50 results on '"Piscione, Federico"'
Search Results
2. Loeffler’s Endocarditis: An Integrated Multimodality Approach
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Polito, Maria Vincenza, Hagendorff, Andreas, Citro, Rodolfo, Prota, Costantina, Silverio, Angelo, De Angelis, Elena, Klingel, Karin, Metze, Michael, Stöbe, Stephan, Hoffmann, Karl Titus, Sabri, Osama, Piscione, Federico, and Galasso, Gennaro
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Loeffler's endocarditis (LE) is the cardiac manifestation of hypereosinophilic syndrome, a rare systemic disease characterized by the sustained production of eosinophils leading to organ damage. Few data, principally by case reports, are available regarding the diagnostic workup in patients with suspected LE. Thus, we have performed a systematic search of the literature dealing with imaging in LE and propose an integrated multimodality imaging approach in the cardiac diagnostics of LE patients. The aim is to provide an updated state-of-the-art review focused on noninvasive and invasive imaging modalities for this rare and underdiagnosed disease. Standard and advanced echocardiography are typically the first cardiac imaging examinations when LE is suspected and they are also used later in follow-up for prognostic stratification and assessing response to treatment. Cardiac magnetic resonance provides a more detailed anatomical and functional evaluation of cardiac chambers, tissue characterization for the presence and extension of myocardial edema and fibrosis, and ventricular thrombi identification. Computed tomography scan and [18F]-fluoro-deoxy-glucose positron emission tomography may be helpful in selected cases to evaluate the cardiac involvement of LE as well as the other noncardiac manifestations of hypereosinophilic syndrome. Endomyocardial biopsy may be considered in patients with high clinical suspicion of LE if noninvasive imaging findings are confusing or not conclusive. The appropriate use of invasive and noninvasive imaging modalities, combining the available techniques with the patients' clinical features, will hopefully lead to early diagnosis, more accurate staging of disease, and timely treatment of LE that may prevent the irreversible myocardial damage of LE and adverse cardiovascular events.
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- 2020
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3. Analysis of regional right ventricular function by tissue doppler imaging in patients with aortic stenosis.
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Polito, Maria, Stoebe, Stephan, Galasso, Gennaro, De Rosa, Roberta, Citro, Rodolfo, Piscione, Federico, Laufs, Ulrich, and Hagendorff, Andreas
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Background: Right ventricular (RV) dysfunction is frequently observed in patients with aortic stenosis (AS). Nevertheless, assessment of regional RV deformation is yet not performed. The aim of the study was to analyze the impact of moderate and severe AS on global and regional RV function by a multisegmental approach using tissue Doppler imaging (TDI). Methods: In 50 patients (Group I – AS [n = 25] and Group II – normal controls [n = 25]), additional echocardiographic views of the RV were prospectively performed. The TDI sample volume was placed in the basal myocardial region of the anterior (RV-anterior), inferior (RV-inferior), and free RV wall (RV-free wall) to assess the following parameters: S'
RV , E'RV , and A'RV waves; IVCTRV ; IVRTRV ; and myocardial performance index (MPIRV ). Results: In AS patients, left ventricular (LV) mass index, left atrial (LA) volume index, and LV end-diastolic pressure were significantly increased. Moreover, AS patients had higher systolic pulmonary artery pressure (sPAP) and lower values for PV AccT (P < 0.0001), but TAPSE was not different between the two groups (P = 0.062). In AS patients, IVRTRV-anterior , IVRTRV-inferior , and IVRTRV-free wall and MPIRV were statistically increased (P < 0.0001). A significant correlation between IVRTRV (evaluated at all three regions) and the parameters including sPAP, PV AccT, and ELV /e'LV ratio was observed in AS. A strong correlation was observed between IVRTRV-free wall/inferior and AS severity by evaluation of velocities, gradient, and aortic valve area (P < 0.0001). Conclusions: The present study reports a correlation between the severity of AS and the increase of IVRTRV and MPIRV . Thus, a distinct analysis of RV performance is important for echocardiographic evaluation of patients with AS. [ABSTRACT FROM AUTHOR]- Published
- 2019
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4. Impact of renal dysfunction and acute kidney injury on outcome in elderly patients with acute coronary syndrome undergoing percutaneous coronary intervention
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De Rosa, Roberta, Morici, Nuccia, De Servi, Stefano, De Luca, Giuseppe, Galasso, Gennaro, Piscione, Federico, Ferri, Luca A, Piatti, Luigi, Grosseto, Daniele, Tortorella, Giovanni, Franco, Nicoletta, Lenatti, Laura, Misuraca, Leonardo, Leuzzi, Chiara, Verdoia, Monica, Sganzerla, Paolo, Cacucci, Michele, Ferrario, Maurizio, Murena, Ernesto, Sibilio, Gerolamo, Toso, Anna, and Savonitto, Stefano
- Abstract
Background Chronic kidney disease is common in patients admitted with acute coronary syndrome and its prevalence dramatically increases with age. Understanding the determinants of adverse outcomes in this extremely high-risk population may be useful for the development of specific treatment strategies and planning of secondary prevention modalities.Aim The aim of this study was to assess the impact of baseline renal function and acute kidney injury on one-year outcome of elderly patients with acute coronary syndrome treated with percutaneous coronary intervention.Methods Patients aged 75 years and older with acute coronary syndrome undergoing successful percutaneous coronary intervention were selected among those enrolled in three Italian multicentre studies. Based on the baseline estimated glomerular filtration rate (eGFR) calculated using the Cockcroft–Gault formula ([(140–age) × body weight × 0.85 if female]/(72 × serum creatinine)* 1.73 m2of body surface area), patients were classified as having none or mild (eGFR ≥60 ml/min/1.73 m2), moderate (eGFR 30–59 ml/min/1.73 m2) or severe (eGFR <30 ml/min/1.73 m2) renal dysfunction. Acute kidney injury was defined according to the Acute Kidney Injury Network classification. All-cause and cardiovascular mortality, non-fatal myocardial infarction, rehospitalisation for cardiovascular causes, stroke and type 2, 3 and 5 Bleeding Academic Research Consortium bleedings were analysed up to 12 months.Results A total of 1904 patients were included. Of these, 57% had moderate and 11% severe renal dysfunction. At 12 months, patients with renal dysfunction had higher rates (P< 0.001) of all-cause (4.5%, 7.5% and 17.8% in patients with none or mild, moderate and severe renal dysfunction, respectively) and cardiovascular mortality (2.8%, 5.2% and 10.2%, respectively). After multivariable adjustment, severe renal dysfunction was associated with a higher risk of all-cause (hazard ratio (HR) 2.86, 95% confidence interval (CI) 1.52–5.37, P= 0.001) and cardiovascular death (HR 3.11, 95% CI 1.41–6.83, P= 0.005), whereas non-fatal events were unaffected. Acute kidney injury incidence was significantly higher in ST-elevation myocardial infarction versus non-ST-elevation acute coronary syndrome patients (11.7% vs. 7.8%, P= 0.036) and in those with reduced baseline renal function (P< 0.001), and it was associated with increased mortality independently from baseline renal function and clinical presentation.Conclusions Baseline renal dysfunction is highly prevalent and is associated with higher mortality in elderly acute coronary syndrome patients undergoing percutaneous coronary intervention. Acute kidney injury occurs more frequently among ST-elevation myocardial infarction patients and those with pre-existing renal dysfunction and is independently associated with one-year mortality.
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- 2024
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5. Does renal function affect the efficacy or safety of a pharmacoinvasive strategy in patients with ST-elevation myocardial infarction? A meta-analysis.
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Russo, Juan J., Goodman, Shaun G., Cantor, Warren J., Ko, Dennis T., Bagai, Akshay, Tan, Mary K., Di Mario, Carlo, Halvorsen, Sigrun, Le May, Michel, Fernandez-Avilés, Francisco, Scheller, Bruno, Armstrong, Paul W., Borgia, Francesco, Piscione, Federico, Sanchez, Pedro L., and Yan, Andrew T.
