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1. Detection of Asymptomatic Mpox Carriers among High-Ri Men Who Have Sex with Men: A Prospective Analysis

Author

Roberto Rossotti, Daniele Calzavara, Massimo Cernuschi, Federico D’Amico, Anna De Bona, Roberto Repossi, Davide Moschese, Simona Bossolasco, Alessandro Tavelli, Camilla Muccini, Giovanni Mulé, and Antonella d’Arminio Monforte

Subjects
mpox, asymptomatic infection, point-of-care testing, PrEP, Medicine
Abstract

Mpox is traditionally considered a zoonotic disease with endemic circulation in Africa, but the 2022–2023 outbreak reached an unprecedented high number of cases in non-endemic countries, so that it was declared a public health emergency of international concern. The reasons for this extensive global spread, characterized by sexual transmission amongst men who have sex with men (MSM), have not been fully clarified. The existence of asymptomatic carriers with viable viral shedding might be an explanation and is under-debated after retrospective studies suggested that infection without symptoms might have a prevalence of 6.5%. We aimed to prospectively assess the presence of mpox infection in asymptomatic high-risk MSM using HIV pre-exposure prophylaxis and living with HIV. We selected individuals with no signs of active infection nor suggestive symptoms in the previous 21 days. Eligible individuals collected oral and anal swabs to undergo point-of-care testing for mpox and completed a 21-days follow-up. Seventy-two individuals were enrolled, and none tested positive for mpox infection nor developed symptoms during follow-up. We selected a high-risk population with a significant history of sexual exposure, but we failed to detect any asymptomatic infection. This observation might have important consequences in terms of contact management and epidemic control.

Published
2023
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2. Real World Estimate of Vaccination Protection in Individuals Hospitalized for COVID-19

Author

Antonella d’Arminio Monforte, Alessandro Tavelli, Sara De Benedittis, Francesca Bai, Camilla Tincati, Lidia Gazzola, Ottavia Viganò, Marina Allegrini, Debora Mondatore, Daniele Tesoro, Diletta Barbanotti, Giovanni Mulé, Roberto Castoldi, Anna De Bona, Teresa Bini, Davide Chiumello, Stefano Centanni, Sabrina Passarella, Nicola Orfeo, Giulia Marchetti, Alessandro Cozzi-Lepri, and for the SPID Group

Subjects
COVID-19, age, anti-SARS-CoV-2 vaccination, in-hospital death, mechanical ventilation, Medicine
Abstract

Whether vaccination confers a protective effect against progression after hospital admission for COVID-19 remains to be elucidated. Observational study including all the patients admitted to San Paolo Hospital in Milan for COVID-19 in 2021. Previous vaccination was categorized as: none, one dose, full vaccination (two or three doses >14 days before symptoms onset). Data were collected at hospital admission, including demographic and clinical variables, age-unadjusted Charlson Comorbidity index (CCI). The highest intensity of ventilation during hospitalization was registered. The endpoints were in-hospital death (primary) and mechanical ventilation/death (secondary). Survival analysis was conducted by means of Kaplan-Meier curves and Cox regression models. Effect measure modification by age was formally tested. We included 956 patients: 151 (16%) fully vaccinated (18 also third dose), 62 (7%) one dose vaccinated, 743 (78%) unvaccinated. People fully vaccinated were older and suffering from more comorbidities than unvaccinated. By 28 days, the risk of death was of 35.9% (95%CI: 30.1–41.7) in unvaccinated, 41.5% (24.5–58.5) in one dose and 28.4% (18.2–38.5) in fully vaccinated (p = 0.63). After controlling for age, ethnicity, CCI and month of admission, fully vaccinated participants showed a risk reduction of 50% for both in-hospital death, AHR 0.50 (95%CI: 0.30–0.84) and for mechanical ventilation or death, AHR 0.49 (95%CI: 0.35–0.69) compared to unvaccinated, regardless of age (interaction p > 0.56). Fully vaccinated individuals in whom vaccine failed to keep them out of hospital, appeared to be protected against critical disease or death when compared to non-vaccinated. These data support universal COVID-19 vaccination.

Published
2022
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3. Dynamics of viral DNA shedding and culture viral DNA positivity in different clinical samples collected during the 2022 mpox outbreak in Lombardy, Italy

Author

Antonio Piralla, Davide Mileto, Alberto Rizzo, Guglielmo Ferrari, Federica Giardina, Stefano Gaiarsa, Greta Petazzoni, Micol Bianchi, Federica Salari, Fiorenza Bracchitta, Josè Camilla Sammartino, Alessandro Ferrari, Gloria Gagliardi, Alessandro Mancon, Claudio Fenizia, Mara Biasin, Francesca Rovida, Stefania Paolucci, Elena Percivalle, Alessandra Lombardi, Valeria Micheli, Silvia Nozza, Antonella Castagna, Davide Moschese, Spinello Antinori, Andrea Gori, Paolo Bonfanti, Roberto Rossotti, Antonella D'Arminio Monforte, Federica Attanasi, Marcello Tirani, Danilo Cereda, Fausto Baldanti, Maria Rita Gismondo, Miriam Cutrera, Marianna Cuomo, Federica De Poli, Giulia Campanini, Antonino Maria Guglielmo Pitrolo, Elizabeth Iskandar, Irene Cassaniti, Raffaele Bruno, Giuliano Rizzardini, Massimo Puoti, Francesco Castelli, Laura Corsico, Andrea Giacomelli, Giacomo Pozza, Giacomo Casalini, Angelo Raccagni, Bendetta Trentacapilli, Costanza Bertoni, Elena Bruzzesi, Caterina Candela, Daniele Tesoro, Giovanni Mule, Alessandra Bandera, Antonio Muscatello Bianca Mariani, Manuel Maffeo, Riccardo Vecchio, and Sara Piccinelli

Subjects
Mpox virus, Molecular epidemiology, Next generation sequencing, Re-Emerging virus, Multiple samples, Arctic medicine. Tropical medicine, RC955-962, Infectious and parasitic diseases, RC109-216
Abstract

Background: Mpox virus (MPXV) has recently spread outside of sub-Saharan Africa. This large multicentre study was conducted in Lombardy, the most densely populated Italian region accounting for more than 40% of Italian cases. The present study aims to: i) evaluate the presence and the shedding duration of MPXV DNA in different body compartments correlating the MPXV viability with the time to onset of symptoms; ii) provide evidence of MPXV persistence in different body compartment as a source of infection and iii) characterize the MPXV evolution by whole genome sequencing (WGS) during the outbreak occurred in Italy. Material and methods: The study included 353 patients with a laboratory-confirmed diagnosis of MPXV infection screened in several clinical specimens in the period May 24th - September 1st, 2022. Viral isolation was attempted from different biological matrices and complete genome sequencing was performed for 61 MPXV strains. Results: MPXV DNA detection was more frequent in the skin (94.4%) with the longest median time of viral clearance (16 days). The actively-replicating virus in cell culture was obtained for 123/377 (32.6%) samples with a significant higher viral quantity on isolation positive samples (20 vs 31, p

Published
2024
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4. Three case reports of West Nile virus neuroinvasive disease: lessons from real-life clinical practice

Author

Camilla Falcinella, Marina Allegrini, Lidia Gazzola, Giovanni Mulè, Daniele Tomasoni, Ottavia Viganò, Antonella d’Arminio Monforte, Giulia Marchetti, and Camilla Tincati

Subjects
West Nile virus, Arbovirus, Neuroinvasive disease, Cerebrospinal fluid, Case report, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background Despite being an uncommon cause of meningoencephalitis, West Nile virus (WNV) recently provoked significant outbreaks throughout Europe. West Nile neuroinvasive disease (WNND) is associated with significant morbidity and mortality in older and compromised individuals, while its diagnosis may be demanding for the clinician. Here discussed are three cases of WNND with a focus on the diagnostic challenges they presented due to atypical clinical presentation and laboratory findings. Case presentation Between July and September 2020 three patients presented to our attention with signs and symptoms compatible with meningoencephalitis. Among routine procedures, they underwent lumbar puncture and imaging. In the absence of microbiological isolates, biological samples were sent for serology and NAATs for WNV. Following diagnosis, the patients gradually recovered and were discharged either home or to rehabilitation facilities. Conclusions The laboratory findings here discussed, in particular CSF parameters, are only partially consistent with those described in the literature, which highlights the need for further research. While serology and NAATs on blood and urine appear the most reliable techniques in the diagnostic work-up of WNND, utility of NAATs on CSF specimens is limited by the kinetics of WNV viremia in biological fluids. This report underlines that WNND should always be included in the differential diagnosis of meningoencephalitis during WNV transmission period.

