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1. Identification of hemodynamically stable patients with acute pulmonary embolism at high risk for death: external validation of different models

Author

Becattini, Cecilia, Gulizia, Michele M., Agnelli, Giancarlo, Dentali, Francesco, Di Lenarda, Andrea, Enea, Iolanda, Fabbri, Andrea, Maggioni, Aldo P., Pomero, Fulvio, Ruggeri, Maria Pia, Lucci, Donata, Vedovati, Maria Cristina, Duranti, Michele, Guercini, Francesco, Groff, Paolo, Verso, Melina, Fabbri, Gianna, Savoia, Martina, Baldini, Ester, Mecatti, Barbara Bartolomei, Bianchini, Francesca, Ceseri, Martina, Gonzini, Lucio, Gorini, Marco, Lorimer, Andrea, Orsini, Giampietro, Tricoli, Martina, Cimini, L.A., Becattini, C., Agnelli, G., Cesarini, V., Sanna, M., Pepe, G., Marchetti, C., Roldan, M. Olivan, Lenzi, L., Cozzio, S., Tomio, P., Diamanti, M., Beltrame, A., Glinski, L., Treleani, M., Coppa, A., Vanni, S., Bartalucci, P., Taccone, A., Costacurta, C., Bortolotti, P., Bortolussi, M., De Vecchi, M., Zanardi, F., Greco, I., Cosentini, R., Gerloni, R., Artusi, N., Cominotto, F., Sisto, U.G., Picariello, C., Roncon, L., Maddalozzo, A., Nitti, C., Riccomi, F., Buzzo, M., Bassanelli, G., Savonitto, S., Bianchi, A., Bilato, C., Lobascio, I., Dalla Valle, C., Pomata, D.P., Giostra, F., Tinuper, A.L., Zalunardo, B., Visonà, A., Panzavolta, C., Novelli, A., Bertini, A., Granai, C., Colombo, S., Periti, E., Bonacchini, L., Abrignani, M.G., Casciolo, M.F., D'Amato, A., Scardovi, A.B., Ricci, R., Iosi, S., Fontana, M.C., Marrazzo, A., Borselli, M., Di Fusco, S.A., Colivicchi, F., Enea, I., Triggiani, M., Papa, I., Pasini, G.F., Fioravanti, C., Panarello, S., Raggi, F., Marzolo, M., Cuppini, S., Milan, M., Barchetti, M., De Laura, D., Caldarola, P., Fiorini, R., Rastelli, G., Ameri, P., La Malfa, G., Cinelli, F., Sganzerla, P.C., Ubaldi, S., Sanchez, F.A., Forgione, C., Cuccia, C., Predieri, S., Fusco, S., Mumoli, N., Porta, C., Romei, M., Lucidi, M., Romaniello, A., Volpe, M., Mogni, P., Pizzolato, E., Martino, G.P., Bitti, G., Righini, G., Bandiera, G., Pennacchio, E., Limauro, S., Dachille, A., Ignone, G., Fuscaldo, G.F., De Rosa, F.M., Vazzana, N., Chesi, G., Di Filippo, F., Pierpaoli, L., Corapi, A., Vatrano, M., Angotti, C., Baccetti, F., Harari, S.A., Luisi, F., Daghini, E., De Curtis, E., Lucà, F., Ciancia, F., Blandizzi, S., Lettica, G.V., D'Orazio, S., Cosmi, F., Zaccaroni, S., Silingardi, M., Valeriano, V., Pugliese, F.R., Murgia, A.P., Parpaglia, P. Pinna, Martinelli, L., Caponi, C., Clemente, M.A., Ciccarone, A., Bongarzoni, A., Garagiola, M., Leone, M.C., Veropalumbo, M.R., Sacco, M., Morella, P., Dorigoni, S., Peterlana, D., Di Paola, R., Felis, S., Correale, M., Brunetti, N.D., Petrelli, G., Feliziani, F.T., Mastroiacovo, D., Romualdi, R., Pasin, F., Bonardi, S., Delfino, P., Scifo, C., Savioli, G., Ceresa, I.F., Galeotalanza, M., Benazzi, B., Porzio, M., Rosini, F., Ancona, C., Verrelli, C., Pasini, A. Fratta, Dalle Carbonare, L., Bozza, N., Nacci, F., Scarabelli, M.A., Amico, F., Marchesi, C., Mazzone, A., Di Tommaso, R., Cocco, F., Pezzuto, G., Luciani, A., Zamboni, P., Muriago, M., Del Pesce, L., Lucarini, A.R., Guglielmelli, E., Vannucchi, V., Moroni, F., Fichera, D., Malatino, L., Sgroi, C., Morana, I.M., Cicero, S., La Rosa, D., Mete, F., Gino, M., De Palma, A., Alessandri, M., Maestripieri, V., Battocchio, M., De Santis, M.T., Saladini, F., Corsi, D.C., Macarone Palmieri, N., Pierfranceschi, M. Giorgi, Palmonari, V., Fontanella, L., Airoldi, L., Bonocore, M., Paliani, U., Prat, L. Iogna, Chiecchi, L., Cuonzo, M., Paludo, A., Padula, D., Antonelli, A., Bicchi, M., Tota, G., Ariello, M., Sai, R., Civita, M., Tucci, M., Barbati, G., Conti, M., Cettina, R., Magnani, O., Levato, M., Gessi, V., De Rui, M., Bellizzi, A., Farneti, L., Salomone, P., Mannarini, A., Grifoni, E., Del Ghianda, S., Campodonico, J., De Cesare, N., Mutone, D., Pasoli, P., Meloni, S., Frenda, A., Viola, G., Torromeo, C., Campana, C., Pistone, M.C., Caravita, S., La Creta, C.P., Miscio, F., Loreno, M., Fenu, P., Mazzetti, M., Rossini, D., Brunacci, M., Capuano, A., Tagliamonte, G., Pinelli, M., Ballocca, F., Parca, G., Pasini, S.M., Maragno, M.G., Vecchi, F., Mancinelli, L., Cavalli, A., Di Mare, F., Conficoni, E., Miceli, R., Pecoraro, R., Fonti, C., Pegoraro, S., Piccinni, G.C., Caruso, G., Boriani, G., Lanzillotta, P., Piccolo, P., Calò, L., Stolfo, D., Mangiacapra, S., Marziali, A., Volponi, M.C., Querci, G., Terribile, R., Menabue, M., Fiorentini, A., Musci, R.L., Uras, S., Cicini, M.P., Manetti, S., Francese, G.M., Melchio, R., Scorpiglione, N., Carrara, D., Pani, A., Morisco, C., Rodolico, M., Colombo, Silvia, Vanni, Simone, Abrignani, Maurizio Giuseppe, Scardovi, Angela Beatrice, Marrazzo, Alessandra, Borselli, Matteo, Barchetti, Marco, and Maggioni, Aldo Pietro

Published
2024
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2. Lyapunov exponents, bifurcation currents and laminations in bifurcation loci

Author

Bassanelli, G. and Berteloot, F.

Subjects
Mathematics - Complex Variables, Mathematics - Dynamical Systems, 37F45, 37F10
Abstract

Bifurcation loci in the moduli space of degree $d$ rational maps are shaped by the hypersurfaces defined by the existence of a cycle of period $n$ and multiplier 0 or $e^{i\theta}$. Using potential-theoretic arguments, we establish two equidistribution properties for these hypersurfaces with respect to the bifurcation current. To this purpose we first establish approximation formulas for the Lyapunov function. In degree $d=2$, this allows us to build holomorphic motions and show that the bifurcation locus has a lamination structure in the regions where an attracting basin of fixed period exists.