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Background: The efficacy and safety of pharmacoinvasive strategy following fibrinolysis for ST-elevation myocardial infarction (STEMI) in relation to renal function have not been established.Methods: Using patient-level data from 4 randomized controlled trials, we examined the efficacy and safety of pharmacoinvasive versus standard treatment after fibrinolysis for STEMI. Patients were stratified based on the estimated glomerular filtration rate (eGFR) on presentation (<60 mL/min/1.73 m2 vs ≥60 mL/min/1.73 m2). The primary outcome was the composite of death or reinfarction at 30 days.Results: Of 2,029 patients, 457 (23%) had an eGFR<60 mL/min/1.73 m2. Patients with eGFR<60 mL/min/1.73 m2 were older and had higher Thrombolysis in Myocardial Infarction risk scores. Compared with patients with eGFR≥60 mL/min/1.73 m2, patients with renal dysfunction had higher rates of the primary outcome (5.3% vs 11.8%, respectively; P<.001). There was no significant heterogeneity in the treatment effect of pharmacoinvasive strategy on the primary outcome (P heterogeneity=.73) or the rate of death or reinfarction at 1 year (P heterogeneity=.64) in relation to eGFR. Patients with renal dysfunction had higher rates of in-hospital major bleeding compared with patients with eGFR ≥60 mL/min/1.73 m2 (7.7% vs 4.3%, respectively; P=.004); however, there was no difference in bleeding events between treatment arms in the overall cohort or in relation to eGFR (P heterogeneity=.67).Conclusions: Renal impairment is associated with increased rates of adverse events in STEMI patients treated with fibrinolysis. However, the safety and efficacy of pharmacoinvasive strategy are preserved in patients with renal impairment on presentation. [ABSTRACT FROM AUTHOR]- Published
- 2017
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6. Comparison of Reduced-Dose Prasugrel and Standard-Dose Clopidogrel in Elderly Patients With Acute Coronary Syndromes Undergoing Early Percutaneous Revascularization
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Savonitto, Stefano, Ferri, Luca A., Piatti, Luigi, Grosseto, Daniele, Piovaccari, Giancarlo, Morici, Nuccia, Bossi, Irene, Sganzerla, Paolo, Tortorella, Giovanni, Cacucci, Michele, Ferrario, Maurizio, Murena, Ernesto, Sibilio, Girolamo, Tondi, Stefano, Toso, Anna, Bongioanni, Sergio, Ravera, Amelia, Corrada, Elena, Mariani, Matteo, Di Ascenzo, Leonardo, Petronio, A. Sonia, Cavallini, Claudio, Vitrella, Giancarlo, Rogacka, Renata, Antonicelli, Roberto, Cesana, Bruno M., De Luca, Leonardo, Ottani, Filippo, De Luca, Giuseppe, Piscione, Federico, Moffa, Nadia, De Servi, Stefano, Bolognese, Leonardo, Bovenzi, Francesco, Steffenino, Giuseppe, Santilli, Ignazio, Bassanelli, Giorgio, Sacco, Alice, Canziani, Federico, Ferri, Marco, Lo Jacono, Emilia, Canosi, Umberto, Fornaro, Giuseppe, Leoncini, Mario, Rosa Conte, Maria, Farina, Rosario, Stefanin, Catia, Di Pede, Francesco, Chella, Piersilvio, Chiara Nardoni, M., Tamburrini, Paola, Trimarco, Bruno, Galasso, Gennaro, Elia, Raffaele, Bolognese, Leonardo, Grotti, Simone, Bovenzi, Francesco, Borrelli, Lucia, Tamburino, Corrado, Capranzano, Piera, Francaviglia, Bruno, Campana, Carlo, Bonatti, Roberto, Martinoni, Alessandro, Abate, Fabio, Coscarelli, Sebastian, Rubartelli, Paolo, Villani, Giovanni Q., and Rossini, Roberta
- Abstract
Supplemental Digital Content is available in the text.
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- 2018
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7. Spontaneous coronary artery rupture presenting as an acute coronary syndrome evolved in pseudoaneurysm and cardiac tamponade: Case report and literature review
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Longobardi, Antonio, Iesu, Severino, Baldi, Cesare, Di Maio, Marco, Panza, Antonello, Mastrogiovanni, Generoso, Masiello, Paolo, Itri, Francesco, Lambiase, Catello, Bossone, Eduardo, Piscione, Federico, and Di Benedetto, Giuseppe
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Spontaneous coronary artery rupture is a rare disorder that may develop early into a sudden death due to the abrupt evolution of the associated cardiac tamponade. In some cases the rupture is contained and a false aneurysm develops with slower evolution of clinical signs. The correct diagnosis of spontaneous coronary artery rupture deserves a high level of suspicion; frequently it may be missed because the time window of its evolution seems to be very short or signs of acute coronary syndrome sometimes can prevail, leading to delays in diagnosis or to misdiagnosis. We report the case of a patient presenting a giant pseudoaneurysm of the right coronary artery due to spontaneous coronary artery rupture without any underlying disease. Moreover we present a review of the few cases in the literature, offering a pathophysiological hypothesis linking the site of rupture and clinical presentation.
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- 2017
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8. Effects of aortic counterpulsation in 6 cases of fulminant myocarditis.
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Vincenza Polito, Maria, Ravera, Amelia, Menneila, Raffaele, Ferrara, Saverio, Baldi, Cesare, Citro, Rodolfo, Di Maio, Marco, Vigorito, Francesco, Farina, Rosario, and Piscione, Federico
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- 2015
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9. Relationship Between Time to Invasive Assessment and Clinical Outcomes of Patients Undergoing an Early Invasive Strategy After Fibrinolysis for ST-Segment Elevation Myocardial Infarction: A Patient-Level Analysis of the Randomized Early Routine...
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Madan, Mina, Halvorsen, Sigrun, Di Mario, Carlo, Tan, Mary, Westerhout, Cynthia M., Cantor, Warren J., Le May, Michel R., Borgia, Francesco, Piscione, Federico, Scheller, Bruno, Armstrong, Paul W., Fernandez-Aviles, Francisco, Sanchez, Pedro L., Graham, John J., Yan, Andrew T., and Goodman, Shaun G.
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Objectives This study investigated the relationship between time to invasive assessment and outcomes among ST-segment elevation myocardial infarction patients randomized to early angiography after fibrinolysis. Background The optimal timing of coronary angiography after fibrinolysis and the association with clinical outcomes is uncertain. Methods Patient-level data from 6 randomized trials, with a median time to angiography <12 h after fibrinolysis, were pooled. The primary endpoint was 30-day death or reinfarction. The key secondary endpoint was in-hospital major bleeding. The relationship between fibrinolysis to angiography time and symptom onset to angiography time with outcomes was studied using 2- and 4-h intervals, respectively, and in multivariable models. Results Among 1,238 patients, the median fibrinolysis to angiography time was 165 min, and the median symptom onset to angiography time was 5.33 h. The primary and key secondary endpoints occurred in 5.7% and 4.7%, respectively. These main endpoints did not vary significantly with increasing fibrinolysis to angiography time. Early angiography (<2 h) after fibrinolysis was not associated with increased bleeding. Recurrent ischemia increased with increasing fibrinolysis to angiography time (3.7% to 7.9%, p for trend = 0.02). Thirty-day and 1-year death/reinfarction and 30-day recurrent ischemia increased significantly with increasing symptom onset to angiography time. Neither fibrinolysis to angiography time nor symptom onset to angiography time was an independent predictor of the primary endpoint. Only symptom onset to angiography time was an independent predictor of 1-year death/reinfarction (hazard ratio: 1.07, 95% confidence interval: 1.02 to 1.12, p = 0.01). Conclusions Very early angiography (<2 h) after fibrinolysis was not associated with an increased risk of 30-day death/reinfarction or in-hospital major bleeding, and angiography within 4 h after fibrinolysis was associated with reduced 30-day recurrent ischemia. A shorter symptom onset to angiography time (<4 h) was associated with reduced 30-day and 1-year death/reinfarction and 30-day recurrent ischemia. In the current environment of regional networks of 24/7 primary percutaneous coronary intervention (PCI) centers, the clinical implication of these findings is that patients initially treated with fibrinolysis should also be promptly transferred to the nearest PCI center for immediate angiography and PCI. (Early Percutaneous Coronary Intervention [PCI] After Fibrinolysis Versus Standard Therapy in ST Segment Elevation Myocardial Infarction [STEMI] Patients; NCT01014182 ) [ABSTRACT FROM AUTHOR]
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- 2015
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10. Contemporary Imaging in Takotsubo Syndrome
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Citro, Rodolfo, Pontone, Gianluca, Pace, Leonardo, Zito, Concetta, Silverio, Angelo, Bossone, Eduardo, and Piscione, Federico
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Transthoracic echocardiography is the first-line imaging modality for evaluating patients with Takotsubo syndrome (TTS). Beyond diagnosis, TTE enables detection of peculiar complications and is useful for risk stratification and management of patients with cardiogenic shock. Cardiac magnetic resonance can be used to detect myocardial edema typically associated with TTS and is helpful in the differential diagnosis with other disease states. Coronary computed tomography angiography can be performed as an alternative to coronary angiography to confirm coronary artery patency. Molecular imaging is a promising approach for identifying patients at increased risk of recurrence.
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- 2016
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11. Impact of Gene Polymorphisms, Platelet Reactivity, and the SYNTAX Score on 1-Year Clinical Outcomes in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: The GEPRESS Study.
