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1. How do cardiologists select patients for dual antiplatelet therapy continuation beyond 1 year after a myocardial infarction? Insights from the EYESHOT Post-MI Study

Author

De Luca L., Colivicchi F., Meessen J., Uguccioni M., Piscione F., Bernabo P., Lardieri G., Granatelli A., Gabrielli D., Gulizia M. M., Silverio A., Benvenga R. M., Mascia F., Fusco A., Cicala S., Oltrona Visconti L., Marinoni B., Canosi U., Cirillo P., Trimarco B., Ziviello F., Grosseto D., Menozzi M., Mezzena D., Mauro C., Sasso A., Bellis A., Calabro P., Gragnano F., Cesaro A., Venturelli V., Porretta V., Borrelli N., Indolfi C., De Rosa S., Torella D., Morici N., Molfese M., Della Rovere F., Caiffa T., Moretto G., Grippo G., Di Vincenzo E., Lucisano L., Pennacchi M., Geraci G., Sanfilippo N., Ledda A., Di Lenarda A., Cherubini A., Russo G., Piemonte F., Di Donato A., Carraturo A., Villari B., Ciampi Q., Contaldi C., Pacher V., Corrada E., Cattani D., Nassiacos D., Meloni S., Barco B., Bonmassari R., Bertoldi A., Tedoldi F., Cannone M., Valenti G., Musci R. L., Caldarola P., Locuratolo N., Sublimi Saponetti L., Gentili L., Maiandi C., Caputo M., Capparuccia C. A., Tonella T., Massari F. M., Lupi A., Tessitori M., Montano M., Scaglione A., Torri A., Tortorella G., Navazio A., Cemin R., Latina L., Briguglia D., Marino R., Scalvini S., Zanelli E., Paganini V., Riboni G., Leiballi E., Della Mattia A., Imperadore F., Tespili M., Santangelo G., Parravicini U., Dellavesa P., Testa R., Venturini E., Feola M., Testa M., Crisci V., Tramontana M., Robiglio L., Varbella F., Meynet I., Galati A., Maddaluna A., Bilato C., Loddo I., Licciardello G., Cassaniti L., Scherillo M., Formigli D., Marullo L., Chianese L., Paolillo C., De Santis A. P. A., Brunetti N. D., Bottigliero D., Della Bona R., Giannico M. B., Tramarin R., Lucibello S., Perna G. P., Marini M., Colavita A. R., Raziliop A., Francese G. M., Mariani M., Collauto F., D'Urbano M., Naio R., Ando G., Saporito F., Assanelli E. M., Cabiati A., Crivaro A., Alberti S., Marchese I., Nejat T., Refice S., Raino R., Aiello A., Cristinziani G. R., Barilla F., Iorio R., Mascelli G., Tartaglione S. N., Di Chiara G., D'Andrea D., Antonicelli R., Malatesta G., Di Mario C., Mattesini A., Tramontana L., Conti S., Sommariva L., Celestini A., Amico F., Giubilato S., Amico A. F., De Filippis M., Pasini G. F., Triggiani M., Ferrara V., Cappetti S., Carugo S., Lucreziotti S., Persico M., Gizzi G., Cipolla T., Caronia A., Buia E., Pastori P., Scarpignato M., Biscottini E., Poletti F., Vimercati C., Pirola R., Barbieri E., Dugo C., De Cesare N., De Benedictis M. L., Ruggeri A., Campana C., Bonura S., Vigna C., Marchese N., Partesana N. G., Bandini P., Farinola G., Santoro D., Cassadonte F., Calabro F., Sansoni M., Abrignani M. G., Bonura F., Benvenuto M., Liso A., Passero T., Mori I., Pozzoni B., Prati F., Finocchiaro M. L., Tufano N., Miserrafiti B., Lacquaniti V., Del Piccolo F., Mohamad B., Spinnler M. T., Bovolo V., Rebulla E., Pieri M., Paloscia L., Di Clemente D., Mazzucco G., Micanti A., Peci P., Ornago O., Proietti F., Michisanti M., Reverzani A., Donatini A., Costa P., Russo S., Franceschini Grisolia E., Mario L., Di Palma F., Dell'Aquila F., Maestroni A., Caico S. I., De Caro G., Attianese L., Perotti S., Cotti Cometti V., Astengo D., Guerri E., Cianflone D., Maranta F., Esposito N., Malvezzi Caracciolo D'Aquino M., Caliendo L., Ricci C., Ceruso C. P., Lanteri S., Serdoz R., Bruno E., De Matteis C., Campagnuolo C., Ammirati M. A., Corrado V. M., Amado Eleas M. A., Fattore L., Ippoliti C., Turiano G., Piergentili C., Chiarella F., Capogrosso P., Perotti M., Di Marco S., Sibilio G., Di Lorenzo L., Aurelio A., Ramondo A. B., Zanna D., Cernetti C., Napolitano G., Negroni S., Alessandri N., Rigo F., Giusti F., Casu G., Vicentini A., Calculli G., Fera M. S., Lettica G. V., Vagheggini G., Piti A., Porfidia A., Di Leo A., Ravera A., Ciotta E., Sacca S., Silvestri O., Isidori S., Natali P., Anselmi M., Testa L., Antonelli A., Tavasci E., Furgi G., Lavorgna A., Gasparetto N., Bisceglia T., De Luca, L., Colivicchi, F., Meessen, J., Uguccioni, M., Piscione, F., Bernabo, P., Lardieri, G., Granatelli, A., Gabrielli, D., Gulizia, M. M., Silverio, A., Benvenga, R. M., Mascia, F., Fusco, A., Cicala, S., Oltrona Visconti, L., Marinoni, B., Canosi, U., Cirillo, P., Trimarco, B., Ziviello, F., Grosseto, D., Menozzi, M., Mezzena, D., Mauro, C., Sasso, A., Bellis, A., Calabro, P., Gragnano, F., Cesaro, A., Venturelli, V., Porretta, V., Borrelli, N., Indolfi, C., De Rosa, S., Torella, D., Morici, N., Molfese, M., Della Rovere, F., Caiffa, T., Moretto, G., Grippo, G., Di Vincenzo, E., Lucisano, L., Pennacchi, M., Geraci, G., Sanfilippo, N., Ledda, A., Di Lenarda, A., Cherubini, A., Russo, G., Piemonte, F., Di Donato, A., Carraturo, A., Villari, B., Ciampi, Q., Contaldi, C., Pacher, V., Corrada, E., Cattani, D., Nassiacos, D., Meloni, S., Barco, B., Bonmassari, R., Bertoldi, A., Tedoldi, F., Cannone, M., Valenti, G., Musci, R. L., Caldarola, P., Locuratolo, N., Sublimi Saponetti, L., Gentili, L., Maiandi, C., Caputo, M., Capparuccia, C. A., Tonella, T., Massari, F. M., Lupi, A., Tessitori, M., Montano, M., Scaglione, A., Torri, A., Tortorella, G., Navazio, A., Cemin, R., Latina, L., Briguglia, D., Marino, R., Scalvini, S., Zanelli, E., Paganini, V., Riboni, G., Leiballi, E., Della Mattia, A., Imperadore, F., Tespili, M., Santangelo, G., Parravicini, U., Dellavesa, P., Testa, R., Venturini, E., Feola, M., Testa, M., Crisci, V., Tramontana, M., Robiglio, L., Varbella, F., Meynet, I., Galati, A., Maddaluna, A., Bilato, C., Loddo, I., Licciardello, G., Cassaniti, L., Scherillo, M., Formigli, D., Marullo, L., Chianese, L., Paolillo, C., De Santis, A. P. A., Brunetti, N. D., Bottigliero, D., Della Bona, R., Giannico, M. B., Tramarin, R., Lucibello, S., Perna, G. P., Marini, M., Colavita, A. R., Francese, G. M., Mariani, M., Collauto, F., D'Urbano, M., Naio, R., Ando, G., Saporito, F., Assanelli, E. M., Cabiati, A., Crivaro, A., Alberti, S., Marchese, I., Nejat, T., Refice, S., Aiello, A., Cristinziani, G. R., Barilla, F., Iorio, R., Mascelli, G., Tartaglione, S. N., Di Chiara, G., D'Andrea, D., Antonicelli, R., Malatesta, G., Di Mario, C., Mattesini, A., Tramontana, L., Conti, S., Sommariva, L., Celestini, A., Amico, F., Giubilato, S., Amico, A. F., De Filippis, M., Pasini, G. F., Triggiani, M., Ferrara, V., Cappetti, S., Carugo, S., Lucreziotti, S., Persico, M., Gizzi, G., Cipolla, T., Caronia, A., Buia, E., Pastori, P., Scarpignato, M., Biscottini, E., Poletti, F., Vimercati, C., Pirola, R., Barbieri, E., Dugo, C., De Cesare, N., De Benedictis, M. L., Ruggeri, A., Campana, C., Bonura, S., Vigna, C., Marchese, N., Partesana, N. G., Bandini, P., Farinola, G., Santoro, D., Cassadonte, F., Calabro, F., Sansoni, M., Abrignani, M. G., Bonura, F., Benvenuto, M., Liso, A., Passero, T., Mori, I., Pozzoni, B., Prati, F., Finocchiaro, M. L., Tufano, N., Miserrafiti, B., Lacquaniti, V., Del Piccolo, F., Mohamad, B., Spinnler, M. T., Bovolo, V., Rebulla, E., Pieri, M., Paloscia, L., Di Clemente, D., Mazzucco, G., Micanti, A., Peci, P., Ornago, O., Proietti, F., Michisanti, M., Reverzani, A., Donatini, A., Costa, P., Russo, S., Franceschini Grisolia, E., Mario, L., Di Palma, F., Dell'Aquila, F., Maestroni, A., Caico, S. I., De Caro, G., Attianese, L., Perotti, S., Cotti Cometti, V., Astengo, D., Guerri, E., Cianflone, D., Maranta, F., Esposito, N., Malvezzi Caracciolo D'Aquino, M., Caliendo, L., Ricci, C., Ceruso, C. P., Lanteri, S., Serdoz, R., Bruno, E., De Matteis, C., Campagnuolo, C., Ammirati, M. A., Corrado, V. M., Amado Eleas, M. A., Fattore, L., Ippoliti, C., Turiano, G., Piergentili, C., Chiarella, F., Capogrosso, P., Perotti, M., Di Marco, S., Sibilio, G., Di Lorenzo, L., Aurelio, A., Ramondo, A. B., Zanna, D., Cernetti, C., Napolitano, G., Negroni, S., Alessandri, N., Rigo, F., Giusti, F., Casu, G., Vicentini, A., Calculli, G., Fera, M. S., Lettica, G. V., Vagheggini, G., Piti, A., Porfidia, A., Di Leo, A., Ravera, A., Ciotta, E., Sacca, S., Silvestri, O., Isidori, S., Natali, P., Anselmi, M., Testa, L., Antonelli, A., Tavasci, E., Furgi, G., Lavorgna, A., Gasparetto, N., Bisceglia, T., Raziliop, A., and Raino, R.