Published
2021
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5. Prevalence of peripheral artery disease by abnormal ankle-brachial index in atrial fibrillation: implications for risk and therapy

Author

Violi, Francesco, Daví, Giovanni, Hiatt, William, Lip, Gregory Y. H., Corazza, Gino R., Perticone, Francesco, Proietti, Marco, Pignatelli, Pasquale, Vestri, Anna R., Basili, Stefania, Desideri, ARAPACIS Study Investigators Alessandri Cesare (Dipartimento di Scienze e Biotecnologie Medico-Chirurgiche, G., Sapienza-Università di Roma), Serviddio Gaetano (Department of Medical and Surgical Sciences, University of Foggia), Fascetti Stefano (UOC Medicina Generale, USL 12 Viareggio, Toscana), Serra, Pietro, Palange Paolo(UOC Medicina Interna, I, Dipartimento di Sanità Pubblica, e Malattie Infettive, Greco, Eleonora, Bruno Graziella (Medicina, 3, Department of Medical Sciences, Città della Salute e della Scienza, A. O., University of Turin), Averna, Maurizio, Giammanco Antonina (Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Università di Palermo), Sposito Pietro (Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, Messina), De Cristofaro Raimondo, De Gennaro Leonardo(Istituto di Medicina Interna, e Geriatria, Centro Emostasi, e Trombosi, Gemelli, Policlinico A., Roma), Loria, Paola, Pellegrini Elisa(Medicina Interna ad Indirizzo Metabolico, – NOCSAE Baggiovara, Department of Internal Medicine, Endocrinology, Metabolism and Geriatrics, Università degli Studi di Modena, e Reggio Emilia), Cominacini, Luciano, Mozzini Chiara (Dipartimento di Medicina, Sezione di Medicina Interna, D, Università di Verona), Sprovieri, Mario, Spagnuolo Vitaliano (UOC Medicina d'Urgenza, e PS, Stabilimento Ospedaliero dell'Annunziata, Cosenza), Cerqua Giannantonio (UOC Medicina Interna per l'Urgenza, S Giovanni Addolorata, Ao, Cerasola Giovanni, Mulé Giuseppe (Università degli Studi di Palermo), Barbagallo, Mario, Lo Sciuto Salvatore, Monteverde Alfredo(UOC di Geriatria, e Lungodegenza, Azienda Ospedaliera Universitaria Policlinico, Aoup, Palermo), Saitta, Antonino, Lo Gullo Alberto (UOC Medicina Interna, Università di Messina), Malatino, Lorenzo, Cilia Chiara (Clinica Medica, Ospedale, Cannizzaro, Università degli Studi di Catania), Licata, Giuseppe, Tuttolomondo, Antonino, Conigliaro Roberta (UOC Medicina Interna, e Cardioangiologia, Dipartimento Biomedico di Medicina Interna, e Specialistica, Università degli Studi di Palermo), Pinto, Antonio, Di Raimondo Domenico (UOC Medicina Vascolare, Dipartimento Biomedico di Medicina Interna e Specialistica, (Di. Bi. M. I. S. )., Signorelli, Santo, Anzaldi Massimiliano (Dipartimento di Medicina Interna, e Patologia, Università degli studi di Catania), De Palma Daniela, Galderisi, Maurizio, Cudemo Giuseppe (Dipartimento di Medicina Clinica, e Sperimentale, AUP Federico II di Napoli), Galletti, Ferruccio, Fazio Valeria(Dipartimento di Medicina Clinica, e Chirurgia, Università di Napoli Federico II), De Luca Nicola, Meccariello Alfonso (Centro Ipertensione, AUO Federico II, Napoli), Caputo, Dario, De Donato Maria Teresa (UO Medicina Interna, Azienda Ospedaliera Universitaria San Giovanni di Dio, e Ruggi D'Aragona, Salerno), Iannuzi, Arcangelo, Bresciani Alessandro (Divisione di Medicina Interna, Cardarelli, Osp. A., Giunta, Riccardo, Cimini Claudia (V Divisione Medicina Interna ed Immunoallergologia, Policlinico, Sun, Utili, Riccardo, Durante Mangoni Emanuele, Agrusta Federica (Medicina Infettivologica, e dei Trapianti, Monaldi, Ao, Sun, Napoli), Adinolfi Luigi, E., Sellitto, Cristiana, Restivo Luciano (Medicina Interna, Seconda Università di Napoli, Ospedale di Marcianise), Bellis, Paolo, Tirelli Paolo (UOC Medicina Interna e di Urgenza, e Pronto Soccorso, del Loreto Nuovo, P. O. S. M., Loreto, Mare), Sacerdoti, David, Pesce Paola (Clinica Medica, 5, Dipartimento di Medicina DIMED, Università degli Studi di Padova), Vanni Dino (UO Medicina Interna Arezzo, Ospedale San Donato, Azienda USL, 8 Arezzo), Iuliano, Luigi, Ciacciarelli, Marco, Pacelli Antonio (Department of Medico-Surgical Sciences and Biotechnology, Vascular Biology, Mass Spectrometry Lab, Sapienza-University of Rome), Palazzuoli Alberto (Sezione Cardiologia, Dipartimento di Medicina Interna, e Malattie Metaboliche, Università di Siena, Ospedale Le Scotte), Cacciafesta, Mauro, Gueli Nicola (UOC di Medicina Geriatrica, e Riabilitazione, Sapienza- Università di Roma, Capeci, William, Tarquinio, Nicola, Pellegrini Francesco (UO Medicina 'SS Benvenuto, e Rocco', Dipartimento di Medicina Interna, Asur, Marche, Area Vasta, n. 2., ex ZT 7), Vincentelli Giovanni Maria (UOS Breve Osservazione, Calibita 'Fatebenefratelli' Isola Tiberina, Ospedale S. G., Ravallese, Ferdinando, Santini Claudio (UOC Medicina Interna, Ospedale, Vannini, Letizia, Claudio, Petramala, Luigi, Zinnamosca Laura (UOD Ipertensione Secondaria, Dipartimento di Medicina Interna, e Specialità Mediche, Cilli, Mirella, Savoriti Claudio (UOC Medicina Interna F, e Malattie Metaboliche Dell'osso-Direttore Minisola Salvatore, Falaschi, Paolo, Martocchia, Antonio, Stefanelli Manuela (UO Geriatria, Andrea, Azienda Ospedaliera S., Facoltà di Medicina, e Psicologia, Marigliano, Vincenzo, Lo Iacono Cristina, Brusco Simona (Centro di Ricerca Interdipartimentale Scienze dell’Invecchiamento, Bertazzoni, Giuliano, Attalla El Halabieh Elias (UOC Medicina d’Urgenza, Dipartimento di Emergenza ed Accettazione, Paradiso, Michele, Lizzi Eugenio Maria, Timmi Stefano (Ospedale San Giovanni Battista, Ordine di Malta, Battisti Paola (Medicina Interna II, Ospedale San Giovanni-Addolorata, Cerci Sabina (UOC Medicina Interna, Ospedali Riuniti Frascati, Marino), Ciavolella Massimo (UOC Cardiologia-UTIC, Ospedale di Frascati, Di Veroli Claudio (Centro dell’Ipertensione Arteriosa e delle Malattie Metaboliche, e Renali, Casa di Cura 'San Domenico', Malci, Francesco, De Ciocchis Anita (UOC di Medicina Interna, Ospedale, ASL Roma, G, Subiaco), Abate, Damiano(Az., Castellino, Pietro, Curto, Irene, Vecchio Claudia (UOC Medicina Interna, Dipartimento di Scienze Mediche, e Pediatriche, Mannarino, Elmo, Pasqualini, Leonella, Fattori Chiara (Medicina Interna, Angiologia, e Malattie da Arteriosclerosi, Università degli Studi di Perugia), Pende, Aldo, Denegri, Andre, Artom Nathan (Clinica di Medicina Interna, 1, Università di Genova, San Martino - IST, IRCCS Az. Osp. Univ., Genova), Ricchio, Roberto, Fimognari Filippo Luca (UOC Geriatria, Azienda Ospedaliera di Cosenza, Alletto, Maurizio, Messina Simona (Unità Operativa di Medicina, Elia, Ospedale S., Caltanissetta), Sesti, Giorgio, Arturi, Franco, Grembiale Alessandro (Università degli Studi, UOC Medicina Interna, Policlinico Universitario 'Mater Domini'), Scarpino Paola Elisa, Carullo Giuseppe (Cattedra di Medicina Interna, UO Malattie Cardiovascolari, Campus Universitario di Germaneto, Università Magna Graecia di Catanzaro), Frugiuele, Pierluigi, Spagnuolo Vitaliano (UOC Medicina Interna, e Reumatologia, Stabilimento Ospedaliero Annunziata, Azienda Ospedaliera Cosenza), Battaglia Giuseppe (UO Lungodegenza, Serra San Bruno, S. O., ASP Vibo Valentia), Vidili, Gianpaolo, Atzori, Sebastiana, Delitala Giuseppe (Clinica Medica, Dipartimento di Medicina Clinica, e Sperimentale, Aou, Sassari), Davì, Giovanni, Angelucci, Ermanno, Sestili Simona (UOC di Clinica Medica, PO Clinicizzato di Chieti), Traisci, Giancarlo, De Feudis Lucrezia (UOC Medicina Interna, 2, PO di Pescara), Di Michele Dario, Fava Alessandra (UOC Medicina Interna, Asl, Teramo), Balsano, Clara, De Ciantis Pierpaolo (Dipartimento di Medicina Interna, e Sanità Pubblica, Università, dell'Aquila), Desideri, Giovambattista, Camerota Antonio (UOC Geriatria, e Lungodegenza Geriatrica, Dipartimento Medico ORM, Avezzano), Po, Migliacci, Rino, Medicina Interna, Porciello Giovanni (S. C., Ospedale della Valdichiana, Cortona, Usl, 8 Arezzo), Mezzetti Matteo (UOC Medicina Interna Ospedale del Casentino-Direttore Dr. Emilio Santoro, AUSL8 Arezzo), Gresele, Paolo, Vedovati, Cristina, Fierro Tiziana (Dipartimento di Medicina Interna, Sezione di Medicina Interna, e Cardiovascolare, Università di Perugia), Puccetti, Luca, Scarpini Francesca (Centro Aterosclerosi, Trombosi, e Coagulopatie, Università degli Studi di Siena, Azienda Ospedaliero-Universitaria Senese), Bertolotti, Marco, Mussi Chiara (UO Geriatria, Università degli Studi di Modena e Reggio Emilia), Dipartimento Integrato di Medicina Endocrinologia Metabolismo e Geriatria., Boddi, Maria, Savino, Andrea, Contri Silvia (Dipartimento di Area Critica Medico- Chirurgica, Università degli Studi di Firenze), Saller, Alois, Fabris Fabrizio (Clinica Medica1, Medicina Interna CLOPD, Departement of Medicine DIMED, University of Padova, Italy), Pesavento, Raffaele, Filippi, Lucia, Vedovetto Valentina (Dipartimento di Scienze Cardiologiche, Toraciche, e Vascolari, Clinica Medica, 2, Azienda Ospedaliera-Università di Padova), Puato Massimo (Clinica Medica IV, Dipartimento di Medicina, Azienda Ospedaliera Universitaria Padova, Padova), Fabris, Fabrizio, Treleani Martina (UOA Medicina, Policlinico, Universitario, Maselli, Monica, Corradin Maria Luisa, Giantin Valter (Clinica Geriatrica, Università di Padova), Semplicini Andrea (Medicina Interna, 1, Giovanni e Paolo, Ospedale SS., Venezia), Minuz, Pietro, Calabria, Stefano, Romano Simone (Sezione di Medicina Interna, C, Università di Verona, Aoui, Verona), Fantin, Francesco, Manica Angela (Dipartimento di Medicina, Sezione di Geriatria, Stockner, Ingrid, Pattis, Peter, Wiedermann), Gutmann Bernhard (Divisione di Medicina Interna-Direttore Prof. J., Ospedale centrale di Bolzano), Catena, Cristiana, Colussi GianLuca (Hypertension Unit and Division of Internal Medicine, Department of Experimental and Clinical Medical Science, University of Udine, Udine, Italy), Annoni, Giorgio, Bruni Adriana Antonella, Castagna Alberto (Clinica Geriatrica, Università degli Studi di Milano- Bicocca, Dipartimento di Scienze della Salute, AO San