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Palmerini, Tullio, Calabrò, Paolo, Piscione, Federico, De Servi, Stefano, Cattaneo, Marco, Maffeo, Diego, Toso, Anna, Bartorelli, Antonio, Palmieri, Cataldo, De Carlo, Marco, Capodanno, Davide, Barozzi, Chiara, Tomasi, Luciana, Della Riva, Diego, Mariani, Andrea, Taglieri, Nevio, Reggiani, Letizia Bacchi, Bianchi, Renatomaria, De Rosa, Roberta, and Mariani, Matteo
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Objectives The aim of this study was to investigate the association between high on-treatment platelet reactivity (HPR) and the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (SS) for risk prediction of major adverse cardiovascular events (MACE) in patients with non–ST-segment elevation acute coronary syndrome (NSTEACS) undergoing percutaneous coronary intervention (PCI). Background Platelet function testing may be used to optimize antiplatelet therapy in high-risk patients, but identification of this category of patients remains challenging. Methods The GEPRESS (Gene Polymorphism, Platelet Reactivity, and the Syntax Score) study was a prospective, multicenter, observational study enrolling 1,053 patients with NSTEACS undergoing PCI and treated with clopidogrel. The platelet reactivity index (PRI) was measured at 3 time points: before PCI, at hospital discharge, and 1 month after PCI. Genetic variants of clopidogrel metabolism were determined in 750 patients. Patients were stratified by the presence of HPR (PRI >50%) and by tertile of the SS (upper SS tertile ≥15). The primary objective of this study was the risk of MACE in the period between 1 month and 1 year. Results Between 1 month and 1 year, 1-month HPR was an independent predictor of MACE in patients with an SS ≥15, but not in those with an SS <15, displaying a 5-fold increase in event rates (10.4% vs. 2.5%; p < 0.0001). CYP2C19*2 was the only single nucleotide polymorphism associated with HPR, but it was not associated with MACE. Although there was a significant variability in the PRI across the 1-month period, predischarge HPR and SS effectively stratified the risk of subsequent MACE up to 1-year follow-up. Conclusions In clopidogrel-treated patients with NSTEACS undergoing PCI, HPR was independently associated with an increased risk of MACE only in the presence of a high SS. [ABSTRACT FROM AUTHOR]
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- 2014
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12. Echocardiographic Correlates of Acute Heart Failure, Cardiogenic Shock, and In-Hospital Mortality in Tako-Tsubo Cardiomyopathy.
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Citro, Rodolfo, Rigo, Fausto, D'Andrea, Antonello, Ciampi, Quirino, Parodi, Guido, Provenza, Gennaro, Piccolo, Raffaele, Mirra, Marco, Zito, Concetta, Giudice, Roberta, Patella, Marco Mariano, Antonini-Canterin, Francesco, Bossone, Eduardo, Piscione, Federico, and Salerno-Uriarte, Jorge
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Objectives: The purpose of this study was to determine clinical and echocardiographic correlates of acute heart failure, cardiogenic shock and in-hospital mortality in a large cohort of tako-tsubo cardiomyopathy (TTC) patients. Background: Despite good long-term prognosis, life-threatening complications due to hemodynamic instability can occur early in TTC patients. Methods: The study population consisted of 227 patients (66.2 ± 12.2 years of age; females, 90.3%) enrolled in the Tako-tsubo Italian Network, undergoing transthoracic two-dimensional echocardiography on admission and at short-term follow-up (4.3 [4 to 6] weeks). Patients were divided into two groups according to the presence or absence of major adverse events, a composite of acute heart failure, cardiogenic shock, and in-hospital mortality. Results: Major adverse events occurred in 59 patients (25.9%). The variables for elderly patients ≥75 years of age (42.4% vs. 23.8%; p = 0.011): left ventricular (LV) ejection fraction (35.1 ± 5.9% vs. 38.4 ± 4.6%, p < 0.001), wall motion score index (1.9 ± 0.2 vs. 1.7 ± 0.2, p < 0.001), E/e′ ratio (13.5 ± 4.3 vs. 9.9 ± 3.3 [where E/e′ is ratio of mitral E peak velocity and averaged e′ velocity], p < 0.001), LV outflow tract obstruction (23.7 vs. 8.9%, p = 0.006), pulmonary artery systolic pressure (47.4 ± 12.3 mm Hg vs. 38.0 ± 9.2 mm Hg; p < 0.001), right ventricular involvement (28.8 vs. 9.5%; p < 0.001), and reversible moderate-to-severe mitral regurgitation (49.1 vs. 11.9%; p < 0.001), were significantly different between groups and were associated with adverse events. At multivariate analysis, LV ejection fraction (HR: 0.92; 95% CI: 0.89 to 0.95; p < 0.001), E/e′ ratio (HR: 1.13; 95% CI: 1.02 to 1.24; p = 0.011), reversible moderate to severe mitral regurgitation (HR: 3.25; 95% CI: 1.16 to 9.10; p = 0.025), and age ≥75 years (HR: 2.81; 95% CI: 1.05 to 7.52; p = 0.039) were independent correlates of major adverse events. Conclusions: Echocardiographic parameters provide additional information compared to other variables routinely used in clinical practice to identify patients at higher risk of hemodynamic deterioration and poor in-hospital outcome, allowing prompt institution of appropriate pharmacological treatment and adequate mechanical support. [Copyright &y& Elsevier]
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- 2014
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13. Renal dysfunction, coronary revascularization and mortality among elderly patients with non ST elevation acute coronary syndrome
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Morici, Nuccia, De Servi, Stefano, Toso, Anna, Murena, Ernesto, Piscione, Federico, Bolognese, Leonardo, Petronio, Anna Sonia, Antonicelli, Roberto, Cavallini, Claudio, Angeli, Fabio, and Savonitto, Stefano
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Aims: To determine the association between baseline creatinine clearance (CrCl), coronary revascularization during index admission, and 1-year mortality in elderly patients with an acute coronary syndrome (ACS).Methods and results: We estimated CrCl using the Cockcroft-Gault (CG) formula in 313 patients aged ≥75 years enrolled in a prospective study of treatment strategies in non ST-elevation ACS (NSTEACS). Patients were stratified into four groups according to CrCl on admission (using a cutoff of 45 ml/min) and coronary revascularization versus medical management. The mean age of the study population was 81 years and the median serum creatinine level on admission was 1.0 mg/dl (interquartile range (IQR) 0.8-1.3). Patients with impaired renal function treated medically had higher in-hospital and 1-year mortality, especially if compared with patients with preserved renal function undergoing revascularization (1-year mortality 22.9% versus 4.9%). Across the spectrum of CrCl categories, coronary revascularization was independently associated with a lower risk of mortality (HR 0.405; 95% CI 0.174-0.940; p=0.035).Conclusions: In elderly patients with NSTEACS, coronary revascularization decreases the risk of 1-year death across each CrCl category, and is one of the most powerful predictors of 1-year outcome.
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- 2015
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14. Early stent thrombosis with bivalirudin in patients undergoing percutaneous coronary intervention
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Piccolo, Raffaele, Biase, Chiara De, D’Anna, Carolina, Trimarco, Bruno, Piscione, Federico, and Galasso, Gennaro
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- 2015
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15. Early Aggressive Versus Initially Conservative Treatment in Elderly Patients With Non–ST-Segment Elevation Acute Coronary Syndrome: A Randomized Controlled Trial.
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Savonitto, Stefano, Cavallini, Claudio, Petronio, A. Sonia, Murena, Ernesto, Antonicelli, Roberto, Sacco, Alice, Steffenino, Giuseppe, Bonechi, Francesco, Mossuti, Ernesto, Manari, Antonio, Tolaro, Salvatore, Toso, Anna, Daniotti, Alessandro, Piscione, Federico, Morici, Nuccia, Cesana, Bruno M., Jori, M. Cristina, and De Servi, Stefano
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TREATMENT of acute coronary syndrome ,OLDER patients ,RANDOMIZED controlled trials ,ELECTROCARDIOGRAPHY ,CORONARY arterial radiography ,TREATMENT effectiveness - Abstract
Objectives: This study sought to determine the risk versus benefit ratio of an early aggressive (EA) approach in elderly patients with non–ST-segment elevation acute coronary syndromes (NSTEACS). Background: Elderly patients have been scarcely represented in trials comparing treatment strategies in NSTEACS. Methods: A total of 313 patients ≥75 years of age (mean 82 years) with NSTEACS within 48 h from qualifying symptoms were randomly allocated to an EA strategy (coronary angiography and, when indicated, revascularization within 72 h) or an initially conservative (IC) strategy (angiography and revascularization only for recurrent ischemia). The primary endpoint was the composite of death, myocardial infarction, disabling stroke, and repeat hospital stay for cardiovascular causes or severe bleeding within 1 year. Results: During admission, 88% of the patients in the EA group underwent angiography (55% revascularization), compared with 29% (23% revascularization) in the IC group. The primary outcome occurred in 43 patients (27.9%) in the EA group and 55 (34.6%) in the IC group (hazard ratio [HR]: 0.80; 95% confidence interval [CI]: 0.53 to 1.19; p = 0.26). The rates of mortality (HR: 0.87; 95% CI: 0.49 to 1.56), myocardial infarction (HR: 0.67; 95% CI: 0.33 to 1.36), and repeat hospital stay (HR: 0.81; 95% CI: 0.45 to 1.46) did not differ between groups. The primary endpoint was significantly reduced in patients with elevated troponin on admission (HR: 0.43; 95% CI: 0.23 to 0.80), but not in those with normal troponin (HR: 1.67; 95% CI: 0.75 to 3.70; p for interaction = 0.03). Conclusions: The present study does not allow a definite conclusion about the benefit of an EA approach when applied systematically among elderly patients with NSTEACS. The finding of a significant interaction for the treatment effect according to troponin status at baseline should be confirmed in a larger size trial. (Italian Elderly ACS Study; NCT00510185) [Copyright &y& Elsevier]
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- 2012
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16. Concomitant coronary and peripheral arterial disease: Relationship between the inflammatory status of the affected limb and the severity of coronary artery disease.