Subjects
Male, Multivariate analysis, Time Factors, medicine.medical_treatment, Myocardial Infarction, 030204 cardiovascular system & hematology, 0302 clinical medicine, Cardiologists, post‐MI, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, Registries, intervention, risk, Dual Anti-Platelet Therapy, focused update, ticagrelor keywords plus:coronary-artery-disease, Atrial fibrillation, General Medicine, clopidogrel, dual antiplatelet therapy, percutaneous coronary intervention, post-mi, secondary prevention, dapt score, duration, management, Middle Aged, Clopidogrel, Treatment Outcome, Female, Cardiology and Cardiovascular Medicine, Ticagrelor, Human, medicine.drug, medicine.medical_specialty, animal structures, Time Factor, Clinical Investigations, Cardiologist, Drug Administration Schedule, Follow-Up Studie, ticagrelor, 03 medical and health sciences, Internal medicine, medicine, Humans, cardiovascular diseases, Aged, Aspirin, post-MI, Follow-Up Studies, Platelet Aggregation Inhibitors, Patient Selection, business.industry, Platelet Aggregation Inhibitor, Percutaneous coronary intervention, medicine.disease, Prospective Studie, Conventional PCI, Observational study, business
Abstract

Background Current guidelines suggest to consider dual antiplatelet therapy (DAPT) continuation for longer than 12 months in selected patients with myocardial infarction (MI). Hypothesis We sought to assess the criteria used by cardiologists in daily practice to select patients with a history of MI eligible for DAPT continuation beyond 1 year. Methods We analyzed data from the EYESHOT Post-MI, a prospective, observational, nationwide study aimed to evaluate the management of patients presenting to cardiologists 1 to 3 years from the last MI event. Results Out of the 1633 post-MI patients enrolled in the study between March and December 2017, 557 (34.1%) were on DAPT at the time of enrolment, and 450 (27.6%) were prescribed DAPT after cardiologist assessment. At multivariate analyses, a percutaneous coronary intervention (PCI) with multiple stents and the presence of peripheral artery disease (PAD) resulted as independent predictors of DAPT continuation, while atrial fibrillation was the only independent predictor of DAPT interruption for patients both at the second and the third year from MI at enrolment and the time of discharge/end of the visit. Conclusions Risk scores recommended by current guidelines for guiding decisions on DAPT duration are underused and misused in clinical practice. A PCI with multiple stents and a history of PAD resulted as the clinical variables more frequently associated with DAPT continuation beyond 1 year from the index MI.

Published
2019

2. Quality control of B-lines analysis in stress Echo 2020

Author

Scali, M. C., Ciampi, Q., Picano, E., Bossone, E., Ferrara, F., Citro, R., Colonna, P., Costantino, M. F., Cortigiani, L., Andrea, A. D., Severino, S., Dodi, C., Gaibazzi, N., Galderisi, M., Barbieri, A., Monte, I., Mori, F., Reisenhofer, B., Re, F., Rigo, F., Trambaiolo, P., Amor, M., Lowenstein, J., Merlo, P. M., Daros, C. B., De Castro E Silva Pretto, J. L., Miglioranza, M. H., Torres, M. A. R., De Azevedo Bellagamba, C. C., Chaves, D. Q., Simova, I., Varga, A., Celutkiene, J., Kasprzak, J. D., Wierzbowska-Drabik, K., Lipiec, P., Weiner-Mik, P., Szymczyk, E., Wdowiak-Okrojek, K., Djordjevic-Dikic, A., Dekleva, M., Stankovic, I., Neskovic, A. N., Zagatina, A., Di Salvo, G., Perez, J. E., Camarozano, A. C., Corciu, A. I., Boshchenko, A., Lattanzi, F., Cotrim, C., Fazendas, P., Haberka, M., Sobkowic, B., Kosmala, W., Witkowski, T., Gosciniak, P., Salustri, A., Rodriguez-Zanella, H., Leal, L. I. M., Nikolic, A., Gligorova, S., Urluescu, M. -L., Fiorino, M., Novo, G., Preradovic-Kovacevic, T., Ostojic, M., Beleslin, B., Villari, B., De Nes, M., Paterni, M., Carpeggiani, C., Andreassi, M. G., Scali, Maria Chiara, Ciampi, Quirino, Picano, Eugenio, Bossone, Eduardo, Ferrara, Francesco, Citro, Rodolfo, Colonna, Paolo, Costantino, Marco Fabio, Cortigiani, Lauro, Andrea, Antonello D'., Severino, Sergio, Dodi, Claudio, Gaibazzi, Nicola, Galderisi, Maurizio, Barbieri, Andrea, Monte, Ine, Mori, Fabio, Reisenhofer, Barbara, Re, Federica, Rigo, Fausto, Trambaiolo, Paolo, Amor, Miguel, Lowenstein, Jorge, Merlo, Pablo Martin, Daros, Clarissa Borguezan, De Castro E Silva Pretto, José Lui, Miglioranza, Marcelo Haertel, Torres, Marco A. R., De Azevedo Bellagamba, Clarissa Carmona, Chaves, Daniel Quesada, Simova, Iana, Varga, Albert, Čelutkiene, Jelena, Kasprzak, Jaroslaw D., Wierzbowska-Drabik, Karina, Lipiec, Piotr, Weiner-Mik, Paulina, Szymczyk, Eva, Wdowiak-Okrojek, Katarzyna, Djordjevic-Dikic, Ana, Dekleva, Milica, Stankovic, Ivan, Neskovic, Aleksandar N., Zagatina, Angela, Di Salvo, Giovanni, Perez, Julio E., Camarozano, Ana Cristina, Corciu, Anca Irina, Boshchenko, Alla, Lattanzi, Fabio, Cotrim, Carlo, Fazendas, Paula, Haberka, Maciej, Sobkowic, Bozena, Kosmala, Wojciech, Witkowski, Tomasz, Gosciniak, Piotr, Salustri, Alessandro, Rodriguez-Zanella, Hugo, Leal, Luis Ignacio Martin, Nikolic, Alexandra, Gligorova, Suzana, Urluescu, Madalina-Loredana, Fiorino, Maria, Novo, Giuseppina, Preradovic-Kovacevic, Tamara, Ostojic, Miodrag, Beleslin, Branko, Villari, Bruno, De Nes, Michele, Paterni, Marco, Carpeggiani, Clara, Andreassi, Maria Grazia, Scali, Mc, Ciampi, Q, Picano, E, Bossone, E, Ferrara, F, Citro, R, Colonna, P, Costantino, Mf, Cortigiani, L, D'Andrea, A, Severino, S, Dodi, C, Gaibazzi, N, Galderisi, M, Barbieri, A, Monte, I, Mori, F, Reisenhofer, B, Re, F, Rigo, F, Trambaiolo, P, Amor, M, Lowenstein, J, Merlo, Pm, Daros, Cb, Pretto, Jlde, Miglioranza, Mh, Torres, Mar, Bellagamba, Ccd, Chaves, Dq, Simova, I, Varga, A, Celutkiene, J, Kasprzak, Jd, Wierzbowska-Drabik, K, Lipiec, P, Weiner-Mik, P, Szymczyk, E, Wdowiak-Okrojek, K, Djordjevic-Dikic, A, Dekleva, M, Stankovic, I, Neskovic, An, Zagatina, A, Di Salvo, G, Perez, Je, Camarozano, Ac, Corciu, Ai, Boshchenko, A, Lattanzi, F, Cotrim, C, Fazendas, P, Haberka, M, Sobkowic, B, Kosmala, W, Witkowski, T, Gosciniak, P, Salustri, A, Rodriguez-Zanella, H, Leal, Lim, Nikolic, A, Gligorova, S, Urluescu, Ml, Fiorino, M, Novo, G, Preradovic-Kovacevic, T, Ostojic, M, Beleslin, B, Villari, B, De Nes, M, Paterni, M, and Carpeggiani, C