Gerardo, Monza), Spinelli Diana (Medicina Interna 1a, Dipartimento di Scienze Cliniche, e di Comunità, Fondazione, Irccs, Università di Milano), Corazza Gino Roberto, Miceli, Emanuela, Padula Donatella (Clinica Medica, I, Reparto, 11, IRCCS Policlinico San Matteo di Pavia, Pavia), Schinco, Giuseppina, Spreafico Sibilla (UOC Geriatria, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico), Secchi Beatrice (UOC Medicina Interna, Ospedale, Bassini, Milano), Vanoli, Massimo, Casella Gianluca (SC Medicina Interna, Azienda Ospedaliera della Provincia di Lecco, Ospedale di Merate, Lecco), Serra Maria Grazia (UOC Medicina, Panico', Azienda Ospedaliera 'Cardinale G., Lecce), Longo, Stefania, Antonaci Salvatore (UOC Medicina Interna, Azienda Ospedaliera Policlinico, Bari), Belfiore, Anna, Giuseppe Palasciano, Frualdo Mariella (Clinica Medica 'A. Murri'-Direttore Prof., Ventrella, Francesco, Iamele Luigi (Struttura Complessa di Medicina Interna, Cerignola, Asl, Foggia), Bianco Cesare (UOC Medicina Interna, Tropea), Santovito, Donato, Mezzetti, Andrea, Cipollone Francesco (Centro di Eccellenza Europeo, e di Riferimento Regionale per l'Aterosclerosi, l'Ipertensione Arteriosa, e le Dislipidemie, Università, Chieti), Nicolai, Salvatore, Salvati Filippo (UO Medicina Interna, Ospedale di Ortona, ASL 02 Abruzzo), Rini Giovan Battista, Scozzari Francesca (UOC Medicina Interna ed Ipertensione, Dipartimento Biomedico di Medicina Interna e Specialistica (Di. Bi. M. I., S), Giaccone' di Palermo), Policlinico 'P., Muiesan Maria Lorenza, Salvetti, Massimo, Bazza Abramo (Dipartimento di Scienze Cliniche, e Sperimentali, Università di Brescia, 2° Medicina Generale Spedali Civili, Brescia), Picardi, Antonio, De Vincentis Antonio (UOC Medicina Clinica, Policlinico Universitario Campus Bio-Medico, Cosio, Paolo, Terzolo Massimo (Medicina Interna, 1, Dipartimento di Scienze Cliniche, e Biologiche, AOU San Luigi Gonzaga, Università di Torino), Madaffari, Bruno, Parasporo Bruno (UO Medicina Interna, Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio, Calabria), Fenoglio, Luigi, Bracco, Christian, Melchio Remo (SC Medicina Interna, Croce e Carle, AO S., Cuneo), Gentili, Tamira, Salvi Aldo (Medicina Generale, - Settore Subintensivo, Azienda, Ospedaliero-Universitaria, Ancona), Nitti, Cinzia, Falsetti Lorenzo (Medicina Generale, - Settore Ordinario, Gabrielli, Armando, Paglione Ivano (Clinica Medica, Capucci, Alessandro, Brambatti, Michela, Sparagna Armando (Clinica di Cardiologia, Ospedale, Torrette, Tirotta Daniela (UO Medicina Generale IV, Ospedale, Cervesi, Cattolica), Andreozzi, Paola, Ettorre, Evaristo, Cipriani Elisa (Area Geriatria, DAI Medicina Interna, Sapienza-Università di Roma, Rossi Fanelli Fillippo, Delfino Massimo (UOC Medicina Interna, H, Immunologia, Clinica, Nutrizione, Clinica, Endocrinologia, Glorioso, Nicola, Melis, Giada, Marras, Gianfranca, Matta Michela (Ambulatorio Ipertensione Arteriosa, e Patologie Correlate, Aou, Sassari, Sassari), Sacco Andrea (UOC Medicina Interna, PO Madonna delle Grazie, Matera), Stellitano, Elio, Scordo Anna (UO Medicina, PO 'Tiberio Evoli', Melito Porto Salvo), Russo, Franco, Caruso Assunta Antonietta (UOC Medicina Generale di Rogliano, AO di Cosenza), Porreca, Ettore, Santilli, Francesca, Tana Marco (UO Medicina Interna, e Geriatria, Ospedale Clinicizzato Colle Dell'Ara, D'Annunzio, Università G., Chieti-Pescara), Ferri, Claudio, Grassi, Davide, Di Giosia Paolo (Divisione di Medicina Interna Universitaria, - Ospedale San Salvatore, Dipartimento, Mesva, Università, Dell'Aquila, L'Aquila), Portincasa Piero (Clinica Medica 'Murri', Dipartimento di Scienze Mediche, e Oncologia Umana, Università degli Studi di Bari), Muscianisi Giuseppe (ASP Reggio Calabria, Saline Joniche), Giordani, Sara, Stanghellini Vincenzo (Dipartimento di Scienze Mediche, e Chirurgiche, Università degli Studi di Bologna), Sabbà, Carlo, Suppressa Patrizia (UOC Geriatria e Centro di assistenza, e ricerca sovraziendale per le malattie rare, Mancuso, Giuseppe, Bartone, Mosè, Calipari Daniela (UOC Medicina Interna, Presidio, Ospedaliero, ASP di Catanzaro), Arcidiacono, Giuseppe, Bellanuova Ignazio (UOC Cardiologia, e UTIC, Catania), Ferraro, Maria, Scalzo, Antonio, Marigliano Giampietro (ASP Cosenza), Cozzolino, Domenico, Lampitella, Antonio, Acri Vera (Dipartimento di Internistica Clinica, e Sperimentale, Galasso, Domenico, Mazzei, Francesca, Galasso Salvatore (RSA Madonna di Porto Gimigliano, Catanzaro), Buratti Alberto (Azienda Ospedaliera della Provincia di Pavia, UO Medicina Interna, Ospedale, Civile, Casorate, Primo, Porta, Massimo, Brizzi Maria Felice (SC Medicina Interna 1U, Azienda, Ospedaliera, Torino), Fattorini, Annalisa, Sampietro, Francesca, D’Angelo Armando (Coagulation Service and Thrombosis Research Unit, IRCCS Ospedale San Raffaele, Pala, Marco, Fabbian, Fabio, Manfredini Roberto (UOC Clinica Medica, Anna, Azienda Ospedaliera-Universitaria S., Ferrara), Moroni, Carlo, Valente, Lucia, Lopreiato Francesco (Laboratorio di Ecocardiografia-Cardiologia Preventiva, DAI Cuore, e Grossi Vasi, Parente Fernando (UOC Medicina Interna, Granata Massimo (Immunologia Clinica, A, Moia, Marco, Braham Simon (Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Rossi, Marco, Pesce Margherita (Dipartimento di Medicina Clinica, e Sperimentale, Università di Pisa), Gentile, Adelina, Catozzo Vania (UO Medicina, Ldp, Loreto, Ferranti, Edoardo, Soldini, Maurizio, Di Napoli Mariarosaria, Baciarello Giacinto (UOC Cardiologia Preventiva, e Riabilitativa, Rancan, Elena, Ageno, Walter, Guasti Luigina (Dipartimento di Medicina Clinica, e Sperimentale, Università, Dell'Insubria, Varese), Ciccaglioni, Antonio, Negri, Silvia, Polselli Marco (Centro Elettro-Stimolazione Cardiaca, Prisco Domenico (SOD Patologia Medica, Aou, Careggi, Firenze), Pignataro Francesca Serena, Pastori, Daniele, Ferro, Domenico, Loffredo, Lorenzo, Cangemi, Roberto, Perri, Ludovica, Polimeni, Licia, Catasca, Elisa, Raparelli, Valeria, Napoleone, Laura, Schillizzi, Marianna, Vicario, Tommasa, Russo, Roberta, Gentile Maria Cristina, Saliola, Mirella, Del Ben Maria, Angelico Francesco (I Clinica Medica, Sapienza-Università di, Roma)., Violi F, Daví G, Hiatt W, Lip GY, Corazza GR, Perticone F, Proietti M, Pignatelli P, Vestri AR, Basili S, ARAPACIS Study Investigators: […, Alessandri C, Serviddio G, Fascetti S, Serra P, Palange P, Greco E, Bruno G, Averna M, Giammanco A, Sposito P, De Cristofaro R, De Gennaro L, Loria P, Pellegrini E, Cominacini L, Mozzini C, Spovieri M, Spagnuolo V, Cerqua G, Cerasola G, Mulé G, Barbagallo M, Lo Sciuto S, Monteverde A, Saitta A, Lo Gullo A, Malatino L, Cilia C, Licata G, Tuttolomondo A, Conigliaro R, Pinto A, Di Raimondo D, Signorelli S, Anzaldi M, De Palma D, Galderisi M, Cudemo G, Galletti F, Fazio V, De Luca N, Meccariello A, Caputo D, De Donato MT, Iannuzi A, Bresciani A, Giunta R, Cimini C, Utili R, Durante M, Emanuele AF, Adinolfi LE, Cristiana S, Restivo L, Bellis P, Tirelli P, Sacerdoti D, Pesce P, Vanni D, Iuliano L, Palazzuoli A, Cacciafesta M, Gueli N, Capeci W, Tarquino N, Pellegrini F, Vincentelli GM, Ravallese F, Santini C, Letizia C, Petramala L, Zinnamosca L, Cilli M, Savoriti C, Falaschi P, Martocchia A, Stefanelli M, Marigliano V, Lo Iacono C, Brusco S, Bertazzoni G, El Halabieh Elias A, Paradiso M, Lizzi EM, Stefano T, Paola B, Cerci S, Ciavolella M, Di Veroli C, Malci F, De Ciocchis A, Abate D, Castellino P, Curto I, Vecchio C, Mannarino E, Pasqualini L, Fattori C, Pende A, Denegri A, Nathan A, Ricchio R, Fimognari FL, Alletto M, Messina S, Sesti G, Arturi F, Gembiale A, Scarpino PE, Carullo G, Pierluigi F, Battaglia G, Vadili G, Atzori S, Delitala G, Davì G, Angelucci E, Simona S, Giancarlo T, De Feudis L, Di Michele D, Fava A, Balsano C, De Ciantis P, Giovambattista D, Camerota A, Migliacci R, Porciello G, Mezzetti M, Gresele P, Vedovati C, Fierro T, Puccetti L, Scarpini F, Bertolotti M, Mussi C, Boddi M, Savino A, Contri S, Saller A, Fabris F, Pesavento R, Filippi L, Vedovetto V, Puato M, Treleani M, Maselli M, Corradin ML, Giantin V, Semplicini A, Minuz P, Calabria S, Romano S, Fantin F, Manica A, Stockner I, Pattis P, Guttman B, Catena C, Colussi GL, Annoni G, Bruni AA, Castagna A, Miceli E, Padula D, Schinco G, Spreafico S, Secchi B, Vanoli M, Casella G, Serra MG, Longo S, Antonaci S, Belfiore A, Frualdo M, Francesco V, Iamele L, Bianco C, Santovito D, Mezzetti A, Cipollone F, Nicolai S, Salvati F, Battista RG, Scozzari F, Muiesan ML, Salvetti M, Bazza A, Picardi A, De Vincentis A, Cosio P, Terzolo M, Fenoglio L, Bracco C, Melchio R, Gentili T, Salvi A, Nitti C, Falsetti L, Gabrielli A, Paglione I, Capucci A, Brambatti M, Sparagna A, Tirotta D, Andreozzi P, Ettorrre E, Cipriani E, Fanelli Fillippo R, Delfino M, Glorioso N, Melis G, Marras G, Matta M, Sacco A, Stellitano E, Scordo A, Russo F, Caruso Assunta A, Porreca E, Santilli F, Tana M, Ferri C, Grassi D, Di Giosia P, Portincasa P, Muscianisi G, Giordani S, Stanghellini V, Sabbà C, Supressa P, Mancuso G, Bartone M, Calipari D, Arcidiacono G, Bellanuova I, Ferraro M, Scalzo A, Marigliano G, Cozzolina D, Lampitella A, Acri V, Galasso D, Mazzei F, Galasso S, Buratti A, Porto M, Brizzi MF, Fattorini A, Sampietro F, D'Angelo A, Pala M, Fabbian F, Manfredini R, Moroni C, Valente L, Lopreiato F, Parente F, Granata M, Moia M, Braham S, Rossi M, Pesce M, Gentile A, Catozzzo V, Ferranti E, Soldini M, Di Napoli M, Baciarello G, Rancan E, Ageno W, Guasti L, Ciccaglioni A, Negri S, Polselli M, Prisco D, Pignataro FS, Pastori D, Ferro D, Loffredo L, Cangemi R, Perri L, Polimeni L, Catasca E, Raparelli V, Napoleone L, Schillizzi M, Vicario T, Russo R, Gentile MC, Saliola M, Del Ben M, Angelico F, Farcomeni A, Di Tanna G, Davi' G, Traisci G, Montebianco Abenavoli L, Grembiale A, Di Minno G, Durante ME, Pattoneri P, Boari B, Fabio G, Perego F, Bianchi Paola I, Angeli A, Colombo BM, Giannelli G, Vidili G, Torres D, Hijazl D, Gatta A, Mannucci Mannuccio P, Licata G., and …]

