62 results on '"Cas, Ld"'
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2. Regular Wine Consumption in Chronic Heart Failure: Impact on Outcomes, Quality of Life, and Circulating Biomarkers
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Cosmi, Franco, Di Giulio, Paola, Masson, Serge, Finzi, Andrea, Marfisi, Rosa Maria, Cosmi, Deborah, Scarano, Marco, Tognoni, Gianni, Maggioni, Aldo P., Porcu, Maurizio, Boni, Silvana, Cutrupi, Giovanni, Tavazzi, Luigi, Latini, Roberto Tavazzi, L, Tognoni, G, Barlera, S, Franzosi, Mg, Latini, R, Lucci, D, Maggioni, Ap, Marchioli, R, Nicolosi, Gl, Porcu, M, Yusuf, S, Camerini, F, Cohn, Jn, Decarli, A, Pitt, B, Sleight, P, Poole-Wilson, Pa, Geraci, E, Scherillo, M, Fabbri, G, Bartolomei, B, Bertoli, D, Cobelli, F, Fresco, C, Ledda, A, Levantesi, G, Opasich, C, Rusconi, F, Sinagra, G, Turazza, F, Volpi, A, Ceseri, M, Alongi, G, Atzori, A, Bambi, F, Bastarolo, D, Bianchini, F, Cangioli, I, Canu, V, Caporusso, C, Cenni, G, Cintelli, L, Cocchio, M, Confente, A, Fenicia, E, Friso, G, Gianfriddo, M, Grilli, G, Lazzaro, B, Lonardo, G, Luise, A, Nota, R, Orlando, M, Petrolo, R, Pierattini, C, Pierota, V, Provenzani, A, Quartuccio, V, Ragno, A, Serio, C, Spolaor, A, Tafi, A, Tellaroli, E, Ghio, S, Ghizzardi, E, Masson, S, Crociati, L, Rovere, Mt, Corra, U, Di Giulio, P, Finzi, A, Gorini, M, Gonzini, L, Milani, V, Orsini, G, Bianchini, E, Cabiddu, S, Cipressa, L, Cipressa, Ml, Di Bitetto, G, Ferri, B, Galbiati, L, Lorimer, A, Pera, C, Priami, P, Rossi, Mg, Pasotti, E, Vaghi, F, Roncarolo, P, Zunino, Mt, Matta, F, Actis, E, Gaita, F, Azzaro, G, Zanetta, M, Paino, Am, Parravicini, U, Vegis, D, Conte, R, Ferraro, P, De Bernardi, A, Morelloni, S, Fagnani, M, Lucchina, Pg, Montagna, L, Bellone, E, Sappe, D, Ferraro, F, Delucchi, M, Reynaud, Sg, Dore, M, La, A, Massobrio, N, Bo, L, Trinchero, R, Imazio, M, Brocchi, G, Nejrotti, A, Rissone, L, Gabasio, S, Zocchi, C, Randazzo, S, Crenna, A, Giannuzzi, P, Bonanomi, E, Mezzani, A, De Marchi, M, Begliuomini, G, Gianonatti, Ca, Gavazzi, A, Grosu, A, Cas, Ld, Nodari, S, Garyfallidis, P, Bertoletti, A, Bonifazi, C, Arisi, S, Mascaro, F, Fraccarollo, M, Dell, S, Sfolcini, M, Bortolini, F, Raccagni, D, Turelli, A, Santarone, M, Miglierina, E, Sormani, L, Jemoli, R, Tettamanti, F, Pirelli, S, Bianchi, C, Verde, S, Mariani, M, Ziacchi, V, Ferrazza, A, Russo, A, Bortolotti, M, Pasini, Gf, Jones, Kn, Cuzzucrea, D, Gullace, G, Carbone, C, Granata, A, De, S, Del Rosso, G, Inserra, C, Renaldini, E, Zappa, C, Moretti, M, Zanini, R, Ferrari, M, Cei, A, Lissi, C, Dovico, E, Fiorentini, C, Palermo, P, Brusoni, B, Negrini, M, Heyman, J, Danzi, Gb, Frigerio, M, Beretta, L, Sachero, A, Casazza, F, Squadroni, L, Lombardi, F, Marano, L, Margonato, A, Fragasso, G, Febo, Oc, Aiolfi, E, Olmetti, F, Grieco, A, Antonazzo, V, Specchia, G, Mortara, A, Robustelli, F, Songini, Mg, Schweiger, C, Frisinghelli, A, Palvarini, M, Campana, C, Scelsi, L, Marsan, Na, Gualco, A, De Feo, S, Iannone, Ma, Diaco, T, Zaniboni, D, Milanesi, G, Nassiacos, D, Meloni, S, Giani, P, Nicoli, T, Malinverni, C, Gusmini, A, Pozzoni, L, Bisiani, G, Margaroli, P, Schizzarotto, A, Daverio, A, Morelli, E, Occhi, G, Partesana, N, Bandini, P, Rosella, Mg, Giustiniani, S, 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Piazza, R, Mos, L, Vriz, O, Pavan, D, Pascottini, G, Alberti, E, Werren, M, Solinas, L, Longaro, F, Fioretti, P, Albanese, Mc, Miani, D, Gianrossi, R, Pende, A, Rubartelli, P, Magaia, O, Caruso, D, Faraguti, As, Magliani, L, Miccoli, F, Guglielmino, G, Cantarelli, A, Orlandi, S, Vallebona, A, Pozzati, A, Brega, G, Pancaldi, Lg, Vandelli, R, Urbinati, S, Poci, Mg, Zoli, M, Costa, Gm, Guiducci, U, Zobbi, G, Tartagni, F, Tisselli, A, Gentili, A, Pieri, P, Cagnetta, E, Bendinelli, S, Barbieri, A, Conti, R, Ferrari, R, Merlini, F, Fucili, A, Moruzzi, P, Buia, E, Galvani, M, Ferrini, D, Baggioni, G, Yiannacopulu, P, Canè, G, Bonfiglioli, A, Zandomeneghi, R, Brugioni, L, Giannini, A, Di, R, Giuliani, M, Rusconi, L, Del Corso, P, Piovaccari, G, Bologna, F, Venturi, P, Melandri, F, Bagni, E, Bolognese, L, Perticucci, R, Zuppiroli, A, Nannini, M, Consoli, N, Petrone, P, Pipitò, C, Colombi, L, Bernardi, D, Mariani, Pr, Testa, R, Mazzinghi, F, Cosmi, F, Cosmi, D, Zipoli, A, Cecchi, A, Castelli, G, Ciaccheri, M, Mori, F, Pieri, F, Valoti, P, Chiarantini, D, Santoro, Gm, Minneci, C, Marchi, F, Milli, M, Zambaldi, G, Geri, Aa, Cipriani, M, Alessandri, M, Severi, S, Stefanelli, S, Comella, A, Poddighe, R, Digiorgio, A, Carluccio, M, Berti, S, Rizza, A, Bonatti, V, Molendi, V, Brancato, A, D'Aprile, N, Giappichini, G, Del Vecchio, S, Mantini, G, De Tommasi, F, Meucci, G, Cordoni, M, Bechi, S, Barsotti, L, Baldini, P, Romei, M, Scopelliti, G, Lauri, G, Pestelli, F, Furiozzi, F, Cocchieri, M, Severini, D, Patriarchi, F, Chiocchi, P, Buccolieri, M, Martinelli, S, Wee, A, Angelici, F, Bernardinangeli, M, Proietti, G, Biscottini, B, Panciarola, R, Marinacci, L, Perna, Gp, Gabrielli, D, Moraca, A, Moretti, L, Partemi, L, Gregori, G, Amici, R, Patteri, G, Capone, P, Savini, E, Morgagni, Gl, Paccaloni, L, Pezzuoli, F, Carincola, S, Papi, S, De Crescentini, S, Gerardi, P, Midi, P, Gallenzi, E, Pajes, G, Mancone, C, Di, V, Di Gennaro, M, Calcagno, S, Toscano, S, Antonicoli, S, Carta, F, Giorgi, G, Comito, F, Daniele, E, Goretti, Sm, Ciarla, O, Gelfo, Pg, Acquaviva, A, Testa, D, Testa, G, Pagliaro, Fa, Russo, F, Vetta, F, Marchese, I, Di, G, D'Ambrosio, A, Leggio, F, Del Sindaco, D, Lacchè, A, Avallone, A, Risa, Mp, Azzolini, P, Baldo, E, Giovannini, E, Pulignano, G, Tondo, C, Picchio, E, Biffani, E, Tanzi, P, Pozzar, F, Farnetti, F, Azzarito, M, Santini, M, Varveri, A, Ferraiuolo, G, Valtorta, C, Gaspardone, A, Barbato, G, Ceci, V, Aspromonte, N, Bellocci, F, Colizzi, C, Fedele, F, Perez, Fi, Galati, A, Rossetti, A, Mainella, A, Ciuffetta, D, Matteucci, C, Busi, G, De, A, Farina, G, Granatelli, A, Leone, F, Frasca, F, Castellani, G, Massaro, G, Mastrogiuseppe, G, Vacri, A, De Sanctis, F, Cioli, M, Di Luzio, S, Napoletano, C, Piccioni, Ll, De Simone, G, Ottaviano, A, Mazza, V, Spedaliere, C, Staniscia, Td, Calgione, E, De Marco, G, Chiacchio, T, Di, T, Romanzi, S, Salvatore, G, Golino, P, Palermo, A, Mascia, F, Vetrano, A, Vinciguerra, A, Caliendo, L, Longobardi, R, De Caro, G, Di Nola, R, Piemonte, F, Prinzi, D, De Rosa, P, De, V, Riello, F, Capuano, V, Vecchio, G, Landi, M, Amato, S, Garofalo, M, D'Avino, M, Sensale, P, Maiolica, O, Santoro, R, Caso, P, Miceli, D, Maurea, N, Bianchi, U, Crispo, C, Chiariello, M, Filardi, Pp, Russo, L, Capuano, N, Ungaro, G, Vergara, G, Scafuro, F, D'Angelo, G, Campaniello, C, Bottiglieri, P, Volpe, A, Battista, R, De Risi, L, Cardillo, G, Sibilio, G, Marino, Ap, Silvestri, F, Predotti, P, Iervoglini, A, De Matteis, C, Sarnicola, P, Matarazzo, Mm, Baldi, S, Iuliano, V, Astarita, C, Cuccaro, P, Liguori, A, Liguori, G, Gregorio, G, Petraglia, L, Antonelli, G, Amodio, G, De Luca, I, Franchini, G, Lenti, Ml, Cavallari, D, D'Agostino, C, Scalera, G, Altamura, Cm, Russo, M, Mascolo, Ar, Pettinati, G, Ciricugno, Sa, Scrutinio, D, Passantino, A, Mastrangelo, D, Di Masi, A, De, R, Cannone, M, Dibiase, F, Pensato, M, Loliva, F, Trapani, F, Panettieri, I, Leone, L, Di, M, Carrone, M, Gallone, V, Cocco, F, Costantini, M, Tritto, C, Cavalieri, F, Stella, L, Magliari, F, Callerame, M, De Giorgi, A, Pellegrino, L, Correra, M, Portulano, V, Nisi, Gl, Grassi, G, Cristallo, E, De Laura, D, Salerno, C, Fanelli, R, Villella, M, Pede, S, Renna, A, De Lorenzi, E, Urso, L, Lenti, V, Peluso, A, Baldi, N, Polimeni, G, Palma, P, Lauletta, R, Tagliamonte, E, Cirillo, T, Centonze, G, D'Alessandro, B, Truncellito, L, Mecca, D, Petruzzi, Ma, Coviello, Ro, Lopizzo, A, Chiaffitelli, M, Barbuzzi, S, Gubelli, S, Germinario, G, Cosentino, N, Mingrone, A, Vico, R, Borrello, G, Mazza, Ml, Cimino, R, Galasso, D, Cassadonte, F, Talarico, U, Perticone, F, Cassano, S, Catapano, F, Calemme, S, Feraco, E, Cloro, C, Misuraca, G, Caporale, R, Vigna, L, Spagnuolo, V, De Rosa, F, Spadafora, G, Zampaglione, G, Russo, R, Schipani, Fa, Ferragina, Af, Stranieri, D, Musca, G, Carpino, C, Bencardino, P, Raimondo, F, Musacchio, D, Pulitano, G, Ruggeri, A, Provenzano, A, Salituri, S, Musolino, M, Calandruccio, S, Marrari, A, Tripodi, E, Scali, R, Anastasio, L, Arone, A, Aragona, P, Donnangelo, L, Comito, Mg, Bilotta, F, Vaccaro, I, Rametta, R, Ventura, V, Bonvegna, A, Alì, A, Cinnirella, C, Raineri, M, Pompeo, F, Ingurgio, Nc, Carini, V, Coco, R, Giunta, G, Leonardi, G, Randazzo, V, Di Blasi, V, Tamburino, C, Russo, G, Mangiameli, S, Cardillo, R, Castelli, D, Inserra, V, Arena, A, Gulizia, Mm, Raciti, S, Rapisarda, G, Romano, R, Prestifilippo, P, Braschi, Gb, Ledda, G, Terrazzino, R, De Caro, M, Scilabra, G, Graffagnino, B, Grassi, R, Scimone, Gf, Vasquez, L, Coppolino, C, Casale, A, Castelli, M, D'Urso, G, D'Antonio, E, Presti, Ll, Badalamenti, E, Conti, P, Sanfilippo, N, Cirrincione, V, Cinà, Mt, Cusimano, G, Taormina, A, Giuliano, P, Bajardi, A, Mandala, V, Canonico, A, Geraci, G, Sabella, Fp, Enia, F, Floresta, Am, Cascio, Il, Gumina, D, Cavallaro, A, Piccione, G, Ferrante, R, Blandino, M, Iudicello, Ms, Mossuti, E, Romano, G, Lombardo, L, Monastra, P, Di Vincenzo, D, Orru, P, Muscas, F, Giardina, G, Corda, M, Locci, G, Podda, A, Ledda, M, Siddi, P, Lai, C, Pili, G, Mercuro, G, Mureddu, G, Ganau, A, Meloni, G, Poddighe, G, Sanna, G., Cosmi, Franco, Di Giulio, Paola, Masson, Serge, Finzi, Andrea, Marfisi, Rosa Maria, Cosmi, Deborah, Scarano, Marco, Tognoni, Gianni, Maggioni, Aldo P, Porcu, Maurizio, Boni, Silvana, Cutrupi, Giovanni, Tavazzi, Luigi, Latini, Roberto, on behalf of the GISSI-HF, Investigator, Margonato, Alberto, DI GIULIO, Paola, Maggioni, Aldo P., GISSI HF, Investigator, and Sinagra, Gianfranco
