishi K, Marwick T, Maceira Gonzalez AM, Ripoll C, Cosin-Sales J, Igual B, Salazar J, Belloch V, Dulai RS, Taylor A, Gupta S. Poster session 1: Wednesday 3 December 2014, 09:00-16:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014; 15:ii25-ii51. [DOI: 10.1093/ehjci/jeu248] [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: 09/02/2023] Open
|
36
|
Conti D, Ballo P, Boccalini R, Boccherini A, Cantini S, Venni A, Pezzati S, Gori S, Franconi F, Zuppiroli A, Pedullà A. The effect of patient sex on the incidence of early adverse effects in a population of elderly patients. Anaesth Intensive Care 2014; 42:455-9. [PMID: 24967759 DOI: 10.1177/0310057x1404200405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Patient sex is known to influence the response to general and regional anaesthesia and recovery after surgery. However, most studies come from analyses carried out on middle-aged patients. As most of the patients admitted to the post-anaesthesia recovery room in our institution are elderly, we took the opportunity to investigate the association between sex and incidence of early adverse events in this older population of patients after major surgery. Consecutive patients undergoing general, orthopaedic, urological and gynaecological surgery, admitted to the recovery room of our institution over a 15-month period, were retrospectively studied. The following adverse events were considered in the analysis: shivering, postoperative nausea and vomiting, hypotension and hypertensive responses, new arrhythmias requiring treatment, acute respiratory failure and desaturation. A total of 1347 patients (mean age 73.3±15.1 years, 61.4% women) were included. Women showed a higher incidence of shivering (relative difference +48%, P=0.0003), postoperative nausea and vomiting (+91%, P<0.0001), hypotension (+32%, P=0.044) and desaturation (+60%, P=0.0030) than men. The incidence of hypertensive response, arrhythmias and acute respiratory failure were not statistically significantly different. The findings of this exploratory study suggest that women have a higher risk of early postoperative adverse events even in a more elderly population.
Collapse
Affiliation(s)
- D Conti
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Spaziani G, Ballo P, Favilli S, Fibbi V, Buonincontri L, Pollini I, Zuppiroli A, Chiappa E. Clinical outcome, valve dysfunction, and progressive aortic dilation in a pediatric population with isolated bicuspid aortic valve. Pediatr Cardiol 2014; 35:803-9. [PMID: 24362596 DOI: 10.1007/s00246-013-0856-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 12/03/2013] [Indexed: 12/01/2022]
Abstract
The aim of this study was to explore the medium-term clinical outcome and the risk of progression of aortic valve disease and aortic dilation in pediatric patients with isolated bicuspid aortic valve (BAV). 179 pediatric patients with isolated BAV were prospectively followed from January 1995 to December 2010. Patients with severe valve dysfunction at baseline were excluded. Clinical outcome included cardiac death, infective endocarditis, aortic complications, cardiac surgery and percutaneous valvuloplasty. Echocardiographic endpoints were: progression of aortic stenosis (AS) or regurgitation (AR) and progressive aortic enlargement at different levels of the aortic root, evaluated as z-score. The median age at diagnosis was 7.8 [2.7-12.0] years. After a median followup of 5.4 [2.3-9.2] years, all patients were alive. The clinical endpoint occurred in 4 (2.2 %) patients (0.41 events per 100 patient-years). A progression of AS and AR was observed in 9 (5.0 %) and 29 (16.2 %) patients, respectively. The z-scores at the end of follow-up were not significantly different from baseline at the annulus, Valsalva sinuses and sinotubular junction, whereas a slight increase was observed at the level of the ascending aorta (1.9 vs 1.5, p = 0.046). Significant progressive aortic dilation occurred in a minority of patients (10.6, 5.6, 9.5, and 19.0 % respectively). The clinical outcome in pediatric patients with isolated BAV is favourable and the progression of aortic valve dysfunction and aortic dilation is relatively slow. These findings may be taken into account to better guide risk assessment and clinical follow-up in these patients.