Subjects
Adult, Male, Risk, therapy, atrial fibrillation, cardiovascular disease, peripheral vascular disease, Aged, Atrial Fibrillation, Female, Humans, Internal Medicine, Italy, Middle Aged, Peripheral Arterial Disease, Prevalence, Registries, Societies, Medical, Ankle Brachial Index, ATRIAL FIBRILLATION, Cardiology and Cardiovascular Medicine, Medical, RISK FACTORS, cardiovascular diseases, Societies
Abstract

To the Editor: Nonvalvular atrial fibrillation (NVAF) is the most common sustained arrhythmia encountered in clinical practice and is associated with a 5-fold increased risk for stroke (1). Moreover, patients with NVAF often suffer from atherosclerotic complications such as acute myocardial infarction (AMI) (2). Peripheral artery disease (PAD) is an established marker of systemic atherosclerosis but its prevalence in NVAF is still unclear. We reasoned that inclusion of ankle-brachial index (ABI), which is an established tool for diagnosis of PAD (3), in the CHA2DS2-VASc (4) score would better define the prevalence of vascular disease. To address this issue, the Italian Society of Internal Medicine (SIMI) established an Italian registry documenting ABI in NVAF patients. The Atrial Fibrillation Registry for the ARAPACIS (Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study) study is an independent research project involving all Regional Councils of SIMI. The first objective of the study was to estimate the prevalence of ABI ≤0.90 in NVAF patients. Consecutive patients with NVAF referred to internal medicine wards were eligible for the enrollment. Enrollment started in October 2010 and continued until October 30, 2012. Patients were enrolled if they were 18 years or older and had a diagnosis of NVAF, recording during the qualifying admission/consultation or in the preceding 12 months, and if it was possible to obtain the ABI measurement. Exclusion criteria included the following: acquired or congenital valvular AF, active cancer, disease with life expectancy 0.90 (93% vs. 82%; p < 0.0001). Logistic regression analysis demonstrated that ABI ≤0.90 was significantly associated with a smoking habit (odds ratio [OR]: 1.99; 95% confidence interval [CI]: 1.48 to 2.66; p < 0.0001), diabetes (OR: 1.93; 95% CI: 1.51 to 2.46; p < 0.0001), age class 65 to 74 years (OR: 2.05; 95% CI: 1.40 to 3.07; p < 0.0001), age class ≥75 years (OR: 3.12; 95% CI: 2.16 to 4.61; p < 0.0001), and history of previous transient ischemic attack/stroke (OR: 1.64; 95% CI: 1.20 to 2.24; p = 0.002). Vascular disease, as assessed by the history elements of CHA2DS2VASc score, was recorded in 17.3% of patients; inclusion of ABI ≤0.90 in the definition of vascular disease yielded a total prevalence of 33%. A higher prevalence of vascular disease was detected if ABI ≤0.90 was included in the CHA2DS2VASc score (Fig. 1). CHA2DS2VASc including ABI ≤0.90 was more associated with previous stroke (43%; OR: 1.85; 95% CI: 1.41 to 2.44; p < 0.0001) compared to CHA2DS2VASc with ABI 0.91 to 1.39 (23%; OR: 1.52; 95% CI: 1.10 to 2.11; p = 0.0117). To the best of our knowledge, there is no large-scale study that specifically examined the prevalence of ABI ≤0.90 in NVAF. In our population, 21% had ABI ≤0.90 indicating that NVAF is often associated with systemic atherosclerosis. The CHADS2 has been recently refined with the CHA2DS2-VASc score, which includes vascular disease as documented by a history of AMI, symptomatic PAD, or detection of atherosclerotic plaque in the aortic arch (4). Comparison of vascular prevalence as assessed by CHA2DS2-VASc score and/or ABI ≤0.90 is of interest to define the potentially positive impact of measuring ABI in the management of NVAF patients. Inclusion of ABI ≤0.90 in the definition of vascular disease greatly increased the prevalence of vascular disease, which increased from 17.3% (based on history alone) to 33% (based on ABI) in the entire population. If ABI ≤0.90 was encompassed in the definition of vascular disease of CHA2DS2-VASc score the prevalence of vascular disease increased in every risk class. Inclusion of ABI ≤0.90 in the CHA2DS2-VASc score allowed us to better define the risk profile of NVAF patients with an up-grading of the risk score in each CHA2DS2-VASc score category. This may have important therapeutic implications if the new score could be tested prospectively, as a higher number of NVAF patients would potentially be candidates for an anticoagulant treatment by measuring ABI. A prospective study is, therefore, necessary to validate the risk score of this new definition of vascular disease. In conclusion, this study provides the first evidence that one-fifth of NVAF patients had an ABI ≤0.90, indicating that it may represent a simple and cheap method to better define the prevalence of vascular disease in NVAF.

Published
2013

6. The importance of patients’ case-mix for the correct interpretation of the hospital fatality rate in COVID-19 disease

Author

Antonella d’Arminio Monforte, Alessandro Tavelli, Francesca Bai, Daniele Tomasoni, Camilla Falcinella, Roberto Castoldi, Diletta Barbanotti, Giovanni Mulè, Marina Allegrini, Daniele Tesoro, Gianmarco Tagliaferri, Debora Mondatore, Matteo Augello, Andrea Cona, Giuseppe Ancona, Lidia Gazzola, Nathalie Iannotti, Camilla Tincati, Ottavia Viganò, Anna De Bona, Teresa Bini, Alessandro Cozzi-Lepri, and Giulia Marchetti

Subjects
Lombardy, Outbreak dynamics, COVID-19, In-hospital fatality rate, Long-term care facilities, Infectious and parasitic diseases, RC109-216
Abstract

Objective: We aimed to document data on the epidemiology and factors associated with clinical course leading to death of patients hospitalised with COVID-19. Methods: Prospective observational cohort study on patients hospitalised with COVID-19 disease in February-24th/May-17th 2020 in Milan, Italy. Uni-multivariable Cox regression analyses were performed. Death’s percentage by two-weeks’ intervals according to age and disease severity was analysed. Results: A total of 174/539 (32.3%) patients died in hospital over 8228 person-day follow-up; the 14-day Kaplan–Meier probability of death was 29.5% (95%CI: 25.5–34.0). Older age, burden of comorbidities, COVID-19 disease severity, inflammatory markers at admission were independent predictors of increased risk, while several drug-combinations were predictors of reduced risk of in-hospital death. The highest fatality rate, 36.5%, occurred during the 2nd–3rd week of March, when 55.4% of patients presented with severe disease, while a second peak, by the end of April, was related to the admission of older patients (55% ≥80 years) with less severe disease, 30% coming from long-term care facilities. Conclusions: The unusual fatality rate in our setting is likely to be related to age and the clinical conditions of our patients. These findings may be useful to better allocate resources of the national healthcare system, in case of re-intensification of COVID-19 epidemics.

Published
2020
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7. A Quantitative Estimate of the Expected Shortening of the Median Isolation Period of Patients With COVID-19 After the Adoption of a Symptom-Based Strategy

Author

Francesca Bai, Alessandro Tavelli, Giovanni Mulè, Camilla Falcinella, Debora Mondatore, Daniele Tesoro, Diletta Barbanotti, Daniele Tomasoni, Roberto Castoldi, Matteo Augello, Marina Allegrini, Gianmarco Tagliaferri, Andrea Cona, Alessandro Cozzi-Lepri, Giulia Marchetti, and Antonella d'Arminio Monforte

Subjects
COVID-19, SARS CoV-2, molecular diagnosis, isolation and quarantine, criteria for releasing COVID-19 patients from isolation, Public aspects of medicine, RA1-1270
Abstract

A long period of isolation was observed in patients hospitalized for COVID-19 in Milan over March-September 2020 (45; IQR: 37–54 days). A significantly shorter period would have been observed by the application of May-WHO (22, IQR: 17–30 days, P < 0.001) and October-Italian (26, IQR: 21–34 days, P < 0.001) Guidelines. The adoption of the new symptom-based criteria is likely to lead to a significant reduction in the length of the isolation period with potential social, economic and psychological benefits, particularly in the younger population with mild/moderate disease and no comorbidities. In our opinion, the release from isolation after 21 days from symptoms onset, even without a PCR diagnostic test, in most cases seems the most adequate strategy that could balance precautions to prevent SARS CoV-2 transmission and unnecessary prolonged isolation or overuse of diagnostic testing.