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Male ,Health Status ,Left ,Wine ,Comorbidity ,Ventricular Function, Left ,Health Statu ,Quality of life ,Risk Factors ,Surveys and Questionnaires ,Prevalence ,Ventricular Function ,Surveys and Questionnaire ,Depression (differential diagnoses) ,Depression ,Medicine (all) ,Middle Aged ,Prognosis ,biological marker ,Italy ,Female ,Risk assessment ,Cardiology and Cardiovascular Medicine ,biological markers ,Human ,Cardiac function curve ,Vasculitis ,medicine.medical_specialty ,Vasculiti ,Alcohol Drinking ,Prognosi ,Lower risk ,Risk Assessment ,Internal medicine ,medicine ,Humans ,Protective Factor ,Aged ,Heart Failure ,business.industry ,Risk Factor ,Stroke Volume ,Biomarker ,quality of life ,wine ,aged ,alcohol drinking ,biomarkers ,chronic disease ,comorbidity ,depression ,female ,heart failure ,humans ,italy ,male ,middle aged ,prevalence ,prognosis ,protective factors ,risk assessment ,risk factors ,stroke volume ,surveys and questionnaires ,vasculitis ,ventricular function, left ,health status ,cardiology and cardiovascular medicine ,Biomarkers ,Chronic Disease ,Protective Factors ,Quality of Life ,medicine.disease ,Clinical trial ,Heart failure ,Physical therapy ,business - Abstract
Background— Moderate, regular alcohol consumption is generally associated with a lower risk of cardiovascular events but data in patients with chronic heart failure are scarce. We evaluated the relations between wine consumption, health status, circulating biomarkers, and clinical outcomes in a large Italian population of patients with chronic heart failure enrolled in a multicenter clinical trial. Methods and Results— A brief questionnaire on dietary habits was administered at baseline to 6973 patients enrolled in the Gruppo Italiano per lo Studio della Sopravvivenza nell’Insufficienza Cardiaca-Heart Failure (GISSI-HF) trial. The relations between wine consumption, fatal and nonfatal clinical end points, quality of life, symptoms of depression, and circulating biomarkers of cardiac function and inflammation (in subsets of patients) were evaluated with simple and multivariable-adjusted statistical models. Almost 56% of the patients reported drinking at least 1 glass of wine per day. After adjustment, clinical outcomes were not significantly different in the predefined 4 groups of wine consumption. However, patients with more frequent wine consumption had a significantly better perception of health status (Kansas City Cardiomyopathy Questionnaire score, adjusted P P =0.01), and lower plasma levels of biomarkers of vascular inflammation (osteoprotegerin and C-terminal proendothelin-1, adjusted P P =0.01) after adjusting for possible confounders. Conclusions— We show for the first time in a large cohort of patients with chronic heart failure that moderate wine consumption is associated with a better perceived and objective health status, lower prevalence of depression, and less vascular inflammation, but does not translate into more favorable clinical 4-year outcomes. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT0033633.
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- 2015
3. Randomized study of traditional versus aggressive systolic blood pressure control (Cardio-Sis): rationale, design and characteristics of the study population. Cardio-Sis Study Group
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Verdecchia P, Staessen JA, Achilli A, DE SIMONE, GIOVANNI, Ganau A, Mureddu G, Pede S, Porcellati C, Fornari G, Repaci S, Castellani C, Achilli P, Jaspers C, Cucchiara G, Panzano C, Angeli F, Aillon C, Sclavo MG, Scherillo M, Raucci D, Di Donato M, Cas LD, Faggiano P, Porcu M, Calamida R, Pistia L, Vancheri F, Alletto M, Curcio M, Pettinati G, Ieva M, Muscella A, Guerrieri M, Denbek C, Gulizia M, Francese GM, Perticone F, Iemma G, Fariello R, Sala N, Mezzetti A, Pierdomenico SD, Bucci M, Benemio G, Gattobigio R, Sacchi N, Cocchieri M, Prosciutti L, Battocchi P, Garognoli O, Arcelli G, Pirelli S, Emanuelli C, Braschi GB, Abrignani M, De Ferrari G, Ponremoli R, Igidbashian D, Marini R, Scarpino L, Mandorla S, Buccolieri M, Picchi L, Casolo G, Pardini M, Marracci G, STRAZZULLO, PASQUALE, GALLETTI, FERRUCCIO, BARBATO, ANTONIO, Cavallini C, Borgioni C, Seghieri G, Cipollini F, Arcangeli E, Boddi W, Palermo C, Savelli F, Lembo G, Vecchione C, Malatino L, Belluardo P, Zoccali C, Leonardis D, Mallamaci F, Lacchè A, Gentile C, Boccanelli A, Mureddu GF, Santini M, Colivicchi F, Ficili S, Uguccioni M, Nardozi C, Tedeschi A, Martin G, Zanata G, Mos L, Dialti V, Martina S, Renna A, Farina G, Tripodi E, Miserrafiti B, Scali R, Stornello M, Valvo E, Bernardinangeli M, Proietti G, Poddighe G, Biscottini B, Panciarola R, Boccali A, Veglio F, Rabbia F, Caserta M, Chiatto M, Stefenelli C, Cioffi G, Bonazza G, Scabbia EV, Bottoni D., Verdecchia, P, Staessen, Ja, Achilli, A, DE SIMONE, Giovanni, Ganau, A, Mureddu, G, Pede, S, Porcellati, C, Fornari, G, Repaci, S, Castellani, C, Achilli, P, Jaspers, C, Cucchiara, G, Panzano, C, Angeli, F, Aillon, C, Sclavo, Mg, Scherillo, M, Raucci, D, Di Donato, M, Cas, Ld, Faggiano, P, Porcu, M, Calamida, R, Pistia, L, Vancheri, F, Alletto, M, Curcio, M, Pettinati, G, Ieva, M, Muscella, A, Guerrieri, M, Denbek, C, Gulizia, M, Francese, Gm, Perticone, F, Iemma, G, Fariello, R, Sala, N, Mezzetti, A, Pierdomenico, Sd, Bucci, M, Benemio, G, Gattobigio, R, Sacchi, N, Cocchieri, M, Prosciutti, L, Battocchi, P, Garognoli, O, Arcelli, G, Pirelli, S, Emanuelli, C, Braschi, Gb, Abrignani, M, De Ferrari, G, Ponremoli, R, Igidbashian, D, Marini, R, Scarpino, L, Mandorla, S, Buccolieri, M, Picchi, L, Casolo, G, Pardini, M, Marracci, G, Strazzullo, Pasquale, Galletti, Ferruccio, Barbato, Antonio, Cavallini, C, Borgioni, C, Seghieri, G, Cipollini, F, Arcangeli, E, Boddi, W, Palermo, C, Savelli, F, Lembo, G, Vecchione, C, Malatino, L, Belluardo, P, Zoccali, C, Leonardis, D, Mallamaci, F, Lacchè, A, Gentile, C, Boccanelli, A, Mureddu, Gf, Santini, M, Colivicchi, F, Ficili, S, Uguccioni, M, Nardozi, C, Tedeschi, A, Martin, G, Zanata, G, Mos, L, Dialti, V, Martina, S, Renna, A, Farina, G, Tripodi, E, Miserrafiti, B, Scali, R, Stornello, M, Valvo, E, Bernardinangeli, M, Proietti, G, Poddighe, G, Biscottini, B, Panciarola, R, Boccali, A, Veglio, F, Rabbia, F, Caserta, M, Chiatto, M, Stefenelli, C, Cioffi, G, Bonazza, G, Scabbia, Ev, and Bottoni, D.
- Abstract
The hypothesis that a therapeutic strategy aimed at lowering systolic blood pressure (SBP) below 130 mm Hg is superior to a conventional strategy targeted at below 140 mm Hg in hypertensive subjects has never been tested in randomized intervention studies. The Studio Italiano Sugli Effetti Cardiovascolari del Controllo della Pressione Arteriosa Sistolica (Cardio-Sis) is a multi-centre study in non-diabetic, treated hypertensive subjects aged >55 years with uncontrolled SBP (>or=150 mm Hg) and at least one additional cardiovascular risk factor (ClinicalTrials.gov identifier: NCT00421863). Subjects are randomized to an SBP goal
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- 2008
4. Randomized study of traditional versus aggressive systolic blood pressure control (Cardio-Sis): rationale, design and characteristics of the study population
- Author
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VERDECCHIA P, CARDIO SIS STUDY G. R. O. U. P., Staessen, Ja, Achilli, A, DE SIMONE, G, Ganau, A, Mureddu, G, Pede, S, Porcellati, C, Fornari, G, Repaci, S, Castellani, C, Achilli, P, Jaspers, C, Cucchiara, G, Panzano, C, Angeli, F, Aillon, C, Sclavo, Mg, Scherillo, M, Raucci, D, DI DONATO, M, Cas, Ld, Faggiano, P, Porcu, M, Calamida, R, Pistia, L, Vancheri, F, Alletto, M, Curcio, M, Pettinati, G, Ieva, M, Muscella, A, Guerrieri, M, Denbek, C, Gulizia, M, Francese, Gm, Perticone, F, Iemma, G, Fariello, R, Sala, N, Mezzetti, A, Pierdomenico, Sd, Bucci, M, Benemio, G, Gattobigio, R, Sacchi, N, Cocchieri, M, Prosciutti, L, Battocchi, P, Garognoli, O, Arcelli, G, Pirelli, S, Emanuelli, C, Braschi, Gb, Abrignani, M, DE FERRARI, G, Ponremoli, R, Igidbashian, D, Marini, R, Scarpino, L, Mandorla, S, Buccolieri, M, Picchi, L, Casolo, G, Pardini, M, Marracci, G, Strazzullo, P, Galletti, F, Barbato, A, Cavallini, C, Borgioni, C, Seghieri, G, Cipollini, F, Arcangeli, E, Boddi, W, Palermo, C, Savelli, F, Lembo, G, Vecchione, C, Malatino, Lorenzo, Belluardo, P, Zoccali, C, Leonerdis, D, Mallamaci, F, Lacchè, A, Gentile, C, Boccanelli, A, Mureddu, Gf, Santini, M, Colivicchi, F, Ficili, S, Uguccioni, M, Nardozi, C, Tedeschi, A, Martin, G, Zanata, G, Mos, L, Dialti, V, Martina, S, Renna, A, Farina, G, Tripodi, E, Miserrafiti, B, Scali, R, Stornello, M, Valvo, E, Bernardinangeli, M, Proietti, G, Poddighe, G, Biscottini, B, Panciarola, R, Boccali, A, Veglio, F, Rabbia, F, Caserta, M, Chiatto, M, Stefenelli, C, Cioffi, G, Bonazza, G, Scabbia, Ev, and Bottoni, D.