Published
2008

5. Valsartan for prevention of recurrent atrial fibrillation

Author

GISSI AF Investigators, Disertori M, Latini R, Barlera S, Franzosi MG, Staszewsky L, Maggioni AP, Lucci D, Di Pasquale G, Tognoni G, Delise P, Bertocchi F, Maiocchi G, Geraci E, Correale E, Lombardi F, Mugelli A, Urso R, Scardi S, Fabbri G, Bartolomei B, Barbato G, Carbonieri E, Ciricugno S, Cosmi F, Pratola C, Rossi MG, Sciarra L, Zeni P, Ceseri M, Atzori A, Bambi F, Baviera M, Bianchini F, Fenicia E, Gianfriddo M, Lonardo G, Luise A, Nota R, Orlando ME, Petrolo R, Pierattini C, Pierota V, Ragno A, Serio C, Tafi A, Tellaroli E, Masson S, Vago T, Gramenzi S, Orso F, Suliman I, Nicolis E, Casola C, Dall'Osso D, Gorini M, Bianchini E, Cabiddu S, Cangioli I, Carnaghi A, Cipressa ML, Cipressa L, Galbiati L, Lorimer A, Priami P, Moccetti T, Vaghi F, Capello AF, Rossetti G, Viada E, Morena L, Delucchi M, Reynaud SG, Allemano P, Massobrio N, Gavazzi A, Taddei F, Mor DA, Bortolini F, Lorini M, Inama G, Durin O, Pirelli S, Spotti A, Procopio R, Cuzzucrea D, Gentile G, Margonato A, Bassanelli G, Tavazzi L, Buzzi MP, Rordorf R, Gualco A, Opasich C, Gronda E, Genovese L, Mattioli R, Donatelli F, Uriarte JA, Rauhe W, Bertagnolli C, Canestrini S, Stefenelli C, Cioffi G, Giovanelli C, Rigatelli G, Boni S, Pasini A, Sitta N, Sacchetta A, Borgese L, Sciascia R, Targa L, Raviele A, Madalosso M, Bertaglia E, Zoppo FC, Capanna M, Fiorencis R, Baracca E, Rossi R, Rossi I, Trappolin R, Morgera T, Barducci E, Baldin MG, Gobbo G, Zardo F, Hrovatin E, Mos L, Vriz O, Sinagra G, Aleksova A, Mazzone C, Fresco C, Rubartelli P, Moroni LA, Camerieri A, Piana M, Mureddu R, Bertoli D, Petacchi R, Pancaldi LG, Gabrieli L, Urbinati S, Pedone C, Di Niro M, Brunelli A, Bosi S, Censi S, Moruzzi P, Pastori P, Modena MG, Malavasi V, Mezzetti M, Melandri F, Zuppiroli A, Fazi A, Testa R, Venturini E, Mazzinghi F, Cosmi D, Santoro GM, Minneci C, Galli M, Paperini L, Bovenzi FM, Cortigiani L, Cocchieri M, Severini D, Arcuri GM, Bagliani G, Bernardinangeli M, Proietti G, Bocconcelli P, Pierantozzi A, Monti F, Giamundo L, Tancredi P, Rossini E, Bianchi C, Bettiol F, Giovannini E, Fera MS, Santini M, Bianconi L, Boccanelli A, Morosetti P, Volpe M, Facciolo C, Vacri A, Romanazzi F, Napoletano C, Piccioni LL, Candelmo F, De Marco G, Arnese MR, Vetrano A, Prinzi D, De Rosa P, Capuano V, Torre S, D'Onofrio A, Ammendola E, Battista R, De Fusco A, Molero U, Iervoglini A, Stefanelli S, Fattore L, Bosco B, Liguori A, Padula G, De Luca I, Sorino M, Colonna P, D'Agostino C, Pierfelice O, Pettinati G, Muscella A, De Lorenzi E, Falco M, Giannattasio C, Baldi N, Clemente MA, D'Alessandro B, Truncellito L, Arabia F, Ciconte VA, Perticone F, Ruberto C, Buffon A, Tomaselli C, De Rosa F, Mazza S, Zampaglione G, Pirozzi AM, Butera A, Levato M, Musacchio D, Polimeni RM, Lacquaniti V, Pulitanò G, Ruggeri A, Provenzano A, Cuccurullo O, Musolino M, Marrari A, Anastasio L, Schiavello M, Comito MG, Gulizia MM, Francese GM, Vasquez L, Coppolino C, Casale A, D'Urso G, Oliva G, Giordano U, Andolina S, Sanfilippo N, Ingrillì F, Accardo S, Grasso S, Buffa L, Serra E., CHIARIELLO, MASSIMO, PERRONE FILARDI, PASQUALE, Delise, P., Bertocchi, F., Maiocchi, G., Geraci, E., Correale, E., Lombardi, F., Mugelli, A., Urso, R., Scardi, S., Fabbri, G., Bartolomei, B., Barbato, G., Carbonieri, E., Ciricugno, S., Cosmi, F., Pratola, C., Rossi, M. G., Sciarra, L., Zeni, P., Ceseri, M., Atzori, A., Bambi, F., Baviera, M., Bianchini, F., Fenicia, E., Gianfriddo, M., Lonardo, G., Luise, A., Nota, R., Orlando, M. E., Petrolo, R., Pierattini, C., Pierota, V., Ragno, A., Serio, C., Tafi, A., Tellaroli, E., Masson, S., Vago, T., Gramenzi, S., Orso, F., Suliman, I., Nicolis, E., Casola, C., Dall'Osso, D., Gorini, M., Bianchini, E., Cabiddu, S., Cangioli, I., Carnaghi, A., Cipressa, M. L., Cipressa, L., Galbiati, L., Lorimer, A., Priami, P., Moccetti, T., Vaghi, F., Capello, A. F., Rossetti, G., Viada, E., Morena, L., Delucchi, M., Reynaud, S. G., Allemano, P., Massobrio, N., Gavazzi, A., Taddei, F., Mor, D. A., Bortolini, F., Lorini, M., Inama, G., Durin, O., Pirelli, S., Spotti, A., Procopio, R., Cuzzucrea, D., Gentile, G., Margonato, A., Bassanelli, G., Tavazzi, L., Buzzi, M. P., Rordorf, R., Gualco, A., Opasich, C., Gronda, E., Genovese, L., Mattioli, R., Donatelli, F., Uriarte, J. A., Rauhe, W., Bertagnolli, C., Canestrini, S., Stefenelli, C., Cioffi, G., Giovanelli, C., Rigatelli, G., Boni, S., Pasini, A., Sitta, N., Sacchetta, A., Borgese, L., Sciascia, R., Targa, L., Raviele, A., Madalosso, M., Bertaglia, E., Zoppo, F. C., Capanna, M., Fiorencis, R., Baracca, E., Rossi, R., Rossi, I., Trappolin, R., Morgera, T., Barducci, E., Baldin, M. G., Gobbo, G., Zardo, F., Hrovatin, E., Mos, L., Vriz, O., Sinagra, G., Aleksova, A., Mazzone, C., Fresco, C., Rubartelli, P., Moroni, L. A., Camerieri, A., Piana, M., Mureddu, R., Bertoli, D., Petacchi, R., Pancaldi, L. G., Gabrieli, L., Urbinati, S., Pedone, C., Di Niro, M., Brunelli, A., Bosi, S., Censi, S., Moruzzi, P., Pastori, P., Modena, M. G., Malavasi, V., Mezzetti, M., Melandri, F., Zuppiroli, A., Fazi, A., Testa, R., Venturini, E., Mazzinghi, F., Cosmi, D., Santoro, G. M., Minneci, C., Galli, M., Paperini, L., Bovenzi, F. M., Cortigiani, L., Cocchieri, M., Severini, D., Arcuri, G. M., Bagliani, G., Bernardinangeli, M., Proietti, G., Bocconcelli, P., Pierantozzi, A., Monti, F., Giamundo, L., Tancredi, P., Rossini, E., Bianchi, C., Bettiol, F., Giovannini, E., Fera, M. S., Santini, M., Bianconi, L., Boccanelli, A., Morosetti, P., Volpe, M., Facciolo, C., Vacri, A., Romanazzi, F., Napoletano, C., Piccioni, L. L., Candelmo, F., De Marco, G., Arnese, M. R., Vetrano, A., Prinzi, D., De Rosa, P., Capuano, V., Torre, S., D'Onofrio, A., Ammendola, E., Chiariello, M., Filardi, Pp., Battista, R., De Fusco, A., Molero, U., Iervoglini, A., Stefanelli, S., Fattore, L., Bosco, B., Liguori, A., Padula, G., De Luca, I., Sorino, M., Colonna, P., D'Agostino, C., Pierfelice, O., Pettinati, G., Muscella, A., De Lorenzi, E., Falco, M., Giannattasio, C., Baldi, N., Clemente, M. A., D'Alessandro, B., Truncellito, L., Arabia, F., Ciconte, V. A., Perticone, F., Ruberto, C., Buffon, A., Tomaselli, C., De Rosa, F., Mazza, S., Zampaglione, G., Pirozzi, A. M., Butera, A., Levato, M., Musacchio, D., Polimeni, R. M., Lacquaniti, V., Pulitano, G., Ruggeri, A., Provenzano, A., Cuccurullo, O., Musolino, M., Marrari, A., Anastasio, L., Schiavello, M., Comito, M. G., Gulizia, M. M., Francese, G. M., Vasquez, L., Coppolino, C., Casale, A., D'Urso, G., Oliva, G., Giordano, U., Andolina, S., Sanfilippo, N., Ingrilli, F., Accardo, S., Grasso, S., Buffa, L., Serra, E., Disertori, Marcello, Latini, Roberto, Barlera, Simona, Franzosi, Maria Grazia, Staszewsky, Lidia, Maggioni, Aldo Pietro, Lucci, Donata, Di Pasquale, Giuseppe, Tognoni, Gianni, GISSI AF, Investigator, Disertori, M, Latini, R, Barlera, S, Franzosi, Mg, Staszewsky, L, Maggioni, Ap, Lucci, D, Di Pasquale, G, Tognoni, G, Delise, P, Bertocchi, F, Maiocchi, G, Geraci, E, Correale, E, Lombardi, F, Mugelli, A, Urso, R, Scardi, S, Fabbri, G, Bartolomei, B, Barbato, G, Carbonieri, E, Ciricugno, S, Cosmi, F, Pratola, C, Rossi, Mg, Sciarra, L, Zeni, P, Ceseri, M, Atzori, A, Bambi, F, Baviera, M, Bianchini, F, Fenicia, E, Gianfriddo, M, Lonardo, G, Luise, A, Nota, R, Orlando, Me, Petrolo, R, Pierattini, C, Pierota, V, Ragno, A, Serio, C, Tafi, A, Tellaroli, E, Masson, S, Vago, T, Gramenzi, S, Orso, F, Suliman, I, Nicolis, E, Casola, C, Dall'Osso, D, Gorini, M, Bianchini, E, Cabiddu, S, Cangioli, I, Carnaghi, A, Cipressa, Ml, Cipressa, L, Galbiati, L, Lorimer, A, Priami, P, Moccetti, T, Vaghi, F, Capello, Af, Rossetti, G, Viada, E, Morena, L, Delucchi, M, Reynaud, Sg, Allemano, P, Massobrio, N, Gavazzi, A, Taddei, F, Mor, Da, Bortolini, F, Lorini, M, Inama, G, Durin, O, Pirelli, S, Spotti, A, Procopio, R, Cuzzucrea, D, Gentile, G, Margonato, A, Bassanelli, G, Tavazzi, L, Buzzi, Mp, Rordorf, R, Gualco, A, Opasich, C, Gronda, E, Genovese, L, Mattioli, R, Donatelli, F, Uriarte, Ja, Rauhe, W, Bertagnolli, C, Canestrini, S, Stefenelli, C, Cioffi, G, Giovanelli, C, Rigatelli, G, Boni, S, Pasini, A, Sitta, N, Sacchetta, A, Borgese, L, Sciascia, R, Targa, L, Raviele, A, Madalosso, M, Bertaglia, E, Zoppo, Fc, Capanna, M, Fiorencis, R, Baracca, E, Rossi, R, Rossi, I, Trappolin, R, Morgera, T, Barducci, E, Baldin, Mg, Gobbo, G, Zardo, F, Hrovatin, E, Mos, L, Vriz, O, Sinagra, G, Aleksova, A, Mazzone, C, Fresco, C, Rubartelli, P, Moroni, La, Camerieri, A, Piana, M, Mureddu, R, Bertoli, D, Petacchi, R, Pancaldi, Lg, Gabrieli, L, Urbinati, S, Pedone, C, Di Niro, M, Brunelli, A, Bosi, S, Censi, S, Moruzzi, P, Pastori, P, Modena, Mg, Malavasi, V, Mezzetti, M, Melandri, F, Zuppiroli, A, Fazi, A, Testa, R, Venturini, E, Mazzinghi, F, Cosmi, D, Santoro, Gm, Minneci, C, Galli, M, Paperini, L, Bovenzi, Fm, Cortigiani, L, Cocchieri, M, Severini, D, Arcuri, Gm, Bagliani, G, Bernardinangeli, M, Proietti, G, Bocconcelli, P, Pierantozzi, A, Monti, F, Giamundo, L, Tancredi, P, Rossini, E, Bianchi, C, Bettiol, F, Giovannini, E, Fera, M, Santini, M, Bianconi, L, Boccanelli, A, Morosetti, P, Volpe, M, Facciolo, C, Vacri, A, Romanazzi, F, Napoletano, C, Piccioni, Ll, Candelmo, F, De Marco, G, Arnese, Mr, Vetrano, A, Prinzi, D, De Rosa, P, Capuano, V, Torre, S, D'Onofrio, A, Ammendola, E, Chiariello, Massimo, PERRONE FILARDI, Pasquale, Battista, R, De Fusco, A, Molero, U, Iervoglini, A, Stefanelli, S, Fattore, L, Bosco, B, Liguori, A, Padula, G, De Luca, I, Sorino, M, Colonna, P, D'Agostino, C, Pierfelice, O, Pettinati, G, Muscella, A, De Lorenzi, E, Falco, M, Giannattasio, C, Baldi, N, Clemente, Ma, D'Alessandro, B, Truncellito, L, Arabia, F, Ciconte, Va, Perticone, F, Ruberto, C, Buffon, A, Tomaselli, C, De Rosa, F, Mazza, S, Zampaglione, G, Pirozzi, Am, Butera, A, Levato, M, Musacchio, D, Polimeni, Rm, Lacquaniti, V, Pulitanò, G, Ruggeri, A, Provenzano, A, Cuccurullo, O, Musolino, M, Marrari, A, Anastasio, L, Schiavello, M, Comito, Mg, Gulizia, Mm, Francese, Gm, Vasquez, L, Coppolino, C, Casale, A, D'Urso, G, Oliva, G, Giordano, U, Andolina, S, Sanfilippo, N, Ingrillì, F, Accardo, S, Grasso, S, and Buffa, L

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Tetrazoles, Cardiomegaly, Comorbidity, Placebo, Cardioversion, Double-Blind Method, Recurrence, Multicenter trial, Internal medicine, Angiotensin II Type 1 Receptor Blocker, Cardiovascular Disease, Atrial Fibrillation, medicine, Left atrial enlargement, Diabetes Mellitus, Humans, Sinus rhythm, cardiovascular diseases, Prospective Studies, Tetrazole, Proportional Hazards Models, Aged, business.industry, Medicine (all), Hazard ratio, Atrial fibrillation, Diabetes Mellitu, Valine, General Medicine, Middle Aged, medicine.disease, valsartan, atrial fibrillation, Prospective Studie, Valsartan, Cardiovascular Diseases, cardiovascular system, Cardiology, Proportional Hazards Model, Female, business, Angiotensin II Type 1 Receptor Blockers, medicine.drug, Human
Abstract

BACKGROUND: Atrial fibrillation is the most common cardiac arrhythmia, and no current therapy is ideal for control of this condition. Experimental studies suggest that angiotensin II-receptor blockers (ARBs) can influence atrial remodeling, and some clinical studies suggest that they may prevent atrial fibrillation. METHODS: We conducted a large, randomized, prospective, placebo-controlled, multicenter trial to test whether the ARB valsartan could reduce the recurrence of atrial fibrillation. We enrolled patients who were in sinus rhythm but had had either two or more documented episodes of atrial fibrillation in the previous 6 months or successful cardioversion for atrial fibrillation in the previous 2 weeks. To be eligible, patients also had to have underlying cardiovascular disease, diabetes, or left atrial enlargement. Patients were randomly assigned to receive valsartan or placebo. The two primary end points were the time to a first recurrence of atrial fibrillation and the proportion of patients who had more than one recurrence of atrial fibrillation over the course of 1 year. RESULTS: A total of 1442 patients were enrolled in the study. Atrial fibrillation recurred in 371 of the 722 patients (51.4%) in the valsartan group, as compared with 375 of 720 (52.1%) in the placebo group (adjusted hazard ratio, 0.97; 96% confidence interval [CI], 0.83 to 1.14; P = 0.73). More than one episode of atrial fibrillation occurred in 194 of 722 patients (26.9%) in the valsartan group and in 201 of 720 (27.9%) in the placebo group (adjusted odds ratio, 0.89; 99% CI, 0.64 to 1.23; P = 0.34). The results were similar in all predefined subgroups of patients, including those who were not receiving angiotensin-converting-enzyme inhibitors. CONCLUSIONS: Treatment with valsartan was not associated with a reduction in the incidence of recurrent atrial fibrillation. (ClinicalTrials.gov number, NCT00376272.) Copyright © 2009 Massachusetts Medical Society.