Subjects
Male, lcsh:Diseases of the circulatory (Cardiovascular) system, Diagnostic accuracy, 030204 cardiovascular system & hematology, 0302 clinical medicine, Nuclear Medicine and Imaging, Reading (process), Medicine, Lung, media_common, Controle de qualidade, certification, lung comets, quality control, stress echocardiography, wall motion, General Medicine, Middle Aged, Echocardiography, Female, Radiology, Cardiology and Cardiovascular Medicine, Human, Echocardiography, Stress, Quality Control, Certification, Lung comets, Quality control, Stress echocardiography, Wall motion, Humans, Internet, Pulmonary Edema, Radiology, Nuclear Medicine and Imaging, medicine.medical_specialty, Correlation coefficient, media_common.quotation_subject, Stress, Lung comet, Ecocardiografia sob estresse, 03 medical and health sciences, Echocardiography, Stre, Internal medicine, Radiology, Nuclear Medicine and imaging, Quality (business), Doenças cardiovasculares, business.industry, 030208 emergency & critical care medicine, Gold standard (test), Lung ultrasound, lcsh:RC666-701, Stress Echo, Nuclear medicine, business, Certificação
Abstract

Background The effectiveness trial “Stress echo (SE) 2020” evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. Purpose To provide web-based upstream quality control and harmonization of B-lines reading criteria. Methods 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. Results All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p

Published
2018
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3. Assessment of left ventricular diastolic function: comparison of contrast ventriculography and equilibrium radionuclide angiography

Author

Villari, B., Betocchi, S., Pace, L., Piscione, F., Russolillo, E., Andrea Ciarmiello, Salvatore, M., Condorelli, M., Chiariello, M., Villari, B, Betocchi, Sandro, Pace, Leonardo, Piscione, F, Russolillo, E, Ciarmiello, A, Salvatore, M, Condorelli, M, Chiariello, M., Betocchi, S, Pace, L, and Salvatore, Marco

Subjects
Male, Erythrocytes, Heart Ventricles, Cineangiography, Humans, Coronary Disease, Female, Gated Blood-Pool Imaging, Middle Aged, Algorithms, Ventricular Function, Left, Iopamidol, Sodium Pertechnetate Tc 99m
Abstract

Twenty-two patients with coronary artery disease were studied first by radionuclide angiography (RNA) and then by contrast ventriculography. Cardiac medications were discontinued at least 72 hr before study. The patients were studied during atrial pacing at heart rates close to their spontaneous sinus rhythm. Contrast ventriculography was performed at 50 frames/sec in the 30 degrees right anterior oblique projection using 40 ml of a nonionic contrast medium (iopamidol) at a flow rate of 10-12 ml/sec. The contours of the left ventricular silhouette at contrast ventriculography were traced, frame by frame, on a graphic table with a digitizing penlight. Equilibrium 99mTc RNA was performed in the best septal 45 degrees left anterior oblique projection, acquiring 150,000 cts/frame, at 50 frames/sec and with a 5% gate tolerance. Time-activity curves from both end-diastolic and end-systolic ROIs were built and interpolated. Both RNA and contrast ventriculography volume curves were filtered with Fourier five harmonics. A close relationship was found between RNA and contrast ventriculography measurements of peak filling rate normalized to end-diastolic cps (r = 0.87, p less than 0.001) and stroke count (r = 0.87, p less than 0.001), ejection fraction (r = 0.94, p less than 0.001). Thus, in patients with coronary artery disease, LV filling can be accurately assessed using RNA.

Published
1991

4. [Coronary artery size in chronic mitral valve insufficiency before and following mitral valve surgery]

Author

Vassalli G, On, Krogmann, Om, Hess, Villari B, Philipp Kaufmann, Turina M, and Hp, Krayenbühl

Subjects
Male, Heart Valve Prosthesis, Chronic Disease, Hemodynamics, Humans, Mitral Valve, Mitral Valve Insufficiency, Female, Hypertrophy, Postoperative Period, Middle Aged, Coronary Vessels
Abstract

The increase of coronary artery size in myocardial hypertrophy represents an adaptive mechanism to keep coronary blood flow normal. The relationship between coronary cross-sectional area and left ventricular muscle mass was determined angiographically in 10 patients with severe mitral regurgitation before and 28 +/- 15 months after successful mitral valve surgery. 10 subjects with atypical chest pain without coronary artery disease served as controls (C). Left ventricular muscle mass was increased preoperatively in mitral regurgitation (257 g vs C = 129 g; p0.001) and decreased postoperatively (205 g; p0.01 vs preop. and vs C). The cross-sectional area of the left coronary (= left anterior descending+left circumflex) artery was augmented preoperatively (26.5 vs C = 14.0 mm2; p0.001) and decreased postoperatively (22.9 mm2; p0.05 vs preop. and vs C). The cross-sectional area of the left coronary artery per 100 g LV muscle mass was not different in the three groups. The cross-sectional area of the right coronary artery was also increased before surgery (12.7 vs C = 8.8 mm2; p0.05) and decreased postoperatively (11.3 mm2; p0.05 vs preop. ns vs C). Our data show that in mitral regurgitation the size of the left coronary artery increases proportionally to the increase in left ventricular muscle mass. Also, the right coronary artery shows slight enlargement which is probably due to the pressure overload of the right ventricle. After surgery there is regression but not normalization of the size of the coronary arteries.

Published
1993

5. Nitrendipine and atenolol: comparison and combination in the treatment of arterial hypertension

Author

Divitiis, O., Petitto, M., Di Somma, S., Maurizio Galderisi, Villari, B., Santomauro, M., Fazio, S., de Divitiis, O, Petitto, Maurizio, Di Somma, S, Galderisi, Maurizio, Villari, B, Santomauro, Maurizio, and Fazio, S.

