156 results on '"Federico Lombardi"'
Search Results
2. Evaluation of the Switch From Amiodarone to Dronedarone in Patients With Atrial Fibrillation: Results of the ARTEMIS AF Studies
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Federico Lombardi, Deepak L. Bhatt, Jean-Marie Martinez, Juan Tamargo, Gerald V. Naccarelli, Jean-Yves Le Heuzey, A. John Camm, Artemis Af Investigators, and Lisa Naditch-Brûlé
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Male ,medicine.medical_specialty ,Amiodarone ,dronedarone ,Recurrence ,Internal medicine ,Clinical Studies ,Atrial Fibrillation ,medicine ,Humans ,Pharmacology (medical) ,In patient ,Prospective Studies ,antiarrhythmic drug therapy ,Aged ,Pharmacology ,Drug Substitution ,business.industry ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Dronedarone ,Treatment Outcome ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents ,medicine.drug - Abstract
Background: Switching between antiarrhythmic drugs is timed to minimize arrhythmia recurrence and adverse reactions. Dronedarone and amiodarone have similar electrophysiological profiles; however, little is known about the optimal timing of switching, given the long half-life of amiodarone. Methods: The ARTEMIS atrial fibrillation (AF) Loading and Long-term studies evaluated switching patients with paroxysmal/persistent AF from amiodarone to dronedarone. Patients were randomized based on the timing of the switch: immediate, after a 2-week, or after a 4-week washout of amiodarone. Patients who did not convert to sinus rhythm after amiodarone loading underwent electrical cardioversion. The primary objectives were, for the Loading study, to evaluate recurrence of AF ≤60 days; and for the Long-term study, to profile the pharmacokinetics of dronedarone and its metabolite according to different timings of dronedarone initiation. Results: In ARTEMIS AF Loading, 176 were randomized (planned 768) after a 28 ± 2 days load of oral amiodarone. Atrial fibrillation recurrence trended less in the immediate switch versus 4-week washout group (hazard ratio [HR] = 0.65 [97.5% CI: 0.34-1.23]; P = .14) and in the 2-week washout versus the 4-week washout group (HR = 0.75 [97.5% CI: 0.41-1.37]; P = .32). In ARTEMIS AF Long-term, 108 patients were randomized (planned 105). Pharmacokinetic analyses (n = 97) showed no significant differences for dronedarone/SR35021 exposures in the 3 groups. Conclusion: The trial was terminated early due to poor recruitment and so our findings are limited by low numbers. However, immediate switching from amiodarone to dronedarone appeared to be well tolerated and safe.
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- 2020
3. Diastolic stress test in heart failure with preserved ejection fraction
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Ciro Canetta, Lara Tondi, Federico Lombardi, Kameswari Maganti, G Malanchini, Michele M. Ciulla, Elisa Gherbesi, and Fabiola B. Sozzi
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Heart Failure, Diastolic ,medicine.medical_specialty ,Epidemiology ,business.industry ,Diastole ,Stroke Volume ,Echocardiography, Doppler ,Dyspnea ,Stress test ,Internal medicine ,Exercise Test ,Cardiology ,Humans ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Heart failure with preserved ejection fraction ,Algorithms ,Biomarkers - Published
- 2020
4. Cardiopulmonary exercise testing in a combined screening approach to individuate pulmonary arterial hypertension in systemic sclerosis
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Marco Vicenzi, Alessandro Santaniello, Lorenzo Beretta, Rosa Casella, Maria De Santis, Gaia Montanelli, Chiara Bellocchi, Federico Lombardi, and Irene Rota
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Male ,medicine.medical_specialty ,Cardiac Catheterization ,systemic sclerosis ,Carbon dioxide production ,030204 cardiovascular system & hematology ,Systemic scleroderma ,Sensitivity and Specificity ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Interquartile range ,Predictive Value of Tests ,Internal medicine ,medicine ,cardiopulmonary exercise testing ,Humans ,Mass Screening ,Pharmacology (medical) ,Aged ,030203 arthritis & rheumatology ,Carbon Monoxide ,Pulmonary Arterial Hypertension ,Scleroderma, Systemic ,business.industry ,Pulmonary Gas Exchange ,screening ,Cardiopulmonary exercise testing ,Exploratory analysis ,Clinical Science ,Middle Aged ,medicine.disease ,Predictive value ,Pulmonary hypertension ,Echocardiography, Doppler ,Respiratory Function Tests ,Breath Tests ,Cardiology ,Exercise Test ,Pulmonary Diffusing Capacity ,Female ,business ,Respiratory minute volume ,Algorithms - Abstract
Objectives The DETECT algorithm has been developed to identify SSc patients at risk for pulmonary arterial hypertension (PAH) yielding high sensitivity but low specificity, and positive predictive value. We tested whether cardiopulmonary exercise testing (CPET) could improve the performance of the DETECT screening strategy. Methods Consecutive SSc patients over a 30-month period were screened with the DETECT algorithm and positive subjects were referred for CPET before the execution of right-heart catheterization. The predictive performance of CPET on top of DETECT was evaluated and internally validated via bootstrap replicates. Results Out of 314 patients, 96 satisfied the DETECT application criteria and 54 were positive. PAH was ascertained in 17 (31.5%) and pre-capillary pulmonary hypertension in 23 (42.6%) patients. Within CPET variables, the slope of the minute ventilation to carbon dioxide production relationship (VE/VCO2 slope) had the best performance to predict PAH at right-heart catheterization [median (interquartile range) of specificity 0.778 (0.714–0.846), positive predictive value 0.636 (0.556–0.750)]; exploratory analysis on pre-capillary yielded a specificity of 0.714 (0.636–0.8) and positive predictive value of 0.714 (0.636–0.8). Conclusion In association with the DETECT algorithm, CPET may be considered as a useful tool in the workup of SSc-related pulmonary hypertension. The sequential determination of the VE/VCO2 slope in DETECT-positive subjects may reduce the number of unnecessary invasive procedures without any loss in the capability to capture PAH. This strategy had also a remarkable performance in highlighting the presence of pre-capillary pulmonary hypertension.
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- 2019
5. Autonomic function in amnestic and non-amnestic mild cognitive impairment: spectral heart rate variability analysis provides evidence for a brain–heart axis
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Federico Lombardi, Silvia Inglese, Daniela Mari, Emanuele Tomasini, Laura Bertagnoli, Paolo Dionigi Rossi, Carlo Abbate, and Paola Nicolini
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0301 basic medicine ,Male ,Cerebrovascular disorders ,Physiology ,Disease ,Electrocardiography - EKG ,Neuropsychological Tests ,Hippocampus ,Severity of Illness Index ,Orthostatic vital signs ,Executive Function ,0302 clinical medicine ,Heart Rate ,Medicine ,Heart rate variability ,Psychology ,Attention ,Cognitive impairment ,Postural Balance ,Aged, 80 and over ,Cerebral Cortex ,Multidisciplinary ,Cognitive ageing ,Cognition ,Heart ,Alzheimer's disease ,Electrophysiology ,Neurology ,Cardiology ,Female ,medicine.symptom ,medicine.medical_specialty ,Science ,Neurophysiology ,Neuroimaging ,Brain damage ,Autonomic Nervous System ,behavioral disciplines and activities ,Dizziness ,Article ,03 medical and health sciences ,Atrophy ,Memory ,Internal medicine ,mental disorders ,Humans ,Cognitive Dysfunction ,Aged ,business.industry ,Cognitive neuroscience ,medicine.disease ,030104 developmental biology ,Cross-Sectional Studies ,Amnesia ,business ,030217 neurology & neurosurgery - Abstract
Mild cognitive impairment (MCI) is a heterogeneous syndrome with two main clinical subtypes, amnestic (aMCI) and non-amnestic (naMCI). The analysis of heart rate variability (HRV) is a tool to assess autonomic function. Cognitive and autonomic processes are linked via the central autonomic network. Autonomic dysfunction entails several adverse outcomes. However, very few studies have investigated autonomic function in MCI and none have considered MCI subtypes or the relationship of HRV indices with different cognitive domains and structural brain damage. We assessed autonomic function during an active orthostatic challenge in 253 oupatients aged ≥ 65, [n = 82 aMCI, n = 93 naMCI, n = 78 cognitively normal (CN), neuropsychologically tested] with power spectral analysis of HRV. We used visual rating scales to grade cerebrovascular burden and hippocampal/insular atrophy (HA/IA) on neuroimaging. Only aMCI showed a blunted response to orthostasis. Postural changes in normalised low frequency (LF) power and in the LF to high frequency ratio correlated with a memory test (positively) and HA/IA (negatively) in aMCI, and with attention/executive function tests (negatively) and cerebrovascular burden (positively) in naMCI. These results substantiate the view that the ANS is differentially impaired in aMCI and naMCI, consistently with the neuroanatomic substrate of Alzheimer's and small-vessel subcortical ischaemic disease.