Published
2009

7. Valsartan for prevention of recurrent atrial fibrillation (New England Journal of Medicine (2009) 360, (1606-1617))

Author

Delise, P., Bertocchi, F., Maiocchi, G., Geraci, E., Correale, E., Lombardi, F., Mugelli, A., Urso, R., Scardi, S., Fabbri, G., Bartolomei, B., Barbato, G., Carbonieri, E., Ciricugno, S., Cosmi, F., Pratola, C., Rossi, M. G., Sciarra, L., Zeni, P., Ceseri, M., Atzori, A., Bambi, F., Baviera, M., Bianchini, F., Fenicia, E., Gianfriddo, M., Lonardo, G., Luise, A., Nota, R., Orlando, M. E., Petrolo, R., Pierattini, C., Pierota, V., Ragno, A., Serio, C., Tafi, A., Tellaroli, E., Masson, S., Vago, T., Gramenzi, S., Orso, F., Suliman, I., Nicolis, E., Casola, C., Dall Osso, D., Gorini, M., Bianchini, E., Cabiddu, S., Cangioli, I., Carnaghi, A., Cipressa, M. L., Cipressa, L., Galbiati, L., Lorimer, A., Priami, P., Moccetti, T., Vaghi, F., Capello, A. F., Rossetti, G., Viada, E., Morena, L., Delucchi, M., Reynaud, S. G., Allemano, P., Massobrio, N., Gavazzi, A., Taddei, F., Mor, D. A., Bortolini, F., Lorini, M., Inama, G., Durin, O., Pirelli, S., Spotti, A., Procopio, R., Cuzzucrea, D., Gentile, G., Margonato, A., Bassanelli, G., Tavazzi, L., Buzzi, M. P., Rordorf, R., Gualco, A., Opasich, C., Gronda, E., Genovese, L., Mattioli, R., Donatelli, F., Uriarte, J. A., Rauhe, W., Bertagnolli, C., Canestrini, S., Stefenelli, C., Cioffi, G., Giovanelli, C., Rigatelli, G., Boni, S., Pasini, A., Sitta, N., Sacchetta, A., Borgese, L., Sciascia, R., Targa, L., Raviele, A., Madalosso, M., Bertaglia, E., Franco Zoppo, Capanna, M., Fiorencis, R., Baracca, E., Rossi, R., Rossi, I., Trappolin, R., Morgera, T., Barducci, E., Baldin, M. G., Gobbo, G., Zardo, F., Hrovatin, E., Mos, L., Vriz, O., Sinagra, G., Aleksova, A., Mazzone, C., Fresco, C., Rubartelli, P., Moroni, L. A., Camerieri, A., Piana, M., Mureddu, R., Bertoli, D., Petacchi, R., Pancaldi, L. G., Gabrieli, L., Urbinati, S., Pedone, C., Di Niro, M., Brunelli, A., Bosi, S., Censi, S., Moruzzi, P., Pastori, P., Modena, M. G., Malavasi, V., Mezzetti, M., Melandri, F., Zuppiroli, A., Fazi, A., Testa, R., Venturini, E., Mazzinghi, F., Cosmi, D., Santoro, G. M., Minneci, C., Galli, M., Paperini, L., Bovenzi, F. M., Cortigiani, L., Cocchieri, M., Severini, D., Arcuri, G. M., Bagliani, G., Bernardinangeli, M., Proietti, G., Bocconcelli, P., Pierantozzi, A., Monti, F., Giamundo, L., Tancredi, P., Rossini, E., Bianchi, C., Bettiol, F., Giovannini, E., Fera, M. S., Santini, M., Bianconi, L., Boccanelli, A., Morosetti, P., Volpe, M., Facciolo, C., Vacri, A., Romanazzi, F., Napoletano, C., Piccioni, L. L., Candelmo, F., Marco, G., Arnese, M. R., Vetrano, A., Prinzi, D., Rosa, P., Capuano, V., Torre, S., D Onofrio, A., Ammendola, E., Chiariello, M., Filardi, Pp, Battista, R., Fusco, A., Molero, U., Iervoglini, A., Stefanelli, S., Fattore, L., Bosco, B., Liguori, A., Padula, G., Luca, I., Sorino, M., Colonna, P., D Agostino, C., Pierfelice, O., Pettinati, G., Muscella, A., Lorenzi, E., Falco, M., Giannattasio, C., Baldi, N., Clemente, M. A., D Alessandro, B., Truncellito, L., Arabia, F., Ciconte, V. A., Perticone, F., Ruberto, C., Buffon, A., Tomaselli, C., Rosa, F., Mazza, S., Zampaglione, G., Pirozzi, A. M., Butera, A., Levato, M., Musacchio, D., Polimeni, R. M., Lacquaniti, V., Pulitano, G., Ruggeri, A., Provenzano, A., Cuccurullo, O., Musolino, M., Marrari, A., Anastasio, L., Schiavello, M., Comito, M. G., Gulizia, M. M., Francese, G. M., Vasquez, L., Coppolino, C., Casale, A., D Urso, G., Oliva, G., Giordano, U., Andolina, S., Sanfilippo, N., Ingrilli, F., Accardo, S., Grasso, S., Buffa, L., Serra, E., Disertori, M., Latini, R., Barlera, S., Franzosi, M. G., Staszewsky, L., Maggioni, A. P., Lucci, D., Di Pasquale, G., Tognoni, G., Delise, P., Bertocchi, F., Maiocchi, G., Geraci, E., Correale, E., Lombardi, F., Mugelli, A., Urso, R., Scardi, S., Fabbri, G., Bartolomei, B., Barbato, G., Carbonieri, E., Ciricugno, S., Cosmi, F., Pratola, C., Rossi, M. G., Sciarra, L., Zeni, P., Ceseri, M., Atzori, A., Bambi, F., Baviera, M., Bianchini, F., Fenicia, E., Gianfriddo, M., Lonardo, G., Luise, A., Nota, R., Orlando, M. E., Petrolo, R., Pierattini, C., Pierota, V., Ragno, A., Serio, C., Tafi, A., Tellaroli, E., Masson, S., Vago, T., Gramenzi, S., Orso, F., Suliman, I., Nicolis, E., Casola, C., Dall'Osso, D., Gorini, M., Bianchini, E., Cabiddu, S., Cangioli, I., Carnaghi, A., Cipressa, M. L., Cipressa, L., Galbiati, L., Lorimer, A., Priami, P., Moccetti, T., Vaghi, F., Capello, A. F., Rossetti, G., Viada, E., Morena, L., Delucchi, M., Reynaud, S. G., Allemano, P., Massobrio, N., Gavazzi, A., Taddei, F., Mor, D. A., Bortolini, F., Lorini, M., Inama, G., Durin, O., Pirelli, S., Spotti, A., Procopio, R., Cuzzucrea, D., Gentile, G., Margonato, A., Bassanelli, G., Tavazzi, L., Buzzi, M. P., Rordorf, R., Gualco, A., Opasich, C., Gronda, E., Genovese, L., Mattioli, R., Donatelli, F., Uriarte, J. A., Rauhe, W., Bertagnolli, C., Canestrini, S., Stefenelli, C., Cioffi, G., Giovanelli, C., Rigatelli, G., Boni, S., Pasini, A., Sitta, N., Sacchetta, A., Borgese, L., Sciascia, R., Targa, L., Raviele, A., Madalosso, M., Bertaglia, E., Zoppo, F. C., Capanna, M., Fiorencis, R., Baracca, E., Rossi, R., Rossi, I., Trappolin, R., Morgera, T., Barducci, E., Baldin, M. G., Gobbo, G., Zardo, F., Hrovatin, E., Mos, L., Vriz, O., Sinagra, G., Aleksova, A., Mazzone, C., Fresco, C., Rubartelli, P., Moroni, L. A., Camerieri, A., Piana, M., Mureddu, R., Bertoli, D., Petacchi, R., Pancaldi, L. G., Gabrieli, L., Urbinati, S., Pedone, C., Di Niro, M., Brunelli, A., Bosi, S., Censi, S., Moruzzi, P., Pastori, P., Modena, M. G., Malavasi, V., Mezzetti, M., Melandri, F., Zuppiroli, A., Fazi, A., Testa, R., Venturini, E., Mazzinghi, F., Cosmi, D., Santoro, G. M., Minneci, C., Galli, M., Paperini, L., Bovenzi, F. M., Cortigiani, L., Cocchieri, M., Severini, D., Arcuri, G. M., Bagliani, G., Bernardinangeli, M., Proietti, G., Bocconcelli, P., Pierantozzi, A., Monti, F., Giamundo, L., Tancredi, P., Rossini, E., Bianchi, C., Bettiol, F., Giovannini, E., Fera, M. S., Santini, M., Bianconi, L., Boccanelli, A., Morosetti, P., Volpe, M., Facciolo, C., Vacri, A., Romanazzi, F., Napoletano, C., Piccioni, L. L., Candelmo, F., De Marco, G., Arnese, M. R., Vetrano, A., Prinzi, D., De Rosa, P., Capuano, V., Torre, S., D'Onofrio, A., Ammendola, E., Chiariello, M., Filardi, Pp., Battista, R., De Fusco, A., Molero, U., Iervoglini, A., Stefanelli, S., Fattore, L., Bosco, B., Liguori, A., Padula, G., De Luca, I., Sorino, M., Colonna, P., D'Agostino, C., Pierfelice, O., Pettinati, G., Muscella, A., De Lorenzi, E., Falco, M., Giannattasio, C., Baldi, N., Clemente, M. A., D'Alessandro, B., Truncellito, L., Arabia, F., Ciconte, V. A., Perticone, F., Ruberto, C., Buffon, A., Tomaselli, C., De Rosa, F., Mazza, S., Zampaglione, G., Pirozzi, A. M., Butera, A., Levato, M., Musacchio, D., Polimeni, R. M., Lacquaniti, V., Pulitano, G., Ruggeri, A., Provenzano, A., Cuccurullo, O., Musolino, M., Marrari, A., Anastasio, L., Schiavello, M., Comito, M. G., Gulizia, M. M., Francese, G. M., Vasquez, L., Coppolino, C., Casale, A., D'Urso, G., Oliva, G., Giordano, U., Andolina, S., Sanfilippo, N., Ingrilli, F., Accardo, S., Grasso, S., Buffa, L., Serra, E., Disertori, Marcello, Latini, Roberto, Barlera, Simona, Franzosi, Maria Grazia, Staszewsky, Lidia, Maggioni, Aldo Pietro, Lucci, Donata, Di Pasquale, Giuseppe, and Tognoni, Gianni

Subjects
Medicine (all)
Published
2009

8. Long-Term (4 Year) Outcome Following Drug Eluting Stent Implantation Versus Coronary Artery Bypass Surgery in Unprotected Left Main Coronary Artery Lesions

Author

Chieffo A, Magni V, Maesano F, Ielasi A, Bassanelli G, Montorfano M, Carlino M, Latib A, Godino C, Ferrari A, Sangiorgi G, Colombo A., ALFIERI , OTTAVIO, Chieffo, A, Magni, V, Maesano, F, Ielasi, A, Bassanelli, G, Montorfano, M, Carlino, M, Latib, A, Godino, C, Ferrari, A, Sangiorgi, G, Alfieri, Ottavio, and Colombo, A.