Collapse
Affiliation(s)
- Gaia Spaziani
- Pediatric Cardiology Unit, Meyer Hospital, Viale Pieraccini 24, Florence, Italy,
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Ballo P, Nistri S, Cameli M, Papesso B, Dini FL, Galderisi M, Zuppiroli A, Mondillo S. Association of Left Ventricular Longitudinal and Circumferential Systolic Dysfunction With Diastolic Function in Hypertension: A Nonlinear Analysis Focused on the Interplay With Left Ventricular Geometry. J Card Fail 2014; 20:110-20. [DOI: 10.1016/j.cardfail.2013.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 12/02/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022]
|
39
|
Balzi D, Di Bari M, Barchielli A, Ballo P, Carrabba N, Cordisco A, Landini MC, Santoro GM, Valente S, Zuppiroli A, Marchionni N, Gensini GF. Should we improve the management of NSTEMI? Results from the population-based "acute myocardial infarction in Florence 2" (AMI-Florence 2) registry. Intern Emerg Med 2013; 8:725-33. [PMID: 22777311 DOI: 10.1007/s11739-012-0817-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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] [Received: 03/06/2012] [Accepted: 06/23/2012] [Indexed: 10/28/2022]
Abstract
ST-segment and non-ST-segment elevation myocardial infarction (STEMI, NSTEMI) have opposite epidemiology, the latter being nowadays more common than the former. Consistently with these epidemiological trends, application of evidence-based clinical practice guidelines on the management of NSTEMI should be promoted. We compared clinical features, hospital management and prognosis of STEMI/NSTEMI in an unselected cohort of 1,496 prospectively enrolled patients (STEMI, 36.9 % and NSTEMI, 63.1 %), admitted in 1 year to one of the six hospitals in Florence health district (Italy). Vital status was assessed after 1 year. NSTEMI patients were older, more often female, and affected by cardiovascular and non-cardiovascular comorbidities. Percutaneous coronary intervention (PCI) was performed more often in STEMI (82 %) than in NSTEMI patients (48 %, p < 0.001). Aspirin, clopidogrel, statins, beta-blockers, and ACE-inhibitors were prescribed more frequently in STEMI. In-hospital mortality was significantly lower in NSTEMI than in STEMI (4.2 vs. 8.9 %, p < 0.001), even after adjusting for confounders in a multivariable logistic model (OR 0.27, 95 % CI 0.16-0.45). One-year mortality was similar in NSTEMI and STEMI patients in an unadjusted comparison (18.0 vs. 16.7 %, p = 0.51), but it was lower in NSTEMI patients in multivariable Cox analysis (HR 0.56, 95 % CI 0.42-0.75). PCI reduced the risk of 1-year mortality similarly in STEMI (HR 0.47, 95 % CI 0.28-0.79) and NSTEMI (HR 0.41, 95 % CI 0.28-0.60). PCI reduces mortality in both STEMI and NSTEMI, but it is underutilised in patients with NSTEMI. To improve overall prognosis of AMI, efforts should be made at improving the care of NSTEMI patients.
Collapse
Affiliation(s)
- Daniela Balzi
- Epidemiology Unit, Local Health Unit 10 Firenze, Via di San Salvi 12, 50135, Florence, Italy,
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Ballo P, Betti I, Barchielli A, Castelli G, De Luca L, Gheorghiade M, Zuppiroli A. Body mass index, gender, and clinical outcome among hypertensive and diabetic patients with stage A/B heart failure. Obesity (Silver Spring) 2013; 21:E500-7. [PMID: 23512886 DOI: 10.1002/oby.20420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 02/06/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The existence of an "obesity paradox" in asymptomatic patients with preclinical heart failure (HF) has not been investigated. The prognostic value of BMI in a cohort of hypertensive and diabetic patients with stage A/B HF enrolled in the PROBE-HF study was explored. DESIGN AND METHODS BMI was measured in 1003 asymptomatic subjects (age 66.4 ± 7.8 years, 48% males) with hypertension and/or type 2 diabetes and no clinical evidence of HF. Predefined endpoints were all-cause mortality and a composite of death and hospitalization for cardiac causes. RESULTS During a follow-up of 38.5 ± 4.1 months, 33 deaths were observed. Mortality in the normal BMI group (1.6 deaths per 100 patient-years) did not differ to that in the overweight group (1.1 per 100 patient-years, p = 0.31), but was higher than that in the obese group (0.4 per 100 patient-years, p = 0.0089). In multivariable analysis, obesity (hazard ratio [HR] 0.27 [0.09-0.85], p = 0.025) but not overweight (HR 0.68 [0.32-1.45], p = 0.32) was associated with lower risk of death. Obesity was also independently associated with reduced risk of the composite endpoint (HR 0.54 [0.28-0.99], p = 0.047). CONCLUSION In asymptomatic hypertensive and diabetic patients with preclinical HF, obesity is associated with better survival and reduced risk of events.