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- 2020
6. Structured telephone support programs in chronic heart failure may be affected by a learning curve
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Holger Thiele, Gregorio Tersalvi, Hilka Gunold, Marcus Sandri, Marco Vicenzi, Federico Lombardi, Katharina Kirsch, and Norman Mangner
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Adult ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Time Factors ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,New york heart association ,Ventricular Function, Left ,Prosthesis Implantation ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Patient Admission ,Quality of life ,Patient Education as Topic ,Internal medicine ,Cause of Death ,medicine ,Clinical endpoint ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Failure ,Ejection fraction ,business.industry ,Stroke Volume ,General Medicine ,Middle Aged ,medicine.disease ,Telephone ,Treatment Outcome ,Heart failure ,Ventricular assist device ,Cohort ,Usual care ,Chronic Disease ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business ,Learning Curve ,Program Evaluation - Abstract
AIMS The efficacy of a telephone support program in chronic heart failure has been questioned particularly when considering short-term follow-up. This study is aimed to assess the impact of the HeartNetCare telephone support program in chronic heart failure within 18 months of observation and to verify a possible effect of a learning-to-care curve on outcome. METHODS We retrospectively compared a cohort of 269 chronic heart failure patients included in HeartNetCare program with 200 patients receiving usual care as a control group. All-cause death and hospitalization for heart failure or implantation of left ventricular assist device were the primary composite outcome. Secondary endpoints were the changes in left ventricular ejection fraction and in New York Heart Association (NYHA) functional class. Outcome data were also analyzed in relation to the time of enrollment from program initiation. RESULTS At baseline, HeartNetCare group showed lower ejection fraction and higher NYHA class. At the follow-up, 59 HeartNetCare patients (21.9%) and 49 usual care patients (24.5%) reached the primary endpoint (P = 0.51). After 18 months of follow-up, HeartNetCare patients improved ejection fraction and NYHA class compared with the usual care patients (P
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- 2020
7. CT Perfusion Versus Coronary CT Angiography in Patients With Suspected In-Stent Restenosis or CAD Progression
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Luca Di Odoardo, Maria Elisabetta Mancini, Piero Montorsi, Daniela Trabattoni, Andrea Annoni, Jeroen Sonck, Giuseppe Muscogiuri, Giuseppe Calligaris, Marco Guglielmo, Daniele Andreini, Antonio L. Bartorelli, Andrea Baggiano, Elisa Consiglio, Alberto Formenti, Mauro Pepi, Stefano De Martini, Edoardo Conte, Paolo Ravagnani, Saima Mushtaq, Cesare Fiorentini, Gianluca Pontone, Federico Lombardi, Franco Fabbiocchi, Giovanni Teruzzi, Paolo Olivares, Marco Magatelli, Andrea D'Errico, Carlos Collet, Andreini, D, Mushtaq, S, Pontone, G, Conte, E, Collet, C, Sonck, J, D'Errico, A, Di Odoardo, L, Guglielmo, M, Baggiano, A, Trabattoni, D, Ravagnani, P, Montorsi, P, Teruzzi, G, Olivares, P, Fabbiocchi, F, De Martini, S, Calligaris, G, Annoni, A, Mancini, M, Formenti, A, Magatelli, M, Consiglio, E, Muscogiuri, G, Lombardi, F, Fiorentini, C, Bartorelli, A, Pepi, M, Clinical sciences, Graduate School, and ACS - Heart failure & arrhythmias
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Male ,Adenosine ,Computed Tomography Angiography ,Vasodilator Agents ,viruses ,medicine.medical_treatment ,invasive coronary angiography ,Perfusion scanning ,Coronary Artery Disease ,Fractional flow reserve ,030204 cardiovascular system & hematology ,Coronary Angiography ,030218 nuclear medicine & medical imaging ,Coronary artery disease ,coronary stent ,0302 clinical medicine ,Restenosis ,heterocyclic compounds ,Prospective Studies ,musculoskeletal, neural, and ocular physiology ,Myocardial Perfusion Imaging ,Middle Aged ,static CT perfusion ,Fractional Flow Reserve, Myocardial ,Treatment Outcome ,Disease Progression ,Female ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,Perfusion ,medicine.drug ,medicine.medical_specialty ,coronary CT angiography ,Article ,Coronary Restenosis ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Predictive Value of Tests ,coronary stents ,Multidetector Computed Tomography ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Aged ,business.industry ,Stent ,Gold standard (test) ,medicine.disease ,Iodixanol ,enzymes and coenzymes (carbohydrates) ,business - Abstract
Objectives: The goal of this study was to assess the diagnostic performance of coronary computed tomography angiography (CTA) alone, adenosine-stress myocardial perfusion assessed by computed tomography (CTP) alone, and coronary CTA + CTP by using a 16-cm Z-axis coverage scanner versus invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the clinical standard. Background: Diagnostic performance of coronary CTA for in-stent restenosis detection is still challenging. Recently, CTP showed additional diagnostic power over coronary CTA in patients with suspected coronary artery disease. However, few data are available on CTP performance in patients with previous stent implantation. Methods: Consecutive stable patients with previous coronary stenting referred for ICA were enrolled. All patients underwent stress myocardial CTP and rest CTP + coronary CTA. Invasive FFR was performed during ICA when clinically indicated. The diagnostic rate and diagnostic accuracy of coronary CTA, CTP, and coronary CTA + CTP were evaluated in stent-, territory-, and patient-based analyses. Results: In the 150 enrolled patients (132 men; mean age 65.1 ± 9.1 years), the CTP diagnostic rate was significantly higher than that of coronary CTA in all analyses (territory based [96.7% vs. 91.1%; p < 0.0001] and patient based [96% vs. 68%; p < 0.0001]). When ICA was used as gold standard, CTP diagnostic accuracy was significantly higher than that of coronary CTA in all analyses (territory based [92.1% vs. 85.5%, p < 0.03] and patient based [86.7% vs. 76.7%, p < 0.03]). The concordant coronary CTA + CTP assessment exhibited the highest diagnostic accuracy values versus ICA (95.8% in the territory-based analysis). The diagnostic accuracy of CTP was significantly higher than that of coronary CTA (75% vs. 30.5%; p < 0.001). The radiation exposure of coronary CTA + CTP was 4.15 ± 1.5 mSv. Conclusions: In patients with coronary stents, CTP significantly improved the diagnostic rate and accuracy of coronary CTA alone compared with both ICA and invasive FFR as gold standard.
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- 2020
8. The search for non-invasive markers of cardiac diseases comes back to the 12-lead electrocardiogram
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Katerina Hnatkova, Georg Schmidt, Marek Malik, Federico Lombardi, and Marco Vicenzi
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medicine.medical_specialty ,Heart Diseases ,business.industry ,Non invasive ,Coronary Stenosis ,12 lead electrocardiogram ,Arrhythmias, Cardiac ,Electrocardiography ,Internal medicine ,medicine ,Cardiology ,Humans ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
9. Usefulness of microvolt T-wave alternans for predicting outcome in patients with Chagas disease with implantable cardioverter defibrillators
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Marco Paulo Tomaz Barbosa, Antonio Luiz Pinho Ribeiro, Federico Lombardi, Manoel Otávio da Costa Rocha, Elson Santos Neto, and Brandão F
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Male ,medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Electric Countershock ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,Risk Assessment ,Disease-Free Survival ,Sudden cardiac death ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Chagas Disease ,Prospective Studies ,cardiovascular diseases ,030212 general & internal medicine ,Prospective cohort study ,Aged ,business.industry ,Arrhythmias, Cardiac ,Atrial fibrillation ,T wave alternans ,Middle Aged ,Prognosis ,medicine.disease ,Implantable cardioverter-defibrillator ,Defibrillators, Implantable ,Death, Sudden, Cardiac ,Ventricular fibrillation ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Brazil - Abstract
Background Chagas disease (ChD) may lead to life-threatening heart disease, including malignant ventricular arrhythmias. The use of implantable cardioverter defibrillators (ICDs) has become the main therapeutic strategy for secondary prevention of SCD in Chagas disease (ChD). Microvolt T-wave alternans (MTWA) is a direct measure of ventricular repolarization instability and has emerged as a potentially useful way of determining arrhythmia vulnerability. However, this methodology has not been evaluated in patients with ChD. Objective To evaluate the predictive value of MTWA testing for appropriate therapy or death in ChD patients with ICDs. Methods This prospective study included consecutive patients who received ICD implantations in a Brazilian tertiary referral center. Results Seventy-two patients were followed for a median time of 422 (range 294–642) days. Thirty-three patients had ChD. The MTWA was non-negative (positive or indeterminate) in 27 (81.8%) of ChD patients. The combined primary outcome (appropriate ICD therapy or death) occurred in 29 patients (40.3%); 17 out 33 ChD patients presented the primary outcome. There was a statistically significant difference in event-free survival between ChD patients with negative and non-negative MTWA results ( p =0.02). Non-negative MTWA tests nearly triple the risk of appropriate ICD therapy or death (HR=2.7, 95% CI: 1.7–4.4, p =0.01) in patients with ChD and was the only variable associated with outcomes. The sensitivity and the negative predictive value was 100% in ChD patients. Conclusions MTWA may be useful in recognizing high-risk ICD patients who may require adjunctive therapies with antiarrhythmic drugs or catheter ablation.
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- 2016
10. CrossTalk proposal: Heart rate variability is a valid measure of cardiac autonomic responsiveness
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Georg Schmidt, Markus Zabel, Federico Lombardi, Katerina Hnatkova, Marek Malik, and Heikki V. Huikuri
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medicine.medical_specialty ,Physiology ,business.industry ,Measure (physics) ,Heart ,030204 cardiovascular system & hematology ,Autonomic Nervous System ,CrossTalk ,03 medical and health sciences ,Crosstalk (biology) ,Autonomic nervous system ,0302 clinical medicine ,Heart Rate ,Internal medicine ,Heart rate ,medicine ,Cardiology ,Heart rate variability ,Animals ,Humans ,business ,030217 neurology & neurosurgery ,Sinoatrial Node - Published
- 2019
11. Is the T
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Marek, Malik, Heikki V, Huikuri, Federico, Lombardi, Georg, Schmidt, Richard L, Verrier, and Markus, Zabel
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Electrocardiography ,Humans ,Arrhythmias, Cardiac ,Heart - Published
- 2019
12. Use of PRECISE-DAPT Score and Admission Platelet Count to Predict Mortality Risk in Patients With Acute Coronary Syndrome
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Stefano Savonitto, Carlo La Vecchia, Laura Antolini, Silvia Cantoni, Dario Brunelli, Marco Cattaneo, Marco Valgimigli, Maria R. Caporale, Giovanni Amedeo Tavecchia, Jacopo Oreglia, Fabrizio Oliva, Paola Bertuccio, Nuccia Morici, Alice Sacco, Paolo Meani, Giovanna Viola, Federico Lombardi, Antonio Segreto, Morici, N, Tavecchia, G, Antolini, L, Caporale, M, Cantoni, S, Bertuccio, P, Sacco, A, Meani, P, Viola, G, Brunelli, D, Oliva, F, Lombardi, F, Segreto, A, Oreglia, J, La Vecchia, C, Cattaneo, M, Valgimigli, M, and Savonitto, S
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Adult ,Male ,medicine.medical_specialty ,Acute coronary syndrome ,animal structures ,medicine.medical_treatment ,Myocardial Infarction ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Risk Assessment ,Coronary artery disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Acute Coronary Syndrome ,610 Medicine & health ,Aged ,Aged, 80 and over ,Framingham Risk Score ,Platelet Count ,business.industry ,Hazard ratio ,acute coronary syndrome, risk score, thrombocytopenia, Acute Coronary Syndrome, Adult, Aged, Aged, 80 and over, Coronary Artery Disease, Drug Therapy, Combination, Drug-Eluting Stents, Female, Humans, Male, Middle Aged, Myocardial Infarction, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Purinergic P2Y Receptor Antagonists, Risk Assessment, Platelet Count, Predictive Value of Tests ,Percutaneous coronary intervention ,Drug-Eluting Stents ,Middle Aged ,medicine.disease ,Confidence interval ,Predictive value of tests ,Purinergic P2Y Receptor Antagonists ,Cardiology ,Platelet aggregation inhibitor ,Drug Therapy, Combination ,Female ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors - Abstract
The PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Antiplatelet Therapy (PRECISE-DAPT) score has been validated to predict bleeding complications in patients undergoing stent implantation and dual antiplatelet therapy. This score does not include the platelet count (PC), which has been shown to be an independent marker of mortality in patients with acute coronary syndrome (ACS). We assessed the role of the PRECISE-DAPT score calculated on admission for mortality risk prediction and evaluated whether the predictive accuracy of this score improved by adding the PC. In a retrospective cohort study of 1000 patients with ACS, after adjustment for relevant covariates, a PRECISE-DAPT score ≥25 was independently associated with mortality (hazard ratio [HR]: 7.91; 95% confidence interval [CI]: 4.37-14.30). When this score was combined with PC, compared to patients with PRECISE-DAPT 9/L, the adjusted HR was 7.2 (95% CI 2.4-21.6) for those with PRECISE-DAPT 9/L; 10.7 (95% CI: 5.2-21.9) for those with PRECISE-DAPT ≥25 and PC ≥150 × 109/L; and 17.9 (95% CI 7.0-45.4) for those with PRECISE-DAPT ≥25 and PC 9/L. Selecting thresholds for high-risk designation, the PRECISE-DAPT score integrated with PC had a higher prediction value, compared to the PRECISE-DAPT and Global Registry of Acute Coronary Events scores.