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- 2008
5. Elastic properties of the ascending aorta in patients with [alpha]1-antitrypsin deficiency (Z homozygotes)
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Vizzardi E, Corda L, Pezzali N, Roca E, Pini L, D'Aloia A, Metra M, Cas LD, and Tantucci C
- Abstract
OBJECTIVE AND DESIGN: [alpha]1-Antitrypsin deficiency (AATD) is a genetic disorder that may be a pathogenic factor in vascular aneurysms and dissection. The aim of this study was to measure the diameters of the Valsalva sinuses (VS), sinotubular junction (STJ), ascending aorta (AA) and aortic arch (AAr) and elastic properties of the AA (distensibility, stiffness and tissue Doppler imaging (TDI strain)) in AATD subjects. PATIENTS: 33 AATD subjects (all Z-homozygous, 17 male, 16 female) were examined. Aortic elastic properties, namely, distensibility and stiffness index, were calculated from the echocardiographically-derived thoracic aortic diameters and TDI strain was measured on the wall of the AA 3 cm above the aortic valve. The results were compared with those obtained in healthy controls matched for age, sex and body mass index. RESULTS: AATD subjects had larger aortic diameters (VS: 3.5±0.5 vs 3.2±0.5 cm, p<0.05; STJ 2.7±0.4 vs 2.4±0.4 cm, p<0.01; AA 3.3±0.5 vs 2.9±0.4 cm, p<0.01; AAr 2.3±0.3 vs 2.1±0.3 cm, p=0.05); greater aortic stiffness 14.9±11.9 versus 7.4±4.4 (pure numbers, p<0.005); and less aortic distensibility 2.4±1.8 versus 4.0±2.6 10(-6)xcm(2)xdyne(-1), p<0.005. Peak systolic (S) and diastolic (E and A) waves of the aortic wall TDI were similar in patients and controls (S wave: 5.4±1.6 vs 5.9± 2.3 cm/s; E wave: -4.8±2.2 vs -4.5±2.2 cm/s; A wave: -6.1±2.2 vs -6.2±2.4 cm/s) while TDI strain of the aortic wall was lesser in patients than controls (-14.7±8.0% vs -28.3±7.1%, p<0.001). CONCLUSIONS: AATD subjects have a larger AA with abnormal elastic properties as compared to controls. The increase in stiffness, decrease in distensibility and abnormal strain of the aortic wall may all reflect pathological changes in its elastic tissue. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
6. Agents with inotropic properties for the management of acute heart failure syndromes. Traditional agents and beyond.
- Author
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Teerlink JR, Metra M, Zacà V, Sabbah HN, Cotter G, Gheorghiade M, Cas LD, Teerlink, John R, Metra, Marco, Zacà, Valerio, Sabbah, Hani N, Cotter, Gadi, Gheorghiade, Mihai, and Cas, Livio Dei
- Abstract
Treatment with inotropic agents is one of the most controversial topics in heart failure. Initial enthusiasm, based on strong pathophysiological rationale and apparent empirical efficacy, has been progressively limited by results of controlled trials and registries showing poorer outcomes of the patients on inotropic therapy. The use of these agents remains, however, potentially indicated in a significant proportion of patients with low cardiac output, peripheral hypoperfusion and end-organ dysfunction caused by heart failure. Limitations of inotropic therapy seem to be mainly related to their mechanisms of action entailing arrhythmogenesis, peripheral vasodilation, myocardial ischemia and damage, and possibly due to their use in patients without a clear indication, rather than to the general principle of inotropic therapy itself. This review will discuss the characteristics of the patients with a potential indication for inotropic therapy, the main data from registries and controlled trials, the mechanism of the untoward effects of these agents on outcomes and, lastly, perspectives with new agents with novel mechanisms of action. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
7. Improvements in signs and symptoms during hospitalization for acute heart failure follow different patterns and depend on the measurement scales used: an international, prospective registry to evaluate the evolution of measures of disease severity in...
- Author
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Allen LA, Metra M, Milo-Cotter O, Filippatos G, Reisin LH, Bensimhon DR, Gronda EG, Colombo P, Felker GM, Cas LD, Kremastinos DT, O'Connor CM, Cotter G, Davison BA, Dittrich HC, Velazquez EJ, Allen, Larry A, Metra, Marco, Milo-Cotter, Olga, and Filippatos, Gerasimos
- Abstract
Background: The natural evolution of signs and symptoms during acute heart failure (AHF) is poorly characterized.Methods and Results: We followed a prospective international cohort of 182 patients hospitalized with AHF. Patient-reported dyspnea and general well-being (GWB) were measured daily using 7-tier Likert (-3 to +3) and visual analog scales (VAS, 0-100). Physician assessments were also recorded daily. Mean age was 69 years and 68% had ejection fraction <40%. Likert measures of dyspnea initially improved rapidly (day 1, 0.22; day 2, 1.31; P <.001) with no significant improvement thereafter (day 7, 1.51; day 2 versus 7 P = .16). In contrast, VAS measure of dyspnea improved throughout hospitalization (day 1, 50.1; day 2, 64.7; day 7, 83.2; day 1 versus 2 P < .001, day 2 versus 7 P < .001). Symptoms of dyspnea and GWB tracked closely (correlation r = .813, P < .001). Physical signs resolved more completely than did symptoms (eg, from day 1 to discharge/day 7, absence of edema increased from 33% to 72% of patients, whereas significant improvements in dyspnea increased from 27% to 52% of patients; P < .001).Conclusions: Changes in patient-reported symptoms and physician-assessed signs followed different patterns during an AHF episode and are influenced by the measurement scales used. Multiple clinical measures should be considered in discharge decisions and evaluation of AHF therapies. [ABSTRACT FROM AUTHOR]- Published
- 2008
- Full Text
- View/download PDF
8. Acute Hemodynamic-effects of Ibopamine in Patients With Severe Congestive Heart-failure
- Author
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UCL, Ghirardi, P., Brusoni, B., Mangiavacchi, M., Bianco, L., Col, Jacques, Metra, M., Cas, LD., UCL, Ghirardi, P., Brusoni, B., Mangiavacchi, M., Bianco, L., Col, Jacques, Metra, M., and Cas, LD.
- Published
- 1985
9. Optimal duration of dual anti-platelet therapy after percutaneous coronary intervention: 2016 consensus position of the Italian Society of Cardiology
- Author
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Livio Dei Cas, Francesco Barillà, Pasquale Perrone Filardi, Ciro Indolfi, Carmine Dario Vizza, Matteo Di Biase, Francesco Pelliccia, Luigi Padeletti, Paolo G. Camici, Giuseppe Mercuro, Vincenzo Montemurro, Mauro Borzi, Francesco Romeo, Barillã , Francesco, Pelliccia, Francesco, Borzi, Mauro, Camici, Paolo, Cas, Livio Dei, Di Biase, Matteo, Indolfi, Ciro, Mercuro, Giuseppe, Montemurro, Vincenzo, Padeletti, Luigi, Filardi, Pasquale Perrone, Vizza, Carmine D., Romeo, Francesco, Barillà, F, Pelliccia, F, Borzi, M, Camici, P, Cas, Ld, Di Biase, M, Indolfi, C, Mercuro, G, Montemurro, V, Padeletti, L, Filardi, Pp, Vizza, Cd, and Romeo, F
- Subjects
Ticagrelor ,Adenosine ,medicine.medical_treatment ,Myocardial Infarction ,drug-eluting stent ,dual anti-platelet therapy ,percutaneous coronary intervention ,ticagrelor ,cardiology and cardiovascular medicine ,Settore MED/11 - Malattie dell'Apparato Cardiovascolare ,030204 cardiovascular system & hematology ,law.invention ,Percutaneous coronary intervention ,0302 clinical medicine ,Randomized controlled trial ,Risk Factors ,law ,Drug-Eluting Stent ,Medicine ,030212 general & internal medicine ,Myocardial infarction ,Societies, Medical ,Randomized Controlled Trials as Topic ,Aspirin ,Cardiology ,Drug Administration Schedule ,Drug-Eluting Stents ,Hemorrhage ,Humans ,Italy ,Percutaneous Coronary Intervention ,Platelet Aggregation Inhibitors ,Risk Assessment ,Thrombosis ,General Medicine ,Thrombosi ,Platelet aggregation inhibitor ,Risk assessment ,Cardiology and Cardiovascular Medicine ,medicine.drug ,Human ,medicine.medical_specialty ,animal structures ,03 medical and health sciences ,Medical ,Internal medicine ,Risk factor ,Dual anti-platelet therapy ,business.industry ,Platelet Aggregation Inhibitor ,Risk Factor ,medicine.disease ,Conventional PCI ,Societies ,business - Abstract
Definition of the optimal duration of dual anti-platelet therapy (DAPT) is an important clinical issue, given the large number of patients having percutaneous coronary intervention (PCI), the costs and risks of pharmacologic therapy, the consequences of stent thrombosis, and the potential benefits of DAPT in preventing ischaemic outcomes beyond stent thrombosis. Nowadays, the rationale for a prolonged duration of DAPT should be not only the prevention of stent thrombosis, but also the prevention of ischaemic events unrelated to the coronary stenosis treated with index PCI. A higher predisposition to athero-thrombosis may persist for years after an acute myocardial infarction, and even stable patients with a history of prior myocardial infarction are at high risk for major adverse cardiovascular events. Recently, results of pre-specified post-hoc analyses of randomized clinical trials, including the PEGASUS-TIMI 54 trial, have shed light on strategies of DAPT in various clinical situations, and should impact the next rounds of international guidelines, and also routine practice. Accordingly, the 2015 to 2016 the Board of the Italian Society of Cardiology addressed newer recommendations on duration of DAPT based on most recent scientific information. The document states that physicians should decide duration of DAPT on an individual basis, taking into account ischaemic and bleeding risks of any given patient. Indeed, current controversy surrounding optimal duration of DAPT clearly reflects the fact that, nowadays, a one size fits all strategy cannot be reliably applied to patients treated with PCI. Indeed, patients usually have factors for both increased ischaemic and bleeding risks that must be carefully evaluated to assess the benefit/risk ratio of prolonged DAPT. Personalized management of DAPT must be seen as a dynamic prescription with regular re-evaluations of the risk/benefit to the patient according to changes in his/her clinical profile. Also, in order to derive more benefit than harm from new treatments, a multi-parametric approach using several risk scores of the ischaemic and bleeding risks might improve the process of risk factor characterization. In patients with high ischaemic risk, particularly those with a history of myocardial infarction, the benefits of extended DAPT (particularly with ticagrelor up to 3 years) are likely to outweigh the risks.
- Published
- 2017
10. Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score: a multiparametric approach to heart failure prognosis
- Author
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Andrea Passantino, Marco Metra, Anna Apostolo, Giuseppe Pacileo, Marco Confalonieri, Angela Beatrice Scardovi, Marco Guazzi, Gianfranco Sinagra, Piergiuseppe Agostoni, Luca Bettari, Romualdo Belardinelli, Andrea Di Lenarda, Michele Emdin, Annamaria Iorio, Fabrizio Veglia, Domenico Scrutinio, Rocco La Gioia, Pietro Palermo, Livio Dei Cas, Massimo F Piepoli, Stefania Paolillo, Damiano Magrì, Gianfranco Parati, R. P. Ricci, Giuseppe Limongelli, Federica Re, Elisabetta Salvioni, Rossella Raimondo, Raffaella Vaninetti, Alessandro Mezzani, Ugo Corrà, Luigi Emilio Pastormerlo, Mauro Contini, Claudio Passino, Gaia Cattadori, Cesare Fiorentini, Pantaleo Giannuzzi, Agostoni, P, Corrà, U, Cattadori, G, Veglia, F, La Gioia, R, Scardovi, Ab, Emdin, M, Metra, M, Sinagra, Gianfranco, Limongelli, G, Raimondo, R, Re, F, Guazzi, M, Belardinelli, R, Parati, G, Magrì, D, Fiorentini, C, Mezzani, A, Salvioni, E, Scrutinio, D, Ricci, R, Bettari, L, DI LENARDA, Andrea, Pastormerlo, Le, Pacileo, G, Vaninetti, R, Apostolo, A, Iorio, A, Paolillo, S, Palermo, P, Contini, M, Confalonieri, M, Giannuzzi, P, Passantino, A, Cas, Ld, Piepoli, Mf, Passino, C, on behalf of the MECKI score research, Group, Scardovi, A, Sinagra, G, Di Lenarda, A, Pastormerlo, L, Dei Cas, L, and Piepoli, M
- Subjects
Male ,medicine.medical_specialty ,Prognosi ,Population ,Renal function ,heart failure ,Kidney Function Tests ,Severity of Illness Index ,Disease-Free Survival ,Cohort Studies ,Metabolic exercise test ,Median follow-up ,Internal medicine ,medicine ,Humans ,Prospective Studies ,education ,Aged ,Prognosis ,survival score ,Heart Failure ,education.field_of_study ,Ejection fraction ,business.industry ,Regression analysis ,MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE ,Stepwise regression ,Middle Aged ,medicine.disease ,oxygen consumption ,prognosis ,Heart failure ,Cohort ,Heart Function Tests ,Cardiology ,Exercise Test ,Female ,Cardiology and Cardiovascular Medicine ,business ,Heart failure, Prognosis, Oxygen consumption ,Follow-Up Studies - Abstract
Objectives We built and validated a new heart failure (HF) prognostic model which integrates cardiopulmonary exercise test (CPET) parameters with easy-to-obtain clinical, laboratory, and echocardiographic variables. Background HF prognostication is a challenging medical judgment, constrained by a magnitude of uncertainty. Methods Our risk model was derived from a cohort of 2716 systolic HF patients followed in 13 Italian centers. Median follow up was 1041days (range 4–5185). Cox proportional hazard regression analysis with stepwise selection of variables was used, followed by cross-validation procedure. The study end-point was a composite of cardiovascular death and urgent heart transplant. Results Six variables (hemoglobin, Na + , kidney function by means of MDRD, left ventricle ejection fraction [echocardiography], peak oxygen consumption [% pred] and VE/VCO 2 slope) out of the several evaluated resulted independently related to prognosis. A score was built from Metabolic Exercise Cardiac Kidney Indexes, the MECKI score, which identified the risk of study end-point with AUC values of 0.804 (0.754–0.852) at 1year, 0.789 (0.750–0.828) at 2years, 0.762 (0.726–0.799) at 3years and 0.760 (0.724–0.796) at 4years. Conclusions This is the first large-scale multicenter study where a prognostic score, the MECKI score, has been built for systolic HF patients considering CPET data combined with clinical, laboratory and echocardiographic measurements. In the present population, the MECKI score has been successfully validated, performing very high AUC.