Collapse
Affiliation(s)
- Piercarlo Ballo
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy
| | | | | | | | | | | | | |
Collapse
|
41
|
Lisi M, Henein M, Cameli M, Ballo P, Reccia R, Bennati E, Chiavarelli M, Maccherini M, Mondillo S. Severity of aortic stenosis predicts early post-operative normalization of left atrial size and function detected by myocardial strain. Int J Cardiol 2013; 167:1450-5. [DOI: 10.1016/j.ijcard.2012.04.057] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 03/18/2012] [Accepted: 04/08/2012] [Indexed: 10/28/2022]
|
42
|
Pedrinelli R, Ballo P, Fiorentini C, Galderisi M, Ganau A, Germanò G, Innelli P, Paini A, Perlini S, Salvetti M, Zacà V. Hypertension and stable coronary artery disease. J Cardiovasc Med (Hagerstown) 2013; 14:545-52. [DOI: 10.2459/jcm.0b013e3283609332] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
43
|
Dini FL, Guarini G, Ballo P, Carluccio E, Maiello M, Capozza P, Innelli P, Rosa GM, Palmiero P, Galderisi M, Razzolini R, Nodari S. The left ventricle as a mechanical engine. J Cardiovasc Med (Hagerstown) 2013; 14:214-20. [DOI: 10.2459/jcm.0b013e32834ae7fe] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
44
|
Bocelli A, Favilli S, Pollini I, Bini RM, Ballo P, Chiappa E, Zuppiroli A. Prevalence and long-term predictors of left ventricular hypertrophy, late hypertension, and hypertensive response to exercise after successful aortic coarctation repair. Pediatr Cardiol 2013; 34:620-9. [PMID: 23052661 DOI: 10.1007/s00246-012-0508-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 08/26/2012] [Indexed: 01/06/2023]
Abstract
Controversial data exist about the long-term results of aortic coarctation (AC) repair. This study explored the prevalence and predictors of left ventricular (LV) hypertrophy, late hypertension, and hypertensive response to exercise in 48 subjects (age, 15.1 ± 9.7 years) currently followed in the authors' tertiary care hospital after successful AC repair. Data on medical history, clinical examination, rest and exercise echocardiography, and ambulatory blood pressure monitoring were collected. The time from AC repair to follow-up evaluation was 12.9 ± 9.2 years. The prevalence of LV hypertrophy ranged from 23 to 38 %, based on the criteria used to identify LV hypertrophy, and that of concentric geometry was 17 %. One sixth of the patients without residual hypertension experienced late-onset hypertension. One fourth of those who remained normotensive without medication showed a hypertensive response to exercise. Age at AC repair was the strongest independent predictor of LV hypertrophy, defined using indexation either for body surface area (odds ratio [OR], 1.03; p = 0.0090) or for height(2.7) (OR 1.02; p = 0.029), and it was the only predictor of late hypertension (OR 1.06; p = 0.0023) and hypertensive response to exercise (OR 1.09; p = 0.029). The risk of LV hypertrophy was 25 % for repair at the age of 3.4 years but rose to 50 and 75 % for repair at the ages of 5.9 and 8.4 years, respectively. Similar increases were found for the risk of late-onset hypertension and hypertensive response to exercise. A considerable risk of LV hypertrophy, late hypertension, and hypertensive response to exercise exists after successful AC repair. Older age at intervention is the most important predictor of these complications.
Collapse
Affiliation(s)
- Arianna Bocelli
- Pediatric Cardiology Unit, A. Meyer Hospital, Florence, Italy
| | | | | | | | | | | | | |
Collapse
|
45
|
D'Andrea A, Mele D, Nistri S, Riegler L, Galderisi M, Agricola E, Losi MA, Ballo P, Mondillo S, Badano LP. The prognostic impact of dynamic ventricular dyssynchrony in patients with idiopathic dilated cardiomyopathy and narrow QRS. Eur Heart J Cardiovasc Imaging 2013; 14:183-189. [DOI: 10.1093/ehjci/jes154] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
|
46
|
Zilberszac R, Gabriel H, Maurer G, Rosenhek R, Dulgheru R, Magne J, Capoulade R, Pierard L, Pibarot P, Lancellotti P, Zito C, Todaro M, Cusma-Piccione M, Falanga G, Di Bella G, Acri E, Pardeo A, Virga V, Barbaro C, Carerj S, Lisi M, Henein M, Cameli M, Ballo P, Reccia R, Bennati E, Chiavarelli M, Maccherini M, Mondillo S, Dahl J, Videbaek L, Poulsen M, Rudbaek T, Pellikka P, Rasmussen L, Moller J, Touati A, Messika-Zeitoun D, Himbert D, Sordi M, Chiampan A, Brochet E, Iung B, Vahanian A, Sordi M, Messika-Zeitoun D, Himbert D, Serfaty J, Chiampan A, Touati A, Brochet E, Iung B, Vahanian A, Muratori M, Tamborini G, Gripari P, Fusini L, Barbier P, Salvi L, Bartorelli A, Maffessanti F, Alamanni F, Pepi M, Rajamannan N, Da Silva C, Manouras A, Winter R, Back M, Ruck A, Settergren M, Sahlen A, Shahgaldi K. Aortic stenosis: prognosis and management: Aortic stenosis. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
47
|
