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Pepe M, Tritto R, Naccarati ML, Quarta S, Marzullo A, Ciccone MM. Aortic valve fibroelastoma presenting with myocardial infarction with non-obstructive coronary arteries (MINOCA): A case report and review of the literature. Cardiovasc Pathol 2024; 71:107631. [PMID: 38467167 DOI: 10.1016/j.carpath.2024.107631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/17/2024] [Accepted: 03/06/2024] [Indexed: 03/13/2024] Open
Abstract
Cardiac papillary fibroelastomas (CPFs) are rare benign cardiac tumors more often involving the left-sided valves and related with threatening embolic complications. We report the case of a 35-year-old woman presenting with relapsing-remitting chest pain and elevated cardiac troponins. After a negative coronary angiography, an integrated imaging assessment based on echocardiography and cardiac magnetic resonance showed a pedunculated mass on the aortic valve causing an intermittent obstructive engagement of the right coronary ostium. A tailored surgical treatment was performed and the histopathological examination of the specimen revealed mesenchymal tissue with the characteristics of CPF.
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Affiliation(s)
- Martino Pepe
- Cardiovascular Diseases Section, Interdisciplinary Department of Medicine (DIM), University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Rocco Tritto
- Cardiovascular Diseases Section, Interdisciplinary Department of Medicine (DIM), University of Bari "Aldo Moro", 70124 Bari, Italy.
| | - Maria Ludovica Naccarati
- Cardiovascular Diseases Section, Interdisciplinary Department of Medicine (DIM), University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Simona Quarta
- Cardiovascular Diseases Section, Interdisciplinary Department of Medicine (DIM), University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Andrea Marzullo
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Marco Matteo Ciccone
- Cardiovascular Diseases Section, Interdisciplinary Department of Medicine (DIM), University of Bari "Aldo Moro", 70124 Bari, Italy
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Pepe M, Carulli E, Larosa C, Napoli G, Nestola PL, Carella MC, Giordano S, Tritto R, Bartolomucci F, Cirillo P, Zoccai GB, Giordano A, Ciccone MM. Comparative effectiveness of Cangrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention: an observational investigation from the M.O.Ca. registry. Sci Rep 2023; 13:10685. [PMID: 37393369 PMCID: PMC10314899 DOI: 10.1038/s41598-023-37084-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/15/2023] [Indexed: 07/03/2023] Open
Abstract
Cangrelor, the first intravenous P2Y12 inhibitor (P2Y12-I), has been approved on the basis of three large RCTs from the CHAMPION program which nevertheless have been criticized for the low bleeding risk of the enrolled patients, the large quote of chronic coronary syndromes, and the use of Clopidogrel as control arm even in the setting of acute coronary syndromes (ACS). We sought to investigate, in the setting of ACS, the comparative performance of Cangrelor in terms of in-hospital ischemic and haemorrhagic outcomes compared with the current gold-standard of oral P2Y12-I. The study retrospectively enrolled 686 consecutive patients admitted to the Divisions of Cardiology of Policlinico of Bari and L. Bonomo Hospital of Andria for ACS and treated with percutaneous coronary intervention. The study population was divided according to the P2Y12-I treatment strategy in two groups: patients given an oral P2Y12-I and patients receiving Cangrelor in the cath lab followed by an oral P2Y12-I. Clinical endpoints included death, ischemic and bleeding events occurring during hospital stay. Cangrelor treated patients presented higher clinical risk profile at presentation and faced higher death rate. However, after PS matching, in-hospital mortality resulted comparable between the groups and Cangrelor use was associated with reduced in-hospital definite stent thrombosis (p = 0.03). Data from our real-world registry highlight that, in the setting of ACS, Cangrelor is prevalently used in patients with very challenging clinical presentations. The adjusted analysis provides for the first time promising data on stent thrombosis reduction associated with Cangrelor use.
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Affiliation(s)
- Martino Pepe
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari "Aldo Moro", Bari, Italy.
- Cardiovascular Diseases Section, Cardiothoracic Department (DAI), University of Bari, Polyclinic of Bari, P.zza Giulio Cesare 11, 70124, Bari, Italy.