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- 2019
13. Quantification of Spatial Heterogeneity of Ventricular Repolarization during Early-Stage Cardiac Ischemia Induced by Coronary Angioplasty
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Federico Lombardi, Roberto Sassi, Luca Mainardi, Filippo Rocchetta, and Massimo W. Rivolta
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medicine.medical_specialty ,medicine.medical_treatment ,Ischemia ,Myocardial Ischemia ,Coronary ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Balloon ,Coronary artery disease ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Angioplasty ,Internal medicine ,Occlusion ,medicine ,Humans ,Myocardial infarction ,Angioplasty, Balloon, Coronary ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Coronary arteries ,medicine.anatomical_structure ,Cardiology ,business ,030217 neurology & neurosurgery - Abstract
Coronary angioplasty (CA) is a surgical procedure meant to break the plaque and restore the blood flow in obstructed coronary arteries. It is based on inserting an inflatable balloon with a catheter in the clogged artery. When the balloon inflation is prolonged, it also provides an excellent model to investigate the electrophysiological changes due to early ischemia. In this work, we tested whether early cardiac ischemia induced by prolonged balloon inflations might lead to changes in spatial heterogeneity of ventricular repolarization (SHVR), as measured by the V-index on the 12-lead ECG. The metric was recently shown to significantly improve the ECG sensitivity for the diagnosis of non-ST elevation myocardial infarction, in patients presenting to the emergency department. The analysis was retrospectively performed on the data of 104 patients who underwent prolonged CA (STAFF III dataset). The V-index was estimated before, during and post-occlusion (limiting the analysis to the first inflation). Successively, it was quantified on short 90 s overlapping windows, during occlusion, to assess the time evolution of SHVR. V-index values estimated during occlusion were significantly larger (median: 6.2 ms, p; 0.05) than baseline room values. Also, pre- and post-occlusion values did not differ (p0.05), suggesting a complete recovery after CA. SHVR progressively increased during the occlusion with respect to baseline (median reaching 55.6 ms vs 34.2 ms). In conclusion, the V-index detected changes in SHVR due to early-stage cardiac ischemia.
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- 2019
14. Italian Chapter of the International Society of Cardiovascular Ultrasound expert consensus document on coronary computed tomography angiography: overview and new insights
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Ketty Savino, Vito Maurizio Parato, Pasquale Palmiero, Ciro Canetta, Federico Lombardi, Maria Maiello, Francesco Pelliccia, and Fabiola B. Sozzi
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medicine.medical_specialty ,Acute coronary syndrome ,Computed Tomography Angiography ,Cardiology ,adverse cardiac events ,atherosclerosis ,coronary artery disease ,coronary computed tomography ,high-risk plaque ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Sensitivity and Specificity ,nuclear medicine and imaging ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Computed tomography angiography ,Evidence-Based Medicine ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Coronary computed tomography angiography ,Reproducibility of Results ,Evidence-based medicine ,medicine.disease ,Coronary computed tomography ,radiology ,cardiology and cardiovascular medicine ,Italy ,Great vessels ,Practice Guidelines as Topic ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Coronary computed tomography angiography is a noninvasive heart imaging test currently undergoing rapid development and advancement. The high resolution of the three-dimensional pictures of the moving heart and great vessels is performed during a coronary computed tomography to identify coronary artery disease and classify patient risk for atherosclerotic cardiovascular disease. The technique provides useful information about the coronary tree and atherosclerotic plaques beyond simple luminal narrowing and plaque type defined by calcium content. This application will improve image-guided prevention, medical therapy, and coronary interventions. The ability to interpret coronary computed tomography images is of utmost importance as we develop personalized medical care to enable therapeutic interventions stratified on the bases of plaque characteristics. This overview provides available data and expert's recommendations in the utilization of coronary computed tomography findings. We focus on the use of coronary computed tomography to detect coronary artery disease and stratify patients at risk, illustrating the implications of this test on patient management. We describe its diagnostic power in identifying patients at higher risk to develop acute coronary syndrome and its prognostic significance. Finally, we highlight the features of the vulnerable plaques imaged by coronary computed tomography angiography.
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- 2016
15. Cyclophilin A modulates bone marrow-derived CD117+ cells and enhances ischemia-induced angiogenesis via the SDF-1/CXCR4 axis
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Maria Corlianò, Gianluca Lorenzo Perrucci, Maurizio C. Capogrossi, Patrizia Nigro, Alessandro Scopece, Giulio Pompilio, Stefania Straino, Bradford C. Berk, Federico Lombardi, and Monica Napolitano
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0301 basic medicine ,Programmed cell death ,Pathology ,medicine.medical_specialty ,Receptors, CXCR4 ,Angiogenesis ,Cell ,Ischemia ,Neovascularization, Physiologic ,Cypa ,Bone Marrow Cells ,030204 cardiovascular system & hematology ,CD117+ cells ,03 medical and health sciences ,Mice ,0302 clinical medicine ,Cell Movement ,medicine ,Cell Adhesion ,Animals ,Humans ,Cell adhesion ,Cells, Cultured ,Cell Proliferation ,biology ,Cell growth ,business.industry ,medicine.disease ,biology.organism_classification ,Hind-limb ischemia ,digestive system diseases ,Chemokine CXCL12 ,3. Good health ,Hindlimb ,Mice, Inbred C57BL ,Disease Models, Animal ,Proto-Oncogene Proteins c-kit ,030104 developmental biology ,medicine.anatomical_structure ,Cancer research ,Bone marrow ,business ,Cardiology and Cardiovascular Medicine ,SDF-1/CXCR4 axis ,Cyclophilin A ,Neo-angiogenesis ,Signal Transduction - Abstract
Background Critical limb ischemia (CLI) is a major health problem with no adequate treatment. Since CLI is characterized by insufficient tissue vascularization, efforts have focused on the discovery of novel angiogenic factors. Cyclophilin A (CyPA) is an immunophilin that has been shown to promote angiogenesis in vitro and to enhance bone marrow (BM) cell mobilization in vivo . However, its potential as an angiogenic factor in CLI is still unknown. Thus, this study aimed to evaluate whether CyPA might induce neo-angiogenesis in ischemic tissues. Methods and results Wild-type C57Bl/6j mice underwent acute hind-limb ischemia (HLI) and received a single intramuscular administration of recombinant CyPA or saline. Limb perfusion, capillary density and arteriole number in adductor muscles were significantly increased after CyPA treatment. Interestingly, BM-derived CD117 + cell recruitment was significantly higher in ischemic adductor tissue of mice treated with CyPA versus saline. Therefore, the effect of CyPA on isolated BM-derived CD117 + cells in vitro was evaluated. Low concentrations of CyPA stimulated CD117 + cell proliferation while high concentrations promoted cell death. Moreover, CyPA enhanced CD117 + cell adhesion and migration in a dose-dependent manner. Mechanistic studies revealed that CyPA up-regulated CXCR4 in CD117 + cells and in adductor muscles after ischemia. Additionally, SDF-1/CXCR4 axis inhibition by the CXCR4 antagonist AMD3100 decreased CyPA-mediated CD117 + cell recruitment in the ischemic limb. Conclusion CyPA induces neo-angiogenesis by recruiting BM-derived CD117 + cell into ischemic tissues, at least in part, through SDF-1/CXCR4 axis.
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- 2016
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16. A comparison between two different definitions of contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
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Stefano Carugo, Carlo Sponzilli, Marianna Spina, Roberta Acquaviva, Marco Centola, Mario Cozzolino, Diego Salerno-Uriarte, Diego Castini, Giulia Ferrante, Federico Lombardi, and Stefano Lucreziotti
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,medicine.medical_treatment ,030232 urology & nephrology ,Contrast-induced nephropathy ,Contrast Media ,030204 cardiovascular system & hematology ,Nephropathy ,Cohort Studies ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Humans ,Medicine ,Prospective Studies ,Myocardial infarction ,Aged ,Aged, 80 and over ,business.industry ,Mortality rate ,Acute kidney injury ,Percutaneous coronary intervention ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business ,TIMI ,Follow-Up Studies - Abstract
Contrast-induced acute kidney injury (CI-AKI) is associated with significantly increased mortality after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). The prognostic value of CI-AKI depends on the definitions used to define it. We compare the predictive accuracy of long-term mortality of two definitions of CI-AKI on consecutive patients undergoing pPCI for STEMI.Incidence, risk factors and long-term prognosis of CI-AKI were assessed according to two different definitions: the first as an increase in serum creatinine ≥ 25% or ≥ 0.5 mg/dl from baseline within 72 h after pPCI (contrast-induced nephropathy (CIN) criteria), the second one according to Acute Kidney Injury Network (AKIN) classification system.A total of 402 patients were enrolled. The median follow-up period was 12 ± 4 months. Long-term mortality rate was 9.5%. Independent predictors of long-term mortality were: older age, basal renal impairment, left ventricular ejection fraction40%, in-hospital major bleedings and CI-AKI. A significant correlation was found between mortality and CI-AKI as assessed by both CIN (HR 4.84, 95% CI: 2.56-9.16, p=0.000) and AKIN (HR 9.70, 95% CI: 5.12-18.37, p=0.000) definitions. The area under the receiver operating curve was significantly larger for predicting mortality with AKIN classification than with CIN criteria (0.7984 versus 0.7759; p=0.0331).In patients with STEMI treated by pPCI, CI-AKI is a frequent complication irrespective of the criteria used for its definition. AKIN, however, seems to provide a better accuracy in predicting long-term mortality than CIN criteria.
- Published
- 2016
17. Neural influence of cardiac electrophysiology
- Author
-
Marek, Malik, Heikki, Huikuri, Federico, Lombardi, Georg, Schmidt, and Markus, Zabel
- Subjects
Epilepsy ,Humans ,Heart ,Cardiac Electrophysiology - Published
- 2018
18. Never trust first impressions when assessing the heart of a pregnant woman
- Author
-
Federico Lombardi, Anna Maria Colli, Carla Bonanomi, G Malanchini, and Elisa Gherbesi
- Subjects
Adult ,medicine.medical_specialty ,MEDLINE ,Crisscross Heart ,Furosemide ,Pregnancy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Diuretics ,Clinical consultation ,Heart Failure ,business.industry ,General surgery ,Heart ,Criss-cross Heart ,medicine.disease ,Cardiac surgery ,Echocardiography ,Heart failure ,Fluid Therapy ,Parasternal long axis view ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
We describe the echocardiographic finding of a 35-year-old pregnant woman, referred for a clinical consultation at our institution because of congestive heart failure. She underwent echocardiography with only little information about a history of cardiac surgery during infancy. At the first sight, parasternal long axis view demonstrates normal structures, but on the apical view we diagnosed a very rare condition with typical imaging findings: Criss Cross heart.