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Brevetti, Gregorio, Piscione, Federico, Schiano, Vittorio, Galasso, Gennaro, Scopacasa, Francesco, and Chiariello, Massimo
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PERIPHERAL vascular diseases ,CORONARY disease ,INFLAMMATION ,LEG blood-vessels ,ATHEROSCLEROSIS ,BLOOD circulation - Abstract
Objective: In coronary artery disease (CAD), concomitant peripheral arterial disease (PAD) entails increased systemic inflammatory profile and more severe coronary atherosclerosis. We investigated the relationship between the inflammatory status in the affected limb and CAD severity. Methods: In 46 CAD+PAD and 31 CAD-alone patients, the inflammatory status of the leg circulation was measured by the transfemoral gradients of neutrophil myeloperoxidase (MPOx) content and interleukin-6 (IL-6). CAD severity was defined by evaluating coronary artery endothelial function, number of significant coronary stenoses, and prevalence of three-vessel CAD and myocardial infarction (MI). Results: In the affected limb of CAD+PAD patients, the transfemoral gradients of neutrophil MPOx content and IL-6 were higher (P < .01, for both) than in the healthy leg of CAD-only patients. At multivariate analysis, CAD+PAD patients with transfemoral gradients of MPOx and IL-6 > median had a more compromised coronary artery endothelial function (P < .05, for both). Furthermore, CAD+PAD patients with transfemoral gradients of neutrophil MPOx content > median showed an independent association with a greater number of significant coronary stenoses, and a greater prevalence of three-vessel CAD and previous MI (P < .01, for all). A more severe coronary atherosclerosis was observed also in CAD+PAD patients with transfemoral gradients of IL-6 > median vs those with IL-6 < median, although differences were not statistically significant. Conclusion: In CAD patients, the coexistence of PAD does not necessarily entail a more severe coronary atherosclerosis. Only those with an inflammatory status of the affected limb presents more severe CAD. Future studies will clarify whether the presence of peripheral inflammation plays a mechanistic role in CAD evolution. [Copyright &y& Elsevier]
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- 2009
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17. An active lifestyle improves outcome of primary angioplasty in elderly patients with acute myocardial infarction.
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Rengo, Giuseppe, Galasso, Gennaro, Piscione, Federico, Golino, Luca, Fortunato, Francesca, Zincarelli, Carmela, Cassese, Salvatore, Abete, Pasquale, Chiariello, Massimo, Rengo, Franco, and Leosco, Dario
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MYOCARDIAL infarction ,CORONARY disease ,CARDIOVASCULAR diseases ,MULTIVARIATE analysis - Abstract
Background: Regular physical activity has been shown to improve outcome of acute myocardial infarction (AMI) in the elderly population. The aim of this study was to evaluate whether the positive role of an active lifestyle on cardiac prognosis extends to elderly patients with AMI who undergo primary percutaneous transluminal coronary angioplasty (PTCA). Methods: We prospectively studied 180 patients with AMI aged ≥70 years and treated with primary PTCA. In all patients, physical activity levels before AMI were quantified by a score derived from the Physical Activity Scale for the Elderly (PASE). Cardiac deaths and nonfatal cardiac events were evaluated within 30 days and 1-year from primary PTCA. Results: A high PASE score was significantly associated with a strong reduction of 30-day cardiac deaths (from 23.1% to 4%; P for trend = .021) and overall nonfatal events (from 21.1% to 10%; P for trend = .01). Accordingly, at 1 year of follow-up, the incidence of cardiac mortality and nonfatal events significantly decreased with increasing PASE score (from 28.8% to 8% and from 55.7% to 14.5%, respectively). Logistic regression analysis indicated that physical activity before AMI was an independent predictor of increased survival in those patients that showed the highest PASE scores. In addition, at 6 months of follow-up, although low ejection fraction and recurrent angina strongly predicted 1-year mortality, high PASE scores still predicted a better outcome. Conclusions: Our data indicate that an active lifestyle may favorably affect early and late outcomes of primary PTCA in the elderly population. [Copyright &y& Elsevier]
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- 2007
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18. Thoracic aortic emergencies: impact of endovascular surgery.
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Iannelli, Gabriele, Piscione, Federico, Di Tommaso, Luigi, Monaco, Mario, Chiariello, Massimo, and Spampinato, Nicola
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AORTIC valve diseases ,TOMOGRAPHY ,ANGIOGRAPHY ,PATIENTS - Abstract
: BackgroundConventional surgery for thoracic aortic emergencies, such as contained or free rupture of thoracic aortic aneurysms, acute type B dissections, and traumatic rupture of the thoracic aorta, is frequently associated with a high rate of mortality and morbidity. To obviate this risk, endovascular surgery is considered to be a valid alternative procedure.: MethodsFrom March 2001 to July 2002, 15 of 22 patients with acute thoracic aortic syndromes were submitted to endovascular surgery: 3 patients (20%) for traumatic rupture, 4 patients (26.7%) for contained or free rupture of thoracic aortic aneurysm, and 8 patients (53.3%) for acute type B dissection evolving to rupture. Computed tomographic scan was diagnostic in all patients. The stent grafts were introduced through the femoral artery.: ResultsIn the endovascular group there were no perioperative deaths or open conversions. The intraoperative angiography and computed tomographic scan performed on discharge showed no significant endoleaks and successful sealing of the aortic dissection. Average intensive care unit and hospital stay was 1.7 ± 0.8 and 5.9 ± 3.0 days. Follow-up ranged between 4 and 23 months and included clinical examinations and serial computed tomographic scan at 3, 6, and 12 months, and every 6 months thereafter. One 84-year-old patient with thoracic aortic aneurysm died of pneumonia 78 days after endovascular surgery. Only one type 1 endoleak was noted in the first patient with traumatic rupture, 3 months after the procedure.: ConclusionsEndovascular surgery is a safe technique, showing encouraging early and midterm results and allowing for prompt treatment of associated lesions in complex multitrauma patients. [Copyright &y& Elsevier]
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- 2004
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19. Treatment of Residual Type A Aortic Dissection With Implantation of the Djumbodis System: Is Purely Endovascular Treatment Becoming a Reality?
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Iannelli, Gabriele, Tommaso, Luigi Di, Cirillo, Plinio, Smimmo, Raffaele, Piscione, Federico, and Vosa, Carlo
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Purpose To evaluate the usefulness of a new transfemoral device to avoid major complications related to residual type A aortic dissection following ascending aortic replacement.Case Reports Three men (aged 60, 61, and 72 years, respectively) with a residual type A aortic dissection following replacement of the ascending aorta 1, 4, and 5 years prior, respectively, were treated with the Djumbodis Dissection System. The residual dissection developed at the distal anastomosis of the aortic graft and involved all the aortic arch. The Djumbodis Dissection System is an uncovered steel stent, available in 3 lengths (40, 90, 140 mm), pre-mounted on a low pressure (0.3 bars) balloon catheter. The mesh of the device is sufficiently large to bring together the dissected layers without occluding main vital branches. The device was implanted through the femoral artery over a stiff guidewire to exclude the residual false lumen. Satisfactory aortic remodeling was documented in all cases at 1 year.Conclusion The Djumbodis Dissection System might be a purely endovascular treatment to replace open surgery for residual type A aortic dissection. More cases and longer follow-up are required.