| | - Eugenio Carulli
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari "Aldo Moro", Bari, Italy
| | - Claudio Larosa
- Division of Cardiology, Lorenzo Bonomo Hospital, Andria, Italy
| | - Gianluigi Napoli
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari "Aldo Moro", Bari, Italy
| | - Palma Luisa Nestola
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari "Aldo Moro", Bari, Italy
| | - Maria Cristina Carella
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari "Aldo Moro", Bari, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Rocco Tritto
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari "Aldo Moro", Bari, Italy
| | | | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Arturo Giordano
- Invasive Cardiology Unit, "Pineta Grande" Hospital, Castel Volturno, Caserta, Italy
| | - Marco Matteo Ciccone
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari "Aldo Moro", Bari, Italy
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Veronese N, Segala FV, Carruba L, La Carrubba A, Pollicino F, Di Franco G, Guido G, Cormio M, Lugli A, De Santis L, Guerra V, Pepe M, Tritto R, Ciccone MM, Bavaro DF, Brindicci G, Mansueto P, Giannitrapani L, Di Gennaro F, Barbagallo M, Saracino A. Anemia as a risk factor for disease progression in patients admitted for COVID-19: data from a large, multicenter cohort study. Sci Rep 2023; 13:9035. [PMID: 37270578 DOI: 10.1038/s41598-023-36208-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/31/2023] [Indexed: 06/05/2023] Open
Abstract
In respiratory infections, anemia is both a consequence of acute inflammation and a predictor of poor clinical outcomes. There are few studies investigating the role of anemia in COVID-19, suggesting a potential role in predicting disease severity. In this study, we aimed to assess the association between the presence of anemia at admission and incidence of severe disease and death in patients hospitalized for COVID-19. Data from all adult patients admitted for COVID-19 in University Hospital "P. Giaccone" Palermo, and University Hospital of Bari, Italy, were retrospectively collected from 1st of September 2020 to 31 August 2022. The association between anemia (defined as Hb < 13 g/dl and < 12 g/dl in males and females, respectively), in-hospital mortality and severe COVID-19 was tested using a Cox's regression analysis. Severe COVID-19 forms were defined as admission to intensive or sub-intensive care unit or a qSOFAscore ≥ 2 or CURB65scores ≥ 3. p values were calculated using the Student's t test for continuous variables and the Mantel-Haenszel Chi-square test for categorical ones. The association between anemia and the mortality was made using a Cox's regression analysis, adjusted, in two models, for the potential confounders and using a propensity score. Among the 1562 patients included in the analysis, prevalence of anemia was 45.1% (95% CI 43-48%). Patients with anemia were significantly older (p < 0.0001), reported more co-morbidities, and presented higher baseline levels of procalcitonin, CRP, ferritin and IL-6. Overall, the crude incidence of mortality was about four times higher in patients with anemia compared to those without. After adjusting for 17 potential confounders, the presence of anemia significantly increased the risk of death (HR = 2.68; 95% CI: 1.59-4.52) and of risk of severe COVID-19 (OR = 2.31; 95% CI: 1.65-3.24). The propensity score analysis substantially confirmed these analyses. Our study provides evidence that, in patients hospitalized for COVID-19, anemia is both associated with a more pronounced baseline pro-inflammatory profile and higher incidence of in-hospital mortality and severe disease.
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Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Francesco Vladimiro Segala
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Luca Carruba
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Anna La Carrubba
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Francesco Pollicino
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Giusi Di Franco
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Giacomo Guido
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy.
| | - Mariangela Cormio
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Alessia Lugli
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Laura De Santis
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Vittorio Guerra
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Martino Pepe
- Section of Cardiovascular Diseases, Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Italy
| | - Rocco Tritto
- Section of Cardiovascular Diseases, Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Italy
| | - Marco Matteo Ciccone
- Section of Cardiovascular Diseases, Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Italy
| | - Davide Fiore Bavaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Gaetano Brindicci
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Pasquale Mansueto
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Lydia Giannitrapani
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Via Ugo La Malfa 153, 90146, Palermo, Italy
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
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Pepe M, Napoli G, Carella MC, De Feo D, Tritto R, Guaricci AI, Forleo C, Ciccone MM. A Young Patient Presenting with Dilated Cardiomyopathy and Renal Infarction during Treatment with Isotretinoin: Mere Coincidence or Serious Side Effect of a Drug Commonly Used in Adolescence? Diagnostics (Basel) 2023; 13:diagnostics13091543. [PMID: 37174936 PMCID: PMC10177891 DOI: 10.3390/diagnostics13091543] [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: 02/28/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Isotretinoin or 13-cis-retinoic acid (RA) is one of the most effective and widely used drugs for the treatment of severe acne vulgaris. Despite being deemed safe, no definite consensus has been reached on the cardiovascular risk of RA derivatives. We report a case of heart failure due to dilated cardiomyopathy (DCM) and concomitant renal infarction occurring after 5 months of isotretinoin use in a previously healthy 18-year-old male. The patient, with a history of acne vulgaris, presented to our emergency department with left iliac fossa pain and effort dyspnea. A trans-thoracic echocardiogram showed DCM and severely reduced left ventricle ejection fraction (LVEF: 29%). During hospitalization, a total body computed tomography (CT) showed an ischemic lesion in the left kidney. Ischemic, autoimmune, infective, and heritable causes of DCM were ruled out. Cardiac magnetic resonance (CMR) evidenced LV circumferential mid-wall late gadolinium enhancement. Heart failure therapy was promptly started and up-titrated, but only poor LVEF improvement was detected overtime. Our case aims to raise awareness on rare life-threatening cardiovascular events possibly associated with isotretinoin use. To the best of our knowledge, this is the first described case of renal thromboembolism and severe DCM leading to implantable cardioverter-defibrillator (ICD) implantation occurring during isotretinoin treatment.