Published
2021
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8. Aortic Stiffness in HIV Infection with and without Antiretroviral Therapy. A Meta-analysis of Observational Studies

Author

Giovanni Mulè, Giuseppe Mulè, Valeria Tranchida, Pietro Colletti, Giovanni Mazzola, Marcello Trizzino, Claudia Colomba, and Antonio Cascio

Subjects
HIV infection, cardiovascular risk, pulse wave velocity, aortic stiffness, Specialties of internal medicine, RC581-951, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: The risk of Cardiovascular (CV) events is higher in HIV-infected patients (HIV+) compared to HIV-uninfected persons (HIV−). Large artery stiffness, a well-documented predictor of adverse CV prognosis, may mediate this enhanced risk. It is usually assessed by measuring aortic Pulse Wave Velocity (aPWV). Studies examining arterial stiffness in HIV+ yielded inconsistent results. We performed a meta-analysis with the aim to evaluate the association of HIV infection and its therapy [Antiretroviral Therapy (ART)] with aPWV. Design and Method: The Standardized Mean Difference (SMD) and corresponding 95% confidence intervals were calculated for aPWV in different comparison groups. Statistical heterogeneity, assessed by Q-test and I2 statistic, was observed in all these comparisons. Therefore, random effects model was implemented. Results: In a total of 12 studies, naive HIV+ (n = 547) showed increased aPWV compared to HIV− (n = 864): SMD = 0.333 (0.125–0.542), p < 0.002. A total of 22 studies were identified comparing HIV+ treated with ART (n = 3348) to HIV− (n = 2547) showing higher values of aPWV in the former than in latter: SMD = 0.391 (0.225–0.556), p < 0.001. In 10 studies, HIV+ treated with ART (n = 761) exhibited greater aPWV values than those of naive HIV+ (n = 457): SMD = 0.262 (0.006–0.518), p = 0.045. Conclusion: Our meta-analysis seems to suggest that HIV infection “per se” and ART may impair aortic distensibility. However, interpretation of our results needs caution due to between-study heterogeneity and some potential publication biases.

Published
2020
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9. Declining Mortality Rate of Hospitalised Patients in the Second Wave of the COVID-19 Epidemics in Italy: Risk Factors and the Age-Specific Patterns

Author

Antonella D’Arminio Monforte, Alessandro Tavelli, Francesca Bai, Daniele Tomasoni, Camilla Falcinella, Roberto Castoldi, Diletta Barbanotti, Giovanni Mulè, Marina Allegrini, Elisa Suardi, Daniele Tesoro, Gianmarco Tagliaferri, Debora Mondatore, Matteo Augello, Andrea Cona, Tomaso Beringheli, Nicole Gemignani, Matteo Sala, Benedetta Varisco, Francesco Molà, Sofia Pettenuzzo, Lorenzo Biasioli, Alessandro Copes, Lidia Gazzola, Ottavia Viganò, Camilla Tincati, Anna De Bona, Teresa Bini, and Giulia Marchetti

Subjects
COVID-19, hospitalised patients, age, in-hospital mortality rate, first and second wave of epidemics, Science
Abstract

Background: Mortality rate from COVID-19 in Italy is among the world’s highest. We aimed to ascertain whether there was any reduction of in-hospital mortality in patients hospitalised for COVID-19 in the second-wave period (October 2020–January 2021) compared to the first one (February–May 2020); further, we verified whether there were clusters of hospitalised patients who particularly benefitted from reduced mortality rate. Methods: Data collected related to in-patients’ demographics, clinical, laboratory, therapies and outcome. Primary end-point was time to in-hospital death. Factors associated were evaluated by uni- and multivariable analyses. A flow diagram was created to determine the rate of in-hospital death according to individual and disease characteristics. Results: A total of 1561 patients were included. The 14-day cumulative incidence of in-hospital death by competing risk regression was of 24.8% (95% CI: 21.3–28.5) and 15.9% (95% CI: 13.7–18.2) in the first and second wave. We observed that the highest relative reduction of death from first to second wave (more than 47%) occurred mainly in the clusters of patients younger than 70 years. Conclusions: Progress in care and supporting therapies did affect population over 70 years to a lesser extent. Preventive and vaccination campaigns should focus on individuals whose risk of death from COVID-19 remains high.

Published
2021
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10. Frequency of Left Ventricular Hypertrophy in Non-Valvular Atrial Fibrillation