- Published
- 2012
11. Authorship: From credit to accountability. Reflections from the Editors' Network.
- Author
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Alfonso F, Zelveian P, Monsuez JJ, Aschermann M, Boehm M, Hernandez AB, Wang TD, Cohen A, Izetbegovic S, Doubell A, Echeverri D, Enç N, Ferreira-González I, Undas A, Fortmüller U, Gatzov P, Ginghina C, Goncalves L, Addad F, Hassanein M, Heusch G, Huber K, Hatala R, Ivanusa M, Lau CP, Marinskis G, Cas LD, Rochitte CE, Nikus K, Fleck E, Pierard L, Obradović S, Passano MDPA, Jang Y, Rødevand O, Sander M, Shlyakhto E, Erol Ç, Tousoulis D, Ural D, Piek JJ, Varga A, Flammer AJ, Mach F, Dibra A, Guliyev F, Mrochek A, Rogava M, Melgar IG, Di Pasquale G, Kabdrakhmanov K, Haddour L, Fras Z, Held C, and Shumakov V
- Subjects
- Humans, Authorship, Biomedical Research methods, Cardiology, Editorial Policies, Information Dissemination methods
- Abstract
The Editors' Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices., (Copyright © 2019 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2019
- Full Text
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12. Data Sharing: A New Editorial Initiative of the International Committee of Medical Journal Editors. Implications for the Editors´ Network.
- Author
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Alfonso F, Adamyan K, Artigou JY, Aschermann M, Boehm M, Buendia A, Chu PH, Cohen A, Cas LD, Dilic M, Doubell A, Echeverri D, Enç N, Ferreira-González I, Filipiak KJ, Flammer A, Fleck E, Gatzov P, Ginghina C, Goncalves L, Haouala H, Hassanein M, Heusch G, Huber K, Hulín I, Ivanusa M, Krittayaphong R, Lau CP, Marinskis G, Mach F, Moreira LF, Nieminen T, Oukerraj L, Perings S, Pierard L, Potpara T, Reyes-Caorsi W, Rim SJ, Rødevand O, Saade G, Sander M, Shlyakhto E, Timuralp B, Tousoulis D, Ural D, Piek JJ, Varga A, and Lüscher TF
- Subjects
- Humans, Periodicals as Topic, Biomedical Research, Editorial Policies, Information Dissemination, Publishing
- Abstract
The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship -emphasizing the importance of responsibility and accountability-, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors´ Network of the European Society of Cardiology.
- Published
- 2017
- Full Text
- View/download PDF
13. Optimal duration of dual anti-platelet therapy after percutaneous coronary intervention: 2016 consensus position of the Italian Society of Cardiology.
- Author
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Barillà F, Pelliccia F, Borzi M, Camici P, Cas LD, Di Biase M, Indolfi C, Mercuro G, Montemurro V, Padeletti L, Filardi PP, Vizza CD, and Romeo F
- Subjects
- Adenosine adverse effects, Adenosine therapeutic use, Aspirin therapeutic use, Drug Administration Schedule, Hemorrhage etiology, Humans, Italy, Platelet Aggregation Inhibitors adverse effects, Randomized Controlled Trials as Topic, Risk Assessment, Risk Factors, Societies, Medical, Thrombosis etiology, Ticagrelor, Adenosine analogs & derivatives, Cardiology standards, Drug-Eluting Stents adverse effects, Myocardial Infarction therapy, Percutaneous Coronary Intervention adverse effects, Platelet Aggregation Inhibitors therapeutic use, Thrombosis prevention & control
- Abstract
Definition of the optimal duration of dual anti-platelet therapy (DAPT) is an important clinical issue, given the large number of patients having percutaneous coronary intervention (PCI), the costs and risks of pharmacologic therapy, the consequences of stent thrombosis, and the potential benefits of DAPT in preventing ischaemic outcomes beyond stent thrombosis. Nowadays, the rationale for a prolonged duration of DAPT should be not only the prevention of stent thrombosis, but also the prevention of ischaemic events unrelated to the coronary stenosis treated with index PCI. A higher predisposition to athero-thrombosis may persist for years after an acute myocardial infarction, and even stable patients with a history of prior myocardial infarction are at high risk for major adverse cardiovascular events. Recently, results of pre-specified post-hoc analyses of randomized clinical trials, including the PEGASUS-TIMI 54 trial, have shed light on strategies of DAPT in various clinical situations, and should impact the next rounds of international guidelines, and also routine practice. Accordingly, the 2015 to 2016 the Board of the Italian Society of Cardiology addressed newer recommendations on duration of DAPT based on most recent scientific information. The document states that physicians should decide duration of DAPT on an individual basis, taking into account ischaemic and bleeding risks of any given patient. Indeed, current controversy surrounding optimal duration of DAPT clearly reflects the fact that, nowadays, a one size fits all strategy cannot be reliably applied to patients treated with PCI. Indeed, patients usually have factors for both increased ischaemic and bleeding risks that must be carefully evaluated to assess the benefit/risk ratio of prolonged DAPT. Personalized management of DAPT must be seen as a dynamic prescription with regular re-evaluations of the risk/benefit to the patient according to changes in his/her clinical profile. Also, in order to derive more benefit than harm from new treatments, a multi-parametric approach using several risk scores of the ischaemic and bleeding risks might improve the process of risk factor characterization. In patients with high ischaemic risk, particularly those with a history of myocardial infarction, the benefits of extended DAPT (particularly with ticagrelor up to 3 years) are likely to outweigh the risks.
- Published
- 2017
- Full Text
- View/download PDF
14. Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score: a multiparametric approach to heart failure prognosis.
- Author
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Agostoni P, Corrà U, Cattadori G, Veglia F, La Gioia R, Scardovi AB, Emdin M, Metra M, Sinagra G, Limongelli G, Raimondo R, Re F, Guazzi M, Belardinelli R, Parati G, Magrì D, Fiorentini C, Mezzani A, Salvioni E, Scrutinio D, Ricci R, Bettari L, Di Lenarda A, Pastormerlo LE, Pacileo G, Vaninetti R, Apostolo A, Iorio A, Paolillo S, Palermo P, Contini M, Confalonieri M, Giannuzzi P, Passantino A, Cas LD, Piepoli MF, and Passino C
- Subjects
- Aged, Cohort Studies, Disease-Free Survival, Exercise Test standards, Female, Follow-Up Studies, Heart Function Tests standards, Humans, Kidney Function Tests standards, Male, Middle Aged, Prognosis, Prospective Studies, Exercise Test methods, Heart Failure diagnosis, Heart Failure physiopathology, Heart Function Tests methods, Kidney Function Tests methods, Severity of Illness Index
- Abstract
Objectives: We built and validated a new heart failure (HF) prognostic model which integrates cardiopulmonary exercise test (CPET) parameters with easy-to-obtain clinical, laboratory, and echocardiographic variables., Background: HF prognostication is a challenging medical judgment, constrained by a magnitude of uncertainty., Methods: Our risk model was derived from a cohort of 2716 systolic HF patients followed in 13 Italian centers. Median follow up was 1041days (range 4-5185). Cox proportional hazard regression analysis with stepwise selection of variables was used, followed by cross-validation procedure. The study end-point was a composite of cardiovascular death and urgent heart transplant., Results: Six variables (hemoglobin, Na(+), kidney function by means of MDRD, left ventricle ejection fraction [echocardiography], peak oxygen consumption [% pred] and VE/VCO2 slope) out of the several evaluated resulted independently related to prognosis. A score was built from Metabolic Exercise Cardiac Kidney Indexes, the MECKI score, which identified the risk of study end-point with AUC values of 0.804 (0.754-0.852) at 1year, 0.789 (0.750-0.828) at 2years, 0.762 (0.726-0.799) at 3years and 0.760 (0.724-0.796) at 4years., Conclusions: This is the first large-scale multicenter study where a prognostic score, the MECKI score, has been built for systolic HF patients considering CPET data combined with clinical, laboratory and echocardiographic measurements. In the present population, the MECKI score has been successfully validated, performing very high AUC., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
15. Echocardiographic evaluation of asymptomatic patients affected by rheumatoid arthritis.
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Vizzardi E, Cavazzana I, Bazzani C, Pezzali N, Ceribelli A, Bonadei I, Franceschini F, D'Aloia A, Metra M, Tincani A, and Cas LD
- Subjects
- Aged, Arthritis, Rheumatoid epidemiology, Echocardiography methods, Female, Humans, Male, Middle Aged, Ventricular Dysfunction, Left epidemiology, Arthritis, Rheumatoid diagnostic imaging, Asymptomatic Diseases, Ventricular Dysfunction, Left diagnostic imaging
- Abstract
Background: Rheumatoid arthritis (RA) is associated with increased mortality and morbidity because of accelerated atherosclerosis. The study assessed the prevalence of left and right ventricle diastolic and systolic dysfunction in outpatients with RA., Methods: The study included 93 outpatients with RA. In all patients and control group, echocardiographic conventional and tissue Doppler (TDI) studies were conducted., Results: In the group of RA patients, we found high prevalence of left ventricular systolic and diastolic dysfunction and right diastolic dysfunction compared with controls (13.5% vs 5.5 %, 76.3% vs 48.8% and 41.9% vs 6.6%, respectively; P < 0.001). Rheumatoid arthritis patients and controls showed significant differences about mitral, tricuspid, and pulmonary flow velocity curves; tissue Doppler curves of the lateral and the septal myocardial walls of the left ventricle; and basal myocardial free wall of the right ventricle. There were not any correlations between inflammatory and functional disease parameters and variables of systolic and diastolic function., Conclusions: Our study shows a high prevalence of left ventricular systolic and diastolic dysfunction in a population of outpatients affected by rheumatoid arthritis.
- Published
- 2012
- Full Text
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16. Elastic properties of the ascending aorta in patients with α1-antitrypsin deficiency (Z homozygotes).
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Vizzardi E, Corda L, Pezzali N, Roca E, Pini L, D'Aloia A, Metra M, Cas LD, and Tantucci C
- Subjects
- Aorta anatomy & histology, Case-Control Studies, Echocardiography, Elasticity, Female, Homozygote, Humans, Male, Middle Aged, alpha 1-Antitrypsin Deficiency genetics, Aorta physiology, Vascular Stiffness physiology, alpha 1-Antitrypsin Deficiency physiopathology
- Abstract
Objective and Design: α1-Antitrypsin deficiency (AATD) is a genetic disorder that may be a pathogenic factor in vascular aneurysms and dissection. The aim of this study was to measure the diameters of the Valsalva sinuses (VS), sinotubular junction (STJ), ascending aorta (AA) and aortic arch (AAr) and elastic properties of the AA (distensibility, stiffness and tissue Doppler imaging (TDI strain)) in AATD subjects., Patients: 33 AATD subjects (all Z-homozygous, 17 male, 16 female) were examined. Aortic elastic properties, namely, distensibility and stiffness index, were calculated from the echocardiographically-derived thoracic aortic diameters and TDI strain was measured on the wall of the AA 3 cm above the aortic valve. The results were compared with those obtained in healthy controls matched for age, sex and body mass index., Results: AATD subjects had larger aortic diameters (VS: 3.5 ± 0.5 vs 3.2 ± 0.5 cm, p<0.05; STJ 2.7 ± 0.4 vs 2.4 ± 0.4 cm, p<0.01; AA 3.3 ± 0.5 vs 2.9 ± 0.4 cm, p<0.01; AAr 2.3 ± 0.3 vs 2.1 ± 0.3 cm, p=0.05); greater aortic stiffness 14.9 ± 11.9 versus 7.4 ± 4.4 (pure numbers, p<0.005); and less aortic distensibility 2.4 ± 1.8 versus 4.0 ± 2.6 10(-6)×cm(2)×dyne(-1), p<0.005. Peak systolic (S) and diastolic (E and A) waves of the aortic wall TDI were similar in patients and controls (S wave: 5.4 ± 1.6 vs 5.9 ± 2.3 cm/s; E wave: -4.8 ± 2.2 vs -4.5 ± 2.2 cm/s; A wave: -6.1 ± 2.2 vs -6.2 ± 2.4 cm/s) while TDI strain of the aortic wall was lesser in patients than controls (-14.7 ± 8.0% vs -28.3 ± 7.1%, p<0.001)., Conclusions: AATD subjects have a larger AA with abnormal elastic properties as compared to controls. The increase in stiffness, decrease in distensibility and abnormal strain of the aortic wall may all reflect pathological changes in its elastic tissue.