Published
2009

9. Valsartan for prevention of recurrent atrial

Author

Disertori, M, Latini, R, Maggioni, Ap, Barlera, S, Di Pasquale, G, Franzosi, Mg, Lucci, D, Staszewsky, L, Tognoni, G, Delise, P, Bertocchi, F, Maiocchi, G, Geraci, E, Correale, E, Lombardi, F, Mugelli, A, Urso, R, Scardi, S, Fabbri, G, Bartolomei, B, Barbato, G, Carbonieri, E, Ciricugno, S, Cosmi, F, Pratola, C, Rossi, Mg, Sciarra, L, Zeni, P, Ceseri, M, Atzori, A, Bambi, F, Baviera, M, Bianchini, F, Cfenicia, E, Gianfriddo, M, Lonardo, G, Luise, A, Nota, R, Orlando, Me, Petrolo, R, Pierattini, C, Pierota, V, Ragno, A, Serio, C, Tafi, A, Tellaroli, E, Masson, S, Vago, T, Gramenzi, S, Orso, F, Suliman, I, Nicolis, E, Casola, C, Dall'Osso, D, Gorini, M, Bianchini, E, Cabiddu, S, Cangioli, I, Carnaghi, A, Cipressa, Ml, Cipressa, L, Galbiati, L, Lorimer, A, Priami, P, Moccetti, T, Vaghi, F, Capello, Af, Rossetti, G, Viada, E, Morena, L, Delucchi, M, Reynaud SG, Allemano, P, Massobrio, N, Gavazzi, A, Taddei, F, Mor, Da, Bortolini, F, Lorini, M, Inama, G, Durin, O, Pirelli, S, Spotti, A, Procopio, R, Cuzzucrea, D, Gentile, G, Margonato, A, Bassanelli, G, Tavazzi, L, Buzzi, Mp, Rordorf, R, Gualco, A, Opasich, C, Gronda, E, Genovese, L, Mattioli, R, Donatelli, F, Uriarte, Ja, Rauhe, W, Bertagnolli, C, Canestrini, S, Stefenelli, C, Cioffi, G, Giovanelli, C, Rigatelli, G, Boni, S, Pasini, A, Sitta, N, Sacchetta, A, Borgese, L, Sciascia, R, Targa L, Raviele, A, Madalosso, M, Bertaglia, E, Zoppo, Fc, Capanna, M, Fiorencis, R, Baracca, E, Rossi, R, Rossi, I, Trappolin, R, Morgera, T, Barducci, E, Baldin, Mg, Gobbo, G, Zardo, F, Hrovatin, E, Mos, L, Vriz, O, Sinagra, G, Aleksova, A, Mazzone, C, Fresco, C, Rubartelli, P, Moroni, La, Camerieri, A, Piana, M, Mureddu, R, Bertoli, D, Petacchi, R, Pancaldi, Lg, Gabrieli, L, Urbinati, S, Pedone, C, Di Niro, M, Brunelli, A, Bosi, S, Censi, S, Moruzzi, P, Pastori, P, Modena, Mg, Malavasi, V, Mezzetti, M, Melandri, F, Zuppiroli, A, Fazi, A, Testa, R, Venturini, E, Mazzinghi, F, Cosmi, D, Santoro, Gm, Minneci, C, Galli, M, Paperini, L, Bovenzi, Fm, Cortigiani, L, Cocchieri, M, Severini, D, Arcuri, Gm, Bagliani, G, Bernardinangeli, M, Proietti, G, Bocconcelli, P, Pierantozzi, A, Monti, F, Giamundo, L, Tancredi, P, Rossini, E, Bianchi, C, Bettiol, F, Giovannini, E, Fera, Ms, Santini, M, Bianconi, L, Boccanelli, A, Morosetti, P, Volpe, M, Facciolo, C, Vacri, A, Romanazzi, F, Napoletano, C, Piccioni, Ll, Candelmo, F, De Marco, G, Arnese, Mr, Vetrano, A, Prinzi, D, De Rosa, P, Capuano, V, Torre, S, D'Onofrio, A, Ammendola, E, Chiariello, M, Filardi, Pp, Battista, R, De Fusco, A, Molero, U, Iervoglini, A, Stefanelli, S, Fattore, L, Bosco, B, Liguori, A, Padula, G, De Luca, I, Sorino, M, Colonna, P, D'Agostino, C, Pierfelice, O, Pettinati, G, Muscella, A, De Lorenzi, E, Falco, M, Giannattasio, C, Baldi, N, Clemente, Ma, D'Alessandro, B, Truncellito, L, Arabia, F, Ciconte, Va, Perticone, F, Ruberto, C, Buffon, A, Tomaselli, C, De Rosa, F, Mazza, S, Zampaglione, G, Pirozzi, Am, Butera, A, Levato, M, Musacchio, D, Polimeni, Rm, Lacquaniti, V, Pulitanò, G, Ruggeri, A, Provenzano, A, Cuccurullo, O, Musolino, M, Marrari, A, Anastasio, L, Schiavello, M, Comito, Mg, Gulizia, Mm, Francese GM, Vasquez, L, Coppolino, C, Casale, A, D'Urso, G, Oliva, G, Giordano, U, Andolina, S, Sanfilippo, N, Ingrillì, F, Accardo, S, Grasso, S, Buffa, L, Bambi, Serra E., Baviera, M., Bianchini, F., Fenicia, E., Gianfriddo, M., Lonardo, G., Luise, A., Nota, R., Orlando, M. E., Petrolo, R., Pierattini, C., Pierota, V., Ragno, A., Serio, C., Tafi, A., Tellaroli, E., Masson, Core Laboratories — S., Latini, R., Vago (Biomarkers), T., Staszewsky, L., Gramenzi (Echocardiography), S., Orso, F., Suliman (Electrocardiography), I., Nicolis, Database Management and Statistics — E., Casola, C., Barlera, S., Dall'Osso, D., Gorini, M., Lucci, D., Regulatory, Administrative, Bianchini, and Secretariat — E., Cabiddu, S., Cangioli, I., Carnaghi, A., Cipressa, M. L., Cipressa, L., Galbiati, L., Lorimer, A., Priami, P., Moccetti, Participating Centers and Investigators — Switzerland: Lugano (T., Rossi, M. G., Vaghi), F., Capello), Italy: Piemonte: Asti (A. F. L., Rossetti, Cuneo (G., Viada, E., Morena), L., Delucchi, Saluzzo (M., Reynaud, S. G., Allemano), P., Massobrio), Torino Valdese (N., Gavazzi, Lombardia: Bergamo (A., Taddei), F., Mor), Brescia (D. A., Bortolini, Chiari (F., Lorini), M., Inama, Crema (G., Durin), O., Pirelli, Cremona (S., Spotti, A., Procopio), R., Cuzzucrea, Giussano (D., Gentile), G., Margonato, Milano San Raffaele (A., Bassanelli), G., Tavazzi, Pavia San Matteo (L., Buzzi, M. P., Rordorf), R., Gualco, Pavia Fondazione Salvatore Maugeri (A., Opasich), C., Gronda, Rozzano (E., Genovese), L., Mattioli, Sesto San Giovanni (R., Donatelli), F., Salerno Uriarte), Varese (J. A., Rauhe), P. A. Bolzano: Bolzano (W., Bertagnolli, P. A. Trento: Cles (C., Canestrini), S., Stefenelli, Trento Villa Bianca (C., Cioffi), G., Disertori, Trento Santa Chiara (M., Zeni, P., Giovanelli), C., Rigatelli, Veneto: Bovolone (G., Boni, S., Pasini), A., Sitta), Conegliano Santa Maria dei Battuti (N., Sacchetta, Conegliano Veneto De Gironcoli (A., Borgese, L., Sciascia), R., Targa), Este (L., Raviele, Mestre (A., Madalosso), M., Bertaglia, Mirano (E., Zoppo), F. C., Capanna, Porto Viro (M., Fiorencis), R., Baracca), Rovigo (E., Rossi, San Bonifacio (R., Carbonieri, E., Rossi), I., Trappolin), Villafranca di Verona (R., Morgera, Friuli Venezia Giulia: Monfalcone (T., Barducci), E., Baldin, Palmanova (M. G., Gobbo), G., Zardo, Pordenone (F., Hrovatin), E., Mos, San Daniele del Friuli (L., Vriz), O., Sinagra, Trieste Az. Ospedaliera-Universitaria Ospedali Riuniti (G., Aleksova), A., Scardi, Trieste Az. Servizi Sanitari n. 1 Triestina (S., Mazzone), C., Fresco), Udine (C., Rubartelli, Liguria: Genova-Sampierdarena (P., Moroni), L. A., Camerieri), Genova-Voltri (A., Piana), Imperia (M., Mureddu), Pietra Ligure (R., Bertoli, Sarzana-Loc. S. Caterina (D., Petacchi), R., Pancaldi, Emilia Romagna: Bentivoglio (L. G., Gabrieli), L., Urbinati, Bologna Bellaria (S., Pedone), C., Di Pasquale, Bologna Maggiore (G., Di Niro, M., Brunelli), A., Bosi, Cotignola (S., Censi), S., Pratola), Ferrara (C., Moruzzi, Fidenza (P., Pastori), P., Modena, Modena (M. G., Malavasi), V., Mezzetti), Rimini (M., Melandri), Sassuolo (F., Zuppiroli, Toscana: Bagno a Ripoli (A., Fazi), A., Testa, Cecina (R., Venturini, E., Mazzinghi), F., Cosmi, Cortona (F., Cosmi), D., Santoro, Firenze Nuovo Osp. S Giovanni di Dio (G. M., Minneci), C., Galli, Livorno (M., Paperini), L., Bovenzi, Lucca (F. M., Cortigiani), L., Cocchieri, Umbria: Città di Castello (M., Severini, D., Arcuri), G. M., Bagliani), Foligno (G., Bernardinangeli, Terni (M., Proietti, G., Proietti), G., Bocconcelli, Marche: Pesaro (P., Pierantozzi), A., Monti, Lazio: Albano Laziale (F., Giamundo), L., Tancredi, Formia (P., Rossini), E., Bianchi), Roma Centro Traumatologico Ortopedico (C., Roma San Camillo, Bettiol), Cardiologia Riabilitativa e Preventiva (F., Giovannini, Cardiologia I (E., Fera), M. S., Santini, Roma San Filippo Neri (M., Bianconi), L., Boccanelli, Roma San Giovanni (A., Morosetti), P., Volpe, Roma Sant'Andrea (M., Facciolo), C., Vacri, Abruzzo: Penne (A., Romanazzi), F., Napoletano, Teramo (C., Piccioni), L. L., Candelmo), Campania: Avellino (F., De Marco, Aversa (G., Arnese), M. R., Vetrano), Caserta (A., Prinzi, Giugliano in Campania (D., De Rosa), P., Capuano, Mercato San Severino (V., Torre), S., D'Onofrio, Napoli Azienda Ospedaliera Monaldi (A., Ammendola), E., Chiariello, Napoli Policlinico Universitario Federico II (M., Perrone Filardi), P., Battista, Piedimonte Matese (R., De Fusco), A., Molero), Pozzuoli (U., Iervoglini, San Felice a Cancello (A., Stefanelli), S., Fattore, Santa Maria Capua Vetere (L., Bosco), B., Liguori, Vallo della Lucania (A., Padula), G., De Luca, Puglia: Bari Ospedale Consorziale Policlinico (I., Sorino, M., Colonna), P., D'Agostino, Bari-Carbonara (C., Pierfelice), O., Pettinati, Casarano (G., Muscella), A., De Lorenzi, Scorrano (E., Falco), M., Giannattasio), Taranto Villa Verde (C., Baldi), Taranto Santissima Annunziata (N., Clemente), Basilicata: Matera (M. A., D'Alessandro, Policoro (B., Truncellito), L., Arabia, Calabria: Catanzaro Pugliese (F., Ciconte), V. A., Perticone, Catanzaro Germaneto (F., Ruberto), C., Buffon, Cosenza Santissima Annunziata (A., Tomaselli), C., De Rosa, Cosenza Mariano Santo (F., Mazza), S., Zampaglione, Crotone (G., Pirozzi), A. M., Butera, Lamezia Terme (A., Levato), M., Musacchio), Paola (D., Polimeni, Polistena (R. M., Lacquaniti), V., Pulitanò, Reggio Calabria (G., Ruggeri), A., Provenzano), Rogliano (A., Cuccurullo), San Marco Argentano (O., Musolino, Scilla (M., Marrari), A., Anastasio, Soriano Calabro (L., Schiavello), M., Comito), Vibo Valentia (M. G. A., Gulizia, Sicilia: Catania (M. M., Francese), G. M., Vasquez, Milazzo (L., Coppolino), C., Casale, Nicosia (A., D'Urso), G., Oliva, Palermo Civico e Benfratelli (G., Giordano, U., Andolina), S., Sanfilippo, Palermo Villa Sofia (N., Ingrillì), F., Accardo), Palermo Buccheri La Ferla (S., Grasso, Palermo Cervello (S., Buffa), L., and Sardegna: Cagliari Brotzu, (E. Serra).

Published
2009

10. Differential long-term effects of carvedilol on proinflammatory and antiinflammatory cytokines, asymmetric dimethylarginine, and left ventricular function in patients with heart failure

Author

Alfieri AB, Briceno L, Fragasso G, Spoladore R, Palloshi A, Bassanelli G, Montano C, Arioli F, Cuko A, Ritotolo G, MARGONATO , ALBERTO, Alfieri, Ab, Briceno, L, Fragasso, G, Spoladore, R, Palloshi, A, Bassanelli, G, Montano, C, Arioli, F, Cuko, A, Ritotolo, G, and Margonato, Alberto

Abstract

Neuroendocrine/inflammatory and endothelial functions have been indicated as crucial for heart failure (HF) patients. We evaluated relation in HF patients among cytokines and asymmetric dimethylarginine (ADMA) and left ventricular ejection fraction (LVEF) at baseline and after long-term administration of carvedilol. Interleukin 10 (IL-10), interleukin 18 (IL-18), and ADMA were measured in 22 NYHA class II to IV HF patients at baseline and after 40 +/- 14 months of carvedilol treatment. Patients were divided into 2 groups according to whether, after treatment with carvedilol, LVEF had increased at least 5% (responders) or less than 5% (non-responders). In responders (I I of 22 patients), LVEF increased from 38 +/- 6% to 50 +/- 7%, (P < 0.001); in non-responders, it decreased from 36 +/- 9% to 31 +/- 6%, (P = 0.02); NYHA class significantly decreased in both groups. IL-18 decreased in responders (from 586.4 +/- 128 to 183.13 +/- 64.4 pg/mL; P < 0.001) and in non-responders (from 529.3 +/- 116.25 to 142.4 +/- 58.9 pg/mL; P < 0.001). IL-10 increased in responders (from 0.49 +/- 0.25 to 2.01 +/- 1.01 pg/mL; P < 0.001) and in non-responders (from 0.64 +/- 0.31 to 1.33 +/- 0.59 pg/mL; P < 0.001). Conversely, ADMA levels decreased only in responders (from 0.67 +/- 0.16 to 0.44 +/- 0.15 mu mol/L; P < 0.001), and an inverse correlation was observed between basal ADMA levels and changes in LVEF after treatment. In HF patients, carvedilol appears to reduce symptoms and the expression of inflammation, regardless of the LV functional response. In those patients showing improvement of LVEF, the reduction of inflammation is paralleled by a reduction of ADMA. We surmise that carvedilol could be effective at various independent levels as a result of possible pleiotropic effects of this agent.