Author

Proietti M, Marra AM, Tassone EJ, De Vuono S, Corrao S, Gobbi P, Perticone F, Corazza GR, Basili S, Lip GY, Violi F, Raparelli V, ARAPACIS Study Investigators, GIS Group, Alessandri Cesare, Serviddio Gaetano, Fascetti Stefano, Serra Pietro, Palange Paolo, Greco Eleonora, Bruno Graziella, Averna Maurizio, Giammanco Antonina, Sposito Pietro, De Cristofaro Raimondo, De Gennaro Leonardo, Loria Paola, Pellegrini Elisa, Cominacini Luciano, Mozzini Chiara, Sprovieri Mario, Spagnuolo Vitaliano, Cerqua Giannantonio, Cerasola Giovanni, Mulé Giuseppe, Barbagallo Mario, Lo Sciuto Salvatore, Monteverde Alfredo, Saitta Antonino, Lo Gullo Alberto, Malatino Lorenzo, Cilia Chiara, Licata Giuseppe, Tuttolomondo Antonino, Conigliaro Roberta, Pinto Antonio, Di Raimondo Domenico, Signorelli Santo, Anzaldi Massimiliano, De Palma Daniela, Galderisi Maurizio, Cudemo Giuseppe, Galletti Ferruccio, Fazio Valeria, De Luca Nicola, Meccariello Alfonso, Caputo Dario, De Donato Maria Teresa, Iannuzi Arcangelo, Bresciani Alessandro, Giunta Riccardo, Cimini Claudia, Durante Mangoni Emanuele, Agrusta Federica, Iorio Federica, Adinolfi Luigi E, Sellitto Ausilia, Restivo Luciano, Bellis Paolo, Tirelli Paolo, Sacerdoti David, Pesce Paola, Vanni Dino, Iuliano Luigi, Ciacciarelli Marco, Pacelli Antonio, Palazzuoli Alberto, Cacciafesta Mauro, Gueli Nicola, Capeci William, Tarquinio Nicola, Pellegrini Francesco, Vincentelli Giovanni Maria, Ravallese Ferdinando, Santini Claudio, Letizia Claudio, Petramala Luigi, Zinnamosca Laura, Cilli Mirella, Savoriti Claudio, Falaschi Paolo, Martocchia Antonio, Stefanelli Manuela, Marigliano Vincenzo, Lo Iacono Cristina, Brusco Simona, Bertazzoni Giuliano, Attalla El Halabieh Elias, Paradiso Michele, Lizzi Eugenio Maria, Timmi Stefano, Battisti Paola, Cerci Sabina, Ciavolella Massimo, Di Veroli Claudio, Malci Francesco, De Ciocchis Anita, Abate Damiano, Castellino Pietro, Curto Irene, Vecchio Claudia, Mannarino Elmo, Pasqualini Leonella, Fattori Chiara, Pende Aldo, Denegri Andrea, Artom Nathan, Ricchio Roberto, Fimognari Filippo Luca, Alletto Maurizio, Messina Simona, Sesti Giorgio, Arturi Franco, Grembiale Alessandro, Perticone Francesco, Maio Raffaele, Scarpino Paola Elisa, Carullo Giuseppe, Sciacqua Angela, Frugiuele Pierluigi, Battaglia Giuseppe, Vidili Gianpaolo, Atzori Sebastiana, Delitala Giuseppe, Davì Giovanni, Angelucci Ermanno, Sestili Simona, Traisci Giancarlo, De Feudis Lucrezia, Di Michele Dario, Fava Alessandra, Balsano Clara, De Ciantis Pierpaolo, Desideri Giovambattista, Camerota Antonio, Migliacci Rino, Porciello Giovanni, Mezzetti Matteo, Gresele Paolo, Vedovati Cristina, Fierro Tiziana, Puccetti Luca, Scarpini Francesca, Bertolotti Marco, Mussi Chiara, Boddi Maria, Savino Andrea, Contri Silvia, Saller Alois, Fabris Fabrizio, Pesavento Raffaele, Filippi Lucia, Vedovetto Valentina, Puato Massimo, Treleani Martina, De Luca Elisabetta, De Zaiacomo Francesca, Giantin Valter, Semplicini Andrea, Minuz Pietro, Calabria Stefano, Romano Simone, Fantin Francesco, Manica Angela, Stockner Ingrid, Pattis Peter, Gutmann Bernhard, Catena Cristiana, Colussi GianLuca, Annoni Giorgio, Bruni Adriana Antonella, Castagna Alberto, Spinelli Diana, Corazza Gino Roberto, Miceli Emanuela, Padula, Schinco Giuseppina, Spreafico Sibilla, Secchi Beatrice, Vanoli Massimo, Casella Gianluca, Serra Maria Grazia, Longo Stefania, Antonaci Salvatore, Belfiore Anna, Ricci Lara, Ventrella Francesco, Iamele Luigi, Bianco Cesare, Santovito Donato, Cipollone Francesco, Nicolai Salvatore, Salvati Filippo, Rini Giovan Battista, Scozzari Francesca, Muiesan Maria Lorenza, Salvetti Massimo, Bazza Abramo, Picardi Antonio, De Vincentis Antonio, Cosio Paolo, Terzolo Massimo, Madaffari Bruno, Parasporo Bruno, Fenoglio Luigi, Bracco Christian, Melchio Remo, Gentili Tamira, Salvi Aldo, Nitti Cinzia, Falsetti L, Gabrielli Armando, Paglione Ivano, Capucci Alessandro, Brambatti Michela, Sparagna Armando, Tirotta Daniela, Andreozzi Paola, Ettorre Evaristo, Viscogliosi Giovanni, Rossi Fanelli Fillippo, Delfino Massimo, Glorioso Nicola, Melis Giada, Marras Gianfranca, Matta Michela, Sacco Andrea, Stellitano Elio, Scordo Anna, Russo Franco, Caruso Assunta Antonietta, Porreca Ettore, Santilli Francesca, Tana Marco, Ferri Claudio, Grassi Davide, Cheli Paola, Portincasa Piero, Muscianisi Giuseppe, Giordani Sara, Stanghellini Vincenzo, Sabbà Carlo, Suppressa Patrizia, Mancuso Gerardo, Bartone Mosè, Calipari Daniela, Arcidiacono Giuseppe, Bellanuova Ignazio, Ferraro Maria, Scalzo Antonio, Marigliano Giampietro, Cozzolino Domenico, Lampitella Antonio, Acri Vera, Galasso Domenico, Mazzei Francesca, Galasso Salvatore, Buratti Alberto, Porta Massimo, Brizzi Maria Felice, Fattorini Annalisa, Sampietro Francesca, D’Angelo Armando, Pala Marco, Fabbian Fabio, Manfredini Roberto, Moroni Carlo, Valente Lucia, Lopreiato Francesco, Parente Fernando, Moia Marco, Braham Simon, Rossi Marco, Pesce Margherita, Gentile Adelina, Catozzo Vania, Di Napoli Mariarosaria, Baciarello Giacinto, Rancan Elena, Ageno Walter, Guasti Luigina, Ciccaglioni Antonio, Negri Silvia, Polselli Marco, Abbate Rosanna, Marcucci Rossella, Cangemi Roberto, Pignataro Francesca Serena, Marco Proietti, Pastori Daniele, Ferro Domenico, Loffredo Lorenzo, Perri Ludovica, Catasca Elisa, Raparelli Valeria, Napoleone Laura, Talerico Giovanni, Calvieri Camilla, Vicario Tommasa, Russo Roberta, Saliola Mirella, Del Ben Maria, Angelico Francesco, Bucci Tommaso, Baratta Francesco, DATA AND SAFETY MONITORING BOARD (DSMB): Vestri Anna Rita, Farcomeni Alessio, Di Tanna Gianluca, STUDY COORDINATORS: Basili Stefania, Davi’ Giovanni, STEERING COMMITTEE OF ARAPACIS STUDY: Violi Francesco, Lip Gregory YH, Hiatt William R, Vestri Anna Rita, Mannucci Pier Mannuccio, Proietti Marco, Bazzini Cristina, Bianchi Paola Ilaria, Boari Benedetta, Buonauro Agostino, Buttà Carmelo, Buzzetti Elena, Carleo Pietro, Carrabba Maria Domenica, Castorani Luigi, Cecchetto Lara, Colombo Barbara Maria, De Giorgi Alfredo, De Vuono Stefano, Del Corso Lisette, Di Giosia Paolo, Falsetti Lorenzo, Forgione Alessandra, Hijazi Daniel, Lorusso Giusi, Marra Alberto Maria, Masala Maristella, Montebianco Abenavoli Ludovico, Murgia Giuseppe, Naccarato Paola, Pattoneri Paolo, Perego Francesca, Pinto Daniela, Pinna Miriam Pretti Vincenzo, Pucci Giacomo, Salinaro Francesco, Sirico Domenico, Tassone Eliezer Joseph, Torres Daniele, Vazzana Natale, Vecchio Claudia Rita, Vitale Francesco, Proietti M, Marra AM, Tassone EJ, De Vuono S, Corrao S, Gobbi P, Perticone F, Corazza GR, Basili S, Lip GY, Violi F, Raparelli V, ARAPACIS Study Investigators, GIS Group, Alessandri Cesare, Serviddio Gaetano, Fascetti Stefano, Serra Pietro, Palange Paolo, Greco Eleonora, Bruno Graziella, Averna Maurizio, Giammanco