- Published
- 2012
- Full Text
- View/download PDF
17. Prevalence of comorbidities and associated cardiac diseases in patients with valve aortic stenosis. Potential implications for the decision-making process.
- Author
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Faggiano P, Frattini S, Zilioli V, Rossi A, Nistri S, Dini FL, Lorusso R, Tomasi C, and Cas LD
- Subjects
- Adult, Aged, Aged, 80 and over, Aortic Valve Stenosis physiopathology, Comorbidity, Female, Follow-Up Studies, Glomerular Filtration Rate physiology, Heart Diseases diagnosis, Heart Diseases epidemiology, Heart Diseases physiopathology, Heart Valve Prosthesis Implantation methods, Humans, Kidney Diseases diagnosis, Kidney Diseases epidemiology, Kidney Diseases physiopathology, Male, Middle Aged, Prevalence, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis epidemiology, Decision Making
- Abstract
Objectives: Aortic valve replacement (AVR) is recommended in patients with symptomatic aortic stenosis (AS). However a large number of elderly patients remain untreated because of a high operative risk. The aim of this study was to assess the risk profile of a group of AS patients, evaluating the prevalence of comorbidities and associated cardiac diseases and their impact on therapeutic decisions., Methods: Two-hundred forty consecutive AS patients underwent complete clinical evaluation, in order to define the stenosis severity, the prevalence of several associated cardiac conditions and comorbidities. Furthermore, the treatment choices based on this approach were recorded., Results: Mean age was 78.6 ± 8.93 years, 75.5% was ≥ 75 years old, 60% females; 226 patients (94.2%) had symptoms and 54.2% was in NYHA classes III-IV. Valve area <1cm(2) was detected in 81.6% of patients. Both comorbidities and associated cardiac diseases were common; particularly, renal dysfunction was detected by estimated glomerular filtration rate in 52.7%, chronic obstructive lung disease in 25.4%, cerebrovascular/peripheral artery disease in 30.8% and 11.6%, respectively, diabetes in 30%, malignancies (current or previous) in 26.6% of patients. Among associated cardiac diseases, coronary artery disease was detected in 43.7%, LV systolic dysfunction in 28.7%, pulmonary hypertension in 67%, at least moderate mitral regurgitation in 32.5% and porcelain aorta in 7.5% of patients. Fourteen asymptomatic patients (pts) (5.9%) remained in follow-up, 77 (32%) underwent surgical AVR, 64 (26.7%) underwent transcatheter valve implantation, 28 (11.6%) underwent balloon valvuloplasty and 57 (23.8%), despite symptoms, remained on medical therapy alone., Conclusions: Comorbidities and coexisting cardiac diseases are very common in AS and may strongly influence the decision-making process., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)
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- 2012
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18. Low cerebrovascular event rate in subjects with patent foramen ovale and different clinical presentations: results from a prospective non randomized study on a population including patients with and without patent foramen ovale closure.
- Author
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Faggiano P, Frattini S, Piovesana P, Lorusso R, Chiari E, Scolari F, Padovani A, and Cas LD
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Cerebrovascular Disorders mortality, Female, Follow-Up Studies, Foramen Ovale, Patent mortality, Humans, Male, Middle Aged, Prospective Studies, Young Adult, Cerebrovascular Disorders epidemiology, Foramen Ovale, Patent epidemiology, Foramen Ovale, Patent surgery
- Abstract
Background: There are conflicting data on the role of a patent foramen ovale (PFO) in the pathogenesis of cryptogenic stroke. The aim of this study was to evaluate the incidence of cerebrovascular events associated with PFO in a large population of patients during mid-term follow-up., Methods and Results: We prospectively investigated 446 consecutive patients (58% female, age 50 ± 14 years) in whom PFO was detected by contrast echocardiography following cryptogenic stroke (30.5%), transient ischemic attack (TIA, 23.7%), migraine(10.5%) or evaluation for other cardiac diseases(35%). Prevalence of other clinical conditions potentially associated with cerebral embolism, such as mitral valve disease, atrial fibrillation and aortic atherosclerosis were 31%, 12.5%, 11.2%, respectively; 99 out of 446 patients (22%, group 1) underwent PFO closure, shortly after diagnosis, while 347 (78%, group 2) received only medical therapy (antiplatelet drugs and vitamin K antagonists). During 54 months (range 12-96) of average follow-up few events had been observed: one fatal stroke (1%) in group 1 and 3 nonfatal strokes (0.86%) in group 2 (not significant); there were more TIAs in group 1 than in group 2 (5, 5% versus 3, 0.86%, p=0.02): 8/12 new cerebrovascular events occurred in patients with previous cerebral ischemia and in 7/12 there were other cardioembolic sources. Kaplan-Meier survival free from cerebrovascular events showed a slightly better prognosis in unclosed PFO patients compared to closed PFO ones, statistically significant (p=0.004)., Conclusions: New cerebrovascular events are rare in unselected subjects with PFO, even in those with previous cerebral ischemia and those who have not undergone PFO closure, with an event rate similar to that observed in the general population., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2012
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19. A Type A Aortic Dissection Mimicking an Acute Myocardial Infarction.
- Author
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D'Aloia A, Vizzardi E, Bugatti S, Magatelli M, Bonadei I, Rovetta R, Quinzani F, Curnis A, and Cas LD
- Abstract
We describe a case of a 54 years old man in whom an initial diagnosis of acute coronary syndrome (ACS) revealed to be finally an acute aortic dissection. This case report stresses the importance to maintain a high grade of suspicion of aortic dissection as a possible alternative in presence of eletrocardiographic myocardial ischemic signs. In many medical centers where thrombolitic therapy, antiplatelets receptor blockers, heparin or percutaneous coronary angioplasty is the first line therapy for ACS the outcome may be catastrophic in situation such as aortic dissection.
- Published
- 2012
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20. When oral anticoagulation therapy is needed in patients with cardiomyopathies: a review of literature.
- Author
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Vizzardi E, Bonadei I, Del Magro F, Bugatti S, D'Aloia A, Curnis A, and Cas LD
- Subjects
- Administration, Oral, Cardiomyopathies complications, Humans, Thromboembolism etiology, Anticoagulants administration & dosage, Cardiomyopathies drug therapy, Thromboembolism prevention & control
- Abstract
The question whether to anticoagulate patients with cardiomyopathy or not is over 50 years old. Multiple clinical trials have demonstrated the superior therapeutic effect of warfarin compared with placebo in the prevention of thromboembolic events amongst patients with nonvalvular atrial fibrillation. The purpose of our work is to review literature about the role of anticoagulation in the main cardiomyopathies., (Copyright © 2011 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)
- Published
- 2012
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21. Effects of ranolazine on cardiovascular system.
- Author
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Bonadei I, Vizzardi E, Quinzani F, Piovanelli B, Rovetta R, D'Aloia A, and Cas LD
- Subjects
- Acetanilides adverse effects, Acetanilides pharmacology, Angina Pectoris physiopathology, Animals, Cardiovascular Diseases drug therapy, Cardiovascular Diseases physiopathology, Drug Design, Enzyme Inhibitors adverse effects, Enzyme Inhibitors pharmacology, Humans, Patents as Topic, Piperazines adverse effects, Piperazines pharmacology, Quality of Life, Ranolazine, United States, Acetanilides therapeutic use, Angina Pectoris drug therapy, Enzyme Inhibitors therapeutic use, Piperazines therapeutic use
- Abstract
Chronic stable angina affects 6-7 million Americans and contributes to a significant reduction in quality of life and life expectancy. Current pharmacotherapy for reducing episodes of exertional angina includes β-blockers, calcium channel blockers and long-acting nitrates. Patients may have contraindications to the use of one or more of these agents or be unable to tolerate initial or larger therapeutic doses. As a result of the inability of current management strategies to optimally control episodes of chronic angina, new therapies have been investigated that do not have some of the limitations of current therapies. New therapies for chronic stable angina are based on a mechanism involving membrane current such as the funny current and the late Na current. Ranolazine (Ran) is an antianginal drug acting on I(Na). After its current indication in the chronic stable angina, the role of this molecule is still being studied for prophylaxis of certain arrhythmias and treatment of heart failure. Moreover, have been recently developed new interesting patents of novel pharmaceutical effects and derivates of Ran.
- Published
- 2011
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22. Old and new intravenous inotropic agents in the treatment of advanced heart failure.
- Author
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Metra M, Bettari L, Carubelli V, and Cas LD
- Subjects
- Cardiac Output drug effects, Cardiotonic Agents adverse effects, Disease Progression, Evidence-Based Medicine, Heart Failure physiopathology, Humans, Infusions, Intravenous, Risk Assessment, Risk Factors, Treatment Outcome, Cardiotonic Agents administration & dosage, Heart Failure drug therapy
- Abstract
Inotropic agents are administered to improve cardiac output and peripheral perfusion in patients with systolic dysfunction and low cardiac output. However, there is evidence of increased mortality and adverse effects associated with current inotropic agents. These adverse outcomes may be ascribed to patient selection, increased myocardial energy expenditure and oxygen consumption, or to specific mechanisms of action. Both sympathomimetic amines and type III phosphodiesterase inhibitors act through an increase in intracellular cyclic adenosine monophoshate and free calcium concentrations, mechanisms that increase oxygen consumption and favor arrhythmias. Concomitant peripheral vasodilation with some agents (phosphodiesterase inhibitors and levosimendan) may also lower coronary perfusion pressure and favor myocardial damage. New agents with different mechanisms of action might have a better benefit to risk ratio and allow an improvement in tissue and end-organ perfusion with less untoward effects. We have summarized the characteristics of the main inotropic agents for heart failure treatment, the data from randomized controlled trials, and future perspectives for this class of drugs., (Copyright © 2011 Elsevier Inc. All rights reserved.)
- Published
- 2011
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23. Elastic properties of the ascending aorta in patients with rheumatoid arthritis.
- Author
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Vizzardi E, Cavazzana I, Pezzali N, Ceribelli A, Bazzani C, Tincani A, Metra M, Franceschini F, and Cas LD
- Subjects
- Adult, Aged, Aorta physiology, Arthritis, Rheumatoid complications, Arthritis, Rheumatoid physiopathology, Humans, Male, Middle Aged, Vasoconstriction physiology, Vasodilation physiology, Aorta pathology, Arthritis, Rheumatoid pathology, Elasticity physiology
- Published
- 2011
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24. Can we improve the treatment of congestion in heart failure?
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Metra M, Bugatti S, Bettari L, Carubelli V, Danesi R, Lazzarini V, Lombardi C, and Cas LD
- Subjects
- Animals, Diuretics adverse effects, Furosemide adverse effects, Heart Failure drug therapy, Humans, Lung pathology, Diuretics administration & dosage, Dyspnea drug therapy, Dyspnea etiology, Edema drug therapy, Edema etiology, Furosemide administration & dosage, Heart Failure complications
- Abstract
Introduction: Dyspnoea and peripheral oedema, caused by fluid redistribution to the lungs and/or by fluid overload, are the main causes of hospitalization in patients with heart failure and are associated with poor outcomes. Treatment of fluid overload should relieve symptoms and have a neutral or favorable effect on outcomes., Areas Covered: We first consider the results obtained with furosemide administration, which is still the mainstay of treatment of congestion in patients with heart failure. We then discuss important shortcomings of furosemide treatment, including the development of resistance and side effects (electrolyte abnormalities, neurohormonal activation, worsening renal function), as well as the relationship of furosemide - and its doses - with patient prognosis. Finally, the results obtained with potential alternatives to furosemide treatment, including different modalities of loop diuretic administration, combined diuretic therapy, dopamine, inotropic agents, ultrafiltration, natriuretic peptides, vasopressin and adenosine antagonists, are discussed., Expert Opinion: Relief of congestion is a major objective of heart failure treatment but therapy remains based on the administration of furosemide, an agent that is often not effective and is associated with poor outcomes. The results of the few controlled studies aimed at the assessment of new treatments to overcome resistance to furosemide and/or to protect the kidney from its untoward effects have been mostly neutral. Better treatment of congestion in heart failure remains a major unmet need.
- Published
- 2011
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25. Differences between nitrates: role of isosorbide 2-mononitrate.