Favilli S, Santoro G, Ballo P, Arcangeli C, Bovenzi FM, Chiappa E, Conti U, Monopoli A, Murzi B, Rosini C, Zuppiroli A. Prevalence and clinical characteristics of adult patients with congenital heart disease in Tuscany. J Cardiovasc Med (Hagerstown) 2012; 13:805-9. [DOI: 10.2459/jcm.0b013e3283569b3a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
48
|
Mangialavori G, Ballo P, Michelagnoli S, Ercolini L, Barbanti E, Passuello F, Abbondanti A, Consoli L, Chechi T, Fibbi V, Nannini M, Chiodi L, Zuppiroli A. Subclavian steal syndrome presenting as recurrent pulmonary oedema associated with acute left ventricular diastolic dysfunction. Cardiovasc Revasc Med 2012; 14:45-8. [PMID: 23036888 DOI: 10.1016/j.carrev.2012.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 08/21/2012] [Accepted: 08/27/2012] [Indexed: 11/25/2022]
Abstract
Subclavian steal syndrome typically presents as angina in patients with internal mammary artery grafts. Atypical clinical presentations have been rarely described. We report an unusual case of subclavian steal syndrome presenting as pulmonary oedema with acute left ventricular diastolic dysfunction and preserved ejection fraction in a patient with internal mammary artery graft and severe stenosis of the proximal left subclavian artery. After successful angioplasty and stenting of subclavian artery, the patient remained asymptomatic for six months, but then experienced acute diastolic dysfunction and recurrent pulmonary oedema associated with critical subclavian in-stent restenosis with stent deformation. This report points out that, in patients with internal mammary-to-LAD grafts, subclavian steal syndrome may present as acute left ventricular diastolic dysfunction and pulmonary oedema even in the presence of normal ejection fraction.
Collapse
|
49
|
Lisi M, Cameli M, Tacchini D, Ballo P, Maccherini M, Mondillo S. Two-dimensional speckle tracking echocardiography of acute cardiac transplant rejection following pregnancy. J Clin Ultrasound 2012; 40:451-454. [PMID: 22287493 DOI: 10.1002/jcu.21886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 12/13/2011] [Indexed: 05/31/2023]
Abstract
A 44-year-old woman, who had undergone orthotopic cardiac transplantation in 1999, presented acute allograft rejection 4 months after childbirth. Analysis of myocardial deformation by speckle tracking echocardiography showed, in contrast with traditional markers of systolic function, a strong reduction of left ventricular strain, which recovered, together with rejection, under pharmacological treatment. This case documents the potential advantages of speckle tracking echocardiography in the noninvasive management of transplant recipients.
Collapse
Affiliation(s)
- Matteo Lisi
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | | | | | | | | | | |
Collapse
|
50
|
Ballo P, Dattolo P, Mangialavori G, Ferro G, Fusco F, Consalvo M, Chiodi L, Pizzarelli F, Zuppiroli A. Acute inflammatory bowel disease complicating chronic alcoholism and mimicking carcinoid syndrome. Case Rep Gastroenterol 2012; 6:545-9. [PMID: 22949895 PMCID: PMC3433029 DOI: 10.1159/000341588] [Citation(s) in RCA: 3] [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: 01/11/2023] Open
Abstract
We report the case of a woman with a history of chronic alcohol abuse who was hospitalized with diarrhea, severe hypokalemia refractory to potassium infusion, nausea, vomiting, abdominal pain, alternations of high blood pressure with phases of hypotension, irritability and increased urinary 5-hydroxyindoleacetic acid and cortisol. Although carcinoid syndrome was hypothesized, abdominal computed tomography and colonoscopy showed non-specific inflammatory bowel disease with severe colic wall thickening, and multiple colic biopsies confirmed non-specific inflammation with no evidence of carcinoid cells. During the following days diarrhea slowly decreased and the patient's condition progressively improved. One year after stopping alcohol consumption, the patient was asymptomatic and serum potassium was normal. Chronic alcohol exposure is known to have several deleterious effects on the intestinal mucosa and can favor and sustain local inflammation. Chronic alcohol intake may also be associated with high blood pressure, behavior disorders, abnormalities in blood pressure regulation with episodes of hypotension during hospitalization due to impaired baroreflex sensitivity in the context of an alcohol withdrawal syndrome, increased urinary 5-hydroxyindoleacetic acid as a result of malabsorption syndrome, and increased urinary cortisol as a result of hypothalamic-pituitary-adrenal axis dysregulation. These considerations, together with the regression of symptoms and normalization of potassium levels after stopping alcohol consumption, suggest the intriguing possibility of a alcohol-related acute inflammatory bowel disease mimicking carcinoid syndrome.
Collapse
|