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- 2011
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20. Immediate angioplasty versus standard therapy with rescue angioplasty after thrombolysis in the Combined Abciximab REteplase Stent Study in Acute Myocardial Infarction (CARESS-in-AMI): an open, prospective, randomised, multicentre trial
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Di Mario, Carlo, Dudek, Dariusz, Piscione, Federico, Mielecki, Waldemar, Savonitto, Stefano, Murena, Ernesto, Dimopoulos, Konstantinos, Manari, Antonio, Gaspardone, Achille, Ochala, Andrzej, Zmudka, Krzysztof, Bolognese, Leonardo, Steg, Philippe Gabriel, and Flather, Marcus
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- 2008
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21. Major complications following endovascular surgery of descending thoracic aorta.
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Di Tommaso, Luigi, Monaco, Mario, Mottola, Michele, Piscione, Federico, Pantaleo, Antonio, Pinna, Giovanni Battista, Stassano, Paolo, and Iannelli, Gabriele
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We evaluated the impact of major complications on clinical outcome in a series of patients undergoing endovascular repair (EVAR) of descending thoracic aorta. From March 2001 to June 2005, 51 patients underwent EVAR for descending aortic diseases. Thirty-five were treated in emergency (60.7%) and 41 (80.4%) were in III-IV ASA class. There were no deaths, surgical conversion or paraplegia. A neurologic complication occurred in one patient (1.9%). Eleven major systemic complications occurred in 5 patients. One patient showed a primary type I endoleak at discharge, resolved spontaneously after 9 months. Three (5.9%) vascular injuries occurred during the endovascular procedure, requiring an emergency rescue iliac-femoral artery bypass. At follow-up (29+/-14 months), there was an overall mortality rate of 5.1% (3/51); 2 deaths (3.9%) were procedure related. Two secondary EVARs (3.9%) were successfully performed, one for a late type I endoleak six months after EVAR in a traumatic patient, and a second for a late rupture distally to the stent-graft implanted 36 months before in an acute type-B dissected patient. EVAR for descending aortic diseases is associated with decreased mortality and complications, however, long-term follow-up and additional studies are mandatory to detect late failure and to confirm clinical safety of this procedure.
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- 2006
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22. Estimation of coronary flow reserve by Tc-99m sestamibi imaging in patients with coronary artery disease: Comparison with the results of intracoronary Doppler technique
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Storto, Giovanni, Cirillo, Plinio, Vicario, Maria Lucia Eufrasia, Pellegrino, Teresa, Sorrentino, Anna Rita, Petretta, Mario, Galasso, Gennaro, Sanctis, Valerio De, Piscione, Federico, and Cuocolo, Alberto
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Background: This study compared coronary flow reserve (CFR) estimated by technetium 99m sestamibi imaging with the results obtained with intracoronary Doppler in patients with coronary artery disease. Intraobserver and interobserver reproducibility of the radionuclide-estimated CFR was also assessed. Methods and Results: Fourteen consecutive patients (mean age, 54 ± 7 years) with documented coronary artery disease in whom percutaneous coronary intervention was planned underwent dipyridamole (0.74 mg/kg) sestamibi imaging and intracoronary Doppler within 5 days. Myocardial blood flow (MBF) was estimated by measurement of first transit counts in the pulmonary artery and myocardial counts from single photon emission computed tomography images. Estimated CFR was expressed as the ratio of stress MBF to rest MBF. In the study vessels, CFR was 1.36 ± 0.43 as estimated by sestamibi and 1.39 ± 0.42 by intracoronary Doppler (P= .69). A significant relationship between CFR estimated by sestamibi and CFR obtained by intracoronary Doppler was observed (r = 0.85, P< .001). On Bland-Altman analysis, the mean difference between CFR by sestamibi and by Doppler was 0.03 and the intraclass correlation coefficients for intraobserver and interobserver reproducibility were high (all P< .001) for both global and regional CFR. Conclusions: This study demonstrates a good agreement between CFR estimated by sestamibi imaging and by intracoronary Doppler results and a lack of intraobserver and interobserver variability of this noninvasive approach.
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- 2004
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23. Increased inflammatory status and higher prevalence of three-vessel coronary artery disease in patients with concomitant coronary and peripheral atherosclerosis
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Brevetti, Gregorio, Piscione, Federico, Silvestro, Antonio, Galasso, Gennaro, Di Donato, AnnaMaria, Oliva, Gabriella, Scopacasa, Francesco, and Chiariello, Massimo
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- 2003
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24. Relationship between contractile reserve, Tl-201 uptake, and collateral angiographic circulation in collateral-dependent myocardium: Implications regarding the evaluation of myocardial viability
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Piscione, Federico, De Luca, Giuseppe, Perrone-Filardi, Pasquale, Prastaro, Mariella, Pace, Leonardo, Galasso, Gennaro, Marrazzo, Gemma, Salvatore, Marco, and Chiariello, Massimo
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BackgroundThe aim of this study was to compare collateral angiographic circulation (CC), thallium 201 single photon emission computed tomography (SPECT), low-dose dobutamine echocardiography (LDDE), and their combination in identifying viable myocardium beyond a chronic occlusion.
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- 2003
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25. Relationship between contractile reserve, Tl-201 uptake, and collateral angiographic circulation in collateral-dependent myocardium: Implications regarding the evaluation of myocardial viability
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Piscione, Federico, De Luca, Giuseppe, Perrone-Filardi, Pasquale, Prastaro, Mariella, Pace, Leonardo, Galasso, Gennaro, Marrazzo, Gemma, Salvatore, Marco, and Chiariello, Massimo
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Background.The aim of this study was to compare collateral angiographic circulation (CC), thallium 201 single photon emission computed tomography (SPECT), low-dose dobutamine echocardiography (LDDE), and their combination in identifying viable myocardium beyond a chronic occlusion. Methods and Results.We studied 33 consecutive patients with a chronic occluded coronary artery and regional ventricular dysfunction who underwent dobutamine infusion (5–10 μg · kg–1· min–1), Tl-201 SPECT, and coronary revascularization (15 patients underwent coronary artery bypass grafting and 18 patients percutaneous transluminal coronary angioplasty). Echocardiography and Tl-201 SPECT at rest were repeated 90 ± 48 days after revascularization. For viability assessment, Tl-201 SPECT showed the best sensitivity and accuracy (77% and 72%, respectively) compared with LDDE (64% and 63%, respectively) and CC (74% and 55%, P< .05 vs Tl-201 SPECT). Specificity was significantly better for both Tl-201 SPECT (65%) and LDDE (62%) compared with collateral circulation (27%, P< .001 vs Tl-201 SPECT and LDDE). Furthermore, combined Tl-201 SPECT and LDDE data improved specificity (from 88% to 92%) and positive predictive power (from 75% to 78%) but not global accuracy. A direct relationship between the number of viable segments and global functional recovery after revascularization was found only in the case of Tl-201 SPECT (r= 0.48, P= .04). Conclusions.This study demonstrates that CC has a very low specificity in the evaluation of viability in collateral-dependent myocardium and that LDDE has a very low sensitivity, whereas Tl-201 SPECT is the most reliable method, particularly in akinetic segments, and optimally identifies patients who will mostly benefit from revascularization in terms of ventricular functional improvement. No additional advantages in terms of accuracy were found when Tl-201 SPECT and LDDE data were combined.
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- 2003
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26. Immediate and Long‐Term Outcome of Recanalization of Chronic Total Coronary Occlusions
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PISCIONE, FEDERICO, GALASSO, GENNARO, MAIONE, ANTON GIULIO, PISANI, ALFONSO, GOLINO, PAOLO, LEOSCO, DARIO, and CHIARIELLO, MASSIMO
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Eighty‐three consecutive patients with 85 coronary total occlusions undergoing coronary angioplasty were retrospectively studied. Patients were divided into two groups according to the occlusion age that was<30 days (subacute total occlusion [STO]: 25 patients; range 1–30 days) or>30 days (chronic total occlusion [CTO]: 58 patients; range 3–144 months). All procedures were carried out using a hydrophilic guidewire. Clinical success, consisting of crossing the lesion, balloon dilatation, stent deployment without complication, was 96% in STO and 81% in CTO. Multiple stepwise logistic regression analysis identified a family history of coronary artery disease (CAD), left anterior descending and right coronary artery occlusions as independent predictors of a successful procedure. No major events occurred during or immediately after the angioplasty. After a mean follow‐up of 24 ± 2 months, no difference was found in survival or freedom from myocardial infarction or target vessel revascularization among the STO and CTO patients. Successful recanalization by using a hydrophilic guidewire was achieved in a high percentage of chronic total occlusions with a low incidence of complications and a satisfactory late clinical outcome. Family history of CAD and occlusion of left anterior descending or right coronary arteries are independent predictors of procedural success.