- Author
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Raddino R, Caretta G, Bonadei I, Teli M, Vizzardi E, and Cas LD
- Subjects
- Animals, Aorta metabolism, Coronary Circulation drug effects, Coronary Vessels metabolism, Cyclic GMP metabolism, Dose-Response Relationship, Drug, Female, In Vitro Techniques, Isosorbide Dinitrate pharmacology, Male, Muscle, Smooth, Vascular drug effects, Nitroglycerin pharmacology, Perfusion, Rabbits, Aorta drug effects, Coronary Vessels drug effects, Drug Tolerance, Isosorbide Dinitrate analogs & derivatives, Vasodilation drug effects, Vasodilator Agents pharmacology
- Abstract
Introduction: Nitrates are used in the treatment of coronary heart disease and heart failure. The major drawback of their therapeutic use is the rapid development of tolerance., Aim of the Study: To investigate the effect of different nitrates on isolated rabbit hearts and aortic strips and the mechanism responsible for nitrate tolerance, using nitroglycerine (NTG), isosorbide dinitrate (ISDN), 5-mononitrate (5MN) and 2-mononitrate (2MN)., Materials and Methods: Preparations were stimulated by different spasmogenic agents: KCl, angiotensin II and noradrenaline; nitrates were administered on the plateau contraction, at the concentration of maximum inhibitory effect. In another series of experiments, preparations were preincubated with the maximum inhibitory concentration of each nitrate to evaluate the induction of tolerance., Results: Nitrates produced the following maximum inhibitions on noradrenaline-induced contraction: NTG 90% (10(-6) mol/l), ISDN 60% (10(-4) mol/l), 5MN 55% (10(-4) mol/l) and 2MN 80% (10(-4) mol/l). After incubation a loss of vasodilator effect of nearly 50-60% was observed for all the nitrates considered except 2MN, whose loss of effect was significantly lower (36%). The cyclic guanosine monophosphate (cGMP) levels measured in the preparations were lower in the presence of 2MN than the other compounds., Conclusion: These data suggest that 2MN is able to induce a lower cGMP increase and less tolerance induction; since these observations seem to be correlated, the vasodilator effect of 2MN probably also involves mechanisms other than stimulation of guanylate cyclase.
- Published
- 2010
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26. Measurement of the myocardial performance index in ambulatory patients with heart failure: correlation with other clinical and echocardiographic parameters and independent prognostic value.
- Author
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Vizzardi E, Chiari E, Faggiano P, D'Aloia A, Bordonali T, Metra M, and Cas LD
- Subjects
- Aged, Ambulatory Care statistics & numerical data, Comorbidity, Echocardiography statistics & numerical data, Female, Humans, Incidence, Italy epidemiology, Male, Prognosis, Reproducibility of Results, Risk Assessment, Risk Factors, Sensitivity and Specificity, Statistics as Topic, Survival Analysis, Survival Rate, Heart Failure diagnosis, Heart Failure mortality, Ventricular Dysfunction, Left diagnosis, Ventricular Dysfunction, Left mortality
- Abstract
Background: Many echocardiographic parameters have been proposed for the assessment of the patients with heart failure (HF). Recently, the myocardial performance index (MPI) has been shown to be an accurate index of myocardial function. We assessed the correlation with other clinical and echocardiographic measurements and the prognostic value of MPI in patients with HF., Methods and Results: The MPI was assessed in 112 consecutive patients with persistent symptoms of HF (II-III NYHA class), sinus rhythm, LV systolic dysfunction (defined by an ejection fraction
0.55 (median value) and medium to severe mitral regurgitation were associated with a relative risk of cardiovascular events of 18.7 (95% confidence interval [CI], 16.6-20.7; P < 0.005) and of 3.03 (95% CI, 2-4.1; P = 0.035), respectively., Conclusions: In our patients with HF, MPI was the best predictor of cardiovascular events. Mitral regurgitation was the only other variable which had an additive prognostic value at multivariate analysis. - Published
- 2010
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27. Tricuspid valve myxoma in a patient with congestive heart failure.
- Author
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Vizzardi E, D'Aloia A, Chiari E, Nardi M, Zanini G, Cabras R, Faden G, Maiandi C, and Cas LD
- Abstract
Myxomas are the most frequent benign primary cardiac tumours (50% of benign heart tumours). This kind of tumour is most likely to be localized in the left atrium, followed by the right atrium, right ventricle and left ventricle. Quite exceptional is the presence of a myxoma originating from the tricuspid valve or from the Eustachian valve. We describe the case of a woman with moderate dyspnoea of unknown origin and the presence of tricuspid myxoma who underwent tricuspid valve curettage.
- Published
- 2010
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28. Imaging of caseous calcification of the mitral annulus.
- Author
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Vizzardi E, D'Aloia A, Farina D, Zanini G, Cabras R, Chiari E, and Cas LD
- Subjects
- Aged, Echocardiography, Female, Humans, Calcinosis diagnostic imaging, Heart Valve Diseases diagnostic imaging, Mitral Valve diagnostic imaging
- Abstract
Caseous calcification of the mitral annulus is a rare form of periannular calcification that generally appears as a calcified mass with a central echolucent area that may lead to diagnostic errors. The case is reported of a 65-year-old woman in whom a suspicious mass was detected with transthoracic echocardiography performed for dyspnea.
- Published
- 2009
29. Multiorgan paradoxical embolism consequent to acute pulmonary thromboembolism with patent foramen ovale: a case report.
- Author
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Caretta G, Robba D, Bonadei I, Teli M, Fontanella B, Vizzardi E, Farina D, Raddino R, and Cas LD
- Abstract
Paradoxical embolism is defined as a systemic arterial embolism requiring the passage of a venous thrombus into the arterial circulatory system through a right-to-left shunt. It is a relatively rare phenomenon, representing about 2% of all cases of arterial embolism. We report a case of a 79-years-old woman admitted to hospital because of dyspnea and lower left limb pain. CT scan revealed multiple thrombi to kidney, lower limb and superior mesenteric artery during acute pulmonary embolism. Echocardiogram documented a patent foramen ovale with a right-to-left shunt. The patient was treated with thrombolytic therapy and heparin with progressive improvement of symptoms and resolution of pulmonary embolism and peripheral thrombosis. Patent foramen ovale closure was not performed because a life-long anticoagulation therapy was necessary, a tunnel-type patent foramen ovale may increases difficulty in realizing device implantation and there are no clear evidence-based guidelines to date addressing treatment in presence of a patent foramen ovale.
- Published
- 2009
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30. [Usefulness of left atrial diametres and volumes for the evaluation of left ventricular diastolic function].
- Author
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Vizzardi E, Bonadei I, Teli M, Caretta G, Maiandi C, Madureri A, Bordonali T, Chiari E, Raddino R, and Cas LD
- Subjects
- Case-Control Studies, Female, Humans, Male, Middle Aged, Organ Size, Heart Atria pathology, Ventricular Dysfunction pathology, Ventricular Dysfunction physiopathology, Ventricular Function, Left
- Abstract
Introduction: The diastolic function of the left ventricle is a main point of the physiological adaptations of the cardiovascular system to the various situations., Aim of the Study: Evaluation of left atrium diameter change during diastole and left atrial volume and their possible correlation with different left ventricular diastolic filling pattern., Material and Methods: Ninety patients with echocardiographically determined diastolic dysfunction and eighty healthy volunteers were included in the study. We measured left atrium emptying fraction (LAEF), defined as ratio of end-diastolic left atrial diameter to end-systolic diameter and left atrial volume. Mitral flow pulsed wave velocities were recorded. E, A, E/A, deceleration time of early diastolic filling, isovolumetric relaxation time were measured. Pulmonary vein S, D and atrial reversal velocities and tissue Doppler imaging of E' and A' mitral anular velocities were obtained., Results: LAEF was found 0.6 +/- 0.4 (mean SE) in the control group, 0.81 +/- 0.04 in pseudonormal pattern (P < 0.05, control vs pseudonormal group), 0.89 +/- 0.01 in the greater A wave than E wave (P < 0.001, control vs restrictive pattern group), and 0.78 +/- 0.2 in the A > E group (P < 0.05, control vs A > E pattern group)., Conclusions: LAEF and atrial volume are a new and practical methods for the differentiation of the normal-pseudonormal mitral flow pattern, in particular in setting without new ultrasound technologies.
- Published
- 2009
31. Acute thrombosis in mitralic mechanical prosthesis: a case report.
- Author
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Vizzardi E, D'Aloia A, Zanini G, Antonioli E, Chiari E, and Cas LD
- Abstract
We describe a case of a man, 42 years old, submitted to successful fibrinolitic strategy with rTPA in acute mitralic prosthesis valve thrombosis and ipomobility of one emidisk. There aren't a consensus agreement in therapeutic strategy but we may support the approach of some authors that employ fibrinolisis in patients without absolute or relative controindications and if thrombus dimension is less than 1 cm otherwise they make use of heparin therapy in non obstructive thrombosis with successive transesophageal echocardiography evaluation for the efficacy and the later indication for thrombolisis or surgery treatment.
- Published
- 2009
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32. Thrombus or tumor? a case of fibroelastoma as indicated during the submission process.
- Author
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Vizzardi E, Faggiano P, Antonioli E, Zanini G, Chiari E, Nodari S, and Cas LD
- Abstract
We describe the case of a 50-year-old woman who was admitted to a pheriferal department for heart failure. The echocardiography revealed a small mass measuring about 1.3 x 1.0 cm adhering to the non-coronary cusp of the aortic valve, mild dilated cardiomiopathy and severe biventricular dysfunction. This mass had erroneously been considered a thrombotic lesion, so the patient was treated with thrombolysis and heparin e.v. Only after a transoesophageal echocardiography a tumour cardiac mass was suspected. The diagnosis of fibroelastoma was confirmed by MRI and then from the anatomic and histoligical definition after surgery.
- Published
- 2009
- Full Text
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33. [Diabetes and ischemic heart disease: specific treatment].
- Author
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Raddino R, Bonadei I, Teli M, Robba D, Caretta G, Madureri A, Zanini G, Pedrinazzi C, Vizzardi E, and Cas LD
- Subjects
- Adrenergic Antagonists therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Humans, Hypolipidemic Agents therapeutic use, Myocardial Ischemia therapy, Myocardial Revascularization, Platelet Aggregation Inhibitors therapeutic use, Thrombolytic Therapy, Acute Coronary Syndrome therapy, Diabetic Angiopathies therapy
- Abstract
Diabetes mellitus is a worldwide epidemic whose incidence and prevalence have significantly increased in recent decades. Diabetic patients have an increased mortality and morbidity related to ischemic heart disease and are more likely to develop multivessel coronary artery disease than non-diabetic patients. An acute coronary event is the leading cause of death among diabetics. These patients have an increased risk of complications after an acute coronary syndrome both during the acute phase and in the post-infarction period. Experimental evidences showed an increased prevalence of atherosclerosis as well as platelet and coagulation abnormalities in patients with diabetes, even after data adjustment for other risk factors. Both hyperglycemia and insulin resistance play a role in the pathogenic link between diabetes and atherosclerosis. Diabetic patients, therefore, could derive a greater benefit from therapies shown to be effective in treating and preventing ischemic heart disease. An aggressive correction of cardiovascular risk factors and accurate risk stratification of patients with diabetes are needed.
- Published
- 2008
34. [Mechanical circulatory supports for the treatment of advanced heart failure].
- Author
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Cas LD, Metra M, Nodari S, Lombardi C, and Zacà V
- Subjects
- Disease Progression, Heart Transplantation, Humans, Time Factors, Ventricular Remodeling physiology, Heart Failure therapy, Heart-Assist Devices
- Abstract
Heart failure (HF) is the final event of virtually all cardiac diseases with a prevalence that has risen to epidemic levels in both Europe and North America. Medical therapy with angiotensin-converting enzyme inhibitors, beta-blockers, and aldosterone inhibitors associated with cardiac resynchronization therapy, when indicated, has allowed an improved survival for HF patients. However, morbidity and mortality rates for advanced HF remain unacceptably high, and the course of HF remains progressive so that patients end to a stage characterized by severe symptoms, poor quality of life, high hospitalization and mortality rates. Heart transplantation represents an effective surgical treatment for advanced HF, yet the interest for alternative surgical options has progressively increased due to shortage of donors and frequent contraindications. Several devices are currently available but the results of controlled studies are still unsatisfactory. It appears likely, however, that mechanical circulatory supports will play a major role in the management of patients with advanced HF.
- Published
- 2008
35. [Acute heart failure: clinical profiles and pathophysiology].
- Author
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Metra M, Zacà V, Lombardi C, Danesi R, Bordonali T, Nodari S, and Cas LD
- Subjects
- Aged, Cardiomyopathies complications, Edema complications, Humans, Hypertension complications, Myocardial Ischemia complications, Myocardium pathology, Necrosis complications, Systole, Heart Failure etiology, Heart Failure physiopathology
- Abstract
Acute heart failure (HF) is the most common diagnosis at discharge in patients aged > 65 years. It carries a dismal prognosis with a high in-hospital mortality rate and very high post-discharge mortality and rehospitalization rates. It is a complex clinical syndrome that is challenging to define as it may vary widely with respect to underlying pathophysiological mechanisms and clinical presentations. Different clinical scenarios have prognostic significance and may influence therapeutic options. Amongst the main clinical presentations, we may include the following: de novo HF vs acutely decompensated chronic HF, HF caused, and/or worsened, by myocardial ischemia, acute HF with low, normal, or high systolic blood pressure, acute HF caused by hydrosaline retention or fluid redistribution to the lungs, acute HF with comorbidities (diabetes, anemia, renal insufficiency, etc.). Different pathophysiological mechanisms and clinical presentations may coexist in the same patient. Identification and, whenever possible, treatment of underlying pathophyisiological mechanisms should be a primary objective of acute HF management.