Published
2008

13. Effect of partial inhibition of fatty acid oxidation by trimetazidine on whole body energy metabolism in patients with chronic heart failure

Author

Fragasso, G, Salerno, A, Lattuada, G, Cuko, A, Calori, G, Scollo, A, Ragogna, F, Arioli, F, Bassanelli, G, Spoladore, R, Luzi, L, Margonato, A, Perseghin, G, PERSEGHIN, GIANLUCA, Fragasso, G, Salerno, A, Lattuada, G, Cuko, A, Calori, G, Scollo, A, Ragogna, F, Arioli, F, Bassanelli, G, Spoladore, R, Luzi, L, Margonato, A, Perseghin, G, and PERSEGHIN, GIANLUCA

Abstract

Objective: Trimetazidine may have beneficial effects on left ventricular (LV) function in patients with systolic heart failure. The authors assessed whether long-term addition of trimetazidine to conventional treatment could improve, along with LV function, resting whole body energy metabolism in patients with chronic systolic heart failure. Design: Single blind randomised study. Setting: University Hospital. Patients: 44 patients with systolic heart failure receiving full medical treatment. Interventions: Indirect calorimetry and two-dimensional echocardiography at baseline and after 3 months. Main outcome measures: Whole body resting energy expenditure (REE), percentage of predicted REE, LV ejection fraction (EF), NYHA class, quality of life. Results: Trimetazidine increased EF compared with conventional therapy alone (from 3568% to 42611% vs from 3567% to 36±6%; p=0.02, analysis of variance for repeated measures). NYHA class and quality of life also improved compared with conventional therapy (p<0.0001). REE (from 1677±264 to 1580±263 kcal/day) and percentage of predicted REE (based on the Harris-Benedict equation: from 114±10% to 108±9%) decreased in the trimetazidine group, but not in the control group (REE from 1679±304 to 1690±337 kcal/day and percentage of predicted REE from 113±12% to 115±14%). The variation was different between groups (p=0.03 and 0.023, respectively). Conclusions: In patients with systolic heart failure, improvement in functional class and LV function induced by middle-term trimetazidine therapy is paralleled by a reduction in whole body REE. The beneficial cardiac effects of trimetazidine may be also mediated by a peripheral metabolic effect

Published
2011

14. The anti-ischemic effect of trimetazidine in patients with postprandial myocardial ischemia is unrelated to meal composition

Author

Fragasso, G, Montano, C, Perseghin, G, Palloshi, A, Calori, G, Lattuada, G, Oggionni, S, Bassanelli, G, Locatelli, M, Lopaschuk, G, Margonato, A, Margonato, A., PERSEGHIN, GIANLUCA, Fragasso, G, Montano, C, Perseghin, G, Palloshi, A, Calori, G, Lattuada, G, Oggionni, S, Bassanelli, G, Locatelli, M, Lopaschuk, G, Margonato, A, Margonato, A., and PERSEGHIN, GIANLUCA

Abstract

Background: Previous studies provide evidence for a significant reduction of coronary flow reserve after ingestion of meals of different compositions. A possible role of hyperinsulinemia and increased free fatty acid levels, which are deleterious during acute myocardial ischemia and reperfusion, has been hypothesized. We assessed in patients with stable coronary disease the effects of high-fat meals (HFMs) and high-carbohydrate meals (HCMs) on ischemic threshold and stress left ventricular function on placebo and after partial fatty acid inhibition by trimetazidine (TMZ). Methods: Ten patients (9 men, age 68 ± 7 years) were allocated to placebo and TMZ (40 mg TID), both administered in the 24 hours preceding testing, according to a randomized double-blind study design. All patients underwent stress (treadmill exercise testing according to the Bruce protocol) echocardiography after fasting (8 hours) and after an HFM and HCM (2 hours) either on placebo or on TMZ. Time to 1-mm ST-segment depression (time to 1 mm) and stress wall motion score index (WMSI) were evaluated. Results: An HFM did not affect exercise variables compared with fasting, whereas an HCM resulted in a reduction of the ischemic threshold (time to 1 mm from 402 ± 141 to 292 ± 123 seconds, P = .025). Compared with placebo, TMZ improved time to 1 mm after fasting, HFM, and HCM (432 ± 153 vs 402 ± 141, 439 ± 118 vs 380 ± 107, 377 ± 123 vs 292 ± 123, F1,9 = 26.91, P = .0006). Compared with placebo, on TMZ, stress WMSI decreased from 1.55 ± 0.25 to 1.29 ± 0.14 after fasting, from 1.57 ± 0.10 to 1.39 ± 0.28 after HFM, and from 1.64 ± 0.21 to 1.39 ± 0.21 after HCM (F1,9 = 37.04, P = .0002). Interestingly, stress WMSI on TMZ was never different from rest WMSI on placebo. Conclusions: In patients with coronary disease, exercise testing after an HCM results in more severe myocardial ischemia compared with that after an HFM. The observed beneficial effects of the partial fatty acid inhibitor TMZ seem to be unrela

Published
2006

15. Effect of partial inhibition of fatty acid oxidation by trimetazidine on whole body energy metabolism in patients with chronic heart failure

Author

Fragasso, G., primary, Salerno, A., additional, Lattuada, G., additional, Cuko, A., additional, Calori, G., additional, Scollo, A., additional, Ragogna, F., additional, Arioli, F., additional, Bassanelli, G., additional, Spoladore, R., additional, Luzi, L., additional, Margonato, A., additional, and Perseghin, G., additional

Published
2011
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20. Effect of partial inhibition of fatty acid oxidation by trimetazidine on whole body energy metabolism in patients with chronic heart failure

Author

Roberto Spoladore, Gianluca Perseghin, Gabriele Fragasso, Giliola Calori, Francesca Ragogna, Giorgio Bassanelli, Guido Lattuada, Anna Salerno, Francesco Arioli, Antonella Scollo, Alberto Margonato, Livio Luzi, Amarild Cuko, Fragasso, G, Salerno, A, Lattuada, G, Cuko, A, Calori, G, Scollo, A, Ragogna, F, Arioli, F, Bassanelli, G, Spoladore, R, Luzi, L, Margonato, Alberto, Perseghin, G., Margonato, A, and Perseghin, G

Subjects
Male, medicine.medical_specialty, Vasodilator Agents, Trimetazidine, Calorimetry, Quality of life, Internal medicine, Vasodilator Agent, Humans, Medicine, Resting energy expenditure, MED/13 - ENDOCRINOLOGIA, Aged, Heart Failure, Ejection fraction, business.industry, Fatty Acids, Repeated measures design, Stroke Volume, medicine.disease, Peripheral, Echocardiography, Heart failure, Chronic Disease, Cardiology, Female, Analysis of variance, Energy Metabolism, Cardiology and Cardiovascular Medicine, business, Oxidation-Reduction, Fatty Acid, Human, medicine.drug
Abstract

"\"Objective Trimetazidine may have beneficial effects on left ventricular (LV) function in patients with systolic heart failure. The authors assessed whether long-term addition of trimetazidine to conventional treatment could improve, along with LV function, resting whole body energy metabolism in patients with chronic systolic heart failure. Design Single blind randomised study. Setting University Hospital. Patients 44 patients with systolic heart failure receiving full medical treatment. Interventions Indirect calorimetry and two-dimensional echocardiography at baseline and after 3 months. Main outcome measures Whole body resting energy expenditure (REE), percentage of predicted REE, LV ejection fraction (EF), NYHA class, quality of life. Results Trimetazidine increased EF compared with conventional therapy alone (from 35 +\\\/- 8% to 42 +\\\/- 11% vs from 35 +\\\/- 7% to 36 +\\\/- 6%; p=0.02, analysis of variance for repeated measures). NYHA class and quality of life also improved compared with conventional therapy (p

Published
2011
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21. Metabolic Therapy of Heart Failure

Author

Roberto Spoladore, Giorgio Bassanelli, Gabriele Fragasso, Anna Salerno, Alberto Margonato, Francesco Arioli, Fragasso, G, Salerno, A, Spoladore, R, Bassanelli, G, Arioli, F, and Margonato, Alberto

Subjects
medicine.medical_specialty, Heart disease, Perhexiline, Trimetazidine, Fatty Acids, Nonesterified, Carbohydrate metabolism, Insulin resistance, Internal medicine, Drug Discovery, medicine, Animals, Humans, Beta oxidation, Heart Failure, Pharmacology, Carnitine O-Palmitoyltransferase, business.industry, Myocardium, Cardiovascular Agents, medicine.disease, Endocrinology, Heart failure, Adjunctive treatment, Cardiology, business, medicine.drug
Abstract

Alterations of cardiac metabolism can be present in several cardiac syndromes. Heart failure may itself promote metabolic changes such as insulin resistance, in part through neurohumoral activation, and determining an increased utilization of non-carbohydrate substrates for energy production. In fact, fasting blood ketone bodies as well as fat oxidation have been shown to be increased in patients with heart failure. The result is depletion of myocardial ATP, phosphocreatine and creatine kinase with decreased efficiency of mechanical work. A direct approach to manipulate cardiac energy metabolism consists in modifying substrate utilization by the failing heart. To date, the most effective metabolic treatments include several pharmacological agents, such as trimetazidine and perhexiline, that directly inhibit fatty acid oxidation. These agents have been originally adopted to increase the ischemic threshold in patients with effort angina. However, the results of current research is supporting the concept that shifting the energy substrate preference away from fatty acid metabolism and toward glucose metabolism could be an effective adjunctive treatment in patients with heart failure, in terms of left ventricular function and glucose metabolism improvement. In fact, these agents have also been shown to improve overall glucose metabolism in diabetic patients with left ventricular dysfunction. In this paper, the recent literature on the beneficial therapeutic effects of modulation of cardiac metabolic substrates utilization in patients with heart failure is reviewed and discussed.

Published
2008
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22. Improved survival in patients with chronic mild/moderate systolic heart failure followed up in a specialist clinic

Author

Amarild Cuko, Roberto Spoladore, Anna Salerno, Gabriele Fragasso, Giliola Calori, Carmela Silipigni, Giorgio Bassanelli, Alberto Margonato, Giovanni Marinosci, Francesco Arioli, Altin Palloshi, Patrizia Puccetti, Fragasso, G, Marinosci, G, Calori, G, Spoladore, R, Arioli, F, Bassanelli, G, Salerno, A, Cuko, A, Puccetti, P, Silipigni, C, Palloshi, A, and Margonato, Alberto

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Adrenergic beta-Antagonists, Kaplan-Meier Estimate, Ambulatory Care Facilities, Cohort Studies, Sex Factors, Diabetes mellitus, Internal medicine, medicine, Humans, Myocardial infarction, Survival analysis, Aged, Ejection fraction, business.industry, Hazard ratio, Age Factors, General Medicine, Middle Aged, medicine.disease, Hospitalization, Survival Rate, Standardized mortality ratio, Heart failure, Chronic Disease, Cardiology, Female, Diuretic, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, Heart Failure, Systolic
Abstract

OBJECTIVE To relate therapeutic issues, comorbidities and functional parameters to mortality/morbidity of mild/moderate heart failure patients. METHODS From our heart failure clinic, 372 heart failure patients (269 men, aged 66 ± 11 years), with stable heart failure and ejection fraction 45% or less were recruited. Survival curves were estimated according to the Kaplan-Meier method. Associations of protective/risk factors with cardiovascular mortality/morbidity were also evaluated. RESULTS One hundred and two patients (27%) died (aged 70 ± 10 years at diagnosis, 76 ± 10 at death) during follow-up (overall mortality at 60 months: 19.2%; mean follow-up period: 67 ± 44 months). Cardiovascular deaths were 64 (63% of total deaths, 44 men, age at diagnosis 70 ± 9). Cardiovascular mortality at 60 months was 12%; standardized mortality ratio was 5.9 for women and 6.8 for men. The remaining 38 patients (37% of total deaths, 30 men, age at diagnosis 70 ± 10) died of noncardiovascular causes. Overall, noncardiovascular mortality at 60 months was 7.2%; mean survival time from diagnosis to death was 63 ± 69 months (median 42, Q1 = 27.5, Q3 = 77.7). Average cardiovascular admission rate was 1.63 ± 1.84 admissions/patient. At multivariate analysis, only previous history of myocardial infarction [hazard ratio: 3.62 (1.70-7.73)], class of ejection fraction at diagnosis [hazard ratio: 0.36 (0.32-0.60)], acute cardiac decompensation at any time [hazard ratio: 1.55 (1.32-1.84)], implanted defibrillator [hazard ratio: 0.11 (0.01-0.83)] and use of statins [hazard ratio: 0.08 (0.007-0.42)] were independently associated with cardiovascular mortality. Factors associated to higher annual cardiovascular morbidity were age at diagnosis, chronic renal failure, diabetes, cardiac decompensation at any time, female sex and diuretic therapy. Angiotensin-converting enzyme (ACE) inhibitors and/or angiotensin-receptor-blockers reduced annual cardiovascular morbidity. CONCLUSION Survival in mild/moderate heart failure patients has consistently improved. Further improvements are warranted in terms of morbidity reduction.