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- 2002
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27. Prediction of long-term effects of revascularization on regional and global left ventricular function by dobutamine echocardiography and rest Tl-201 imaging alone and in combination in patients with chronic coronary artery disease
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Dellegrottaglie, Santo, Perrone-Filardi, Pasquale, Pace, Leonardo, Prastaro, Mariella, Morte, Anna Maria Della, Ponticelli, Maria Paola, Piscione, Federico, Storto, Giovanni, Luca, Giuseppe De, Salvatore, Marco, and Chiariello, Massimo
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Background: The aim of this study was to evaluate the accuracy of low-dose dobutamine echocardiography (DE) and resting thallium 201 single photon emission computed tomography (SPECT) alone and in combination for prediction of functional recovery at late follow-up (1 year) after revascularization. Methods and Results: Twenty-six patients with coronary artery disease and ventricular dysfunction (ejection fraction, 42% ± 9%) underwent DE and Tl-201 SPECT 14 ± 9 (mean ± SD) days before revascularization and repeated echocardiography 12 ± 5 months thereafter. Discriminant analysis was applied to combine Tl-201 SPECT and DE data to classify dysfunctional segments as viable or nonviable. In 78 akinetic/dyskinetic revascularized segments, Tl-201 SPECT provided a sensitivity of 83% and a specificity of 55%, whereas DE showed a sensitivity of 60% and a specificity of 91%, for prediction of improvement in regional function at follow-up. The combination of data through use of discriminant analysis provided a sensitivity of 80% and a specificity of 86%, with an overall accuracy of 82%, significantly higher than DE (71%; P < .05) and Tl-201 SPECT (73%; P < .05) alone. Moreover, discriminant analysis identified 12 (75%) of 16 patients with and 8 (80%) of 10 patients without significant improvement in ejection fraction at follow-up, with an accuracy of 77%. Conclusions: The combination of Tl-201 SPECT and DE data provides higher accuracy than either technique alone for prediction of recovery of regional and global function after revascularization.
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- 2002
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28. Prediction of long-term effects of revascularization on regional and global left ventricular function by dobutamine echocardiography and rest Tl-201 imaging alone and in combination in patients with chronic coronary artery disease
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Dellegrottaglie, Santo, Perrone-Filardi, Pasquale, Pace, Leonardo, Prastaro, Mariella, Della Morte, Anna Maria, Ponticelli, Maria Paola, Piscione, Federico, Storto, Giovanni, De Luca, Giuseppe, Salvatore, Marco, and Chiariello, Massimo
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Background.The aim of this study was to evaluate the accuracy of low-dose dobutamine echocardiography (DE) and resting thallium 201 single photon emission computed tomography (SPECT) alone and in combination for prediction of functional recovery at late follow-up (1 year) after revascularization. Methods and Results.Twenty-six patients with coronary artery disease and ventricular dysfunction (ejection fraction, 42% ± 9%) underwent DE and Tl-201 SPECT 14 ± 9 (mean ± SD) days before revascularization and repeated echocardiography 12 ± 5 months thereafter. Discriminant analysis was applied to combine Tl-201 SPECT and DE data to classify dysfunctional segments as viable or nonviable. In 78 akinetic/dyskinetic revascularized segments, Tl-201 SPECT provided a sensitivity of 83% and a specificity of 55%, whereas DE showed a sensitivity of 60% and a specificity of 91%, for prediction of improvement in regional function at follow-up. The combination of data through use of discriminant analysis provided a sensitivity of 80% and a specificity of 86%, with an overall accuracy of 82%, significantly higher than DE (71%; P< .05) and Tl-201 SPECT (73%; P< .05) alone. Moreover, discriminant analysis identified 12 (75%) of 16 patients with and 8 (80%) of 10 patients without significant improvement in ejection fraction at follow-up, with an accuracy of 77%. Conclusions.The combination of Tl-201 SPECT and DE data provides higher accuracy than either technique alone for prediction of recovery of regional and global function after revascularization. (J Nucl Cardiol 2002;9:174-82.)
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- 2002
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29. Diagnostic accuracy of low-dose dobutamine echocardiography in predicting post-revascularisation recovery of function in patients with chronic coronary artery disease: relationship to thallium-201 uptake
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Pace, Leonardo, Filardi, Pasquale, Cuocolo, Alberto, Prastaro, Mariella, Acampa, Wanda, Dellegrottaglie, Santo, Storto, Giovanni, Morte, Anna, Piscione, Federico, Chiariello, Massimo, and Salvatore, Marco
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It is known that contractile reserve may be blunted if perfusion and coronary flow reserve are reduced. Thus, it is conceivable that the predictive accuracy of dobutamine echocardiography may differ according to perfusion tracer uptake. The aim of this study was therefore to assess the relationship between the level of thallium-201 uptake and the accuracy of dobutamine echocardiography in identifying reversible dysfunction. Sixty-nine patients (age 59±8 years, ejection fraction 40%±11%) with chronic coronary artery disease scheduled for coronary revascularisation were studied. All patients underwent rest 201Tl single-photon emission tomography and two-dimensional echocardiography at rest and during low-dose dobutamine infusion on the same day before revascularisation and repeated echocardiography at least 30 days thereafter. At follow-up, recovery of function was observed in 49% of 339 dysfunctional segments. The percentage of segments with post-revascularisation recovery of function and the percentage with contractile reserve increased in parallel with 201Tl uptake both in the total group of segments (?2=35.5, P<0.0001 and ?2=35.9, P<0.0001, respectively) and among the 183 akinetic segments (?2=44.4, P<0.0001 and ?2=14.6, P<0.05, respectively). The dysfunctional segments were divided into three groups according to 201Tl uptake: (a) uptake <65%, (b) uptake between 65% and 79%, (c) uptake >80%. The positive predictive value increased significantly with the level of 201Tl uptake, and was suboptimal (46%) in akinetic segments with severely reduced 201Tl uptake. The negative predictive value decreased significantly with 201Tl uptake, and it was less than suboptimal (29%) in akinetic segments with normal tracer uptake. Sensitivity was lower in the subset of akinetic segments (42%–63%) than in all dyssynergic segments (63%–76%), whereas specificity was very high in akinetic segments (80%–84%). It is concluded that the accuracy of low-dose dobutamine echocardiography in predicting reversibility of regional dysfunction varies considerably according to 201Tl uptake at rest and to the severity of regional dysfunction.
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- 2001
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30. Prediction of improvement in global left ventricular function in patients with chronic coronary artery disease and impaired left ventricular function: rest thallium-201 SPET versus low-dose dobutamine echocardiography
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Pace, Leonardo, Perrone-Filardi, Pasquale, Storto, Giovanni, Della Morte, Anna Maria, Dellegrottaglie, Santo, Prastaro, Mariella, Crisci, Teresa, Ponticelli, Maria Paola, Piscione, Federico, Chiariello, Massimo, and Salvatore, Marco
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Accurate assessment of myocardial viability permits selection of patients who would benefit from myocardial revascularization. Currently, rest-redistribution thallium-201 scintigraphy and low-dose dobutamine echocardiography are among the most used techniques for the identification of viable myocardium. Thirty-one consecutive patients (all men, mean age 60±8 years) with chronic coronary artery disease and reduced left ventricular ejection fraction (31%±7%) were studied. Rest 201Tl single-photon emission tomography (SPET), low-dose dobutamine echocardiography and radionuclide angiography were performed before revascularization. Radionuclide angiography and echocardiography were repeated after revascularization. An a/dyskinetic segment was considered viable on 201Tl SPET when tracer uptake was >65%, while improvement on low-dose dobutamine echocardiography was considered a marker of viability. Increase in global ejection fraction was considered significant at ≥5%. In identifying viable segments, rest 201Tl SPET showed higher sensitivity than low-dose dobutamine echocardiography (72% vs 53%,P<0.05), while specificity was not significantly different (86% vs 88%). In 17 patients, global ejection fraction increased ≥5% (group 1) while in 14 it did not (group 2). A higher number of a/dyskinetic segments were viable on 201Tl SPET in group 1 than in group 2 (2.6±1.9 vs 0.6±1.2,P<0.005), while no significant differences were observed on low-dose dobutamine echocardiography (1.7±1.6 vs 1.1±1.6). A significant correlation was found between the number of a/dyskinetic segments viable on 201Tl SPET and post-revascularization changes in ejection fraction (r=0.52,P<0.05), but such a correlation was not observed for low-dose dobutamine echocardiography. Using as the cut-off the presence of at least one viable a/dyskinetic segment, rest 201Tl SPET had a higher sensitivity (82% vs 53%,P=0.07) and showed a trend towards higher accuracy and specificity (77% vs 58%, and 71% vs 64%, respectively) as compared with low-dose dobutamine echocardiography. In conclusion, these findings suggest that when severely reduced global function is present, rest 201Tl SPET evaluation of viability is more accurate than low-dose dobutamine echocardiography for the identification of patients who will benefit most from revascularization.