- Published
- 2008
36. Right ventricular thrombus and pulmonary thromboembolism/thrombosis in Behçet's disease: a case report.
- Author
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Chiari E, Fracassi F, D'Aloia A, Vizzardi E, Zanini G, Rocca P, Metra M, and Cas LD
- Subjects
- Humans, Male, Young Adult, Behcet Syndrome diagnostic imaging, Echocardiography, Pulmonary Embolism diagnostic imaging, Thrombosis diagnostic imaging, Ventricular Dysfunction, Right diagnostic imaging
- Abstract
Behçet's disease (BD) is a multisystemic, chronic, inflammatory disease of unknown origin characterized by alternation of exacerbation and quiescence phases. Cardiac involvement in BD is infrequent. We report a case of a young man with BD with right ventricular thrombus and pulmonary thromboembolism. A 20-year-old man was admitted to our hospital with a 6-month history of dyspnea at rest, asthenia, and fever. Transthoracic echocardiography showed right wall thickened and presence of floating masses in the right outflow tract. Transesophageal echocardiography confirmed the presence of diffuse thrombosis in the right ventricle, with mobile ramifications in its outflow tract. Cardiovascular magnetic resonance and computed tomography of heart confirmed the presence of thrombi, the increased thickness of endocardiac tissue, and altered cardiac wall signal transmission. Computed tomography scan showed multiple pulmonary thrombi. Myocardial biopsy specimen showed diffused subendocardial thrombosis with damage of cardiac myocytes and presence of granulocytes. Six months after discharge, no cardiac masses were detected by transthoracic echocardiography. However, a few weeks after this last echocardiogram, the patient was again hospitalized for a new episode of acute pulmonary embolism. The patient was discharged with increasing dose of oral anticoagulant, with no evidence of cardiac masses at transthoracic echocardiography and thrombosis at computed tomography. The patient is still healthy on anticoagulant, immunosuppressive, and steroid therapy. This case provides a rare example of BD, in which we found-at the same time-heart and pulmonary manifestations, with the presence of right ventricular thrombus and pulmonary thrombi in situ.
- Published
- 2008
- Full Text
- View/download PDF
37. [The CORONA study].
- Author
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Metra M, Zacá V, Nodari S, Cas LD, and Maggioni AP
- Subjects
- Age Factors, Aged, Aged, 80 and over, Cholesterol, LDL blood, Fluorobenzenes administration & dosage, Follow-Up Studies, Heart Failure, Systolic blood, Heart Failure, Systolic mortality, Hospitalization, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage, Middle Aged, Prospective Studies, Pyrimidines administration & dosage, Randomized Controlled Trials as Topic, Risk Factors, Rosuvastatin Calcium, Sulfonamides administration & dosage, Time Factors, Treatment Outcome, Fluorobenzenes therapeutic use, Heart Failure, Systolic drug therapy, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Pyrimidines therapeutic use, Sulfonamides therapeutic use
- Published
- 2008
38. [Peripartum cardiomyopathy].
- Author
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Raddino R, Bonadei I, Teli M, Chieppa F, Caretta G, Robba D, Zanini G, Vizzardi E, and Cas LD
- Subjects
- Adult, Cardiomyopathy, Dilated, Early Diagnosis, Echocardiography, Female, Humans, Postpartum Period, Pregnancy, Prognosis, Risk Factors, Heart Failure diagnosis, Heart Failure epidemiology, Heart Failure etiology, Heart Failure therapy, Pregnancy Complications, Cardiovascular diagnosis, Pregnancy Complications, Cardiovascular epidemiology, Pregnancy Complications, Cardiovascular etiology, Pregnancy Complications, Cardiovascular therapy, Ventricular Dysfunction, Left diagnosis, Ventricular Dysfunction, Left epidemiology, Ventricular Dysfunction, Left etiology, Ventricular Dysfunction, Left therapy
- Abstract
Peripartum cardiomyopathy (PPCM) is a rare disorder in which left ventricular dysfunction and symptoms of heart failure occur in the peripartum period in previously healthy women. Incidence of PPCM ranges from 1 in 1300 to 1 in 15,000 pregnancies. The etiology of PPCM is unknown, but viral, autoimmune, and idiopathic causes may contribute. The diagnostic criteria are onset of heart failure in the last month of pregnancy or in the first 5 months postpartum, absence of determinable cause for cardiac failure, and absence of a demonstrable heart disease before the last month of pregnancy. Risk factors for PPCM include advanced maternal age, multiparity, African race, twinning, gestational hypertension, and long-term tocolysis. The clinical presentation of patients with PPCM is similar to that of patients with dilated cardiomyopathy. Echocardiography is central to diagnosis. Early diagnosis and initiation of treatment are essential to optimize pregnancy outcome. Treatment is similar to medical therapy for other forms of dilated cardiomyopathy. About half the patients of PPCM recover without complications. The prognosis is poor in patients with persistent cardiomyopathy. Persistence of disease after 6 months indicates irreversible cardiomyopathy and portends worse survival.
- Published
- 2008
- Full Text
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39. QT prolongation: a case of arsenical pericardial and pleural effusion.
- Author
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Vizzardi E, Zanini G, Antonioli E, D'Aloia A, Raddino R, and Cas LD
- Subjects
- Aged, Arsenic Trioxide, Humans, Leukemia, Promyelocytic, Acute drug therapy, Long QT Syndrome physiopathology, Male, Pericardial Effusion physiopathology, Pleural Effusion physiopathology, Recovery of Function, Withholding Treatment, Antineoplastic Agents adverse effects, Arsenicals adverse effects, Long QT Syndrome chemically induced, Oxides adverse effects, Pericardial Effusion chemically induced, Pleural Effusion chemically induced
- Abstract
Arsenic trioxide is an effective treatment for patients with acute promyelocytic leukaemia (APL) who have relapsed from or are refractory to all trans-retinoic acid and anthracycline chemotherapy. Cardiac effects observed include electrocardiographic changes such as QTc prolongation, T-wave abnormalities, torsades de pointes and sudden death. We describe a case of a man, 76 years old, who was admitted to our department for dyspnoea in APL in treatment with arsenic trioxide. Chest radiograph illustrated an enlarged cardiac silhouette and bilateral pleuric effusion and the ECG evidenced QT prolongation. The patient was also submitted to transthoracic echocardiography that revealed moderate pericardial effusion without signs of cardiac tamponade and a normal biventricular function. This condition was considered to be associated with arsenic trioxide polyserosit and the drug therapy was immediately discontinued and steroid drugs started. After 2 weeks of arsenic trioxide therapy suspension there was evidence of complete resolution of pericardial and pleuric effusion and the ECG showed normal QT interval.
- Published
- 2008
- Full Text
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40. Coronary artery spasm as a cause of ST elevation and inappropriate implantable cardioverter defibrillator intervention.
- Author
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Mascioli G, Bontempi L, Racheli M, Cerini M, Curnis A, and Cas LD
- Subjects
- Coronary Angiography, Coronary Vasospasm diagnostic imaging, Coronary Vasospasm physiopathology, Coronary Vasospasm therapy, Electrocardiography, Electrophysiologic Techniques, Cardiac, Humans, Male, Middle Aged, Myocardial Ischemia diagnostic imaging, Myocardial Ischemia physiopathology, Myocardial Ischemia therapy, Prosthesis Failure, Syncope diagnostic imaging, Syncope physiopathology, Syncope therapy, Tachycardia, Ventricular diagnostic imaging, Tachycardia, Ventricular etiology, Tachycardia, Ventricular physiopathology, Treatment Outcome, Ventricular Fibrillation diagnostic imaging, Ventricular Fibrillation etiology, Ventricular Fibrillation physiopathology, Coronary Vasospasm complications, Defibrillators, Implantable adverse effects, Myocardial Ischemia etiology, Syncope etiology, Tachycardia, Ventricular therapy, Ventricular Fibrillation therapy
- Abstract
Coronary artery spasm can cause both brady- and tachyarrhythmia, through induction of AV block (usually linked to coronary spasm of the right coronary artery) or ventricular tachycardia/fibrillation linked to extensive myocardial ischemia. The electrocardiographic aspect of coronary artery spasm is an ST segment elevation. We describe the case of patient implanted with an implantable cardioverter defibrillator (ICD) for unexplained syncope which, during coronary artery spasm, received an inappropriate device firing due to ST segment elevation, leading to a double count of the QRS by the ICD.
- Published
- 2007
- Full Text
- View/download PDF
41. Out of the guidelines: should an intracardiac defibrillator be implanted in patients with recurrent early ventricular fibrillation due to recurrent acute myocardial infarction?
- Author
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Faggiano P, Pulcini E, Curnis A, Vizzardi E, and Cas LD
- Subjects
- Angioplasty, Balloon, Coronary, Coronary Angiography, Electrocardiography, Humans, Male, Middle Aged, Myocardial Infarction pathology, Myocardial Infarction physiopathology, Myocardial Infarction therapy, Practice Guidelines as Topic, Recurrence, Time Factors, Ventricular Fibrillation etiology, Ventricular Fibrillation physiopathology, Ventricular Function, Left, Defibrillators, Implantable, Electric Countershock, Myocardial Infarction complications, Patient Selection, Ventricular Fibrillation therapy
- Abstract
We report the case of a patient admitted to the hospital on two different occasions, separated by a time interval of 12 years, with the same clinical picture: acute anterior myocardial infarction complicated by early ventricular fibrillation. The patient was successfully resuscitated because, in both circumstances, he was 'lucky' to arrive at hospital within a few minutes of the onset of chest pain, and to have ventricular fibrillation in the Emergency Department. The issue of intracardiac defibrillator implantation, despite this situation is not contemplated in the current guidelines (left ventricular ejection fraction was preserved), is discussed here.
- Published
- 2007
- Full Text
- View/download PDF
42. [Urocortin: molecular biology and cardiovascular effects].
- Author
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Raddino R, Pedrinazzi C, Zanini G, Robba D, Bonadei I, Scarabelli TM, and Cas LD
- Subjects
- Chromosomes, Human, Pair 2 genetics, Chromosomes, Human, Pair 3 genetics, Heart drug effects, Humans, Urocortins, Cardiovascular System drug effects, Corticotropin-Releasing Hormone genetics, Corticotropin-Releasing Hormone pharmacology
- Abstract
Urocortins and the corticotropin releasing hormone have a long evolutionary history. In the nervous system the corticotropin releasing hormone is responsible of anxiogenic effects associated with stress, while urocortins are concerned with adaptive behavior. Urocortins are also expressed in the heart, where they may play an autocrine/paracrine role binding to corticotropin releasing hormone-R2 receptors. The expression of endogenous cardiac urocortin is increased by in vitro ischemia-reperfusion damage, and the addiction of exogenous urocortins is associated with reduction of myocardial cell death during ischemia-reperfusion damage in vitro, ex vivo and in vivo. In isolated perfused heart urocortin enhances cardiac contractility and decreases high energy phosphates reduction after ischemia-reperfusion damage. Urocortin is also associated with peripheral and coronary vasodilation and with positive inotropic effect. There are experimental data which suggest a beneficial effect of urocortins in subjects with heart failure and a possible beneficial role of urocortin in preventing the iatrogenic ischemia-reperfusion damage caused by cardioplegic arrest during cardiac surgery. These early observations suggest that assessment of the clinical use of urocortin in heart failure and for the prevention of ischemia-reperfusion damage in cardiac surgery should be actively pursued.
- Published
- 2007
43. Intracranial bleeding mimicking an extensive acute myocardial infarction with reversible apical ballooning and systolic left ventricular dysfunction. A case report.