Subjects
Adult, Male, Clinical Trials as Topic, Nifedipine, Nitrendipine, Body Weight, Blood Pressure, Calcium Channel Blockers, Electrocardiography, Random Allocation, Atenolol, Double-Blind Method, Hypertension, Humans, Drug Therapy, Combination, Female, Calcium Channel Blocker, Pulse, Human, Adult, Atenolol, administration /&/ dosage/adverse effects/therapeutic use, Blood Pressure, drug effects, Body Weight, drug effects, Calcium Channel Blockers, administration /&/ dosage/adverse effects/therapeutic use, Clinical Trials as Topic, Double-Blind Method, Drug Therapy, Combination, Electrocardiography, Female, Humans, Hypertension, drug therapy, Male, Nifedipine, administration /&/ dosage/adverse effects/analogs /&/ derivatives/therapeutic use, Nitrendipine, Pulse, drug effects, Random Allocation
Abstract

The effectiveness and tolerability of nitrendipine (Bay e 5009) and atenolol in the treatment of mild or moderate arterial hypertension in monotherapy and in association were evaluated in a randomized double-blind study. The drugs were administered once daily at the dose of 20 mg for nitrendipine and 100 mg for atenolol. The trial consisted in two phases of monotherapy and of a combined regimen phase, whose sequence was randomly established; tablets were administered according to a double-dummy design. The results were evaluated according to the criteria of the Hypertension Detection and Follow-up Program Cooperative Group. 5/20 patients were considered "responders" after atenolol treatment, 4/20 after nitrendipine alone, and 14/20 after combined therapy. Side effects resulted mild in severity, and their incidence was lower during the association phase. The combination of atenolol and nitrendipine appears to improve the effectiveness and acceptability of both drugs.

Published
1985

6. Thrombocytopenia and purpura-like lesions associated with clopidogrel

Author

Briguori, C., Manganelli, F., Marco PICARDI, Villari, B., Ricciardelli, B., Briguori, C, Manganelli, F, Picardi, Marco, Villari, B, and Ricciardelli, B.

Subjects
Male, Ticlopidine, Purpura, Thrombocytopenic, Humans, Treatment Failure, Middle Aged, Platelet Aggregation Inhibitors, Clopidogrel
Abstract

We report a case of moderate thrombocytopenia associated with purpura-like phenomenon (four ecchymoses) that occurred within 72 hours of clopidogrel initiation and resolved promptly with drug withdrawal. This 61-year-old patient previously experienced an adverse skin reaction to ticlopidine without changes in the platelet count and without any other laboratory abnormalities. Since the introduction of clopidogrel instead of ticlopidine for the prevention or treatment of several cardiovascular diseases, only 11 cases of thrombotic thrombocytopenic purpura among more than 3 million individuals treated with clopidogrel have been reported. Recently, a case of severe thrombocytopenia, without concomitant purpura-like lesions, during therapy with clopidogrel has been described. To our knowledge, this is the first case of thrombocytopenia associated with purpura-like lesions with no evidence of thrombotic thrombocytopenic purpura during clopidogrel treatment.

7. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era

Author

De Rosa, Salvatore, Spaccarotella, Carmen, Basso, Cristina, Calabrò, Maria Pia, Curcio, Antonio, Filardi, Pasquale Perrone, Mancone, Massimo, Mercuro, Giuseppe, Muscoli, Saverio, Nodari, Savina, Pedrinelli, Roberto, Sinagra, Gianfranco, Indolfi, Ciro, Angelini, Filippo, Barillà, Francesco, Bartorelli, Antonio, Benedetto, Francesco, Bernabò, Paola, Bolognese, Leonardo, Briani, Martina, Cacciavillani, Luisa, Calabrese, Alice, Calabrò, Paolo, Caliendo, Luigi, Calò, Leonardo, Casella, Gianni, Casu, Gavino, Cavallini, Claudio, Ciampi, Quirino, Ciccone, Marco, Comito, Michele, Corrada, Elena, Crea, Filippo, D’Andrea, Antonello, D’Urbano, Maurizio, De Caterina, Raffaele, De Ferrari, Gaetano, De Ponti, Roberto, Della Mattia, Alessio, Di Mario, Carlo, Donazzan, Luca, Esposito, Giovanni, Fedele, Francesco, Ferraro, Alessandro, Galasso, Gennaro, Galiè, Nazzareno, Gnecchi, Massimiliano, Golino, Paolo, Golia, Bruno, Guarini, Pasquale, Leonardi, Sergio, Locuratolo, Nicola, Luzza, Francesco, Manganiello, Vincenzo, Francesca Marchetti, Maria, Marenzi, Giancarlo, Margonato, Alberto, Meloni, Luigi, Metra, Marco, Milo, Marco, Mongiardo, Annalisa, Monzo, Luca, Morisco, Carmine, Novo, Giuseppina, Pancaldi, Stefano, Parollo, Matteo, Paternò, Giovanni, Patti, Giuseppe, Priori, Silvia, Ravera, Amelia, Giuseppe Rebuzzi, Antonio, Rossi, Massimo, Scherillo, Marino, Semprini, Franco, Senni, Michele, Sibilio, Gerolamo, Siviglia, Massimo, Tamburino, Corrado, Tortorici, Gianfranco, Versace, Francesco, Villari, Bruno, Volpe, Massimo, De Rosa S., Spaccarotella C., Basso C., Calabro M.P., Curcio A., Filardi P.P., Mancone M., Mercuro G., Muscoli S., Nodari S., Pedrinelli R., Sinagra G., Indolfi C., Angelini F., Barilla F., Bartorelli A., Benedetto F., Bernabo P., Bolognese L., Briani M., Cacciavillani L., Calabrese A., Calabro P., Caliendo L., Calo L., Casella G., Casu G., Cavallini C., Ciampi Q., Ciccone M., Comito M., Corrada E., Crea F., D'Andrea A., D'Urbano M., De Caterina R., De Ferrari G., De Ponti R., Della Mattia A., DI Mario C., Donnazzan L., Esposito G., Fedele F., Ferraro A., Galasso G., Galie N., Gnecchi M., Golino P., Golia B., Guarini P., Leonardi S., Locuratolo N., Luzza F., Manganiello V., Francesca Marchetti M., Marenzi G., Margonato A., Meloni L., Metra M., Milo M., Mongiardo A., Monzo L., Morisco C., Novo G., Pancaldi S., Parollo M., Paterno G., Patti G., Priori S., Ravera A., Giuseppe Rebuzzi A., Rossi M., Scherillo M., Semprini F., Senni M., Sibilio G., Siviglia M., Tamburino C., Tortorici G., Versace F., Villari B., Volpe M., De Rosa, S., Spaccarotella, C., Basso, C., Calabro, M. P., Curcio, A., Filardi, P. P., Mancone, M., Mercuro, G., Muscoli, S., Nodari, S., Pedrinelli, R., Sinagra, G., Indolfi, C., Angelini, F., Barilla, F., Bartorelli, A., Benedetto, F., Bernabo, P., Bolognese, L., Briani, M., Cacciavillani, L., Calabrese, A., Calabro, P., Caliendo, L., Calo, L., Casella, G., Casu, G., Cavallini, C., Ciampi, Q., Ciccone, M., Comito, M., Corrada, E., Crea, F., D'Andrea, A., D'Urbano, M., De Caterina, R., De Ferrari, G., De Ponti, R., Della Mattia, A., DI Mario, C., Donnazzan, L., Esposito, G., Fedele, F., Ferraro, A., Galasso, G., Galie, N., Gnecchi, M., Golino, P., Golia, B., Guarini, P., Leonardi, S., Locuratolo, N., Luzza, F., Manganiello, V., Francesca Marchetti, M., Marenzi, G., Margonato, A., Meloni, L., Metra, M., Milo, M., Mongiardo, A., Monzo, L., Morisco, C., Novo, G., Pancaldi, S., Parollo, M., Paterno, G., Patti, G., Priori, S., Ravera, A., Giuseppe Rebuzzi, A., Rossi, M., Scherillo, M., Semprini, F., Senni, M., Sibilio, G., Siviglia, M., Tamburino, C., Tortorici, G., Versace, F., Villari, B., Volpe, M., De Rosa, S, Spaccarotella, C, Basso, C, Calabro, M, Curcio, A, Filardi, P, Mancone, M, Mercuro, G, Muscoli, S, Nodari, S, Pedrinelli, R, Sinagra, G, Indolfi, C, Angelini, F, Barilla, F, Bartorelli, A, Benedetto, F, Bernabo, P, Bolognese, L, Briani, M, Cacciavillani, L, Calabrese, A, Calabro, P, Caliendo, L, Calo, L, Casella, G, Casu, G, Cavallini, C, Ciampi, Q, Ciccone, M, Comito, M, Corrada, E, Crea, F, D'Andrea, A, D'Urbano, M, De Caterina, R, De Ferrari, G, De Ponti, R, Della Mattia, A, DI Mario, C, Donnazzan, L, Esposito, G, Fedele, F, Ferraro, A, Galasso, G, Galie, N, Gnecchi, M, Golino, P, Golia, B, Guarini, P, Leonardi, S, Locuratolo, N, Luzza, F, Manganiello, V, Francesca Marchetti, M, Marenzi, G, Margonato, A, Meloni, L, Metra, M, Milo, M, Mongiardo, A, Monzo, L, Morisco, C, Novo, G, Pancaldi, S, Parollo, M, Paterno, G, Patti, G, Priori, S, Ravera, A, Giuseppe Rebuzzi, A, Rossi, M, Scherillo, M, Semprini, F, Senni, M, Sibilio, G, Siviglia, M, Tamburino, C, Tortorici, G, Versace, F, Villari, B, Volpe, M, De Rosa, Salvatore, Spaccarotella, Carmen, Basso, Cristina, Calabrò, Maria Pia, Curcio, Antonio, Filardi, Pasquale Perrone, Mancone, Massimo, Mercuro, Giuseppe, Muscoli, Saverio, Nodari, Savina, Pedrinelli, Roberto, Sinagra, Gianfranco, and Indolfi, Ciro