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- 2000
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31. BAG3 Protein in Advanced-Stage Heart Failure
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De Marco, Margot, D’Auria, Raffaella, Rosati, Alessandra, Vitulano, Gennaro, Gigantino, Alberto, Citro, Rodolfo, Piscione, Federico, Zilinski, Jodi, Januzzi, James L., and Turco, Maria Caterina
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- 2014
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32. Multi-slice computed tomography assessment of stent position in a patient with acute coronary syndrome and anomalous origin of the coronary arteries.
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CIRILLO, PLINIO, PETRILLO, GIANLUCA, PICCOLO, RAFFAELE, MESSALLI, GIANCARLO, ZIVIELLO, FRANCESCA, BEVILACQUA, MICHELE, SALVATORE, MARCO, PISCIONE, FEDERICO, and TRIMARCO, BRUNO
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- 2013
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33. Complicated acute type B aortic dissection involving the arch: Treatment by simultaneous hybrid approach under local anesthesia.
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Iannelli, Gabriele, Monaco, Mario, Di Tommaso, Luigi, and Piscione, Federico
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- 2008
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34. Effect of a single oral dose of milrinone on left ventricular diastolic performance in the failing human heart
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Piscione, Federico, Jaski, Brian E., Wenting, Gert J., and Serruys, Patrick W.
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In 14 patients with severe congestive heart failure, left ventricular pressure (measured by tip manometer) and derived variables were measured before and every 10 minutes after administration of oral milrinone (10 mg) for 50 minutes along with measurements of coronary sinus blood flow and drug plasma levels. Arterial and coronary sinus catecholamines were measured only before and 50 minutes after milrinone. Left ventricular pressure, volume (as determined by angiography) and derived indexes were simultaneously assessed at matched atrial paced heart rate before and 60 minutes after milrinone. Three patients who did not achieve a therapeutic plasma level (<150 ng/ml) were excluded.
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- 1987
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35. Combined evaluation of rest-redistribution thallium-201 tomography and low-dose dobutamine echocardiography enhances the identification of viable myocardium in patients with chronic coronary artery disease
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Pace, Leonardo, Perrone-Filardi, Pasquale, Mainenti, PierPaolo, Prastaro, Mariella, Vezzuto, Pasquale, Varrone, Andrea, Crisci, Teresa, Cuocolo, Alberto, Dellegrottaglie, Santo, Piscione, Federico, Chiariello, Massimo, and Salvatore, Marco
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Abstract.: The purpose of this study was to evaluate whether combined evaluation by discriminant analysis of rest-redistribution thallium-201 tomography and low-dose dobutamine echocardiography enhances the accuracy in identifying viable myocardium in patients with chronic coronary artery disease. Rest-redistribution
201 Tl has high sensitivity but low specificity in identifying viable myocardium, while the opposite is true for low-dose dobutamine echocardiography. Forty-six patients underwent low-dose dobutamine echocardiography and rest-redistribution201 Tl tomography on the same day. Rest echocardiography was repeated at least 30 days (mean 40±20) after myocardial revascularization. Discriminant analysis was applied to the results of201 Tl tomography and dobutamine echocardiography to classify a/dyskinetic segments as viable or non-viable. In 92 a/dyskinetic segments that were revascularized, rest-redistribution201 Tl tomography yielded an accuracy of 75%, while the accuracy of dobutamine echocardiography was 70% (P<0.05). When discriminant analysis was used, the combined evaluation gave an accuracy of 83% (P<0.05 vs both tests). These findings demonstrate that low-dose dobutamine echocardiography and201 Tl imaging are useful and complementary techniques for identifying viable myocardium in patients with chronic coronary artery disease. Combined evaluation by discriminant analysis significantly improves accuracy, although the cost-effectiveness of such an approach remains to be determined.- Published
- 1998
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36. Effects of induced asynchrony on left ventricular diastolic function in patients with coronary artery disease
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Betocchi, Sandro, Piscione, Federico, Villari, Bruno, Pace, Leonardo, Ciarmiello, Andrea, Perrone-Filardi, Pasquale, Salvatore, Carmen, Salvatore, Marco, and Chiariello, Massimo
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Objectives. This study was designed to increase asynchrony with sequential atrioventricular (AV) pacing and to study its effects on left ventricular isovolumetric relaxation, rapid filling and stiffness.
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- 1993
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37. Effects of myocardial revascularization on regional thallium-201 uptake and systolic function in regions with reverse redistribution on tomographic thallium-201 imaging at rest in patients with chronic coronary artery disease
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Pace, Leonardo, Perrone-Filardi, Pasquale, Mainenti, Pier Paolo, Prastaro, Mariella, Cuocolo, Alberto, Varrone, Andrea, Vezzuto, Pasquale, Crisci, Teresa, Soricelli, Andrea, Piscione, Federico, Chiariello, Massimo, and Salvatore, Marco
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Objectives: There is growing evidence that myocardial segments with reverse redistribution are viable in patients with chronic coronary artery disease. The aim of this study was to assess the effects of myocardial revascularization on systolic function and thallium-201 uptake in such segments. Methods: Rest-redistribution thallium-201 tomography before and after myocardial revascularization was performed in 47 patients with chronic coronary artery disease. Regional function was evaluated by two-dimensional echocardiography before and after revascularization according to a 3-point scale (1=normal, 2=hypokinetic, 3=a/dyskinetic). Improvement of dysfunctional segments was defined when systolic function score decreased ≥1 after revascularization. Reverse redistribution was defined as ≥8% decrease in relative thallium-201 uptake between rest and redistribution images. Results: Reverse redistribution was found in 27 (57%) of 47 patients, corresponding to 60 (11%) of 564 myocardial segments. Of such segments, 24 (40%) had normal systolic function, 19 (32%) were hypokinetic, and 17 (28%) were a/dyskinetic. Thirty-six segments underwent myocardial revascularization, and reverse redistribution was no longer present in 86% of them subsequent to the procedure. Of 26 dyssynergic segments with reverse redistribution subjected to revascularization, 18 (69%) improved at follow-up. Conclusions: The findings of the present study indicate that reverse redistribution is a reversible phenomenon and is often associated with improvement of systolic function following revascularization in patients with chronic coronary artery disease.
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- 1998
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38. Influence of reversible segmental left ventricular dysfunction on heart period variability in patients with one-vessel coronary aetery disease
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Bonaduce, Domenico, Petretta, Mario, Piscione, Federico, Indolfi, Ciro, Migaux, Marie Louise, Bianchi, Valter, Esposito, Nicola, Marciano, Fortunato, and Chiariello, Massimo
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Objectives. This study evaluated the relation between reversible segmental left ventricular dysfunction and frequency domain measures of heart period variability in patients with coronary artery disease.
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- 1994
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39. Assessment of Left Ventricular Function Using Radionuclide Angiography After Dipyridamole Infusion
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Indolfi, Ciro, Betocchi, Sandro, Piscione, Federico, Perrone-Filardi, Pasquale, Salvatore, Marco, and Chiariello, Massimo
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Thirty-six patients with significant coronary artery stenosis and no previous myocardial infarction and 25 subjects with normal coronary arteries underwent 99mTc RNV before and after coronary vasodilatation induced by dipyridamole, 0.75 mg/kg, given IV over 10 min. In subjects with normal coronary arteries, dipyridamole induced an increase in LVEF (from 66±8 to 76±8 percent; mean±SD; p<0.001); in patients with significant coronary artery stenosis (≥75 percent narrowing of at least one major vessel), dipyridamole injection did not affect LVEF (from 63±12 to 62±12 percent). In ten patients a complete, successful PTCA was performed and the RNV with the dipyridamole test repeated. The EF did not change with the dipyridamole test before PTCA (63±7 to 65±9 percent), but increased significantly after PTCA (62±11 to 70±9 percent; p<0.01). Sensitivity and specificity of EF changes after dipyridamole infusion were 75 and 76 percent, respectively. The test produced no major side effects or complications. Radionuclide angiography with dipyridamole helps to detect coronary artery stenosis and might be used to assess the effects of angioplasty on coronary flow reserve.
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- 1989
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40. Independent Impact of RV Involvement on In-Hospital Outcome of Patients With Takotsubo Syndrome.
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Citro, Rodolfo, Bossone, Eduardo, Parodi, Guido, Rigo, Fausto, Nardi, Federico, Provenza, Gennaro, Zito, Concetta, Novo, Giuseppina, Vitale, Giovanni, Prota, Costantina, Silverio, Angelo, Vriz, Olga, D’Andrea, Antonello, Antonini-Canterin, Francesco, Salerno-Uriarte, Jorge, and Piscione, Federico
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- 2016
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41. Stress-induced cardiomyopathy in pheochromocytoma: the way we treat and the way we think.