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Affiliation(s)
- Martino Pepe
- Cardiovascular Diseases Section, Interdisciplinary Department of Medicine (DIM), University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Gianluigi Napoli
- Cardiovascular Diseases Section, Interdisciplinary Department of Medicine (DIM), University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Maria Cristina Carella
- Cardiovascular Diseases Section, Interdisciplinary Department of Medicine (DIM), University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Daniele De Feo
- Cardiovascular Diseases Section, Interdisciplinary Department of Medicine (DIM), University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Rocco Tritto
- Cardiovascular Diseases Section, Interdisciplinary Department of Medicine (DIM), University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Andrea Igoren Guaricci
- Cardiovascular Diseases Section, Interdisciplinary Department of Medicine (DIM), University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Cinzia Forleo
- Cardiovascular Diseases Section, Interdisciplinary Department of Medicine (DIM), University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Marco Matteo Ciccone
- Cardiovascular Diseases Section, Interdisciplinary Department of Medicine (DIM), University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
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Napoli G, Tritto R, Moscarelli M, Forleo C, La Marca MGC, Yang L, Biondi-Zoccai G, Giordano A, Tshomba Y, Pepe M. Role of pre-operative embolization in carotid body tumor surgery according to Shamblin classification: A systematic review and meta-analysis. Head Neck 2023; 45:1141-1148. [PMID: 36896854 DOI: 10.1002/hed.27318] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/20/2023] [Accepted: 02/02/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Pre-operative embolization prior to surgical resection of carotid body tumors was meant to decrease intraoperative blood loss and operative time. Yet, potential confounders such as different Shamblin classes have never been analyzed. Aim of our meta-analysis was to investigate effectiveness of a pre-operative embolization according to different Shamblin classes. METHODS Five studies comprising 245 patients were included. A random effects model meta-analysis was conducted, and the I2 statistic was used to assessment for heterogeneity. RESULTS Pre-operative embolization was associated with a significant reduction in blood loss (WM: 276.4 mL; 95% CI, 201.9-378.3, p < 0.01); an absolute mean reduction, though not statistically significant, was observed in both Shamblin 2 and 3 classes. No difference in operative time was found between the two strategies (WM: 192.0 min; 95% CI, 157.7-234.1, p = 1.0). CONCLUSIONS Embolization proved an overall significant reduction in perioperative bleeding, which did not reach threshold for statistical significance when Shamblin classes were singularly considered.
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Affiliation(s)
- Gianluigi Napoli
- Cardiovascular Diseases Section, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Rocco Tritto
- Cardiovascular Diseases Section, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Marco Moscarelli
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital GVM Care & Research, Cotignola, Ravenna, Italy
| | - Cinzia Forleo
- Cardiovascular Diseases Section, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | | | - Lin Yang
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Naples, Italy
| | - Arturo Giordano
- Invasive Cardiology Unit, "Pineta Grande" Hospital, Castel Volturno, Caserta, Italy
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Roma, Italy
| | - Martino Pepe
- Cardiovascular Diseases Section, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
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D'Alessandro P, Tritto R, Cillis ED, Acquaviva T, Giordano A, Nestola PL, Pepe M, Bortone AS. MitraClip™ implantation plus left atrial appendage occlusion in a hereditary hemorrhagic telangiectasia patient. Future Cardiol 2022; 18:849-855. [PMID: 36128856 DOI: 10.2217/fca-2022-0043] [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] [Indexed: 01/26/2023] Open
Abstract
Hereditary hemorrhagic telangiectasia is regarded as a high hemorrhagic risk condition, and the management of anticoagulation and heart surgery in these patients can be challenging. The authors describe a combined percutaneous treatment of mitral regurgitation and left atrial appendage occlusion in a patient affected by hereditary hemorrhagic telangiectasia and atrial fibrillation, supporting the safety and feasibility of the procedure and the optimal short-term outcome.
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Affiliation(s)
- Pasquale D'Alessandro
- Division of Heart Surgery, Department of Emergency & Organ Transplantation, University of Bari, Bari, Italy
| | - Rocco Tritto
- Division of Cardiology, Department of Emergency & Organ Transplantation, University of Bari, Bari, Italy
| | - Emanuela De Cillis
- Division of Heart Surgery, Department of Emergency & Organ Transplantation, University of Bari, Bari, Italy
| | - Tommaso Acquaviva
- Division of Heart Surgery, Department of Emergency & Organ Transplantation, University of Bari, Bari, Italy
| | - Arturo Giordano
- Invasive Cardiology Unit, "Pineta Grande" Hospital, Castel Volturno, Caserta, Italy
| | - Palma L Nestola
- Division of Cardiology, Department of Emergency & Organ Transplantation, University of Bari, Bari, Italy
| | - Martino Pepe
- Division of Cardiology, Department of Emergency & Organ Transplantation, University of Bari, Bari, Italy
| | - Alessandro S Bortone
- Division of Heart Surgery, Department of Emergency & Organ Transplantation, University of Bari, Bari, Italy
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