Subjects
Male, Myocardial Infarction, 030204 cardiovascular system & hematology, Settore MED/11, 0302 clinical medicine, Acute myocardial infarction, Cardiac care units, STEMI, Aged, Aged, 80 and over, COVID-19, Female, Hospitalization, Humans, Italy, Male, Middle Aged, SARS-CoV-2, Betacoronavirus, Coronavirus Infections, Myocardial Infarction, Pandemics, Pneumonia, Viral, Case fatality rate, 80 and over, Medicine, 030212 general & internal medicine, Myocardial infarction, Viral, Aged, 80 and over, Acute myocardial infarction, Cardiac care units, COVID-19, SARS-CoV2, STEMI, Aged, Female, Hospitalization, Humans, Italy, Middle Aged, Betacoronavirus, Coronavirus Infections, Pandemics, Pneumonia, Viral, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, Fast Track Clinical Research, 03 medical and health sciences, Cardiac care unit, cardiovascular diseases, Betacoronaviru, Pandemic, business.industry, Coronavirus Infection, SARS-CoV-2, Pneumonia, medicine.disease, acute myocardial infarction, cardiac care units, Confidence interval, Relative risk, Emergency medicine, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Myocardial infarction complications, Observational study, Myocardial infarction diagnosis, business, Complication
Abstract

Aims To evaluate the impact of the COVID-19 pandemic on patient admissions to Italian cardiac care units (CCUs). Methods and Results We conducted a multicentre, observational, nationwide survey to collect data on admissions for acute myocardial infarction (AMI) at Italian CCUs throughout a 1 week period during the COVID-19 outbreak, compared with the equivalent week in 2019. We observed a 48.4% reduction in admissions for AMI compared with the equivalent week in 2019 (P < 0.001). The reduction was significant for both ST-segment elevation myocardial infarction [STEMI; 26.5%, 95% confidence interval (CI) 21.7–32.3; P = 0.009] and non-STEMI (NSTEMI; 65.1%, 95% CI 60.3–70.3; P < 0.001). Among STEMIs, the reduction was higher for women (41.2%; P = 0.011) than men (17.8%; P = 0.191). A similar reduction in AMI admissions was registered in North Italy (52.1%), Central Italy (59.3%), and South Italy (52.1%). The STEMI case fatality rate during the pandemic was substantially increased compared with 2019 [risk ratio (RR) = 3.3, 95% CI 1.7–6.6; P < 0.001]. A parallel increase in complications was also registered (RR = 1.8, 95% CI 1.1–2.8; P = 0.009). Conclusion Admissions for AMI were significantly reduced during the COVID-19 pandemic across Italy, with a parallel increase in fatality and complication rates. This constitutes a serious social issue, demanding attention by the scientific and healthcare communities and public regulatory agencies.

Published
2020

8. Feasibility and functional correlates of left atrial volume changes during stress echocardiography in chronic coronary syndromes

Author

Ana Djordjevic-Dikic, Maria Grazia D'Alfonso, Karina Wierzbowska-Drabik, Jarosław D. Kasprzak, Clarissa Borguezan Daros, Clara Carpeggiani, Tamara Ryabova, Elisa Merli, Michele De Nes, Nikola Boskovic, Jorge Lowenstein, Miguel Amor, Jesús Peteiro, Pablo Merlo, Angela Zagatina, Lauro Cortigiani, José Luis de Castro e Silva Pretto, Alla A. Boshchenko, Doralisa Morrone, Milica Dekleva, Maria Chiara Scali, Giuseppe Limongelli, Federica Re, Ana Cristina Camarozano, Milorad Tesic, Iana Simova, Francesco Antonini-Canterin, Diego M. Lowenstein Haber, Quirino Ciampi, Fabio Lattanzi, Paolo Colonna, R Arbucci, Ines Monte, Valentina Lorenzoni, Nicola Gaibazzi, Fabio Mori, Branko Beleslin, Paul E Vargas Mieles, Hugo Rodríguez-Zanella, Giovanni Di Salvo, Gergely Ágoston, Bruno Villari, Marco Paterni, Eugenio Picano, Albert Varga, Rodolfo Citro, Marco Antonio Rodrigues Torres, Antonello D'Andrea, Costantina Prota, Nadezhda Zhuravskaya, Morrone, D., Arbucci, R., Wierzbowska-Drabik, K., Ciampi, Q., Peteiro, J., Agoston, G., Varga, A., Camarozano, A. C., Boshchenko, A., Ryabova, T., Dekleva, M., Simova, I., Lowenstein Haber, D. M., Tesic, M., Boskovic, N., Djordjevic-Dikic, A., Beleslin, B., D'Alfonso, M. G., Mori, F., Rodriguez-Zanella, H., Kasprzak, J. D., Cortigiani, L., Lattanzi, F., Scali, M. C., Torres, M. A. R., Daros, C. B., de Castro e Silva Pretto, J. L., Gaibazzi, N., Zagatina, A., Zhuravskaya, N., Amor, M., Mieles, P. E. V., Merlo, P. M., Monte, I., D'Andrea, A., Re, F., Di Salvo, G., Merli, E., Lorenzoni, V., De Nes, M., Paterni, M., Limongelli, G., Prota, C., Citro, R., Colonna, P., Villari, B., Antonini-Canterin, F., Carpeggiani, C., Lowenstein, J., and Picano, E.

Subjects
Male, Vasodilator Agents, Vasodilation, Coronary Artery Disease, 030204 cardiovascular system & hematology, Logistic regression, 0302 clinical medicine, Atrial Pressure, Left atrial, Dobutamine, 030212 general & internal medicine, Prospective Studies, Cardiac imaging, Aged, 80 and over, Dipyridamole, Echocardiography, Exercise, Left atrial volume, Stress, Syndrome, Middle Aged, Europe, Italy, Adrenergic beta-1 Receptor Agonists, Cardiology, Atrial Function, Left, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, Brazil, medicine.drug, Echocardiography, Stress, medicine.medical_specialty, Argentina, Asymptomatic, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, medicine, Stress Echocardiography, Humans, Radiology, Nuclear Medicine and imaging, Heart Atria, Aged, Echocardiography, Doppler, Pulsed, business.industry, Chronic Disease, Feasibility Studies, business
Abstract

An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify left atrial volume (LAV) within minutes. Aim of this study was to assess the feasibility and functional correlates of LAV-stress echocardiography (SE) Out of 514 subjects referred to 10 quality-controlled labs, LAV-SE was completed in 490 (359 male, age 67 ± 12years) with suspected or known chronic coronary syndromes (n = 462) or asymptomatic controls (n = 28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAV was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. The intra-observer and inter-observer LAV variability were 5% and 8%, respectively. ∆-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r = −0.271, p < 0.001) and heart rate reserve (r = -.239, p < 0.001). LAV-dilators were defined as those with stress-rest increase ≥ 6.8ml/m2, a cutoff derived from a calculated reference change value above the biological, analytical and observer variability of LAVI. LAV dilation occurred in 56 patients (11%), more frequently with exercise (16%) and dipyridamole (13%) compared to dobutamine (4%, p < 0.01). At multivariable logistic regression analysis, B-lines ≥ 2 (OR: 2.586, 95% CI = 1.1293–5.169, p = 0.007) and abnormal contractile reserve (OR: 2.207, 95% CI = 1.111–4.386, p = 0.024) were associated with LAV dilation. In conclusion, LAV-SE is feasible with high success rate and low variability in patients with chronic coronary syndromes. LAV dilation is more likely with reduced left ventricular contractile reserve and pulmonary congestion.