Published
2011

23. Prognosis of mild/moderate chronic systolic heart failure

Author

Alberto Margonato, Altin Palloshi, Roberto Spoladore, Giorgio Bassanelli, Giliola Calori, Gabriele Fragasso, Anna Salerno, Francesco Arioli, Giovanni Marinosci, Fragasso, G, Marinosci, G, Calori, G, Palloshi, A, Spoladore, R, Arioli, F, Bassanelli, G, Salerno, A, and Margonato, Alberto

Subjects
medicine.medical_specialty, Population, Kaplan-Meier Estimate, Severity of Illness Index, Intracardiac injection, Internal medicine, medicine, Humans, education, Cardiovascular mortality, Aged, Aged, 80 and over, education.field_of_study, Ejection fraction, business.industry, Mortality rate, Chronic systolic heart failure, Middle Aged, medicine.disease, Prognosis, Health Surveys, Intensity (physics), Heart failure, Chronic Disease, Cardiology, Cardiology and Cardiovascular Medicine, business, Heart Failure, Systolic
Abstract

⁎ Corresponding author. Tel.: +39 02 26437366; fax: +39 02 26437358. E-mail address: gabriele.fragasso@hsr.it (G. Fragasso). Despite many advances in diagnosis and therapy, heart failure (HF) is still apparently related to poor prognosis, with reported mortality rates at 5-year over 40% (9% per year) — a six-fold adverse rate compared with the general population [1–3]. To address this important public health issue, we sought to determine morbidity and mortality rates in our population of chronic HF out-patients, followed-up in the heart failure clinic of our Institution and compare them with rates reported in previous surveys. Of a total of 403 systolic heart failure patients attending our clinic from March 1992 to December 2005 and on optimal medical and device therapy, 372 (269 males, age at diagnosis 66±11 yrs) were considered eligible for study analysis. The remaining 31 patients could not be traced. Patients lost at followup were tested for baseline variables (age, gender, NYHA class, ejection fraction) and were not statistically different compared with the group with complete followup. Mean follow-up from first diagnosis was 67±44 months (median 58.50, Q1=40.75, Q3=80.25). The diagnosis of HF was ascertained according to European Society of Cardiology criteria: I) symptoms of heart failure and II) objective evidence (by echocardiography) of cardiac systolic dysfunction (at rest) and (in cases where the diagnosis was in doubt) III) response to treatment directed towards heart failure. Criteria I and II had to be fulfilled in all cases. Furthermore, we selected only patients with a baseline ejection fraction (EF)≤45% (Simpson biplane). Cardiovascular mortality was calculated as the number of events per 1000 person-year at risk. Mortality and morbidity were compared with the national population by using standardized mortality ratios, referring to national data classified by age and sex (data from the Italian Central Statistics Institute – ISTAT – We found that application twice of 4.3 MHz intracardiac ultrasound for 60 s at an intensity of 1.0 W/cm were suitable parameters for higher efficiency of transfection and low percentage of myocardial tissue impairment. Furthermore, the EGFP mRNA of EGFP+MB/US group was significantly higher than those of other groups, which confirmed that that the combination of intracardiac ultrasonic exposure and intramyocardial injection of microbubbles could enhance gene transfection. The main findings of this investigation were: 1) the intracardiac ultrasonic exposure technology and injection system provides an accurate and reliable means of delivering an injectate transendocardially into the LV, 2) this system allows for the injection of a naked DNA gene into designated myocardial sites and results in successful gene transfer and protein expression. This novel approach could also obviously reduce gene and microbubble dosage. In sum, intramyocardial injection microbubble combination of intracardiac ultrasonic exposure can enhance gene expression. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [5].

Published
2010

24. Barbari e Diritto nell'Occidente post Costantiniano

Author

FASCIONE, Lorenzo, BASSANELLI G., and Fascione, Lorenzo

Subjects
Codice Teodosiano, Barbari, Impero romano d'occidente
Abstract

Lo studio indaga caratteristiche del diritto occidentale, presenti all’età della codificazione teodosiana, riprese nella legislazione romano-barbarica. The study investigates the characteristics of Western law, in the age of Theodosius codification, which were retrieved in Roman barbaric law.

Published
2010

25. The anti-ischemic effect of trimetazidine in patients with postprandial myocardial ischemia is unrelated to meal composition

Author

Gianluca Perseghin, Chiara Montano, Giliola Calori, Silvia Oggionni, Massimo Locatelli, Gary D. Lopaschuk, Guido Lattuada, Gabriele Fragasso, Alberto Margonato, Altin Palloshi, Giorgio Bassanelli, Fragasso, G, Montano, C, Perseghin, G, Palloshi, A, Calori, G, Lattuada, G, Oggionni, S, Bassanelli, G, Locatelli, M, Lopaschuk, G, Margonato, A, Locateilli, M, and Margonato, Alberto

Subjects
Male, medicine.medical_specialty, Vasodilator Agents, Myocardial Ischemia, Trimetazidine, Placebo, Bruce protocol, Double-Blind Method, Internal medicine, Dietary Carbohydrates, medicine, Hyperinsulinemia, Humans, Ingestion, MED/13 - ENDOCRINOLOGIA, Aged, chemistry.chemical_classification, business.industry, Fatty acid, Coronary flow reserve, Postprandial Period, medicine.disease, Dietary Fats, Endocrinology, Postprandial, chemistry, Food, Cardiology, Female, business, Cardiology and Cardiovascular Medicine, Echocardiography, Stress, medicine.drug
Abstract

Background: Previous studies provide evidence for a significant reduction of coronary flow reserve after ingestion of meals of different compositions. A possible role of hyperinsulinemia and increased free fatty acid levels, which are deleterious during acute myocardial ischemia and reperfusion, has been hypothesized. We assessed in patients with stable coronary disease the effects of high-fat meals (HFMs) and high-carbohydrate meals (HCMs) on ischemic threshold and stress left ventricular function on placebo and after partial fatty acid inhibition by trimetazidine (TMZ). Methods: Ten patients (9 men, age 68 ± 7 years) were allocated to placebo and TMZ (40 mg TID), both administered in the 24 hours preceding testing, according to a randomized double-blind study design. All patients underwent stress (treadmill exercise testing according to the Bruce protocol) echocardiography after fasting (8 hours) and after an HFM and HCM (2 hours) either on placebo or on TMZ. Time to 1-mm ST-segment depression (time to 1 mm) and stress wall motion score index (WMSI) were evaluated. Results: An HFM did not affect exercise variables compared with fasting, whereas an HCM resulted in a reduction of the ischemic threshold (time to 1 mm from 402 ± 141 to 292 ± 123 seconds, P = .025). Compared with placebo, TMZ improved time to 1 mm after fasting, HFM, and HCM (432 ± 153 vs 402 ± 141, 439 ± 118 vs 380 ± 107, 377 ± 123 vs 292 ± 123, F1,9 = 26.91, P = .0006). Compared with placebo, on TMZ, stress WMSI decreased from 1.55 ± 0.25 to 1.29 ± 0.14 after fasting, from 1.57 ± 0.10 to 1.39 ± 0.28 after HFM, and from 1.64 ± 0.21 to 1.39 ± 0.21 after HCM (F1,9 = 37.04, P = .0002). Interestingly, stress WMSI on TMZ was never different from rest WMSI on placebo. Conclusions: In patients with coronary disease, exercise testing after an HCM results in more severe myocardial ischemia compared with that after an HFM. The observed beneficial effects of the partial fatty acid inhibitor TMZ seem to be unrelated to meal composition and are possibly caused by the better glucose use induced by the drug. © 2006 Mosby, Inc. All rights reserved

Published
2006

26. Nitric-oxide mediated effects of transdermal capsaicin patches on the ischemic threshold in patients with stable coronary disease

Author

Giorgio Bassanelli, Gabriele Fragasso, Pier Marco Piatti, Altin Palloshi, Chiara Montano, E. Rossetti, Giliola Calori, Lucilla D. Monti, Emanuela Setola, Alberto Margonato, Fragasso, G, Palloshi, A, Piatti, Pm, Monti, L, Rossetti, E, Setola, E, Montano, C, Bassanelli, G, Calori, G, and Margonato, Alberto

Subjects
Male, Time Factors, Calcitonin Gene-Related Peptide, Blood Pressure, Coronary Artery Disease, Calcitonin gene-related peptide, Administration, Cutaneous, Nitric Oxide, Placebo, Nitric oxide, Angina, Electrocardiography, chemistry.chemical_compound, Bruce protocol, Double-Blind Method, Heart Rate, Humans, ST segment, Medicine, Aged, Pharmacology, ST depression, business.industry, Middle Aged, medicine.disease, chemistry, Capsaicin, Anesthesia, Chronic Disease, Exercise Test, Pharmaceutical Vehicles, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Oleic Acid
Abstract

Background Capsaicin has been shown to exert direct vasodilating effects through increased calcitonin gene-related peptide (CGRP) release. However, no data exist on its effect following systemic administration in humans. Methods Twelve male patients with stable coronary disease and a persistently positive exercise were selected for study. According to a double blind, placebo-controlled, cross-over study, patients were randomized to placebo or 3 g oleic capsaicin-containing patches, on 2 different days and with a 2-day interval between treatments. Patients performed treadmill exercise testing according to the Bruce protocol. Time to 1 mm ST segment depression and to peak exercise, maximal ST segment depression, and the number of ECG leads showing diagnostic changes were also measured. Blood samples for nitric oxide (NO) and CGRP were drawn at baseline, 2, 6, and 24 hours after exercise. Results On placebo, all patients had a positive ECG during exercise test. Only 1 patient experienced angina, on both treatments. With capsaicin, 1 patient had a negative exercise, while 8 patients significantly increased time to 1 mm ST depression from 328 +/- 167 to 401 +/- 174 seconds (P = 0.01). Of the remaining patients, 1 did not show any changes and 2 showed a worse ischemic threshold when on capsaicin. CGRP levels were not significantly different between placebo and capsaicin treatment. Conversely, when on capsaicin, NO significantly increased at 6 hours. Conclusions Transdermal capsaicin may improve ischemic threshold in patients with stable coronary disease, probably through arteriolar vasodilation. Increased capsaicin-induced NO availability could represent the principal mechanism of action.