- Published
- 2018
19. The decline of rate and mortality of acute myocardial infarction. Almost there, still a long way to go
- Author
-
Georg Schmidt, Heikki V. Huikuri, Federico Lombardi, and Marek Malik
- Subjects
medicine.medical_specialty ,Epidemiology ,business.industry ,Norway ,MEDLINE ,Myocardial Infarction ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Sex Factors ,Sex factors ,Internal medicine ,medicine ,Cardiology ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
20. Reply to the Editor—10-second ECG-based RMSSD as approximate measure of HRV
- Author
-
Federico Lombardi and Marek Malik
- Subjects
Cohort Studies ,Electrocardiography ,Heart Rate ,business.industry ,Physiology (medical) ,Measure (physics) ,Humans ,Medicine ,Pattern recognition ,Artificial intelligence ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
21. Value of measurement of QRS-T angle from a standard 12-lead electrocardiogram
- Author
-
Heikki V. Huikuri, Marek Malik, Georg Schmidt, Markus Zabel, and Federico Lombardi
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,12 lead electrocardiogram ,030204 cardiovascular system & hematology ,Prognosis ,Qrs t angle ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Cardiology ,Humans ,Medicine ,030212 general & internal medicine ,Non-ST Elevated Myocardial Infarction ,Cardiology and Cardiovascular Medicine ,business ,Value (mathematics) ,Biomarkers - Published
- 2019
22. Cor triatriatum dexter associated with atrial septal defect: Management in a complex clinical case
- Author
-
Laura Pavone, Massimo Zilocchi, Federico Lombardi, Laura Bacà, R. Meazza, Giacomo Maria Viani, Ciro Canetta, Claudia Montanaro, and Fabiola B. Sozzi
- Subjects
Adult ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Cor triatriatum dexter ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Asymptomatic ,Heart Septal Defects, Atrial ,Prominent Eustachian valve ,Diagnosis, Differential ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Cardiac magnetic resonance imaging ,Internal medicine ,Cor Triatriatum ,otorhinolaryngologic diseases ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Heart Atria ,medicine.diagnostic_test ,business.industry ,food and beverages ,030229 sport sciences ,Eustachian Valve ,Echocardiography ,cardiovascular system ,Cardiology ,Female ,Clinical case ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Watchful waiting - Abstract
The coexistence of an atrial septal defect and a prominent eustachian valve is a rare congenital anomaly, rarely reported in literature. Differentiation between a giant eustachian valve and cor triatriatum dexter can be difficult. A case of a large atrial septal defect associated with cor triatriatum dexter diagnosed by echocardiography in an asymptomatic woman is reported. A watchful waiting strategy was adopted.
- Published
- 2017
23. Incremental value of normal adenosine perfusion cardiac magnetic resonance: Long-term outcome
- Author
-
Federico Lombardi, Frederic Berthier, Laura Iacuzio, Gilles Dreyfus, Stephane Rusek, Philippe Rossi, Filippo Civaia, Vincent Dor, Fabiola B. Sozzi, and Ciro Canetta
- Subjects
Male ,medicine.medical_specialty ,Adenosine ,medicine.medical_treatment ,Myocardial Ischemia ,Ischemia ,Coronary Disease ,Revascularization ,Risk Assessment ,Coronary artery disease ,Cardiac magnetic resonance imaging ,Cause of Death ,Internal medicine ,medicine ,Humans ,Myocardial infarction ,Aged ,medicine.diagnostic_test ,business.industry ,Unstable angina ,Hazard ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Magnetic Resonance Angiography ,Follow-Up Studies - Abstract
Background The purpose of the study was to determine the long-term prognostic value of normal adenosine stress cardiac magnetic resonance imaging (CMR) in patients referred for evaluation of myocardial ischemia. Methods We reviewed 300 consecutive patients (age 65 ± 11 years, 74% male) with suspected or known coronary disease and normal wall motion who had undergone adenosine stress CMR negative for ischemia and scar. Most patients were at intermediate risk of coronary artery disease. The end points studied were all causes of mortality and major adverse cardiac events, including cardiac death, myocardial infarction, revascularization, and hospitalization for unstable angina. Results During a mean follow-up of 5.5 years (mean = 5.4 ± 1.1), 16 patients died because of various causes (cardiac death in 5 patients). Three patients had a nonfatal myocardial infarction, 7 patients were hospitalized for revascularization, and 11 were medically treated for unstable angina. The annual cardiac event rate was 1.3% (0.78% in the first 3 years and 1.9% between the fourth and sixth years). The predictors of major adverse cardiac events in a multivariate analysis model were as follows: advanced age (hazard ratio [HR] 1.15, 95% confidence interval [95% CI] 1.02-1.30), diabetes (HR 17.5, 95% CI 2.2-140), and the habit of smoking (HR 5.9, 95% CI 1.0-35.5). For all causes of mortality, the only predictor was diabetes (HR 11.4, 95% CI 1.76-74.2). Patients with normal stress CMR had an excellent outcome during the 3 years after the study. The cardiac event rate was higher between the fourth and sixth years. Conclusion Over a 5.5-year period, a low event rate and excellent prognosis occurred in patients with normal adenosine stress CMR. Low- to intermediate-risk patients with a normal CMR are at low risk for subsequent cardiac events.
- Published
- 2015
24. Circulating cardiac biomarkers and postoperative atrial fibrillation in the OPERA trial
- Author
-
Alejandro Macchia, Simona Barlera, Maria Giuseppina Silletta, Lorella Dreas, Serge Masson, Javier Mariani, John D. Puskas, Luca Dozza, Caterina Simon, Tarcisio Vago, Roberto Latini, Alejandro Hershson, Roberto Marchioli, Aneta Aleksova, Jason H Y Wu, Federico Lombardi, Dariush Mozaffarian, Roberto R. Favaloro, Gianni Tognoni, Masson, Serge, Wu, Jason H. Y., Simon, Caterina, Barlera, Simona, Marchioli, Roberto, Mariani, Javier, Macchia, Alejandro, Lombardi, Federico, Vago, Tarcisio, Aleksova, Aneta, Dreas, Lorella, Favaloro, Roberto R., Hershson, Alejandro R., Puskas, John D., Dozza, Luca, Silletta, Maria G., Tognoni, Gianni, Mozaffarian, Dariush, and Latini, Roberto
- Subjects
Male ,medicine.medical_specialty ,Clinical Biochemistry ,Fish oil ,Biochemistry ,Preoperative care ,Troponin T ,Natriuretic Peptide ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,Natriuretic Peptide, Brain ,Preoperative Care ,Clinical endpoint ,medicine ,Humans ,Prospective Studies ,Cardiac Surgical Procedures ,Prospective cohort study ,Postoperative Care ,Cardiac surgery ,High-sensitive cardiac troponin ,N-terminal pro-B-type natriuretic peptide ,Postoperative atrial fibrillation ,Medicine (all) ,business.industry ,Biomarkers ,Female ,Middle Aged ,Peptide Fragments ,Treatment Outcome ,Brain ,EuroSCORE ,Atrial fibrillation ,General Medicine ,Perioperative ,medicine.disease ,Cardiology ,business - Abstract
Background Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery and predicts increased morbidity and mortality. Identification of patients at high risk of POAF with the help of circulating biomarkers may enable early preventive treatment but data are limited, especially in contemporary surgical patients. Methods Plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) were measured at enrolment, on the morning of cardiac surgery, at end surgery, and 2 days postsurgery in 562 patients undergoing cardiac surgery, randomized to perioperative supplementation with oral fish oil or placebo in the Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation trial (OPERA). The primary endpoint was incident POAF lasting ≥ 30 s, centrally adjudicated and confirmed electrocardiographically. Results Higher levels of NT-proBNP and hs-cTnT before surgery were associated with older age, renal or cardiac dysfunction and EuroSCORE. NT-proBNP peaked on postoperative day 2 (2172 [1238–3758] ng/L, median [Q1–Q3]), while hs-cTnT peaked at the end of surgery (373 [188–660] ng/L). Fish oil supplementation did not alter the time course of the cardiac biomarkers (P > 0·05). Concentrations of NT-proBNP or hs-cTnT, on the morning of surgery, or changes in their level between morning of surgery and postsurgery, were not significantly associated with POAF after adjustment for clinical and surgical characteristics. Conclusion Among patients undergoing cardiac surgery, NT-proBNP and hs-cTnT are related to clinical and surgical characteristics, have different perioperative time courses but are not independently associated with risk of POAF.
- Published
- 2015
25. Additional value of systolic wall thickening in myocardial stunning evaluated by stress-rest gated perfusion SPECT
- Author
-
Alberto Bestetti, Federico Lombardi, Alessio Galli, Adriano Decarli, and Besart Cuko
- Subjects
Male ,medicine.medical_specialty ,Ischemia ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,Coronary Circulation ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Aged ,Myocardial Stunning ,Tomography, Emission-Computed, Single-Photon ,Myocardial stunning ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Stunning ,Gated Blood-Pool Imaging ,Stroke Volume ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Ventricle ,Angiography ,Cardiology ,Exercise Test ,Female ,Cardiology and Cardiovascular Medicine ,business ,Perfusion - Abstract
The aim of the present study is to evaluate the additional value of systolic wall thickening to myocardial perfusion in diagnosing myocardial stunning in patients with angiography proven coronary artery disease. We selected 91 ischemic patients (82 males; mean age 59.7 ± 10.3) with CAD documented by angiography. Ischemia was defined as a summed difference score ≥5. All patients underwent a 2-day gated perfusion SPECT protocol. The patients received a dose of 740 MBq of 99mTc-tetrofosmin after stress and at rest. Treadmill maximal exercise tests were performed on all patients. The post-stress LVEF was significantly lower than rest LVEF (48.1% ± 10.3% vs 50.3% ± 10.7%; P = .0001). The wall thickening summed difference score was 4.44 ± 4.13 (P = .0001). At a multivariate regression analysis, only WT-SDS as independent variable was significantly correlated with myocardial ischemia (SDS). We also divided patients according to SDS in those with mild (SDS
- Published
- 2017
26. [A late diagnosis of left atrial myxoma: how to gain time?]
- Author
-
Ferdinando Maria, Massari, Tatiana, Tonella, Giuseppe, Pomè, Alessandra, Di Mauro, Claudio, Clemente, and Federico, Lombardi
- Subjects
Heart Neoplasms ,Male ,Delayed Diagnosis ,Dyspnea ,Time Factors ,Echocardiography ,Humans ,Coronary Artery Disease ,Heart Atria ,Middle Aged ,Myxoma - Abstract
A 56-year-old man presented to the Outpatient Cardiology Unit for dyspnea that had been lasting 6 months and an occasional episode of cold perspiration on climbing a flight of stairs. In the suspicion of coronary artery disease, he was prescribed a complete blood panel, an echocardiogram and a treadmill stress test. The echocardiogram, performed as late as 78 days after the first evaluation and only by chance scheduled 2 days before the stress test, enabled a diagnosis of left atrial myxoma for which the patient successfully underwent cardiac surgery. The authors discuss the aspecific and potentially misleading nature of myxoma symptoms and highlight the latency between cardiological evaluation and diagnostic echocardiography.