Antonina, Sposito Pietro, De Cristofaro Raimondo, De Gennaro Leonardo, Loria Paola, Pellegrini Elisa, Cominacini Luciano, Mozzini Chiara, Sprovieri Mario, Spagnuolo Vitaliano, Cerqua Giannantonio, Cerasola Giovanni, Mulé Giuseppe, Barbagallo Mario, Lo Sciuto Salvatore, Monteverde Alfredo, Saitta Antonino, Lo Gullo Alberto, Malatino Lorenzo, Cilia Chiara, Licata Giuseppe, Tuttolomondo Antonino, Conigliaro Roberta, Pinto Antonio, Di Raimondo Domenico, Signorelli Santo, Anzaldi Massimiliano, De Palma Daniela, Galderisi Maurizio, Cudemo Giuseppe, Galletti Ferruccio, Fazio Valeria, De Luca Nicola, Meccariello Alfonso, Caputo Dario, De Donato Maria Teresa, Iannuzi Arcangelo, Bresciani Alessandro, Giunta Riccardo, Cimini Claudia, Durante Mangoni Emanuele, Agrusta Federica, Iorio Federica, Adinolfi Luigi E, Sellitto Ausilia, Restivo Luciano, Bellis Paolo, Tirelli Paolo, Sacerdoti David, Pesce Paola, Vanni Dino, Iuliano Luigi, Ciacciarelli Marco, Pacelli Antonio, Palazzuoli Alberto, Cacciafesta Mauro, Gueli Nicola, Capeci William, Tarquinio Nicola, Pellegrini Francesco, Vincentelli Giovanni Maria, Ravallese Ferdinando, Santini Claudio, Letizia Claudio, Petramala Luigi, Zinnamosca Laura, Cilli Mirella, Savoriti Claudio, Falaschi Paolo, Martocchia Antonio, Stefanelli Manuela, Marigliano Vincenzo, Lo Iacono Cristina, Brusco Simona, Bertazzoni Giuliano, Attalla El Halabieh Elias, Paradiso Michele, Lizzi Eugenio Maria, Timmi Stefano, Battisti Paola, Cerci Sabina, Ciavolella Massimo, Di Veroli Claudio, Malci Francesco, De Ciocchis Anita, Abate Damiano, Castellino Pietro, Curto Irene, Vecchio Claudia, Mannarino Elmo, Pasqualini Leonella, Fattori Chiara, Pende Aldo, Denegri Andrea, Artom Nathan, Ricchio Roberto, Fimognari Filippo Luca, Alletto Maurizio, Messina Simona, Sesti Giorgio, Arturi Franco, Grembiale Alessandro, Perticone Francesco, Maio Raffaele, Scarpino Paola Elisa, Carullo Giuseppe, Sciacqua Angela, Frugiuele Pierluigi, Spagnuolo Vitaliano, Battaglia Giuseppe, Vidili Gianpaolo, Atzori Sebastiana, Delitala Giuseppe, Davì Giovanni, Angelucci Ermanno, Sestili Simona, Traisci Giancarlo, De Feudis Lucrezia, Di Michele Dario, Fava Alessandra, Balsano Clara, De Ciantis Pierpaolo, Desideri Giovambattista, Camerota Antonio, Migliacci Rino, Porciello Giovanni, Mezzetti Matteo, Gresele Paolo, Vedovati Cristina, Fierro Tiziana, Puccetti Luca, Scarpini Francesca, Bertolotti Marco, Mussi Chiara, Boddi Maria, Savino Andrea, Contri Silvia, Saller Alois, Fabris Fabrizio, Pesavento Raffaele, Filippi Lucia, Vedovetto Valentina, Puato Massimo, Fabris Fabrizio, Treleani Martina, De Luca Elisabetta, De Zaiacomo Francesca, Giantin Valter, Semplicini Andrea, Minuz Pietro, Calabria Stefano, Romano Simone, Fantin Francesco, Manica Angela, Stockner Ingrid, Pattis Peter, Gutmann Bernhard, Catena Cristiana, Colussi GianLuca, Annoni Giorgio, Bruni Adriana Antonella, Castagna Alberto, Spinelli Diana, Corazza Gino Roberto, Miceli Emanuela, Padula, Schinco Giuseppina, Spreafico Sibilla, Secchi Beatrice, Vanoli Massimo, Casella Gianluca, Serra Maria Grazia, Longo Stefania, Antonaci Salvatore, Belfiore Anna, Ricci Lara, Ventrella Francesco, Iamele Luigi, Bianco Cesare, Santovito Donato, Cipollone Francesco, Nicolai Salvatore, Salvati Filippo, Rini Giovan Battista, Scozzari Francesca, Muiesan Maria Lorenza, Salvetti Massimo, Bazza Abramo, Picardi Antonio, De Vincentis Antonio, Cosio Paolo, Terzolo Massimo, Madaffari Bruno, Parasporo Bruno, Fenoglio Luigi, Bracco Christian, Melchio Remo, Gentili Tamira, Salvi Aldo, Nitti Cinzia, Falsetti L, Gabrielli Armando, Paglione Ivano, Capucci Alessandro, Brambatti Michela, Sparagna Armando, Tirotta Daniela, Andreozzi Paola, Ettorre Evaristo, Viscogliosi Giovanni, Rossi Fanelli Fillippo, Delfino Massimo, Glorioso Nicola, Melis Giada, Marras Gianfranca, Matta Michela, Sacco Andrea, Stellitano Elio, Scordo Anna, Russo Franco, Caruso Assunta Antonietta, Porreca Ettore, Santilli Francesca, Tana Marco, Ferri Claudio, Grassi Davide, Cheli Paola, Portincasa Piero, Muscianisi Giuseppe, Giordani Sara, Stanghellini Vincenzo, Sabbà Carlo, Suppressa Patrizia, Mancuso Gerardo, Bartone Mosè, Calipari Daniela, Arcidiacono Giuseppe, Bellanuova Ignazio, Ferraro Maria, Scalzo Antonio, Marigliano Giampietro, Cozzolino Domenico, Lampitella Antonio, Acri Vera, Galasso Domenico, Mazzei Francesca, Galasso Salvatore, Buratti Alberto, Porta Massimo, Brizzi Maria Felice, Fattorini Annalisa, Sampietro Francesca, D’Angelo Armando, Pala Marco, Fabbian Fabio, Manfredini Roberto, Moroni Carlo, Valente Lucia, Lopreiato Francesco, Parente Fernando, Moia Marco, Braham Simon, Rossi Marco, Pesce Margherita, Gentile Adelina, Catozzo Vania, Di Napoli Mariarosaria, Baciarello Giacinto, Rancan Elena, Ageno Walter, Guasti Luigina, Ciccaglioni Antonio, Negri Silvia, Polselli Marco, Abbate Rosanna, Marcucci Rossella, Cangemi Roberto, Pignataro Francesca Serena, Marco Proietti, Pastori Daniele, Ferro Domenico, Loffredo Lorenzo, Perri Ludovica, Catasca Elisa, Raparelli Valeria, Napoleone Laura, Talerico Giovanni, Calvieri Camilla, Vicario Tommasa, Russo Roberta, Saliola Mirella, Del Ben Maria, Angelico Francesco, Bucci Tommaso, Baratta Francesco, DATA AND SAFETY MONITORING BOARD (DSMB): Vestri Anna Rita, Farcomeni Alessio, Di Tanna Gianluca, STUDY COORDINATORS: Basili Stefania, Davi’ Giovanni, STEERING COMMITTEE OF ARAPACIS STUDY: Violi Francesco, Perticone Francesco, Lip Gregory YH, Hiatt William R, Vestri Anna Rita, Corazza Gino Roberto, Mannucci Pier Mannuccio, Licata Giuseppe, Moroni Carlo, Proietti Marco, Anzaldi Massimiliano, Bazzini Cristina, Bianchi Paola Ilaria, Boari Benedetta, Bracco Christian, Buonauro Agostino, Buttà Carmelo, Buzzetti Elena, Calabria Stefano, Capeci William, Carleo Pietro, Carrabba Maria Domenica, Castorani Luigi, Cecchetto Lara, Cimini Claudia, Colombo Barbara Maria, De Giorgi Alfredo, De Vuono Stefano, Denegri Andrea, Del Corso Lisette, Di Giosia Paolo, Durante Mangoni Emanuele, Falsetti Lorenzo, Forgione Alessandra, Grassi Davide, Grembiale Alessandro, Hijazi Daniel, Iamele Luigi, Lorusso Giusi, Marra Alberto Maria, Masala Maristella, Montebianco Abenavoli Ludovico, Murgia Giuseppe, Naccarato Paola, Pattoneri Paolo, Perego Francesca, Pesce Paola, Petramala Luigi, Pinto Daniela, Pinna Miriam Pretti Vincenzo, Pucci Giacomo, Raparelli Valeria, Salinaro Francesco, Santilli Francesca, Scarpini Francesca, Sirico Domenico, Suppressa Patrizia, Tassone Eliezer Joseph, Torres Daniele, Vazzana Natale, Vecchio Claudia Rita, Vidili Gianpaolo, Vitale Francesco, Proietti, M., Marra, A., Tassone, E., De Vuono, S., Corrao, S., Gobbi, P., Perticone, F., Corazza, G., Basili, S., Lip, G., Violi, F., Raparelli, V., Marra, A. M., Tassone, E. J., Corazza, G. R., and Lip, G. Y. H.