Published
2020

9. Left ventricular remodelling in the year after myocardial infarction

Author

Gianfranco Morgano, Mario Petretta, Bruno Villari, Achille Pulcino, Domenico Bonaduce, Bianchi, Luigi Salemme, Sakis Themistoclakis, Gabriele Conforti, Bonaduce, Domenico, Petretta, Mario, Morgano, G, Villari, B, Bianchi, V, Conforti, G, Salemme, L, Themistoclakis, S, and Pulcino, A.

Subjects
Male, medicine.medical_specialty, Cardiac Volume, Heart Ventricles, Myocardial Infarction, Diastole, Infarction, Hemodynamics, Coronary Disease, Coronary Angiography, Ventricular Function, Left, Coronary Circulation, Internal medicine, Ventricular Pressure, medicine, Humans, Prospective Studies, cardiovascular diseases, Myocardial infarction, Cardiac Output, business.industry, Left ventricular remodeling, Reproducibility of Results, Electrocardiography in myocardial infarction, Stroke Volume, Thrombosis, General Medicine, Middle Aged, medicine.disease, Radionuclide angiography, medicine.anatomical_structure, Echocardiography, Ventricle, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, TIMI, Follow-Up Studies, Artery
Abstract

BACKGROUND: The factors that influence infarct expansion early after myocardial infarction have been identified; however, there is less information about late-phase left ventricular enlargement. This study was designed to identify the clinical, haemodynamic, echocardiographic, and radionuclide angiographic criteria that predict the progress of left ventricular dilation after discharge for a first-anterior myocardial infarction. METHODS: Sixty-seven patients with first Q-wave acute anterior myocardial infarction not treated with thrombolytic agents underwent baseline echocardiographic, haemodynamic, and radionuclide angiographic evaluation 4-7 days after the onset of symptoms. The echocardiographic and radionuclide evaluations were repeated after 1 year in the 55 patients who completed the follow-up. By multivariate stepwise linear regression analysis, left ventricular end-diastolic volume after 1 year and change from baseline were modelled as a function of baseline left ventricular end-diastolic volume and other potential predictors. RESULTS: A model including left ventricular end-diastolic pressure, global wall motion score, baseline left ventricular end-diastolic volume, and a Thrombolysis in Myocardial Infarction (TIMI) score of 0-1 was able to predict 84% of the left ventricular end-diastolic volume at the follow-up; a TIMI score of 0-1, the transverse end-diastolic diameter, global wall motion score, and the number of coronary vessels with 70% stenosis accounted for 81% of the variation in left ventricular end-diastolic volume from baseline, while the transverse end-diastolic diameter was inversely related to this parameter. CONCLUSIONS: The results of this study demonstrate that after an anterior myocardial infarction, the patency of the infarct-related artery is the major determinant of late left ventricular dilation, while left ventricular end-diastolic pressure influences early left ventricular dilation and baseline end-diastolic volume. Therefore, to improve left ventricular remodelling, it appears necessary to increase the patency of the infarct-related artery and improve the diastolic loading of the left ventricle at an early stage in the infarction. The inverse relationship between baseline left ventricular transverse diameter and the change in left ventricular volume after discharge indicates that the higher the baseline left ventricular volume, the less it changed during the follow-up. The global wall motion score appears to be a non-invasive parameter that is useful for identifying patients with a high risk of progressive left ventricular dilation.

Published
1994
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10. Effects of induced asynchrony on left ventricular diastolic function in patients with coronary artery disease

Author

Andrea Ciarmiello, Carmen Salvatore, Sandro Betocchi, Leonardo Pace, Federico Piscione, Pasquale Perrone-Filardi, Bruno Villari, Massimo Chiariello, Marco Salvatore, Betocchi, S, Piscione, F, Villari, B, Pace, L, Ciarmiello, A, Perrone Filardi, P, Salvatore, C, Salvatore, Marco, Chiariello, M., Betocchi, Sandro, Pace, Leonardo, Perronefilardi, P, and Salvatore, M

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Diastole, Cardiac index, Blood Pressure, Coronary Disease, Ventricular Function, Left, Radionuclide angiography, Internal medicine, medicine, Humans, Isovolumetric contraction, Cardiac catheterization, Ejection fraction, medicine.diagnostic_test, business.industry, Cardiac Pacing, Artificial, Hemodynamics, Middle Aged, Blood pressure, Anesthesia, cardiovascular system, Cardiology, Ventricular pressure, Female, business, Cardiology and Cardiovascular Medicine
Abstract

Objectives. This study was designed to increase asynchrony with sequential atrioventricular (AV) pacing and to study its effects on left ventricular isovolumetric relaxation, rapid filling and stiffness. Background. Left ventricular nonuniformity is a major determinant of diastolic function. Methods. Thirteen patients with coronary artery disease were studied by simultaneous equilibrium radionuclide angiography and cardiac catheterization during atrial and AV pacing. Ejection fraction and peak filling rate were measured by radionuclide angiography. Regional analysis was obtained by analyzing time-activity curves of four left ventricular sectors; systolic and diastolic asynchrony were evaluated as the coefficient of variation of time to end-systole and, respectively, time to peak filling rate in the four sectors. Cardiac index and left ventricular pressure were measured with high fidelity catheters at cardiac catheterization. The time constant of isovolumetric relaxation was derived from left ventricular pressure. Pressure-volume loops were assembled and constants of chamber stiffness were computed. Results. Atrioventricular pacing led to a decrease in cardiac index (3.7 ± 0.9 to 3.3 ± 0.8 liters/min per m2, p = 0.01) and peak filling rate (352 ± 125 to 287 ± 141 ml/s, p = 0.03; 2.4 ± 0.8 to 2.0 ± 0.8 end-diastolic counts/s, p = 0.02; 4 ± 1.3 to 3.2 ± 1.0 stroke counts/s, p = 0.008). The time constant of isovolumetric relaxation increased (57 ± 10 to 64 ± 12 ms, p = 0.04) and the global diastolic pressure-volume relation shifted upward. Conclusions. Atrioventricular pacing induces left ventricular asynchrony, which is associated with a slower rate of isovolumetric relaxation. The isovolumetric relaxation lasts after the filling phase has begun, thereby reducing the rate of rapid filling.

Published
1993
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11. Diastolic function and BNP changes during exercise predict oxygen consumption in chronic heart failure patients

Author

Bruno Villari, Bruno Petruzziello, Gabriele Borzillo, Quirino Ciampi, Sandro Betocchi, Emanuele Barbato, Ciampi, Q, Borzillo, G, Barbato, E, Petruzziello, B, Betocchi, Sandro, Villari, B., and Barbato, Emanuele

Subjects
Male, medicine.medical_specialty, medicine.drug_class, chemistry.chemical_element, heart failure, Oxygen, Ventricular Function, Left, Oxygen Consumption, diastole, Predictive Value of Tests, Internal medicine, Natriuretic Peptide, Brain, medicine, Natriuretic peptide, Humans, Diastolic function, cardiovascular diseases, Prospective Studies, Peak exercise, Aged, Echocardiography, Doppler, Pulsed, Ejection fraction, Exercise Tolerance, natriuretic peptide, business.industry, Cardiopulmonary exercise testing, Stroke Volume, Exercise capacity, Middle Aged, medicine.disease, Prognosis, Myocardial Contraction, Echocardiography, Doppler, Color, chemistry, Heart failure, Chronic Disease, cardiovascular system, Cardiology, Exercise Test, Female, Cardiology and Cardiovascular Medicine, business, human activities, Biomarkers, circulatory and respiratory physiology
Abstract

B-type natriuretic peptide (BNP) is a diagnostic and prognostic marker in heart failure (CHF) patients. Aim. To assess the relation between BNP, diastolic function and exercise capacity in CHF patients. Methods. Fifty CHF patients underwent cardiopulmonary exercise testing. BNP levels were determined at baseline and at peak exercise. Patients were divided in two groups: with lower (/=14 ml/kg/min) peak oxygen consumption (VO(2)). Results. Seventeen patients with lower peak VO(2) showed larger incidence of restrictive pattern of the transmitral flow (7/17 vs 4/33, p =0.036). E/Ea ratio was inversely related with peak VO(2) (r =-0.419, p =0.004) and directly related with BNP levels at baseline (r =0.449, p =0.001) and at peak exercise (r =0.475, p =0.001). LV ejection fraction was similar in the two groups. Independent predictors of exercise tolerance were E/Ea ratio (p =0.003), lg BNP at baseline (p =0.034) and increase in lg BNP during exercise (p =0.038). Conclusions. In CHF patients, E/Ea ratio is a predictor of exercise tolerance and is related with BNP level at rest and at peak exercise.