- Published
- 2017
27. Reference values of heart rate variability
- Author
-
Federico Lombardi, Georg Schmidt, Axel Bauer, Sergio Cerutti, Yoshiharu Yamamoto, Alberto Porta, Peter J. Schwartz, Roberto Sassi, Marek Malik, Przemysław Guzik, A. John Camm, Chung-Kang Peng, Heikki V. Huikuri, and Phyllis K. Stein
- Subjects
business.industry ,030204 cardiovascular system & hematology ,Circadian Rhythm ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Heart Rate ,Reference Values ,Physiology (medical) ,Reference values ,Statistics ,Calculus ,Electrocardiography, Ambulatory ,Medicine ,Heart rate variability ,Humans ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Published
- 2017
28. Detection of atrial fibrillation episodes using a wristband device
- Author
-
Valentina D. A. Corino, Lorenzo Ferranti, Giorgio Scarpini, Rita Laureanti, Luca Mainardi, and Federico Lombardi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Physiology ,Biophysics ,Biomedical Engineering ,Blood volume pulse ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Wearable Electronic Devices ,0302 clinical medicine ,Rhythm ,Computer-Assisted ,Similarity (network science) ,Internal medicine ,Photoplethysmogram ,Physiology (medical) ,Atrial Fibrillation ,Neighbor classifier ,medicine ,80 and over ,Humans ,Photoplethysmography ,Normal Sinus Rhythm ,Aged ,Aged, 80 and over ,irregularity ,Blood Volume ,business.industry ,variability ,Floating search ,Signal Processing, Computer-Assisted ,Atrial fibrillation ,Middle Aged ,Wrist ,medicine.disease ,Case-Control Studies ,Signal Processing ,Cardiology ,atrial fibrillation ,rhythm classification ,wave similarity ,Female ,business ,030217 neurology & neurosurgery - Abstract
Undiagnosed atrial fibrillation (AF) patients are at high risk of cardioembolic stroke or other complications. The aim of this study was to analyze the blood volume pulse (BVP) signals obtained from a wristband device and develop an algorithm for discriminating AF from normal sinus rhythm (NSR) or from other arrhythmias (ARR).Thirty patients with AF, 9 with ARR and 31 in NSR were included in the study. The recordings were obtained at rest from Empatica E4 wristband device and lasted 10 min. The analysis, on a 2 min segment, included spectral, variability and irregularity analysis performed on the inter-diastolic interval series, and similarity analysis performed on the BVP signal. Main results and Significance: Variability parameters were the highest in AF, the lowest in NSR and intermediate for ARR, as an example pNN50 values were, respectively, [Formula: see text], [Formula: see text], [Formula: see text] (p 0.05). The similarity parameters were the highest in NSR, the lowest in AF and intermediate for ARR, as an example using a threshold for assessing similarity of [Formula: see text]: [Formula: see text], [Formula: see text], [Formula: see text], all p 0.05. The rhythm classification was preceded by over-sampling (using synthetic minority over-sampling technique) the class of ARR, being it the smallest class. Then, the features selection was performed (using the sequential forward floating search algorithm) which identified two variability parameters (pNN70 and pNN40) as the best selection. The classification by the k-nearest neighbor classifier reached an accuracy of about 0.9 for NSR and AF, and 0.8 for ARR. Using pNN70 and pNN40, the specificity for the three rhythms was Spnsr = 0.928, Spaf = 0.963, Sparr = 0.768, while the sensitivity was Spnsr = 0.773, Spaf = 0.754, Sparr = 0.758.
- Published
- 2017
29. [The slow acceptance of new oral anticoagulants in Italy: a critical analysis of a problem]
- Author
-
Giovanni Luca, Botto, Claudio, Cuccia, Edoardo, Gronda, Federico, Lombardi, Maurizio, Lunati, Antonio, Maggi, Ferdinando Maria, Massari, Giuseppe, Musumeci, Fabrizio, Oliva, Luigi Oltrona, Visconti, Cesare, Proto, Enrico, Pusineri, and Walter, Ageno
- Subjects
Stroke ,Time Factors ,Italy ,Attitude of Health Personnel ,Thromboembolism ,Atrial Fibrillation ,Administration, Oral ,Anticoagulants ,Humans ,Drug Utilization - Abstract
The introduction of non-vitamin K antagonist oral anticoagulants (NOACs) into clinical practice has revolutionized the prevention and the therapeutic approaches to thromboembolic events in patients with nonvalvular atrial fibrillation and represents with no doubts one of the most remarkable advances in the history of cardiovascular medicine over the last years. NOACs beyond a comparable efficacy with vitamin K antagonists allow to overcome the limitations of this last category of drugs owing to their less drug to drug interactions and a predictable anticoagulant effect that allows a fixed dose administration without the need for continuous monitoring. However, the penetration of NOACs into the Italian market is still lower than predicted with respect to their use in other European countries.The aim of this review is to critically analyze the reasons behind this attitude through the adoption of the nominal group technique, a methodology that permits to reach an official consensus.
- Published
- 2017
30. Non-linear regularity of arterial blood pressure variability in patient with atrial fibrillation in tilt-test procedure
- Author
-
Valentina D. A. Corino, Roberto Sassi, Aktaruzzaman, Federico Lombardi, Sergio Cerutti, and LucaT Mainardi
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Diastole ,Tilt table test ,Orthostatic vital signs ,Predictive Value of Tests ,Tilt-Table Test ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Tilt test ,Arterial Pressure ,Computer Simulation ,Aged ,medicine.diagnostic_test ,business.industry ,Models, Cardiovascular ,Blood Pressure Determination ,Numerical Analysis, Computer-Assisted ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Sample entropy ,Blood pressure ,Nonlinear Dynamics ,Predictive value of tests ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Dynamics of cardiovascular series may be explored with non-linear techniques. It is unknown if the arterial pressure irregularity commonly observed in patients with atrial fibrillation (AF) might be further increased by a sympathetic stimulus such as orthostatic tilt. Methods and results Twenty patients (62 ± 14 years, 15 men) were recruited for the study. Continuous beat-to-beat non-invasive arterial pressure was acquired at rest and during a passive orthostatic stimulus (‘tilt test’). Systolic (SAP) and diastolic (DAP) arterial pressure series of 300 samples were analysed in both conditions. Approximate (ApEn) and sample entropy (SampEn) were computed, as irregularity measures. Equivalent metrics (ApEnAR and SampEnAR) derived from an autoregressive model of the series were also obtained through numerical simulations, to further elucidate the non-linear mechanisms present in the series. In 11 patients (Group A), SAP significantly increased during tilt (from 103 ± 13 to 114 ± 17 mmHg, P < 0.001 rest vs. tilt), whereas in 9 patients (Group B) SAP remained almost unchanged (SAP: 110 ± 18 vs. 106 ± 19 mmHg, rest vs. tilt). No clinical differences were found between Groups A and B. When analysing Group A, all irregularity measures significantly increased in SAP (ApEn: 1.75 ± 0.20 vs. 1.88 ± 0.16, P < 0.05; SampEn: 1.71 ± 0.30 vs. 1.88 ± 0.27, P < 0.05; ApEnAR: 1.87 ± 0.20 vs. 1.96 ± 0.18, P < 0.05; SampEnAR: 1.94 ± 0.27 vs. 2.06 ± 0.18, P < 0.05; rest vs. tilt), whereas no differences were found in DAP series. No significant differences were found in Group B for either SAP or DAP. Conclusion The alterations of SAP during tilt in AF patients are not uniform and seem associated with different regularity patterns. The pressor response to sympathetic stimulation was also associated with an increase of SAP series irregularity.
- Published
- 2014
31. Measurement of cardiovascular autonomic function: Where to go from here?
- Author
-
Federico Lombardi, Markus Zabel, Marek Malik, and Heikki V. Huikuri
- Subjects
Autonomic function ,medicine.medical_specialty ,business.industry ,Blood Pressure ,030204 cardiovascular system & hematology ,Autonomic Nervous System ,Cardiovascular System ,Cardiovascular Physiological Phenomena ,03 medical and health sciences ,0302 clinical medicine ,Autonomic Nervous System Diseases ,Heart Rate ,Internal medicine ,Cardiology ,Humans ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
32. Cardiovascular Profile of Propranolol after Multiple Dosing in Infantile Hemangioma
- Author
-
Alessandra Giavarini, Erica Gondoni, Mario G. Bianchetti, Patrizia Salice, R. Cavalli, Anna Maria Colli, and Federico Lombardi
- Subjects
Male ,Adrenergic beta-Antagonists ,Diastole ,Blood Pressure ,Propranolol ,Ventricular Function, Left ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Infantile hemangioma ,Heart rate ,Medicine ,Humans ,030212 general & internal medicine ,Pharmacology ,Ejection fraction ,Dose-Response Relationship, Drug ,business.industry ,Infant ,General Medicine ,Discontinuation ,Dose–response relationship ,Blood pressure ,Anesthesia ,Female ,Drug Monitoring ,business ,Hemangioma ,medicine.drug - Abstract
Propranolol is becoming the treatment of choice for complicated infantile hemangioma. We report here data on peripheral blood flow, O2-saturation, electrocardiographic PR-interval, left ventricular function, blood pressure and heart rate that were assessed before and during treatment for ≥4 weeks with propranolol 2 mg/kg of body weight daily in 67 infants 2-saturation, electrocardiographic PR-interval and left ventricular fractional shortening or ejection fraction. Absolute blood pressure levels were similar without and with propranolol. However, age-adjusted centile levels for both systolic and diastolic levels were significantly lower while on propranolol. The heart rate was significantly lower both when expressed as absolute value and when expressed as age-adjusted centile on treatment with propranolol. In conclusion, propranolol 2 mg/kg of body weight daily causes a statistically though not clinically relevant decrease in blood pressure and heart rate in cardially healthy infants affected by infantile hemangioma. Temporary discontinuation during acute febrile illnesses and during diarrheal diseases should be considered to prevent excessive hypotension.
- Published
- 2016
33. Heart rate variability regression and risk of sudden unexpected death in epilepsy
- Author
-
Alessio Galli and Federico Lombardi
- Subjects
Male ,medicine.medical_specialty ,Disease ,030204 cardiovascular system & hematology ,Autonomic Nervous System ,Sudden cardiac death ,Cohort Studies ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,Heart Rate ,Internal medicine ,Heart rate ,Medicine ,Heart rate variability ,Humans ,Risk factor ,business.industry ,Dysautonomia ,Arrhythmias, Cardiac ,Heart ,General Medicine ,Models, Theoretical ,medicine.disease ,Death, Sudden, Cardiac ,ROC Curve ,Cardiology ,Disease Progression ,Biomarker (medicine) ,Regression Analysis ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Biomarkers - Abstract
The exact mechanisms of sudden unexpected death in epilepsy remain elusive, despite there is consensus that SUDEP is associated with severe derangements in the autonomic control to vital functions as breathing and heart rate regulation. Heart rate variability (HRV) has been advocated as biomarker of autonomic control to the heart. Cardiac dysautonomia has been found in diseases where other branches of the autonomous nervous system are damaged, as Parkinson disease and multiple system atrophy. In this perspective, an impaired HRV not only is a risk factor for sudden cardiac death mediated by arrhythmias, but also a potential biomarker for monitoring a progressive decline of the autonomous nervous system. This slope may lead to an acute imbalance of the regulatory pathways of vital functions after seizure and then to SUDEP.