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Di Maio, Marco, Polito, Maria Vincenza, Citro, Rodolfo, and Piscione, Federico
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- 2014
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42. Reply: Complexity of Assessment and Management of Tako-Tsubo Cardiomyopathy.
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Citro, Rodolfo, Salerno-Uriarte, Jorge, Rigo, Fausto, Parodi, Guido, Ciampi, Quirino, Antonini-Canterin, Francesco, Bossone, Eduardo, and Piscione, Federico
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- 2014
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43. Reply: What Truly Causes the Adverse Outcome in Tako-Tsubo Cardiomyopathy?
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Citro, Rodolfo, Salerno-Uriarte, Jorge, Rigo, Fausto, Parodi, Guido, Ciampi, Quirino, Antonini-Canterin, Francesco, Bossone, Eduardo, and Piscione, Federico
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- 2014
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44. A peculiar etiology of acute heart failure: adrenergic myocarditis.
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Polito, Maria Vincenza, Ravera, Amelia, Silverio, Angelo, Prota, Costantina, Lambiase, Catello, Dellegrottaglie, Santo, Ascoli, Roberto, Farina, Rosario, Citro, Rodolfo, and Piscione, Federico
- Abstract
Pheochromocytoma can occur with a variety of cardiovascular signs and symptoms, and this tumor can also precipitate an acute heart failure associated with the typical clinical and instrumental findings of myocarditis. This peculiar etiology of acute myocarditis, known as “adrenergic myocarditis,” should be suspected when specific “red flags” of pheochromocytoma such as headache, palpitations, diaphoresis, hypertension, orthostatic hypotension, and left ventricular dysfunction suggesting Takotsubo syndrome are detected. In fact, its diagnosis allows a specific targeted therapy. [ABSTRACT FROM AUTHOR]
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- 2015
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45. CRT-103 NSTEMI In Elderly Patients Treated With Early Revascularization: Long-term Outcome.
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D' Anna, Carolina, Piscione, Federico, De Luca, Giuseppe, Rapacciuolo, Antonio, Esposito, Giovanni, Cirillo, Plinio, Luciano, Rossella, De Biase, Chiara, Trimarco, Bruno, and Galasso, Gennaro
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- 2015
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46. Routine invasive management early after fibrinolysis: Relationship between baseline risk and treatment effects in a pooled patient-level analysis of 7 randomized controlled trials.
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Bagai, Akshay, Tan, Mary, Di Mario, Carlo, Halvorsen, Sigrun, Cantor, Warren J., Le May, Michel R., Fernandez-Aviles, Francisco, Scheller, Bruno, Armstrong, Paul W., Borgia, Francesco, Piscione, Federico, Sánchez, Pedro L., Westerhout, Cynthia M., Goodman, Shaun G., and Yan, Andrew T.
- Abstract
Background The efficacy of a routine invasive strategy early after fibrinolysis in relation to baseline risk status is unclear. We sought to characterize the interaction between patient risk and treatment with routine invasive strategy early after fibrinolysis for ST-segment elevation myocardial infarction. Methods We pooled 2,974 patients from 7 randomized trials of fibrinolysis-treated patients with ST-segment elevation myocardial infarction comparing a routine early invasive strategy with a standard approach of percutaneous coronary intervention (PCI) guided by recurrent ischemia or need for rescue. Cox proportional hazards regression was used to examine the interaction between baseline patient risk classified by Thrombolysis in Myocardial Infarction risk score (low/intermediate: ≤5 [n = 2,697] vs high: >5 [n = 277]) and treatment with routine early invasive strategy. Results Time to PCI after fibrinolysis was longer among patients randomized to standard treatment compared with routine early invasive strategy in the low/intermediate-risk strata (median 11.4 vs 3.5 hours), but was only marginally different between the 2 groups in the high-risk strata (median 4.1 vs 3.5 hours). There was a significant interaction between treatment assignment and risk status for the composite of 30-day death or reinfarction ( P = .01). Compared with standard treatment, routine early invasive strategy was associated with lower 30-day death/reinfarction in the low/intermediate-risk stratum (7.5% vs 4.0%, P < .001), but not in the high-risk stratum (14.9% vs 19.6%, P = .45). Conclusions Although clearly beneficial among the larger subgroup of patients at low/intermediate risk, the benefit of a routine early invasive strategy was not evident in the smaller subgroup of higher-risk patients in the context of an increased requirement for urgent PCI in the comparative standard treatment arm. [ABSTRACT FROM AUTHOR]
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- 2014
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47. Assessing the role of eptifibatide in patients with diffuse coronary disease undergoing drug-eluting stenting: The INtegrilin plus STenting to Avoid myocardial Necrosis Trial.
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Biondi-Zoccai, Giuseppe, Valgimigli, Marco, Margheri, Massimo, Marzocchi, Antonio, Lettieri, Corrado, Stabile, Amerigo, Petronio, A. Sonia, Binetti, Giorgio, Bolognese, Leonardo, Bellone, Pietro, Sardella, Gennaro, Contarini, Marco, Sheiban, Imad, Marra, Sebastiano, Piscione, Federico, Romeo, Francesco, Colombo, Antonio, and Sangiorgi, Giuseppe
- Abstract
Background: The optimal antiplatelet regimen in elective patients undergoing complex percutaneous coronary interventions (PCIs) is uncertain. We aimed to assess the impact of glycoprotein IIb/IIIa (GpIIb/IIIa) inhibition with eptifibatide in clinically stable subjects with diffuse coronary lesions. Methods: Patients with stable coronary artery disease undergoing PCI by means of implantation of >33 mm of drug-eluting stent were single-blindedly randomized to heparin plus eptifibatide versus heparin alone. The primary end point was the rate of abnormal post-PCI creatine kinase–MB mass values. Secondary end points were major adverse cardiovascular events (MACEs) (ie, cardiac death, myocardial infarction, or urgent revascularization) and MACE plus bailout GpIIb/IIIa inhibitor use. Results: The study was stopped for slow enrollment and funding issues after including a total of 91 patients: 44 were randomized to heparin plus eptifibatide, and 47, to heparin alone. Analysis for the primary end point showed a trend toward lower rates of abnormal post-PCI creatine kinase–MB mass values in the heparin-plus-eptifibatide group (18 [41%]) versus the heparin-alone group (26 [55%], relative risk 0.74 [95% CI 0.48-1.15], P = .169). Similar nonstatistically significant trends were found for rates of MACE, their components, or MACE plus bailout GpIIb/IIIa inhibitors (all P > .05). Notably, heparin plus eptifibatide proved remarkably safe because major bleedings or minor bleeding was uncommon and nonsignificantly different in both groups (all P > .05). Conclusions: Given its lack of statistical power, the INSTANT study cannot definitively provide evidence against or in favor of routine eptifibatide administration in stable patients undergoing implantation of multiple drug-eluting stent for diffuse coronary disease. However, the favorable trend evident for the primary end point warrants further larger randomized studies. [ABSTRACT FROM AUTHOR]
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- 2012
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48. CARESS-in-AMI study – Authors' reply
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Mario, Carlo Di, Piscione, Federico, Gaspardone, Achille, Bolognese, Leonardo, and Steg, Gabriel
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- 2008
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49. Dual Chamber Pacing in Hypertrophic Cardiomyopathy: Influence of Atrioventricular Delay on Left Ventricular Outflow Tract Obstruction
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Losi, Maria-Angela, Betocchi, Sandro, Briguori, Carlo, Piscione, Federico, Manganelli, Fiore, Ciampi, Quirino, Stabile, Giuseppe, and Chiariello, Massimo
- Abstract
AbstractThe impact of the duration of atrioventricular (AV) delay on obstruction in hypertrophic cardiomyopathy was evaluated in 12 patients by cardiac catheterization, and in 8 of them also by Doppler echocardiography. The AV delay was programmed in random order at 125, 100 and 75 ms in the invasive study and at 120, 100 and 80 ms after pacemaker implantation. The arterial pressure did not changed throughout the studies, whereas the gradient decreased significantly by reducing the AV delay value; the greater gradient reduction was obtained, in both studies, with the AV delay set between 75 or 80 and 100 ms. QRS duration increased significantly by reducing the AV delay during both studies. The widest QRS was not associated with the smallest gradient in all patients. Changes in gradients were similar during the invasive and noninvasive protocols.
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- 1997
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50. Evidence against significant Alpha2 postsynaptic coronary vasoconstruction in resting man
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Indolfi, Ciro, Piscione, Federico, Guth, Brian D., Golino, Paolo, Villari, Bruno, Focaocio, Amelia, and Chiariello, Massimo
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- 1990
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