Published
2008

12. Effects of late administration of tissue-type plasminogen activator on left ventricular remodeling and function after myocardial infarction

Author

Mario Petretta, Tonino Lanzillo, Bruno Villari, Gabriele Conforti, Gianfranco Morgano, Roberto Breglio, Domenico Bonaduce, M. V. Montemurro, Bonaduce, Domenico, Petretta, Mario, Villari, B, Breglio, R, Conforti, G, Montemurro, Mv, Lanzillo, T, and Morgano, G.

Subjects
Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Myocardial Infarction, Coronary artery disease, Group A, Ventricular Function, Left, Group B, Internal medicine, medicine, Humans, Thrombolytic Therapy, Myocardial infarction, Radionuclide Angiography, Ventricular remodeling, Vascular Patency, tissue-type plasminogen activator, End-systolic volume, left ventricular remodeling, Ejection fraction, business.industry, Thrombolysis, Middle Aged, medicine.disease, Coronary Vessels, Echocardiography, Tissue Plasminogen Activator, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, TIMI, Follow-Up Studies
Abstract

To evaluate the effects of late thrombolysis on left ventricular volume and function in acute myocardial infarction, two-dimensional echocardiography and radionuclide angiography were performed before discharge and after 1 year of follow-up study in 34 patients with acute anterior myocardial infarction. Of these, 10 admitted to the coronary care unit within 4 h from the onset of symptoms were treated with recombinant tissue-type plasminogen activator (rt-PA) (Group A) and 24 admitted between 4 and 8 h after onset were randomly assigned to receive either rt-PA (Group B, n = 12) or conventional therapy (Group C, n = 12). Seven to 10 days after admission, all patients underwent cardiac catheterization and coronary angiography. Patency of the infarct-related vessel was 70% in Group A, 66% in Group B and 33% in Group C and the average Thrombolysis in Myocardial Infarction (TIMI) coronary perfusion grade was 1.9 +/- 0.8 for Group A, 1.6 +/- 1.0 for Group B and 0.84 +/- 0.95 for Group C (Group A versus Group C p less than 0.01; Group B versus Group C p less than 0.05). At predischarge evaluation, mean left ventricular end-systolic and end-diastolic volumes were higher in Group C than in Group B (p less than 0.001 and 0.05, respectively) and Group A (p less than 0.005 for both); mean left ventricular ejection fraction at rest was lower in Group C than in Group B and Group A (p less than 0.05 for both). At 1 year follow-up study, end-systolic and end-diastolic volumes remained higher in Group C than in Group B (p less than 0.05 for both) and Group A (p less than 0.005 for end-systolic volume and p less than 0.001 for end-diastolic volume); ejection fraction at rest was lower in Group C than in Groups A and B (p less than 0.05 for both); during exercise, it increased more in Group A than in Group C (p less than 0.01). Comparison of data obtained before discharge and at the 1 year follow-up study revealed a significant differences in end-systolic volume (p less than 0.05) in Group C patients and in end-diastolic volume in patients in Groups B (p less than 0.05) and C (p less than 0.001). The beneficial effect of late thrombolysis with rt-PA may be related to a reduction in myocardial expansion and thus to a favorable influence on postinfarction left ventricular remodeling.

Published
1990
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13. Abnormal blood-pressure response to exercise and oxygen consumption in patients with hypertrophic cardiomyopathy

Author

Bruno Villari, Alberto Cuocolo, Quirino Ciampi, Massimo Chiariello, Maria Angela Losi, Sandro Betocchi, Adele Ferro, Raffaella Lombardi, Ciampi, Q, Betocchi, Sandro, Losi, MARIA ANGELA, Ferro, A, Cuocolo, Alberto, Lombardi, R, Villari, B, and Chiariello, M.

Subjects
Adult, Male, Cardiac output, medicine.medical_specialty, Adolescent, Cardiomyopathy, Hemodynamics, Blood Pressure, hemodynamics, Oxygen Consumption, Internal medicine, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Ejection fraction, exercise, business.industry, Hypertrophic cardiomyopathy, VO2 max, Stroke volume, Cardiomyopathy, Hypertrophic, Middle Aged, medicine.disease, medicine.anatomical_structure, Blood pressure, Hypertension, Vascular resistance, Cardiology, Exercise Test, Female, hypertrophy, Cardiology and Cardiovascular Medicine, business
Abstract

Background. Abnormal blood-pressure response during exercise occurs in about one third of patients with hypertrophic cardiomyopathy (HCM), and it has been associated with a high risk of sudden cardiac death. We assessed the hemodynamics of exercise in HCM patients with abnormal blood-pressure response by using ambulatory radionuclide monitoring (VEST) of left-ventricular (LV) function, and exercise tolerance by oxygen consumption. Methods. Twenty-two HCM patients uderwent treadmill exercise during VEST monitoring. A cardiopulmonary exercise test was performed a few days after. The VEST data were averaged for I minute. Stroke volume, cardiac output, and systemic vascular resistance were expressed as percent of baseline. Exercise tolerance was assessed as maximal oxygen consumption. Results. In eight HCM patients (36%) with an abnormal blood-pressure response, end-systolic volume increased more (52% +/- 21% vs 31% +/- 28%, P = .012), and the ejection fraction (-31% +/- 17% vs -14% +/- 22%, P = .029) and stroke volume (-21% +/- 21% vs 3% +/- 28%, P = .026) fell more, than in patients with normal response. Cardiac output increased less in the former patients (49% +/- 44% vs 94% +/- 44%, P = .012). Systemic vascular resistance decreased similarly, irrespective of blood-pressure response (-28% +/- 26% vs -34% +/- 26%, P = N.S.). Percent of maximal predicted oxygen consumption was lower in HCM patients with an abnormal blood-pressure response (63% +/- 11% vs 78% +/- 15%, P = .025). Conclusions. In HCM patients, abnormal blood-pressure response was associated with exercise-induced LV systolic dysfunction and impairment in oxygen consumption. This may cause hemodynamic instability, associated with a high risk of sudden cardiac death.

Published
2007
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14. Endogenous prostaglandin endoperoxides may alter infarct size in the presence of thromboxane synthase inhibition: studies in a rabbit model of coronary artery occlusion-reperfusion

Author

Leonardo Pace, Amelia Focaccio, Massimo Chiariello, Mario Condorelli, Fred De Clerk, Giuseppe Ambrosio, Paolo Golino, Massimo Ragni, Bruno Villari, Golino, Paolo, Ambrosio, G, Villari, B, Ragni, M, Focaccio, A, Pace, L, Declerk, F, Condorelli, M, Chiariello, M., Golino, P, Pace, Leonardo, and DE CLERK, F

Subjects
Male, medicine.medical_specialty, Platelet Aggregation, Thromboxane, Pyridines, Receptors, Thromboxane, Myocardial Infarction, Prostaglandin, Myocardial Reperfusion Injury, Prostaglandin Endoperoxides, Thromboxane A2, chemistry.chemical_compound, Internal medicine, medicine, Animals, Dazoxiben, Pentanoic Acids, biology, Aspirin, business.industry, Imidazoles, Bridged Bicyclo Compounds, Heterocyclic, Prostaglandin Endoperoxides, Synthetic, Endocrinology, Hydrazines, chemistry, Coronary occlusion, biology.protein, Fatty Acids, Unsaturated, Female, Thromboxane-A synthase, Rabbits, Thromboxane-A Synthase, medicine.symptom, business, Cardiology and Cardiovascular Medicine, Vasoconstriction, Prostaglandin H2
Abstract