- Published
- 2016
34. Reveal LINQTM experience out of the electrophysiology lab
- Author
-
Francesca Venturini, Federico Lombardi, F. Ambrosini, Alessandra Giavarini, Luca A F Di Odoardo, and Marco Vicenzi
- Subjects
Adult ,Male ,Time Factors ,Transducers ,030204 cardiovascular system & hematology ,Syncope ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Medicine ,Humans ,Telemetry ,030212 general & internal medicine ,Aged ,business.industry ,Arrhythmias, Cardiac ,Signal Processing, Computer-Assisted ,General Medicine ,Equipment Design ,Middle Aged ,Prognosis ,Electrophysiology ,Italy ,Feasibility Studies ,Female ,Cardiology and Cardiovascular Medicine ,business ,Electrophysiologic Techniques, Cardiac ,Neuroscience - Published
- 2016
35. Long-Term Prognostic Value of Cardiac Magnetic Resonance in Left Ventricle Noncompaction: A Prospective Multicenter Study
- Author
-
Daniele, Andreini, Gianluca, Pontone, Jan, Bogaert, Alberto, Roghi, Andrea, Barison, Juerg, Schwitter, Saima, Mushtaq, Georgios, Vovas, Paola, Sormani, Giovanni D, Aquaro, Pierre, Monney, Chiara, Segurini, Marco, Guglielmo, Edoardo, Conte, Laura, Fusini, Antonio, Dello Russo, Massimo, Lombardi, Paola, Gripari, Andrea, Baggiano, Cesare, Fiorentini, Federico, Lombardi, Antonio L, Bartorelli, Mauro, Pepi, and Pier Giorgio, Masci
- Subjects
Adult ,Male ,Isolated Noncompaction of the Ventricular Myocardium ,Time Factors ,Heart Ventricles ,Magnetic Resonance Imaging, Cine ,Reproducibility of Results ,Middle Aged ,Prognosis ,Echocardiography ,Disease Progression ,Humans ,Female ,Prospective Studies ,Follow-Up Studies - Abstract
Cardiac magnetic resonance (CMR) is useful for the diagnosis of left ventricular noncompaction (LVNC). However, there are limited data regarding its prognostic value.The goal of this study was to evaluate the prognostic relevance of CMR findings in patients with LVNC.A total of 113 patients with an echocardiographic diagnosis of LVNC underwent CMR at 5 referral centers. CMR diagnostic criterion of LVNC (noncompacted/compacted ratio2.3 in end-diastole) was confirmed in all patients. We performed left ventricular (LV) and right ventricular quantitative analysis and late gadolinium enhancement (LGE) assessments and analyzed the following LVNC diagnostic criteria: left ventricular noncompacted myocardial mass (LV-ncMM)20% and25%, total LV-ncMM index15 g/mAt a mean follow-up of 48 ± 24 months, cardiac events (CEs) occurred in 36 patients (16 heart failure hospitalizations, 10 ventricular arrhythmias, 5 cardiac deaths, and 5 thromboembolic events). LV dilation, impaired LV ejection fraction, and LV-ncMM20% was significantly more frequent in patients with CEs. LV fibrosis was detected by using LGE in 11 cases. CMR predictors of CEs were LV dilation and LGE. LGE was associated with improved prediction of CEs, compared with clinical data and CMR functional parameters in all 3 models. No CEs occurred in patients without dilated cardiomyopathy and/or LGE.In patients with LVNC evaluated by using CMR, the degree of LV trabeculation seems to have no prognostic impact over and above LV dilation, LV systolic dysfunction, and presence of LGE.
- Published
- 2016
36. The STRATEGY Study (Stress Cardiac Magnetic Resonance Versus Computed Tomography Coronary Angiography for the Management of Symptomatic Revascularized Patients): Resources and Outcomes Impact
- Author
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Andrea Igoren Guaricci, Marco Guglielmo, Edoardo Conte, Saima Mushtaq, Gianluca Pontone, Paola Gripari, Antonio L. Bartorelli, Laura Fusini, Anna Solbiati, Giuseppe Muscogiuri, Chiara Segurini, Mauro Pepi, Alberto Formenti, Andrea Baggiano, Federico Lombardi, Maria Petullà, Virginia Beltrama, Cristina Rota, Andrea Annoni, Daniele Andreini, Pontone, G, Andreini, D, Guaricci, A, Rota, C, Guglielmo, M, Mushtaq, S, Baggiano, A, Beltrama, V, Fusini, L, Solbiati, A, Segurini, C, Conte, E, Gripari, P, Annoni, A, Formenti, A, Petulla', M, Lombardi, F, Muscogiuri, G, Bartorelli, A, and Pepi, M
- Subjects
Male ,Time Factors ,Cost effectiveness ,Computed Tomography Angiography ,medicine.medical_treatment ,Cost-Benefit Analysis ,Vasodilator Agents ,Myocardial Infarction ,cost-effectivene ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Chest pain ,Coronary Angiography ,030218 nuclear medicine & medical imaging ,Coronary artery disease ,0302 clinical medicine ,Cause of Death ,cost ,Myocardial Revascularization ,Myocardial infarction ,Prospective Studies ,Registries ,Prospective cohort study ,medicine.diagnostic_test ,Health Care Costs ,Middle Aged ,Radiation Exposure ,Coronary Vessels ,Magnetic Resonance Imaging ,Treatment Outcome ,Italy ,Predictive value of tests ,Cardiology ,outcome ,revascularization ,Female ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Revascularization ,Radiation Dosage ,magnetic resonance ,03 medical and health sciences ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,business.industry ,Reproducibility of Results ,Magnetic resonance imaging ,computed tomography ,medicine.disease ,business - Abstract
Background— Computed tomography coronary angiography (cTCA) and stress cardiac magnetic resonance (stress-CMR) are suitable tools for diagnosing obstructive coronary artery disease in symptomatic patients with previous history of revascularization. However, performance appraisal of noninvasive tests must take in account the consequent diagnostic testing, invasive procedures, clinical outcomes, radiation exposure, and cumulative costs rather than their diagnostic accuracy only. We aimed to compare an anatomic (cTCA) versus a functional (stress-CMR) strategy in symptomatic patients with previous myocardial revascularization procedures. Methods and Results— Six hundred patients with chest pain and previous revascularization included in a prospective observational registry and evaluated by clinically indicated cTCA (n=300, mean age 68.2±9.7 years, male 255) or stress-CMR (n=300, mean age 67.6±9.7 years, male 263) were enrolled and followed-up in terms of subsequent noninvasive tests, invasive coronary angiography, revascularization procedures, cumulative effective radiation dose, major adverse cardiac events, defined as a composite end point of nonfatal myocardial infarction and cardiac death, and medical costs. The mean follow-up for cTCA and stress-CMR groups was similar (773.6±345 versus 752.8±291 days; P =0.21). Compared with stress-CMR, cTCA was associated with a higher rate of subsequent noninvasive tests (28% versus 17%; P =0.0009), invasive coronary angiography (31% versus 20%; P =0.0009), and revascularization procedures (24% versus 16%; P =0.007). Stress-CMR strategy was associated with a significant reduction of radiation exposure and cumulative costs (59% and 24%, respectively; P P P Conclusions— Compared with cTCA, stress-CMR is more cost-effective in symptomatic revascularized patients.
- Published
- 2016
37. Serum Amyloid A and C-Reactive Protein Independently Predict the Recurrences of Atrial Fibrillation After Cardioversion in Patients With Preserved Left Ventricular Function
- Author
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Gian Vico Melzi d’Eril, Alessandra Barassi, S. Belletti, Giampaolo Merlini, Giada Dogliotti, Massimiliano M. Corsi, Raffaele Pezzilli, Federico Lombardi, and Antonio Maria Morselli-Labate
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Electric Countershock ,Hemodynamics ,Cardioversion ,Risk Assessment ,Sensitivity and Specificity ,Severity of Illness Index ,Ventricular Function, Left ,Cohort Studies ,Electrocardiography ,Predictive Value of Tests ,Recurrence ,Internal medicine ,Atrial Fibrillation ,Natriuretic Peptide, Brain ,Confidence Intervals ,Odds Ratio ,Humans ,Medicine ,Prospective Studies ,cardiovascular diseases ,Serum amyloid A ,Aged ,Analysis of Variance ,Serum Amyloid A Protein ,Ejection fraction ,biology ,business.industry ,C-reactive protein ,Atrial fibrillation ,Odds ratio ,Middle Aged ,Prognosis ,medicine.disease ,Peptide Fragments ,Confidence interval ,Survival Rate ,C-Reactive Protein ,Logistic Models ,Multivariate Analysis ,Cardiology ,biology.protein ,Female ,Inflammation Mediators ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Subclinical inflammation and atrial stretch have been recognized as important contributors to atrial fibrillation (AF) onset and perpetuation. The aim of the study was to compare the predictive role of serum inflammatory markers (serum amyloid A [SAA], and C-reactive protein [CRP]) and N-terminal pro brain natriuretic peptide (NT-proBNP) an indice of atrial strain in relation to subacute arrhythmic recurrence rate in patients with persistent AF and normal left ventricular ejection fraction (LVEF). Methods We studied 57 patients with a mean LVEF of 58.7 ± 6%. NT-proBNP, SAA and CRP levels were determined few hours before electrical cardioversion and 3 weeks after cardioversion. Results Subacute AF recurrences were documented in 19 (33 %) patients. Whereas NT-proBNP levels did not predict arrhythmic outcome, higher SAA (> 6.16-6.19 mg/L) and CRP levels (> 2.99-3.10 mg/L) were significantly associated with AF recurrences (odds ratio [OR], 5.39; 95% confidence interval [CI], 1.59-18.26; P = 0.007 and OR, 14.93; 95% CI, 3.90-57.19; P P = 0.009) and high sensitivity CRP (OR, 42.03; 95% CI, 4.83-365.45; P = 0.001) through the multivariate logistic regression analysis show an independent role in predicting the AF recurrence with a sensitivity of 100% (38/38) and a specificity of 52.6% (10/19). Conclusions The present study demonstrates that in patients with persistent AF and preserved LVEF, SAA and CRP levels are independent predictors of AF subacute recurrence rate, whereas NT-proBNP, not associated with arrhythmic outcome, reflects the hemodynamic alterations secondary to arrhythmia presence. The simultaneous determination of SAA and high sensitivity CRP has a very high sensitivity (100%) in predicting the AF recurrence.