Published
2004

28. Acute pulmonary embolism and cancer: findings from the COPE study.

Author

Becattini C, Cimini LA, Bassanelli G, Maggioni AP, Pomero F, Lobascio I, Enea I, Pomata DP, Ruggieri MP, Zalunardo B, Novelli A, Di Fusco SA, Triggiani M, Marzolo M, Fioravanti C, Agnelli G, Gonzini L, and Gulizia MM

Subjects
Adult, Humans, Acute Disease, Anticoagulants, Hemorrhage epidemiology, Hemorrhage chemically induced, Prospective Studies, Neoplasms complications, Neoplasms diagnosis, Neoplasms epidemiology, Pulmonary Embolism diagnosis, Pulmonary Embolism epidemiology, Pulmonary Embolism therapy
Abstract

Background: Patients with acute venous thromboembolism associated with cancer have an increased risk of recurrences and bleeding in the long term., Research Question: To describe the clinical features and short-term course of patients with acute pulmonary embolism (PE) and active cancer, previous cancer or no cancer., Study Design and Methods: Patients with acute PE included in COPE-prospective, multicentre study of adult patients with acute, symptomatic, objectively diagnosed PE-were classified as having active cancer, previous cancer, or no cancer., Results: Overall, 832 patients had active cancer, 464 with previous cancer and 3660 patients had no cancer at the time of acute PE. The most prevalent primary sites of active cancer were urogenital (23.0%), gastrointestinal (21.0%), and lung (19.8%), with a high prevalence of metastatic disease (57.6%) and ongoing anticancer treatment (16.2%). At discharge, a direct oral anticoagulant was used in 43.1%, 78.8%, and 82.0% of patients with active cancer, previous cancer, and no cancer, respectively. Rates of death in-hospital and at 30 days were higher in patients with active cancer compared to patients with previous cancer and no cancer (7.9% vs. 4.3% vs. 2.2% and 13.8% vs. 5.2% vs. 2.6%, respectively). Rates of major bleeding were 4.8%, 2.6%, and 2.4%, respectively. Among patients with active cancer, lung or metastatic cancer were independent predictors of death; brain, hematological or gastrointestinal cancer had the highest risk of major bleeding., Interpretation: Among patients with acute PE, those with active cancer have high risks for death or major bleeding within 30 days. These risks vary based on primary site of cancer., Clinical Trial Registration: clinicaltrial.gov identifier: NCT03631810., (© 2023. The Author(s).)

Published
2024
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29. SARS-CoV-2 detection in the pericardial fluid of a patient with cardiac tamponade.

Author

Farina A, Uccello G, Spreafico M, Bassanelli G, and Savonitto S

Subjects
Acute Coronary Syndrome diagnosis, COVID-19, Coronary Artery Bypass adverse effects, Coronary Artery Bypass methods, Echocardiography methods, Humans, Male, Middle Aged, Patient Care Management methods, Postoperative Complications diagnosis, Postoperative Complications therapy, Respiratory Insufficiency diagnosis, Respiratory Insufficiency etiology, Respiratory Insufficiency therapy, SARS-CoV-2, Treatment Outcome, Acute Coronary Syndrome surgery, Betacoronavirus isolation & purification, Cardiac Tamponade diagnosis, Cardiac Tamponade etiology, Cardiac Tamponade therapy, Coronavirus Infections complications, Coronavirus Infections diagnosis, Coronavirus Infections physiopathology, Coronavirus Infections therapy, Pandemics, Pericardial Effusion diagnosis, Pericardial Effusion etiology, Pericardial Effusion surgery, Pericardial Effusion virology, Pericardiocentesis methods, Pneumonia, Viral complications, Pneumonia, Viral diagnosis, Pneumonia, Viral physiopathology, Pneumonia, Viral therapy
Abstract

Competing Interests: Declaration of Competing Interest All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Published
2020
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30. Ultrasound-guided central venous catheter placement through the axillary vein in cardiac critical care patients: safety and feasibility of a novel technique in a prospective observational study.

Author

Farina A, Coppola G, Bassanelli G, Bianchi A, Lenatti L, Ferri LA, Liccardo B, Spinelli E, Savonitto S, and Mauri T

Subjects
Aged, Aged, 80 and over, Anticoagulants therapeutic use, Catheterization, Central Venous adverse effects, Echocardiography, Feasibility Studies, Female, Humans, Male, Middle Aged, Noninvasive Ventilation, Prospective Studies, Ultrasonography, Interventional, Axillary Vein diagnostic imaging, Catheterization, Central Venous methods, Critical Care methods, Heart Diseases therapy
Abstract

Background: Central venous catheterization is essential for careful administration of fluids and drugs in cardiac critical care patients. The axillary vein might represent an alternative to subclavian and jugular vein accesses, with the advantage of being extra-thoracic, more distal from the pleural space and with more likehood of comfort for the patient. Conventional ultrasound-guided cannulation of the axillary vein is technically demanding and does not guarantee precise visualization of the needle tip., Methods: We describe a new in-plane technique with a dedicated bracket support for the needle, giving full tip control and continuous visualization of the tip and vessel, making the maneuver easier and safer. In a prospective observational study we also report the feasibility and safety of the novel procedure in a series of 35 cardiac critical care patients, also receiving non-invasive ventilatory support and/or being fully anti-coagulated., Results: With the novel technique, we obtained 97% success with procedural times comparable to other insertion sites and without complications., Conclusions: Placement of a central line catheter in the axillary vein using a novel ultrasound-guided bracket-assisted technique may be a feasible, safe and rapid alternative to the conventional jugular and subclavian approaches.

Published
2020
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32. History of vasomotor symptoms, extent of coronary artery disease, and clinical outcomes after acute coronary syndrome in postmenopausal women.

Author

Ferri LA, Morici N, Bassanelli G, Franco N, Misuraca L, Lenatti L, Jacono EL, Leuzzi C, Corrada E, Aranzulla TC, Colombo D, Cagnacci A, Prati F, and Savonitto S

Subjects
Age Factors, Aged, Coronary Angiography, Coronary Artery Disease etiology, Female, Hot Flashes etiology, Humans, Italy epidemiology, Middle Aged, Prospective Studies, Severity of Illness Index, Surveys and Questionnaires, Acute Coronary Syndrome diagnostic imaging, Coronary Artery Disease epidemiology, Hot Flashes epidemiology, Postmenopause
Abstract

Objective: Vasomotor symptoms (VMS) during menopausal transition have been linked to a higher burden of cardiovascular risk factors, subclinical vascular disease, and subsequent vascular events. We aim to investigate the association of VMS with the extent of coronary disease and their prognostic role after an acute coronary syndrome., Methods: The Ladies Acute Coronary Syndrome study enrolled consecutive women with an acute coronary syndrome undergoing coronary angiography. A menopause questionnaire was administered during admission. Angiographic data underwent corelab analysis. Six out of 10 enrolling centers participated in 1-year follow-up. Outcome data included the composite endpoint of all-cause mortality, recurrent myocardial infarction, stroke, and rehospitalization for cardiovascular causes within 1 year., Results: Of the 415 women with available angiographic corelab analysis, 373 (90%) had complete 1-year follow-up. Among them, 202 women had had VMS during menopausal transition. These women had the same mean age at menopause as those without VMS (50 years in both groups), but were younger at presentation (median age 71 vs 76 years; P < 0.001), despite a more favorable cardiovascular risk profile (chronic kidney dysfunction 4.5% vs 15.9%; P = 0.001; prior cerebrovascular disease 4.5 vs 12.2%; P = 0.018). Extent of coronary disease at angiography was similar between groups (mean Gensini score 49 vs 51; P = 0.6; mean SYNTAX score 14 vs 16; P = 0.3). Overall cardiovascular events at 1 year did not differ between groups (19% vs 22%; P = 0.5)., Conclusions: In postmenopausal women with an acute coronary syndrome, a history of VMS was associated with younger age at presentation, despite a lower vascular disease burden and similar angiographically defined coronary disease as compared with women without VMS. No difference could be found in terms of overall clinical outcomes. These results should be interpreted cautiously as all analyses were unadjusted and did not account for risk factor differences between women with and without a history of VMS.

Published
2018
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33. Malignant Cough Syncope from Idiopathic Vagal Inflammation.

Author

Farina A, Bassanelli G, Bianchi A, Coppola G, and Savonitto S

Abstract

We describe the case of a patient with malignant vasodepressive cough syncope. We demonstrated a vaso-vagal mechanism related to left vagal neuritis, by means of laryngoscopy and laryngeal electromyography. The condition resolved with steroid therapy., Learning Points: Left vagal neuritis should be considered in the differential diagnosis of recent onset repetitive loss of consciousness, in particular if cough related.Steroids were used to successfully treat recent onset cough-related syncope.Relatively simple trials of drug therapy can sometimes avoid intensive investigations; in our case, the use of a systemic steroid would probably have avoided many radiological and endoscopic examinations., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests.

Published
2018
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34. [Treatment of acute coronary syndrome in older adults and high-risk patients."When the going gets tough…"].

Author

Bassanelli G, Morici N, De Luca L, De Servi S, and Savonitto S

Subjects
Acute Coronary Syndrome physiopathology, Aged, Cooperative Behavior, Humans, Risk Factors, Survival, Acute Coronary Syndrome therapy, Life Expectancy
Abstract

The increasing life expectancy in older adults and the better survival of patients with multiple pathologies require the capability to treat complex clinical conditions with an increased risk of iatrogenic complications. Nevertheless, recent improvements in the pharmacological and interventional treatment of acute coronary syndrome (ACS) have promoted a shift from therapeutic nihilism to a more active management of complex ACS cases. Despite the paucity of specific randomized clinical trials, observational studies seem to show benefit of an early invasive treatment in these patients. This approach requires close cooperation of clinical intensivists, interventional cardiologists and cardiovascular surgeons either in a specialized heart center or in a network of hospitals.

Published
2015
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35. Predictors of cardiac death in patients with coronary chronic total occlusion not revascularized by PCI.

Author

Godino C, Bassanelli G, Economou FI, Takagi K, Ancona M, Galaverna S, Mangieri A, Magni V, Latib A, Chieffo A, Carlino M, Montorfano M, Cappelletti A, Margonato A, and Colombo A

Subjects
Adult, Aged, Aged, 80 and over, Chronic Disease, Cohort Studies, Coronary Occlusion surgery, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Revascularization trends, Percutaneous Coronary Intervention trends, Predictive Value of Tests, Treatment Outcome, Coronary Occlusion diagnosis, Coronary Occlusion mortality, Death, Myocardial Revascularization mortality, Percutaneous Coronary Intervention mortality
Abstract

Background: Limited data are available on clinical outcome of patients with previously failed or not attempted chronic total occlusion (CTO) recanalization by percutaneous coronary intervention (PCI). The aim of the study is to determine prevalence and predictors of cardiac death in patients with CTO not revascularized by PCI., Methods: Double-center study analyzing data of 1.345 consecutive patients with at least one CTO between 1998 and 2008. Of these, 847 patients were successfully revascularized (Revascularized group) and 498 patients were not revascularized (Not revascularized group) either due to failure of CTO-PCI (n=337) or because no attempt was made (n=161)., Results: At 4-year clinical follow-up, Not revascularized patients had a significantly higher rate of cardiac mortality (8.5% vs. 2.5%, p<0.0001) and sudden cardiac death (2.7% vs. 0.5%, p=0.001) compared to those Revascularized. The separate adjusted Cox-model analysis made for Not revascularized patients showed the most significant independent predictors of cardiac death were: chronic renal failure [HR (CI), 6.0 (2.66-13.80)], low-LVEF [5.7 (2.84-11.58)], insulin-dependent diabetes mellitus (IDDM) 4.6 [(1.96-10.97)]. In the Revascularized group, the presence of 3-vessel disease was the only significant independent predictor of cardiac death [4.4 (1.40-13.70)]., Conclusions: CTO patients Not revascularized had a significant higher rate of cardiac mortality and sudden cardiac death compared to those Revascularized. Within Not revascularized patients, the presence of low-LVEF, or CRF or IDDM was associated with an incidence of cardiac death at least 4 times higher than those without the same risk factors., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Published
2013
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36. Improved survival in patients with chronic mild/moderate systolic heart failure followed up in a specialist clinic.

Author

Fragasso G, Marinosci G, Calori G, Spoladore R, Arioli F, Bassanelli G, Salerno A, Cuko A, Puccetti P, Silipigni C, Palloshi A, and Margonato A

Subjects
Adrenergic beta-Antagonists therapeutic use, Age Factors, Aged, Ambulatory Care Facilities, Chronic Disease, Cohort Studies, Female, Follow-Up Studies, Heart Failure, Systolic drug therapy, Hospitalization statistics & numerical data, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Sex Factors, Survival Rate, Heart Failure, Systolic mortality
Abstract

Objective: To relate therapeutic issues, comorbidities and functional parameters to mortality/morbidity of mild/moderate heart failure patients., Methods: From our heart failure clinic, 372 heart failure patients (269 men, aged 66 ± 11 years), with stable heart failure and ejection fraction 45% or less were recruited. Survival curves were estimated according to the Kaplan-Meier method. Associations of protective/risk factors with cardiovascular mortality/morbidity were also evaluated., Results: One hundred and two patients (27%) died (aged 70 ± 10 years at diagnosis, 76 ± 10 at death) during follow-up (overall mortality at 60 months: 19.2%; mean follow-up period: 67 ± 44 months). Cardiovascular deaths were 64 (63% of total deaths, 44 men, age at diagnosis 70 ± 9). Cardiovascular mortality at 60 months was 12%; standardized mortality ratio was 5.9 for women and 6.8 for men. The remaining 38 patients (37% of total deaths, 30 men, age at diagnosis 70 ± 10) died of noncardiovascular causes. Overall, noncardiovascular mortality at 60 months was 7.2%; mean survival time from diagnosis to death was 63 ± 69 months (median 42, Q1 = 27.5, Q3 = 77.7). Average cardiovascular admission rate was 1.63 ± 1.84 admissions/patient. At multivariate analysis, only previous history of myocardial infarction [hazard ratio: 3.62 (1.70-7.73)], class of ejection fraction at diagnosis [hazard ratio: 0.36 (0.32-0.60)], acute cardiac decompensation at any time [hazard ratio: 1.55 (1.32-1.84)], implanted defibrillator [hazard ratio: 0.11 (0.01-0.83)] and use of statins [hazard ratio: 0.08 (0.007-0.42)] were independently associated with cardiovascular mortality. Factors associated to higher annual cardiovascular morbidity were age at diagnosis, chronic renal failure, diabetes, cardiac decompensation at any time, female sex and diuretic therapy. Angiotensin-converting enzyme (ACE) inhibitors and/or angiotensin-receptor-blockers reduced annual cardiovascular morbidity., Conclusion: Survival in mild/moderate heart failure patients has consistently improved. Further improvements are warranted in terms of morbidity reduction.