Subjects
Registrie, Male, Cross-sectional study, Myocardial Infarction, Longitudinal Studie, Left ventricular hypertrophy, Cohort Studies, non-valvular atrial fibrillation, Atrial Fibrillation, 80 and over, Prevalence, echocardiography, Myocardial infarction, Longitudinal Studies, Prospective Studies, Registries, Prospective cohort study, Ultrasonography, Aged, 80 and over, education.field_of_study, Medicine (all), Atrial fibrillation, Diabetes Mellitu, Middle Aged, Left Ventricular, left ventricular hypertrophy, Italy, Hypertension, Cardiology, Age Distribution, Aged, Ankle Brachial Index, Cross-Sectional Studies, Diabetes Mellitus, Female, Humans, Hypertrophy, Left Ventricular, Logistic Models, Peripheral Arterial Disease, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, Logistic Model, Population, Concentric hypertrophy, Socio-culturale, non-valvular atrial fibrillation, left ventricular hypertrophy, echocardiography, cardiovascular diseases, Internal medicine, medicine, cardiovascular diseases, education, Cross-Sectional Studie, business.industry, Odds ratio, Hypertrophy, medicine.disease, Prospective Studie, Cohort Studie, business
Abstract

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 ± 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index ≤0.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc ≥2 seen in 93% of LVH and in 73% of patients without LVH (p

Published
2015
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