- Published
- 2012
38. The purpose of heart rate variability measurements
- Author
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Georg Schmidt, Federico Lombardi, Heikki V. Huikuri, and Marek Malik
- Subjects
medicine.medical_specialty ,Neurology ,Clinical Neurology ,SOCIETY ,030204 cardiovascular system & hematology ,Autonomic Nervous System ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Diabetes mellitus ,medicine ,Humans ,Myotonic Dystrophy ,Heart rate variability ,POSITION STATEMENT ,General Clinical Medicine ,Science & Technology ,Endocrine and Autonomic Systems ,business.industry ,Neurosciences ,Heart ,QT ,1103 Clinical Sciences ,ELECTROPHYSIOLOGY ,medicine.disease ,Diabetes Mellitus, Type 2 ,e-Health/Digital Rhythm Study Group of the European Heart Rhythm Association ,Emergency medicine ,ESC WORKING GROUP ,Neurosciences & Neurology ,Neurology (clinical) ,CONSENSUS ,business ,Life Sciences & Biomedicine ,030217 neurology & neurosurgery - Published
- 2017
39. Weekend effect on Acute MI mortality
- Author
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Federico Lombardi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Weekend effect ,Myocardial Infarction ,MEDLINE ,Hospital mortality ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,After-Hours Care ,Risk Factors ,Humans ,Medicine ,Hospital Mortality ,030212 general & internal medicine ,Acute Coronary Syndrome ,Acute mi ,Aged ,business.industry ,Age Factors ,Middle Aged ,Hospitalization ,Italy ,Emergency medicine ,Female ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
40. Efficacy of Acupuncture in Preventing Atrial Fibrillation Recurrences After Electrical Cardioversion
- Author
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Alberto Lomuscio, Pier Maria Battezzati, Sebastiano Belletti, and Federico Lombardi
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Acupuncture Therapy ,Electric Countershock ,Amiodarone ,Kaplan-Meier Estimate ,Cardioversion ,Risk Assessment ,Risk Factors ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,Secondary Prevention ,Acupuncture ,medicine ,Palpitations ,Humans ,Sinus rhythm ,Aged ,Proportional Hazards Models ,Chi-Square Distribution ,Ejection fraction ,business.industry ,Hazard ratio ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Treatment Outcome ,Italy ,Anesthesia ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents ,medicine.drug - Abstract
Antiarrhythmic Effect of Acupuncture. Introduction: In traditional Chinese medicine, stimulation of the Neiguan spot has been utilized to treat palpitations. We evaluated whether acupuncture might prevent or reduce the rate of arrhythmia recurrences in patients with persistent atrial fibrillation (AF). Methods and Results: We studied 80 patients with persistent AF after restoring sinus rhythm with electrical cardioversion. Twenty-six subjects who were already on amiodarone treatment constituted the AMIO reference group. The remaining patients were randomly allocated to receive acupuncture (ACU group, n = 17), sham acupuncture (ACU-sham group, n = 13), or neither acupuncture nor antiarrhythmic therapy (CONTROL group, n = 24). Patients in the ACU and ACU-sham groups attended 10 acupuncture sessions on a once-a-week basis. Only in the former group the Neiguan, Shenmen, and Xinshu spots were punctured. During a 12-month follow-up, AF recurred in 35 patients. Cumulative AF recurrence rates in the AMIO, ACU, ACU-sham, and CONTROL patients were 27%, 35%, 69%, and 54%, respectively (P = 0.0075, log-rank test). Ejection fraction (P = 0.0005), hypertension (0.0293), and left atrial diameter (P = 0.0361) were also significantly associated with AF recurrence. Compared with AMIO group, recurrence rate was similar in ACU patients (hazard ratio: 1.15, 95% CI: 0.38–3.49; P = 0.801) but significantly higher in ACU-sham and CONTROL patients (3.77, 1.39–10; P = 0.009 and 3.15, 1.23–8.06; P = 0.017, respectively) after adjustment for ejection fraction, hypertension, and left atrial diameter using Cox modeling. Conclusion: Our data indicate that acupuncture treatment prevents arrhythmic recurrences after cardioversion in patients with persistent AF. This minimally invasive procedure was safe and well tolerated. (J Cardiovasc Electrophysiol, Vol. 22, pp. 241-247, March 2011)
- Published
- 2010
41. Standard Deviation of normal interbeat intervals as a risk marker in patients with left ventricular systolic dysfunction: A meta-analysis
- Author
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Marco Paulo Tomaz Barbosa, Antonio Luiz Pinho Ribeiro, Federico Lombardi, and Marcos Roberto de Sousa
- Subjects
medicine.medical_specialty ,Heart disease ,Systole ,Ventricular Dysfunction, Left ,Heart Rate ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,Heart rate variability ,Risk factor ,Heart Failure ,business.industry ,Prognosis ,medicine.disease ,Surgery ,Transplantation ,Strictly standardized mean difference ,Data Interpretation, Statistical ,Heart failure ,Meta-analysis ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,circulatory and respiratory physiology ,Interbeat interval - Abstract
Our aim was to evaluate the Standard Deviation of Normal–Normal (SDNN) interbeat interval as a risk marker in left ventricular systolic dysfunction (LVSD) patients through a meta-analysis. We searched PubMed for studies that evaluated SDNN as a predictor of all-cause-death, cardiac death, transplantation, and progressive clinical deterioration using a search strategy validated for MEDLINE. Mean values and SD for SDNN in sixteen studies included were 115±48 ms in survivors versus 87±40 ms in non-survivors, resulting in a statistically significant standardized mean difference (0.594, 95%CI 0.385 to 0.803). In conclusion, SDNN may be a useful prognostic marker in LVSD. Additional studies must evaluate if SDNN may be used to subsidize therapeutic decisions.
- Published
- 2010
42. Clinical predictors of atrial fibrillation recurrence in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico–Atrial Fibrillation (GISSI-AF) trial
- Author
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Prisca Zeni, Maria Grazia Franzosi, Federico Lombardi, Franco Cosmi, Simona Barlera, Marcello Disertori, Roberto Latini, Aldo P. Maggioni, and Giuseppe Di Pasquale
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Amiodarone ,Tetrazoles ,Cardioversion ,Placebo ,Lower risk ,Recurrence ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,Heart rate ,Humans ,Medicine ,Sinus rhythm ,Diuretics ,Antihypertensive Agents ,Aged ,Proportional Hazards Models ,business.industry ,Valine ,Atrial fibrillation ,Middle Aged ,Prognosis ,medicine.disease ,Valsartan ,Cardiology ,Female ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents ,medicine.drug - Abstract
Background Atrial fibrillation (AF) is a common arrhythmia that frequently recurs after restoration of sinus rhythm (SR). Identifying risk factors for recurrence may help define the best strategy for secondary prevention. Methods The GISSI-AF trial enrolled 1,442 patients in SR with at least 2 documented AF episodes in the previous 6 months or after cardioversion in the last 2 weeks. Patients were randomized to valsartan or placebo; all other treatments for AF or underlying heart diseases were allowed. Primary end points were time to first recurrence of AF and proportion of patients with >1 AF episode during 1-year follow-up. We evaluated clinical and electrocardiographic baseline characteristics of all patients to identify independent predictors for AF recurrence using a Cox multivariable model. Results Risk factors for AF recurrence were a history of 2 or more AF episodes in the previous 6 months, independent of the modality of SR restoration, spontaneous (HR 1.42, 95% CI 1.14-1.77, P = .002), or by cardioversion (HR 1.19, 95% CI 1.01-1.40, P = .038), and a lower heart rate during SR (HR 0.99, 95% CI 0.99-1.00, P = .052). The risk factors were the same for >1 AF recurrence. Patients treated with amiodarone had a lower risk for both end points ( P P = .017), whereas those on diuretics had a greater risk ( P = .009 and P = .003). Conclusions In the GISSI-AF study population, AF history had significant prognostic value independent of the modality of SR restoration. Amiodarone and diuretic treatment affected the rate of AF recurrence.
- Published
- 2010
43. On the reliability of frequency components in systolic arterial pressure in patients with atrial fibrillation
- Author
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Federico Lombardi, Luca Mainardi, and Valentina D. A. Corino
- Subjects
Male ,medicine.medical_specialty ,Biomedical Engineering ,Blood Pressure ,Baroreflex ,Contractility ,Electrocardiography ,Internal medicine ,Atrial Fibrillation ,medicine ,Electronic engineering ,Humans ,Aged ,Mathematics ,Series (mathematics) ,medicine.diagnostic_test ,Models, Cardiovascular ,Signal Processing, Computer-Assisted ,Atrial fibrillation ,Middle Aged ,Spectral component ,medicine.disease ,Computer Science Applications ,Blood pressure ,Autoregressive model ,Cardiology ,Female ,Algorithms - Abstract
Atrial fibrillation (AF) is characterized by desynchronization of atrial electrical activity causing a consequent irregular ventricular response. In AF, the beat-to-beat variation of blood pressure is increased because of variations in filling time and contractility. However, only a few studies have analyzed short-term blood pressure variations in AF, and we have recently observed a harmonic low-frequency (LF) component in systolic arterial pressure (SAP) during AF. Aim of the present study is to propose a method to verify the reliability of the spectral component found in SAP series, based on the position of the poles of the autoregressive spectral decomposition in the z-plane. In particular, 1,000 random permutations of the series allowed the definition of an area in the z-plane where poles from random process are likely to occur. Poles lying outside this area are considered as reliable oscillations. We tested the method on 53 recordings obtained at rest from patients with persistent AF. LF component was found in, respectively, 51 and 43 recordings in SAP and RR series. High-frequency (HF) component was found in all the recordings for both SAP and RR series. Using the proposed test, the percentage of reliable components in LF and HF bands was 80 and 38 in SAP series, and 20 and 18 in RR series. We concluded that, at variance with RR ones, SAP LF components are likely to represent true physiological oscillations.
- Published
- 2010
44. Prevention of Contrast-induced Nephropathy: A Single Center Randomized Study
- Author
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Carlo Sponzilli, Diego Salerno Uriarte, Fesc Federico Lombardi Md, Laura Bosotti, Alessandro Verzoni, Stefano Lucreziotti, and Diego Castini
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Clinical Investigations ,Urology ,Contrast-induced nephropathy ,Contrast Media ,Renal function ,Sodium Chloride ,Coronary Angiography ,Nephropathy ,chemistry.chemical_compound ,Clinical endpoint ,Humans ,Medicine ,Prospective Studies ,Angioplasty, Balloon, Coronary ,Prospective cohort study ,Aged ,Creatinine ,Sodium bicarbonate ,business.industry ,Incidence ,Percutaneous coronary intervention ,Free Radical Scavengers ,General Medicine ,medicine.disease ,Acetylcysteine ,Surgery ,Sodium Bicarbonate ,chemistry ,Acute Disease ,Female ,Kidney Diseases ,Cardiology and Cardiovascular Medicine ,business ,Glomerular Filtration Rate - Abstract
Background Contrast-induced nephropathy (CIN) is the third cause of acute deterioration of renal function in hospitalized patients. Hypothesis The purpose of the study was to compare the efficacy of saline infusion, saline infusion plus N-acetylcysteine (NAC), and sodium bicarbonate (SB) infusion to prevent CIN in patients undergoing coronary angiography and/or percutaneous coronary intervention. Methods We prospectively studied 156 patients with a baseline creatinine level ≥ 1.2 mg/dL. The primary endpoint was the development of CIN, defined as an increase in serum creatinine concentration ≥ 25% over the baseline value within 5 days from contrast exposure. Results Contrast-induced nephropathy developed in 23 patients (14.7%). Incidence of the primary endpoint was similar in the 3 groups of treatment, occurring in 7 patients (14%) in the saline infusion group, in 9 (17%) in the saline infusion plus NAC group, and in 7 (14%) in the SB infusion group. Conclusions Our findings suggest that neither the addition of NAC nor the administration of SB add further benefit in CIN prevention, compared to standard hydration with isotonic saline infusion. Copyright © 2009 Wiley Periodicals, Inc.
- Published
- 2010
45. Low frequency component in systolic arterial pressure variability in patients with persistent atrial fibrillation
- Author
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Paolo Terranova, Federico Lombardi, Luca Mainardi, S. Belletti, and Valentina D. A. Corino
- Subjects
Adult ,Male ,Sympathetic Nervous System ,Systole ,Diastole ,Hemodynamics ,Blood Pressure ,Baroreflex ,Electrocardiography ,Cellular and Molecular Neuroscience ,Biological Clocks ,Atrial Fibrillation ,medicine ,Humans ,Heart rate variability ,Sinus rhythm ,Endocrine and Autonomic Systems ,business.industry ,Arrhythmias, Cardiac ,Heart ,Signal Processing, Computer-Assisted ,Atrial fibrillation ,Stroke volume ,Middle Aged ,medicine.disease ,Blood pressure ,Anesthesia ,Neurology (clinical) ,business - Abstract
Atrial fibrillation (AF) is a common arrhythmia characterized by irregular ventricular response. During AF, beat-to-beat variability of arterial pressure (AP) is increased because of continuous changes in filling time, stroke volume and contractility. Only a few studies have analyzed short-term AP variability during AF but they were mainly focused on the effects of respiration. We therefore analyzed short-term systolic (S), diastolic (D) and mean (M) AP variability by autoregressive method and an FFT-based spectral estimation (Welch periodogram) in 26 patients with persistent AF before and after restoration of sinus rhythm by electrical cardioversion. A low frequency (LF) component (central frequency 0.07 ± 0.02 Hz, mean ± standard deviation) of SAP variability was observed in 23 out of 26 patients during AF. Frequency analysis of DAP and MAP also showed a LF component with a central frequency of 0.08 ± 0.03 Hz (20 patients) and 0.07 ± 0.03 Hz (25 patients), respectively. After recovery of sinus rhythm, we found significant reduction in mean SAP, DAP and MAP variability in all frequency bands. Squared coherence between SAP and heart rate variability after recovery of sinus rhythm revealed a weak and strong coupling within, respectively, LF and HF frequency bands. These data indicate that in patients with AF, in spite of an absence of rhythmical oscillation in RR interval time series, it is possible to observe a LF component in SAP, DAP and MAP variability signals. These 0.1 Hz fluctuations reflect the influence of the sympathetic fibres acting on the cardiovascular system.