- Author
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D'Aloia A, Vizzardi E, Faggiano P, Fiorina C, and Cas LD
- Subjects
- Aged, Aneurysm, Ruptured complications, Aneurysm, Ruptured diagnostic imaging, Cardiomyopathies diagnosis, Cardiomyopathies physiopathology, Diagnosis, Differential, Electrocardiography, Female, Humans, Radiography, Subarachnoid Hemorrhage etiology, Systole, Ventricular Dysfunction, Left physiopathology, Vertebral Artery Dissection complications, Vertebral Artery Dissection diagnostic imaging, Myocardial Infarction diagnosis, Myocardial Infarction physiopathology, Subarachnoid Hemorrhage diagnosis, Ventricular Dysfunction, Left diagnosis
- Abstract
A novel syndrome with transient asynergy of the apical segments of the left ventricle, also known as tako-tsubo cardiomyopathy, has been recently described and presents characteristics and effects similar to acute myocardial infarction. We report the case of a 69-year-old woman presenting with chest pain typical of myocardial ischemia, electrocardiographic abnormalities typical of antero-lateral transmural myocardial infarction, and unstable clinical and hemodynamic condition. Trans-thoracic echocardiography showed a left ventricular dysfunction with a markedly decreased ejection fraction. The patient received heparin and abciximab bolus but coronary angiography demonstrated the absence of coronary stenoses, thrombi, and coronary spasm. Due to impaired neurological conditions the patient underwent brain tomography that showed subarachnoid haemorrhage secondary to a right vertebral artery aneurysm rupture. The possible occurrence of a reversible cardiomyopathy mimicking an acute coronary syndrome in presence of intracranial bleeding should be always considered.
- Published
- 2007
- Full Text
- View/download PDF
44. Tumour markers in chronic heart failure. Review of the literature and clinical implications.
- Author
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Faggiano P, D'Aloia A, Antonini-Canterin F, Vizzardi E, Nicolosi GL, and Cas LD
- Subjects
- Chronic Disease, Humans, Sensitivity and Specificity, Biomarkers, Tumor blood, CA-125 Antigen blood, Heart Failure blood
- Abstract
Over the last years a growing interest for the biochemical abnormalities detectable in heart failure has become evident. In particular, large scientific evidence has been provided on hormones (catecholamines, renin-angiotensin-aldosterone system, natriuretic peptides) and cytokines (tumour necrosis factor, interleukins, etc.). Quite recently the attention of clinicians and researchers has also been directed towards high serum levels of tumour markers in this syndrome. Carbohydrate antigen 125 has been observed to increase in patients with congestive heart failure, to correlate with haemodynamic and clinical parameters of severity, and to show significant changes after adequate treatment. The aim of this paper is to review the data currently available on serum levels of tumour markers in patients with chronic heart failure, focusing the attention on the potential clinical use of carbohydrate antigen 125.
- Published
- 2006
- Full Text
- View/download PDF
45. Epidemiology and cardiovascular risk factors of aortic stenosis.
- Author
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Faggiano P, Antonini-Canterin F, Baldessin F, Lorusso R, D'Aloia A, and Cas LD
- Subjects
- Humans, Prevalence, Prognosis, Risk Factors, Ultrasonography, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis epidemiology, Atherosclerosis diagnostic imaging, Atherosclerosis epidemiology, Risk Assessment methods, Ventricular Outflow Obstruction diagnostic imaging, Ventricular Outflow Obstruction epidemiology
- Abstract
The abnormalities of aortic valve morphology and function represent the most common cardiac-valve lesion particularly in elderly. The etiology of aortic stenosis is degenerative-calcific in the majority of patients. Many risk factors seems to be linked to the calcification and the stenosis of the aortic valve but they must be confirmed. In this review the etiology and the possible physiopathology of the aortic valve stenosis is discussed.
- Published
- 2006
- Full Text
- View/download PDF
46. Beta-blockers in heart failure: are pharmacological differences clinically important?
- Author
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Metra M, Cas LD, di Lenarda A, and Poole-Wilson P
- Subjects
- Adrenergic beta-Antagonists therapeutic use, Clinical Trials as Topic, Dose-Response Relationship, Drug, Heart Failure metabolism, Heart Failure mortality, Humans, Myocardial Infarction drug therapy, Myocardial Infarction metabolism, Myocardial Infarction mortality, Receptors, Adrenergic, beta-1 drug effects, Receptors, Adrenergic, beta-1 metabolism, Receptors, Adrenergic, beta-2 drug effects, Receptors, Adrenergic, beta-2 metabolism, Adrenergic beta-Antagonists pharmacology, Heart Failure drug therapy
- Abstract
Beta-blockers are not an homogeneous group of agents. Only three beta-blockers, carvedilol, bisoprolol and metoprolol succinate, have had favorable effects on prognosis in controlled clinical trials in the patients with chronic heart failure. However, pharmacological differences exist between them. Metoprolol and bisoprolol are selective for beta(1)-adrenergic receptors while carvedilol blocks also beta(2)-, and alpha(1)- adrenergic receptors, and has associated antioxidant, anti-endothelin and antiproliferative properties. In COMET carvedilol was associated with a significant reduction in mortality compared to metoprolol tartrate further showing that different beta-blockers may have different effects on the outcome. These differences may be related to the ancillary properties of carvedilol or to its broader antiadrenergic profile. However, also more effective and prolonged blockade of beta1 adrenergic receptors may occur with carvedilol compared to metoprolol.
- Published
- 2004
- Full Text
- View/download PDF
47. Is total arterial myocardial revascularization with composite grafts a safe and useful procedure in the elderly?
- Author
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Muneretto C, Negri A, Bisleri G, Manfredi J, Terrini A, Metra M, Nodari S, and Cas LD
- Subjects
- Aged, Coronary Artery Bypass methods, Coronary Artery Bypass mortality, Female, Graft Occlusion, Vascular prevention & control, Humans, Length of Stay, Male, Multivariate Analysis, Myocardial Revascularization mortality, Prospective Studies, Regression Analysis, Secondary Prevention, Survival Analysis, Treatment Outcome, Angina Pectoris surgery, Myocardial Revascularization methods
- Abstract
Objective: The aim of the study was to evaluate the mid-term results of total arterial myocardial revascularization (TAMR) with composite grafts in patients older than 70 years when compared to standard CABG technique, since the usefulness of TAMR in the elderly has not been demonstrated yet., Methods: A prospective randomized study was designed with the following end-points: post-operative complications, death, recurrence of angina, graft occlusion, any cardiac event and reinterventions. One hundred and eighty-eight patients older than 70 years were enrolled and assigned to Group 1(G1)=94 pts, for total arterial revascularization or Group 2(G2)=94 pts, for standard CABG (LITA on LAD plus additional saphenous veins). The groups were comparable in terms of pre-operative characteristics and Euroscore (mean: G1=8.4 vs. G2=8.2)., Results: No differences between the groups were observed in terms of mean number of grafted vessels (G1=2.1 vs. G2=2.3), mean aortic cross-clamping time (G1=34+/-8 vs. G2=33+/-6min), mechanical ventilation time (G1=23+/-4 vs. G2=22+/-4hr), ICU stay (G1=40+/-10 vs. G2=39+/-9hr), post-operative complications and hospital mortality (G1=5.3% vs. G2=4.2%). At a mean follow-up of 12+/-4 months, cumulative incidence of angina recurrence was 2.1% in G1 vs. 11% in G2 (P=0.021). Angiographic evaluation showed 98.2% arterial patency in G1 vs. 86% saphenous vein graft patency in G2 (P<0.001). Multivariate analysis identified conventional CABG surgery as independent predictor of angina recurrence, graft occlusion and late cardiac events., Conclusions: Total arterial revascularization with composite grafts proved to be a safe and effective procedure also in the elderly. Composite arterial grafts provided superior clinical outcome with a lower rate of angina recurrence, graft occlusion and late cardiac events when compared to conventional CABG strategy.
- Published
- 2003
- Full Text
- View/download PDF
48. [Dilated cardiomyopathy: indication and role of invasive evaluation].
- Author
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Metra M, Nodari S, Trussardi E, Vizzardi E, and Cas LD
- Subjects
- Cardiac Catheterization, Cardiology methods, Cardiomyopathy, Dilated therapy, Diagnosis, Differential, Hemodynamics, Humans, Myocardial Ischemia diagnosis, Prognosis, Cardiomyopathy, Dilated diagnosis
- Abstract
Coronary angiography is still the first choice method for the diagnosis of coronary artery disease in patients with dilated cardiomyopathy. The diagnosis of coronary artery disease is, in its turn, essential as patients with associated coronary artery disease have a worse prognosis, compared to patients with idiopathic dilated cardiomyopathy, and, more importantly, coronary revascularization may significantly improve left ventricular function, clinical symptoms and prognosis, when performed in the presence of a significant amount of viable myocardium. The favorable effects on the left ventricular function are greater when a contractile reserve is shown. However, revascularization of viable myocardium may have other beneficial effects like a reduction in left ventricular remodeling and in the incidence of recurrent ischemic events and malignant arrhythmias. The detection of viable myocardium should, however, be preceded by the detection of coronary artery disease through coronary angiography. The clinical history and the results of the non-invasive evaluation, with the possible exception of coronary calcium detection by electron beam computed tomography, do not, in fact, allow the diagnosis of coronary artery disease. Coronary angiography is thus indicated in all the patients with suspected coronary artery disease (e.g. males > 35 years, with coronary risk factors, a history of chest pain and/or regional wall motion abnormalities and/or perfusion defects at stress scintigraphy) in whom the age and general conditions warrant a coronary revascularization procedure. Coronary angiography is also indicated in all the patients who are candidates to heart transplantation or whose symptoms are secondary to a mechanical complication of myocardial infarction.
- Published
- 2002
49. [New and old beta-blockers in the treatment of heart failure].
- Author
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Metra M, Nodari S, Bignotti T, Gnesin P, Trussardi E, and Cas LD
- Subjects
- Humans, Time Factors, Adrenergic beta-Antagonists therapeutic use, Heart Failure drug therapy
- Abstract
Controlled clinical trials, performed in more than 16,000 patients to date, have consistently shown the beneficial effects of long-term beta-blocker therapy in patients with chronic heart failure. However, it is not clear whether this represents a class effect or it is specific only to some agents. Beneficial effects on the prognosis of the patients with mild to moderate heart failure have been shown with metoprolol, bisoprolol, and carvedilol. However, these beta-blockers differ in their pharmacological characteristics. Metoprolol and bisoprolol are selective for beta 1-adrenergic receptors and are devoid of ancillary properties. Carvediol, at doses of 50 mg daily, blocks all beta 1-, beta 2-, and alpha 1- adrenergic receptors, and has associated antiproliferative and antioxidant activities. These differences cause a different acute hemodynamic response with a reduction in cardiac output and a tendency to a rise in pulmonary wedge pressure with selective agents and no change in cardiac output and a slight decrease in pulmonary pressures with carvedilol. Accordingly, when the therapy is started, the most frequent side effects are worsening heart failure with metoprolol and bisoprolol and hypotension and dizziness with carvedilol. It is still controversial whether these differences may also influence the long-term effects of therapy. Differently from selective beta-blockers, carvedilol does not upregulate beta 1-receptors, blocks all adrenergic receptors, decreases cardiac norepinephrine release, thus providing a more comprehensive blockade of the cardiac adrenergic drive. These properties have caused a larger increase in LV function and a lack of improvement in maximal exercise capacity with carvedilol, compared to selective beta-blockers. It is however, unclear whether these differences may also influence the patients' outcome.
- Published
- 2002
50. PTX3, A prototypical long pentraxin, is an early indicator of acute myocardial infarction in humans.
- Author
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Peri G, Introna M, Corradi D, Iacuitti G, Signorini S, Avanzini F, Pizzetti F, Maggioni AP, Moccetti T, Metra M, Cas LD, Ghezzi P, Sipe JD, Re G, Olivetti G, Mantovani A, and Latini R
- Subjects
- Aged, Enzyme-Linked Immunosorbent Assay, Female, Humans, Immunohistochemistry, Male, Middle Aged, Myocardial Infarction blood, Myocardial Infarction pathology, Myocardium metabolism, Myocardium pathology, Necrosis, Osmolar Concentration, Reference Values, Time Factors, C-Reactive Protein metabolism, Myocardial Infarction metabolism, Serum Amyloid P-Component metabolism
- Abstract
Background: Inflammation is an important component of ischemic heart disease. PTX3 is a long pentraxin whose expression is induced by cytokines in endothelial cells, mononuclear phagocytes, and myocardium. The possibility that PTX3 is altered in patients with acute myocardial infarction (AMI) has not yet been tested., Methods and Results: Blood samples were collected from 37 patients admitted to the coronary care unit (CCU) with symptoms of AMI. PTX3 plasma concentrations, as measured by ELISA, higher than the mean+2 SD of age-matched controls (2.01 ng/mL) were found in 27 patients within the first 24 hours of CCU admission. PTX3 peaked at 7.5 hours after CCU admission, and mean peak concentration was 6.94+/-11.26 ng/mL. Plasma concentrations of PTX3 returned to normal in all but 3 patients at hospital discharge and were unrelated to AMI site or extent, Killip class at entry, hours from symptom onset, and thrombolysis. C-reactive protein peaked in plasma at 24 hours after CCU admission, much later than PTX3 (P<0.001). Patients >64 years old and women had significantly higher PTX3 concentrations at 24 hours (P<0.05). PTX3 was detected by immunohistochemistry in normal but not in necrotic myocytes., Conclusions: PTX3 is present in the intact myocardium, increases in the blood of patients with AMI, and disappears from damaged myocytes. We suggest that PTX3 is an early indicator of myocyte irreversible injury in ischemic cardiomyopathy.
- Published
- 2000
- Full Text
- View/download PDF
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