Published
2013
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37. Coronary chronic total occlusions: mid-term comparison of clinical outcome following the use of the guided-STAR technique and conventional anterograde approaches.

Author

Godino C, Latib A, Economou FI, Al-Lamee R, Ielasi A, Bassanelli G, Figini F, Chieffo A, Montorfano M, Colombo A, and Carlino M

Subjects
Aged, Angioplasty, Balloon, Coronary adverse effects, Angioplasty, Balloon, Coronary instrumentation, Angioplasty, Balloon, Coronary mortality, Chi-Square Distribution, Chronic Disease, Coronary Angiography, Coronary Occlusion diagnostic imaging, Coronary Occlusion mortality, Coronary Restenosis etiology, Drug-Eluting Stents, Female, Humans, Italy, Kaplan-Meier Estimate, Male, Middle Aged, Proportional Hazards Models, Prosthesis Design, Retrospective Studies, Risk Assessment, Risk Factors, Thrombosis etiology, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary methods, Coronary Occlusion therapy
Abstract

Aim: There are limited data on the mid-term safety following the use of the guided-subintimal tracking and re-entry (guided-STAR) technique for the treatment of chronic total occlusions (CTO) and concerns have arisen about a potential increased risk of stent thrombosis (ST)., Objectives: The aim of this study was to evaluate the mid-term safety in terms of cardiac death and ST after recanalization using the contrast guided-STAR technique when compared to conventional anterograde CTO recanalization (CA-CTO)., Methods and Results: This retrospective study analyzed 355 consecutive patients with successful angiographic recanalization (residual stenosis <20% and TIMI flow grade ≥2) of CTO lesion. Seventy-four (20.8%) underwent guided-STAR and 281 (79.2%) had CA-CTO. Survival rates were estimated using the Kaplan-Meier method. Compared to CA-CTO patients, the rate of the following clinical, angiographic, and procedural characteristics were significantly higher in guided-STAR patients: hypercholesterolemia (84 vs. 67%, P = 0.004), previous CABG (41.3 vs. 15.7%, P < 0.0001), three-vessel disease, (62.7 vs. 47%, P = 0.019), right coronary artery CTO (62.7 vs. 41.6%, P = 0.002), stent length (68.15 vs. 54.05 mm, P < 0.0001). A drug-eluting stent was implanted in the majority of cases (89.2% guided-STAR vs. 93.5% CA-CTO). At a median follow-up of 779 days (IQR 495-1035), there were no significant differences in cardiac survival (97.2 vs. 97.5%, Log-rank P = 0.912) and cumulative ARC ST rates (2.8 vs. 1.8%, Log-rank P = 0.610) for guided-STAR and CA-CTO patients, respectively. The rate of restenosis was significantly higher in the guided-STAR group compared to the CA-CTO group (54 vs. 30%, Log-rank P < 0.0001). The adjusted Cox proportional-hazard analysis for procedural technique showed that the only significant independent predictor of restenosis was the stent length (HR, 1.017; 95% CI, 1.008-1.027; P < 0.0001)., Conclusion: At mid-term follow-up, the guided-STAR was not inferior to CA-CTO in terms of safety. The only significant independent predictor of restenosis was the stent length., (Copyright © 2011 Wiley Periodicals, Inc.)

Published
2012
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38. Prognosis of mild/moderate chronic systolic heart failure.

Author

Fragasso G, Marinosci G, Calori G, Palloshi A, Spoladore R, Arioli F, Bassanelli G, Salerno A, and Margonato A

Subjects
Aged, Aged, 80 and over, Chronic Disease, Health Surveys, Humans, Kaplan-Meier Estimate, Middle Aged, Prognosis, Heart Failure, Systolic mortality, Severity of Illness Index
Published
2010
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39. Clinical outcomes after unrestricted implantation of everolimus-eluting stents.

Author

Latib A, Ferri L, Ielasi A, Godino C, Chieffo A, Magni V, Bassanelli G, Sharp AS, Gerber R, Michev I, Carlino M, Airoldi F, Sangiorgi GM, Montorfano M, and Colombo A

Subjects
Aged, Angioplasty, Balloon, Coronary adverse effects, Angioplasty, Balloon, Coronary mortality, Chi-Square Distribution, Coronary Artery Disease mortality, Everolimus, Female, Humans, Kaplan-Meier Estimate, Logistic Models, Male, Middle Aged, Myocardial Infarction etiology, Practice Guidelines as Topic, Registries, Retrospective Studies, Risk Assessment, Risk Factors, Sirolimus administration & dosage, Thrombosis etiology, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary instrumentation, Cardiovascular Agents administration & dosage, Coronary Artery Disease therapy, Drug-Eluting Stents, Sirolimus analogs & derivatives
Abstract

Objectives: The aim of this study was to evaluate the efficacy and safety of unrestricted everolimus-eluting stent (EES) implantation in a contemporary cohort of real-world patients., Background: The randomized SPIRIT (A Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System in the Treatment of Patients With de Novo Native Coronary Artery Lesions) trials have evaluated the performance of EES, resulting in their approval by the Food and Drug Administration, but data regarding unselected usage, including off-label indications are lacking., Methods: Consecutive patients treated with EES (either PROMUS, Boston Scientific Corp., Natick, Massachusetts, or XIENCE-V, Abbott Vascular Devices, Santa Clara, California) between October 2006 and February 2008 were analyzed. End points were cardiac death, myocardial infarction (MI), ischemic-driven target lesion revascularization (TLR), stent thrombosis (ST), and major adverse cardiac events (MACE) (a composite of cardiac death, MI, TLR) during follow-up., Results: We identified 345 patients (573 lesions) treated with EES. The majority of patients (71.9%) were treated for > or =1 off-label or untested indication. Clinical follow-up was completed in 99%. At a median follow-up of 378 days (interquartile range 334 to 473), MACE occurred in 36 (10.6%) patients, TLR in 27 (7.9%), MI in 7 (2.1%), and cardiac death in 7 (2.1%). Definite and probable ST was observed in 3 (0.9%) cases. Off-label EES implantation was not associated with a statistically significant increased risk of MACE (12.2% vs. 6.3%, p = 0.17), TLR (9.3% vs. 4.2%, p = 0.18), or ST (0.8% vs. 1.1%, p = 1.0). On multivariable analysis, previous bypass surgery (p = 0.002) and diabetes (p = 0.03) were associated with MACE., Conclusions: In unrestricted daily practice, EES were implanted predominantly for off-label indications and associated with a relative low rate of MACE and TLR.

Published
2009
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40. The anti-ischemic effect of trimetazidine in patients with postprandial myocardial ischemia is unrelated to meal composition.

Author

Fragasso G, Montano C, Perseghin G, Palloshi A, Calori G, Lattuada G, Oggionni S, Bassanelli G, Locatelli M, Lopaschuk G, and Margonato A

Subjects
Aged, Double-Blind Method, Echocardiography, Stress, Female, Humans, Male, Myocardial Ischemia diagnostic imaging, Dietary Carbohydrates, Dietary Fats, Food, Myocardial Ischemia drug therapy, Postprandial Period, Trimetazidine therapeutic use, Vasodilator Agents therapeutic use
Abstract

Background: Previous studies provide evidence for a significant reduction of coronary flow reserve after ingestion of meals of different compositions. A possible role of hyperinsulinemia and increased free fatty acid levels, which are deleterious during acute myocardial ischemia and reperfusion, has been hypothesized. We assessed in patients with stable coronary disease the effects of high-fat meals (HFMs) and high-carbohydrate meals (HCMs) on ischemic threshold and stress left ventricular function on placebo and after partial fatty acid inhibition by trimetazidine (TMZ)., Methods: Ten patients (9 men, age 68 +/- 7 years) were allocated to placebo and TMZ (40 mg TID), both administered in the 24 hours preceding testing, according to a randomized double-blind study design. All patients underwent stress (treadmill exercise testing according to the Bruce protocol) echocardiography after fasting (8 hours) and after an HFM and HCM (2 hours) either on placebo or on TMZ. Time to 1-mm ST-segment depression (time to 1 mm) and stress wall motion score index (WMSI) were evaluated., Results: An HFM did not affect exercise variables compared with fasting, whereas an HCM resulted in a reduction of the ischemic threshold (time to 1 mm from 402 +/- 141 to 292 +/- 123 seconds, P = .025). Compared with placebo, TMZ improved time to 1 mm after fasting, HFM, and HCM (432 +/- 153 vs 402 +/- 141, 439 +/- 118 vs 380 +/- 107, 377 +/- 123 vs 292 +/- 123, F(1,9) = 26.91, P = .0006). Compared with placebo, on TMZ, stress WMSI decreased from 1.55 +/- 0.25 to 1.29 +/- 0.14 after fasting, from 1.57 +/- 0.10 to 1.39 +/- 0.28 after HFM, and from 1.64 +/- 0.21 to 1.39 +/- 0.21 after HCM (F(1,9) = 37.04, P = .0002). Interestingly, stress WMSI on TMZ was never different from rest WMSI on placebo., Conclusions: In patients with coronary disease, exercise testing after an HCM results in more severe myocardial ischemia compared with that after an HFM. The observed beneficial effects of the partial fatty acid inhibitor TMZ seem to be unrelated to meal composition and are possibly caused by the better glucose use induced by the drug.

Published
2006
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41. Nitric-oxide mediated effects of transdermal capsaicin patches on the ischemic threshold in patients with stable coronary disease.

Author

Fragasso G, Palloshi A, Piatti PM, Monti L, Rossetti E, Setola E, Montano C, Bassanelli G, Calori G, and Margonato A

Subjects
Administration, Cutaneous, Aged, Blood Pressure drug effects, Calcitonin Gene-Related Peptide blood, Capsaicin administration & dosage, Capsaicin therapeutic use, Chronic Disease, Coronary Artery Disease diagnosis, Double-Blind Method, Electrocardiography adverse effects, Exercise Test methods, Heart Rate drug effects, Humans, Male, Middle Aged, Nitric Oxide pharmacology, Oleic Acid administration & dosage, Oleic Acid chemistry, Pharmaceutical Vehicles administration & dosage, Pharmaceutical Vehicles chemistry, Time Factors, Capsaicin pharmacokinetics, Coronary Artery Disease drug therapy, Coronary Artery Disease physiopathology, Nitric Oxide metabolism
Abstract

Background: Capsaicin has been shown to exert direct vasodilating effects through increased calcitonin gene-related peptide (CGRP) release. However, no data exist on its effect following systemic administration in humans., Methods: Twelve male patients with stable coronary disease and a persistently positive exercise were selected for study. According to a double blind, placebo-controlled, cross-over study, patients were randomized to placebo or 3 g oleic capsaicin-containing patches, on 2 different days and with a 2-day interval between treatments. Patients performed treadmill exercise testing according to the Bruce protocol. Time to 1 mm ST segment depression and to peak exercise, maximal ST segment depression, and the number of ECG leads showing diagnostic changes were also measured. Blood samples for nitric oxide (NO) and CGRP were drawn at baseline, 2, 6, and 24 hours after exercise., Results: On placebo, all patients had a positive ECG during exercise test. Only 1 patient experienced angina, on both treatments. With capsaicin, 1 patient had a negative exercise, while 8 patients significantly increased time to 1 mm ST depression from 328 +/- 167 to 401 +/- 174 seconds (P = 0.01). Of the remaining patients, 1 did not show any changes and 2 showed a worse ischemic threshold when on capsaicin. CGRP levels were not significantly different between placebo and capsaicin treatment. Conversely, when on capsaicin, NO significantly increased at 6 hours., Conclusions: Transdermal capsaicin may improve ischemic threshold in patients with stable coronary disease, probably through arteriolar vasodilation. Increased capsaicin-induced NO availability could represent the principal mechanism of action.

Published
2004
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