Objectives. The aim of this study was to assess whether prostaglandin endoperoxides, which continue to be formed in the setting of thromboxane A2 synthase inhibition, might influence the fate of ischemic myocardium in a model of coronary occlusion and reperfusion. Background. It was recently demonstrated that thromboxane A2 synthase inhibitors reduce ischemic myocardial injury through a redirection of prostaglandin (PG) endoperoxides toward the synthesis of ''cardioprotective'' prostaglandins, such as PGI2, PGE2 and PGD2. However, part of these prostaglandin endoperoxides may also stimulate a receptor, shared with thromboxane A2, mediating platelet aggregation and vasoconstriction. Methods. New Zealand White rabbits were subjected to 30 min of coronary occlusion, followed by 5.5 h of reperfusion. Fifteen minutes before reperfusion, the animals were randomized to receive 1) saline solution (control animals, n = 8); 2) SQ 29548, a potent and selective thromboxane A2/PGH2 receptor antagonist (n = 8); 3) dazoxiben, a selective thromboxane A2 synthase inhibitor (n = 8); 4) R 68070 (Ridogrel), a drug with dual thromboxane A2 synthase-inhibiting and thromboxane A2/PGH2 receptor-blocking properties (n = 8); or 5) aspirin + R 68070 (n = 8). Results. Dazoxiben and R 68070, but not SQ 29548, significantly reduced thromboxane B2 formation and increased plasma levels of 6-keto-PGF1alpha, PGE2 and PGF2alpha. Ex vivo platelet aggregation induced by U46619 (a thromboxane A2 mimetic) Was inhibited by SQ 29548 and R 68070 but not by dazoxiben. In control animals, infarct size determined at the end of the experiment by triphenyltetrazolium chloride staining averaged 57.7 +/-3.2% of the area at risk of infarction. The administration of SQ 29548 did not significantly reduce infarct size compared with that in control animals, whereas dazoxiben and R 68070 significantly reduced infarct size to 36.7 +/- 2.8% and 16.6 +/- 3.6% of area at risk of infarction, respectively (p < 0.001 vs. control values). In rabbits treated with R 68070, infarct size was also significantly smaller than that of dazoxiben-treated rabbits (p < 0.01). This protective effect of R 68070 was completely abolished when the drug was administered with aspirin, infarct size in this group averaging 59.7 +/- 1.6% (p = NS vs. control values). No differences in regional myocardial blood flow, systemic blood pressure, heart rate or extent of area at risk were observed among groups. Conclusions. Thus, prostaglandin endoperoxides play an important role in modulating the cardioprotective effects of thromboxane A2 synthase inhibitors. The simultaneous inhibition of thromboxane A2 Synthase and blockade of thromboxane A2/PGH2 receptors by R 68070 identify a pharmacologic interaction of potential therapeutic importance.

Published
1993

15. The effects of calcium channel antagonist treatment, and of oxygen radical scavenging, on infarct size and the no-reflow phenomenon in reperfused hearts

Author

Marco Salvatore, Bruno Villari, Isabella Tritto, Giuseppe Ambrosio, Massimo Chiariello, Paolo Golino, Massimo Ragni, Amelia Focaccio, Villari, B, Ambrosio, G, Golino, Paolo, Ragni, M, Focaccio, A, Tritto, I, Salvatore, M, Chiariello, M., Golino, P, and Salvatore, Marco

Subjects
Male, Mean arterial pressure, Time Factors, Gallopamil, Free Radicals, Drug Evaluation, Preclinical, Myocardial Infarction, Ischemia, chemistry.chemical_element, Myocardial Reperfusion Injury, Calcium, Pharmacology, Superoxide dismutase, Oxygen Consumption, Coronary Circulation, Animals, Medicine, Radionuclide Imaging, Analysis of Variance, Dose-Response Relationship, Drug, biology, Superoxide Dismutase, business.industry, Calcium channel, Heart, Free Radical Scavengers, medicine.disease, chemistry, Anesthesia, No reflow phenomenon, biology.protein, Regression Analysis, Drug Therapy, Combination, Female, Rabbits, Cardiology and Cardiovascular Medicine, business, Reperfusion injury, medicine.drug
Abstract

Calcium antagonists reduce ischemic injury, and anti-free-radical interventions may reduce reperfusion injury. However, the effects of treatment with both interventions have never been investigated. In the present study, anesthetized rabbits underwent 30 minutes of coronary artery ligation, which was followed by 5.5 hours of reflow. Eight animals in each group received: (1) the calcium antagonist gallopamil during ischemia, (2) the oxygen radical scavenger superoxide dismutase during reperfusion, (3) combined treatment with gallopamil and superoxide dismutase, and (4) saline solution. All groups were similar with respect to collateral flow during ischemia and extent of risk region. Infarct size averaged 60.2% +/- 5.5% of risk region in controls and was significantly smaller (p < 0.001) in rabbits that were treated with either gallopamil (28.1% +/- 3.4%) or superoxide dismutase (29.3% +/- 3.2%). Little further reduction in infarct size was observed with combination therapy (22.9% +/- 3.2% of risk region; p = NS). Superoxide dismutase had no effects on hemodynamics, whereas gallopamil significantly reduced heart rate, mean arterial pressure, and rate-pressure product. However, the reduction in infarct size that was observed in gallopamil-treated rabbits significantly exceeded the expected value in this group after corrections were made for changes in these determinants of ischemic injury. Therefore we investigated whether other factors may have contributed to the beneficial effects of gallopamil. In vitro the drug had no oxygen radical scavenging activity, nor did it exert antioxidant effects. In addition, gallopamil did not affect neutrophil function. In conclusion, in this acute model myocardial cell necrosis was significantly reduced either by administration of a calcium antagonist during ischemia or by removing oxygen radicals during reperfusion. However, superoxide dismutase administration did not further reduce infarct size when given to animals that had been treated with gallopamil. Since gallopamil has no direct effect on several mechanisms of reperfusion injury, these, data suggest that calcium antagonists, by decreasing myocardial oxygen demand during ischemia, may indirectly reduce oxygen radical damage during subsequent reperfusion.

Published
1993

16. DIGOXIN-INDUCED VASOCONSTRICTION OF NORMAL AND ATHEROSCLEROTIC EPICARDIAL CORONARY-ARTERIES

Author

Bruno Villari, Paolo Golino, E Russolillo, Ciro Indolfi, Federico Piscione, Vittorio Ambrosini, Massimo Chiariello, Mario Condorelli, Indolfi, C, Piscione, F, Russolillo, E, Villari, B, Golino, Paolo, Ambrosini, V, Condorelli, M, and Chiariello, M.

Subjects
Male, Digoxin, medicine.medical_specialty, Cardiac output, Coronary Artery Disease, Isosorbide Dinitrate, Coronary Angiography, Sublingual administration, Coronary artery disease, Internal medicine, medicine, Humans, Phentolamine, business.industry, Angiography, Digital Subtraction, Middle Aged, Receptors, Adrenergic, alpha, medicine.disease, Coronary Vessels, Coronary arteries, medicine.anatomical_structure, Vasoconstriction, Anesthesia, Cardiology, Vascular resistance, Female, medicine.symptom, Isosorbide dinitrate, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

This study evaluated the effect of bolus infusion of digoxin (0.014 mg/kg in 10 minutes, intravenously) on large coronary arteries measured by quantitative digital angiography. Twenty-two patients (mean age +/- standard deviation 47 +/- 12 years) divided into 3 groups were studied. The effects of digoxin infusion (after 10 and 20 minutes) and sublingual administration of isosorbide dinitrate were investigated in group I (patients with angiographically normal coronary arteries, n = 9) and in group II (patients with atherosclerotic coronary arteries, n = 8). To determine whether the effects of digoxin were mediated by activation of alpha-adrenergic receptors, coronary angiography was performed in group III after alpha-adrenoceptor blockade (phentolamine 0.11 mg/kg, intravenously) (n = 5). Ten minutes after the end of digoxin infusion, the cross-sectional area decreased from 7.7 +/- 4.1 to 6.0 +/- 2.2 mm2, and after 20 minutes to 5.6 +/- 2.6 mm2 (p < 0.05) in group I. Isosorbide dinitrate reverted digoxin-induced vasoconstriction as cross-sectional area increased to 8.5 +/- 3.4 mm2 (p = not significant versus baseline). Twenty minutes after digoxin infusion, heart rate significantly decreased from 79 +/- 16 to 74 +/- 13 beats/min (p < 0.01). Ten minutes after digoxin infusion, peripheral vascular resistance increased significantly from 1,396 +/- 693 to 1,693 +/- 984 dynes . s . cm-5 (p < 0.05), whereas cardiac output did not change. Twenty minutes after digoxin infusion, minimal stenosis diameter decreased significantly from 1.6 +/- 0.5 to 1.4 +/- 0.5 mm (p < 0.05) in group II. Again, isosorbide dinitrate reverted digoxin-induced vasoconstriction as minimal stenosis diameter increased (p = not significant versus control values). In group III, alpha-adrenoceptor blockade with phentolamine did not prevent the decrease in coroary artery diameter in patients with angiographically normal coronary arteries, from 2.3 +/- 0.7 to 1.9 +/- 0.7 mm (p < 0.001). Thus, bolus infusion of digoxin induced vasoconstriction of normal epicardial coronary arteries and reduced minimal stenosis diameter in patients with coronary artery disease. Digoxin-induced vasoconstriction was not mediated by an alpha-adrenergic mechanism and was revertedby sublingual administration of isosorbide dinitrate.

Published
1991

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