- Published
- 2009
46. Early occurrence of anti-muscarinic autoantibodies and abnormal vagal modulation in Chagas disease
- Author
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Antonio Carlos Carvalho, Manoel Otávio da Costa Rocha, Mauro M. Teixeira, Ciria C. Hernandez, Luis E. Gimenez, Federico Lombardi, Valesca Costa Guedes, Márcio Vinícius Lins Barros, and Antonio Luiz Pinho Ribeiro
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Pathogenesis ,Ventricular Dysfunction, Left ,Internal medicine ,Heart rate ,medicine ,Humans ,Heart rate variability ,Chagas Disease ,cardiovascular diseases ,Autoantibodies ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Autoantibody ,Dysautonomia ,Receptors, Muscarinic ,Endocrinology ,Autonomic Nervous System Diseases ,Circulatory system ,Electrocardiography, Ambulatory ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Electrocardiography ,Biomarkers - Abstract
Autoimmunity and dysautonomia are established features of Chagas disease (ChD) that could be related to its pathogenesis. Our objective was to assess heart rate variability (HRV) and levels of anti-M2 receptors autoantibodies in ChD patients with and without left ventricular (LV) dysfunction, in order to establish if these abnormalities occur early and concomitantly in the course of the illness.ChD patients (n=75) and healthy controls (n=14) underwent a standardized protocol including Doppler echocardiogram, Holter monitoring, HRV analysis, and measurement of anti-M2 receptors autoantibodies (ELISA). ChD patients were divided accordingly by the absence (group 1, n=45) or presence (group 2, n=30) of LV dysfunction, defined as reduced LV ejection fraction (55%) or regional wall motion abnormalities (including ventricular aneurysm).Both ChD groups displayed increased optical density values of anti-M2 cholinergic autoantibodies (Median (IQR): control=1.98(0.51); ChD 1=2.76(0.97); ChD 2=2.72(1.34), p.001) and reduced HF power of spectral analysis of HRV when compared to controls (Median (IQR) in ms2: control=1087(2284); ChD 1=286(763); ChD 2=285(763), p.001). M2 levels were significantly correlated with HF power values (r=-0.32, p=0.023), but not with LV ejection fraction.Anti-muscarinic autoantibodies and abnormal vagal modulation occur early in ChD patients, independently of the presence of LV dysfunction. Levels of antibodies against M2 muscarinic receptors were significantly and negatively correlated with HRV index HF power, suggesting an inhibitory effect of autoantibodies in vagal function.
- Published
- 2007
47. Effects of gastric banding on glucose tolerance, cardiovascular and renal function, and diabetic complications: a 13-year study of the morbidly obese
- Author
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Antonio E. Pontiroli, Maurizio Cristina, Alessandro Saibene, Federico Lombardi, Anna Veronelli, Giancarlo Micheletto, Ahmed S. Zakaria, and Luca Rossetti
- Subjects
Adult ,Blood Glucose ,Male ,Reoperation ,medicine.medical_specialty ,Adolescent ,Gastroplasty ,Renal function ,030209 endocrinology & metabolism ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Insulin resistance ,Weight loss ,Diabetes mellitus ,Glucose Intolerance ,Weight Loss ,Medicine ,Humans ,Diabetic Nephropathies ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Glycated Hemoglobin ,Analysis of Variance ,Diabetic Retinopathy ,business.industry ,Diabetic retinopathy ,Middle Aged ,medicine.disease ,Surgery ,Obesity, Morbid ,Blood pressure ,Treatment Outcome ,Diabetes Mellitus, Type 2 ,Case-Control Studies ,Hypertension ,Female ,Laparoscopy ,medicine.symptom ,Insulin Resistance ,business ,Body mass index ,Diabetic Angiopathies ,Retinopathy ,Glomerular Filtration Rate - Abstract
Limited information is available on weight loss, metabolic control, cardiovascular disease and diabetic complications in morbidly obese patients undergoing gastric banding (LAGB) compared with morbidly obese patients receiving medical treatment.To assess the long-term effects of laparoscopic adjustable gastric banding (LAGB) on glucose tolerance, arterial hypertension, and cardiovascular disease and prevention of diabetic complications (retinopathy and renal function) in morbidly obese patients.University hospitals, Italy.In this retrospective study, 87 morbidly obese patients who underwent LAGB (20 with diabetes) and 87 morbidly obese patients who did not undergo surgery (36 with diabetes) for the treatment of obesity during the period 1995 to 2003 consented for re-examination after a mean (±standard deviation) period of 13.8±2.04 years. At baseline, all mobidly obese patients had a body mass index (BMI)≥35 kg/m(2) and were aged 18 to 65 years.At follow-up, LAGB patients maintained a lower weight compared with baseline values and demonstrated significant decreases in both blood pressure and heart rate measurements compared with control patients. LAGB patients also experienced greater improvement of glucose tolerance than did control patients (28% versus 10%, respectively; P.01) and reduction of insulin and homeostasis model assessment for insulin resistance. Fewer LAGB patients developed carotid plaques than did control patients (10% versus 26%, respectively; P.01). Intensification of antihypertensive therapy was required in 31% of surgery versus 60% of control patients (P.05). Among diabetic patients, improved glucose tolerance occurred in 55% of surgery patients versus 0% in the control group (P.01). In addition, insulin treatment was necessary in 9 control patients versus 0 in the surgery group (P.05), and carotid plaques occurred in 10% of LAGB patients versus 50% of control patients (P.01). Creatinine levels and the estimated glomerular filtration rate improved in LAGB diabetic patients but not in control patients (P.05).Despite a very small weight loss over the long term (i.e., 2.2 kg/m(2)), improvement of glucose tolerance persisted for long periods after LAGB, with no unfavorable effect on kidney function and retinopathy. In contrast, no effect was observed on prevention of arterial hypertension or cardiovascular disease.
- Published
- 2015
48. Oxidative Stress Biomarkers and Incidence of Postoperative Atrial Fibrillation in the Omega‐3 Fatty Acids for Prevention of Postoperative Atrial Fibrillation (OPERA) Trial
- Author
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Joann Marsala, Peter Libby, Nancy J. Brown, Ginger L. Milne, Alberto Domenech, Dariush Mozaffarian, Ralph J. Damiano, Roberto Marchioli, Serge Masson, Caterina Simon, Luigi Tavazzi, Maria Giuseppina Silletta, Mauro Rinaldi, Jason H Y Wu, Federico Lombardi, and Frank W. Sellke
- Subjects
Male ,medicine.medical_specialty ,Urine ,Isoprostanes ,medicine.disease_cause ,Electrocardiography ,Postoperative Complications ,Dietary Fats, Unsaturated ,Internal medicine ,Atrial Fibrillation ,Fatty Acids, Omega-3 ,medicine ,Humans ,Postoperative Period ,Original Research ,Omega-3 ,Unsaturated ,F2-Isoprostanes ,medicine.diagnostic_test ,atrial fibrillation ,cardiac surgery ,isofurans ,isoprostanes ,oxidative stress ,Biomarkers ,Female ,Incidence ,Middle Aged ,Treatment Outcome ,Oxidative Stress ,business.industry ,Incidence (epidemiology) ,Fatty Acids ,Atrial fibrillation ,Perioperative ,medicine.disease ,Dietary Fats ,3. Good health ,Cardiac surgery ,Anesthesia ,Cardiology ,Biomarker (medicine) ,Cardiology and Cardiovascular Medicine ,business ,Oxidative stress - Abstract
Background Animal study results point to oxidative stress as a key mechanism triggering postoperative atrial fibrillation (Po AF ), yet the extent to which specific biomarkers of oxidative stress might relate to Po AF risk in humans remains speculative. Methods and Results We assessed the association of validated, fatty acid–derived oxidative stress biomarkers (F 2 ‐isoprostanes, isofurans, and F 3 ‐isoprostanes) in plasma and urine, with incident Po AF among 551 cardiac surgery patients. Biomarkers were measured at enrollment, the end of surgery, and postoperative day 2. Po AF lasting ≥30 seconds was confirmed with rhythm strip or electrocardiography and centrally adjudicated. Outcomes were assessed until hospital discharge or postoperative day 10, whichever occurred first. Urine level of each oxidative stress biomarker rose at the end of surgery (2‐ to 3‐fold over baseline, P 2 ‐isoprostanes and isofurans at the end of surgery were 20% and 50% higher in subjects who developed Po AF ( P ≤0.009). While baseline biomarker levels did not associate significantly with Po AF , end of surgery and postoperative day 2 isoprostanes and isofurans demonstrated relatively linear associations with Po AF . For example, the end of surgery extreme quartile multivariate adjusted OR (95% CI ) for urine isofurans and F 3 ‐isoprostanes were 1.95 (1.05 to 3.62; P for trend=0.01) and 2.10 (1.04 to 2.25, P for trend=0.04), respectively. The associations of biomarkers with Po AF varied little by demographics, surgery type, and medication use ( P ≥0.29 for each). Conclusions These novel results add to accumulating evidence supporting the likely key pathogenic role of elevated oxidative stress in Po AF . Clinical Trial Registration URL: Clinicaltrials.gov Unique identifier: NCT00970489.
- Published
- 2015
49. Self-Terminating Ventricular Fibrillation in Vandetanib-Induced Torsades de Pointes
- Author
-
Marco, Loffi, Laura, Toffetti, Carola, Gianni, and Federico, Lombardi
- Subjects
Male ,Time Factors ,Action Potentials ,Antineoplastic Agents ,Piperidines ,Heart Conduction System ,Heart Rate ,Risk Factors ,Torsades de Pointes ,Ventricular Fibrillation ,Electrocardiography, Ambulatory ,Quinazolines ,Humans ,Protein Kinase Inhibitors ,Aged - Published
- 2015
50. Assessment of spatial organization in the atria during paroxysmal atrial fibrillation and adrenergic stimulation
- Author
-
Luca Mainardi, Valentina D. A. Corino, Massimo Mantica, and Federico Lombardi
- Subjects
Male ,medicine.medical_specialty ,Paroxysmal atrial fibrillation ,Biomedical Engineering ,Adrenergic ,Adrenergic stimulation ,Heart Conduction System ,Heart Rate ,Internal medicine ,Atrial Fibrillation ,Humans ,Medicine ,Computer Simulation ,Sinus rhythm ,Diagnosis, Computer-Assisted ,Heart Atria ,business.industry ,Isoproterenol ,Models, Cardiovascular ,Atrial fibrillation ,Drug infusion ,Adrenergic beta-Agonists ,Middle Aged ,medicine.disease ,Drug Therapy, Computer-Assisted ,cardiovascular system ,Cardiology ,Female ,business ,Algorithms - Abstract
Non-linear parameters were computed to assess the extent of spatial organization in the atria in terms of coupling/synchronization between electrograms recorded in different atrial sites. Recordings of 9 patients suffering from paroxysmal atrial fibrillation were tested during four clinical experimental conditions: sinus rhythm and atrial fibrillation, both before and after isoproterenol infusion, a drug mimicking adrenergic activation. Two non-linear metrics were investigated: an index of non-linear association (NLA) and a synchronization (S) index based on the cross-conditional entropy. Results evidence the presence of reduced coupling after drug infusion in both sinus rhythm and atrial fibrillation. Moreover, passing from the NLA to the S index, the capability of the parameter to capture the subtle changes due to isoproterenol administration increased.
- Published
- 2006
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