25 results on '"I. Franzoni"'
Search Results
2. 039 Outcomes following unprotected left main stenting with first vs second generation drug-eluting stents: the Milan experience
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S Ferrarello, Alessandro Colombo, I Franzoni, Alfonso Ielasi, Mauro Carlino, Gill Louise Buchanan, Filippo Figini, Chiara Bernelli, Matteo Montorfano, M Slavich, F M Sacco, and Azeem Latib
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Target lesion ,medicine.medical_specialty ,Ejection fraction ,Everolimus ,Interventional cardiology ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,Stent ,Surgery ,Intravascular ultrasound ,medicine ,Cardiology and Cardiovascular Medicine ,business ,Mace ,medicine.drug - Abstract
Background Second-generation drug-eluting stents (DES) are said to be more safe and effective. Our aim was to assess clinical outcomes following first- vs second-generation DES implantation in patients undergoing unprotected left main (ULMCA) percutaneous coronary intervention. Methods All consecutive patients from our single-center prospective registry treated for ULMCA with DES implantation from January 2005 to November 2010 were analysed. The study endpoint was major adverse cardiac event (MACE) defined as all-cause mortality, target lesion revascularisation (TLR), and target vessel revascularisation (TVR) at clinical follow-up. Results A total of 179 patients were included: mean age 66.5±12.7 years and 83.2% were male with mean left ventricular ejection fraction 54.6±8.4% and SYNTAX score 23.3±31.2. The median follow-up was 705.5 days (IQR 339.8–1168.0). First-generation DES were used in 53.1% (of which 51.6% were sirolimus and paclitaxel 48.4%) and 46.9% had second-generation DES (85.7% everolimus; 11.9% zotorolimus; 2.4% biolimus). Interestingly, there were more patients with diabetes treated with first-generation (30.5% vs 14.3%; p=0.023). Regarding the procedure, intravascular ultrasound guidance was similar between first and second-generation (respectively 47.4% vs 59.5%; p=0.130). There were more patients in the first-generation group with distal ULMCA disease (82.1% vs 67.9%; p=0.064). At follow-up, there was a significant difference in MACE favouring second-generation (30.5% vs 19.0%; p=0.047), most related to a reduction in the TLR (13.7% vs 4.8%; p=0.026) and TVR (24.2% vs 14.3%; p=0.031). However, there was no difference in all-cause mortality (10.5% vs 7.1%; p=0.138) with a trend for increased cardiovascular mortality in those treated by first-generation (8.4% vs 2.4%; p=0.082). Moreover, there was no difference in definite/probable stent thromboses (5.3% vs 2.4%; p=0.114). Conclusions Second-generation DES have improved results with regards to MACE at mid-term follow-up, perhaps secondary to patient selection. This needs to be confirmed at longer-term follow-up.
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- 2012
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3. Discovery and Characterization of a Chemical Probe Targeting the Zinc-Finger Ubiquitin-Binding Domain of HDAC6.
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Harding RJ, Franzoni I, Mann MK, Szewczyk MM, Mirabi B, Ferreira de Freitas R, Owens DDG, Ackloo S, Scheremetjew A, Juarez-Ornelas KA, Sanichar R, Baker RJ, Dank C, Brown PJ, Barsyte-Lovejoy D, Santhakumar V, Schapira M, Lautens M, and Arrowsmith CH
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- Histone Deacetylase 6, Histone Deacetylase Inhibitors pharmacology, Protein Binding, Zinc Fingers, Ubiquitin metabolism, Ubiquitins
- Abstract
Histone deacetylase 6 (HDAC6) inhibition is an attractive strategy for treating numerous cancers, and HDAC6 catalytic inhibitors are currently in clinical trials. The HDAC6 zinc-finger ubiquitin-binding domain (UBD) binds free C-terminal diglycine motifs of unanchored ubiquitin polymer chains and protein aggregates, playing an important role in autophagy and aggresome assembly. However, targeting this domain with small molecule antagonists remains an underdeveloped avenue of HDAC6-focused drug discovery. We report SGC-UBD253 ( 25 ), a chemical probe potently targeting HDAC6-UBD in vitro with selectivity over nine other UBDs, except for weak USP16 binding. In cells, 25 is an effective antagonist of HDAC6-UBD at 1 μM, with marked proteome-wide selectivity. We identified SGC-UBD253N ( 32 ), a methylated derivative of 25 that is 300-fold less active, serving as a negative control. Together, 25 and 32 could enable further exploration of the biological function of the HDAC6-UBD and investigation of the therapeutic potential of targeting this domain.
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- 2023
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4. Photoredox Activation of Anhydrides for the Solvent-Controlled Switchable Synthesis of gem-Difluoro Compounds.
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Giri R, Mosiagin I, Franzoni I, Nötel NY, Patra S, and Katayev D
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- Lactams, Lactones, Solvents, Alkenes, Anhydrides
- Abstract
The incorporation of the gem-difluoromethylene (CF
2 ) group into organic frameworks is highly sought due to the influence of this unit on the physicochemical and pharmacological properties of molecules. Herein we report an operationally simple, mild, and switchable protocol to access various gem-difluoro compounds that employs chlorodifloroacetic anhydride (CDFAA) as a low-cost and versatile fluoroalkylating reagent. Detailed mechanistic studies revealed that electron-transfer photocatalysis triggers mesolytic cleavage of a C-Cl bond generating a gem-difluoroalkyl radical. In the presence of alkene, this radical species acts as a unique intermediate that, under solvent-controlled reaction conditions, delivers a wide range of gem-difluorinated γ-lactams, γ-lactones, and promotes oxy-perfluoroalkylation. These protocols are flow- and batch-scalable, possess excellent chemo- and regioselectivity, and can be used for the late-stage diversification of complex molecules., (© 2022 The Authors. Angewandte Chemie International Edition published by Wiley-VCH GmbH.)- Published
- 2022
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5. Enantioselective Total Synthesis of Hyperforin and Pyrohyperforin.
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Ji Y, Hong B, Franzoni I, Wang M, Guan W, Jia H, and Li H
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- Lithium, Stereoisomerism, Phloroglucinol analogs & derivatives, Terpenes
- Abstract
Capitalizing on the late-stage diversification of an essential 1,3-diene intermediate, we describe herein a 9-step enantioselective total synthesis of (+)-hyperforin and (+)-pyrohyperforin, starting from commercially available allylacetone. Our convergent synthesis features a series of critical reactions: 1) an enantioselective deconjugative α-alkylation of α,β-unsaturated acid using chiral lithium amides as noncovalent stereodirecting auxiliaries; 2) a HfCl
4 -mediated carbonyl α-tert-alkylation to forge the intricate bicyclo[3.3.1]nonane framework; 3) an abiotic cascade pyran formation; and 4) a selective 1,4-semihydrogenation of polyenes. During the course of our synthesis, we also identified a 1,2-cyclopropanediol overbred intermediate which was responsible for the 1,3-diene precursor formation through a controlled fragmentation., (© 2022 Wiley-VCH GmbH.)- Published
- 2022
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6. Dearomative Cyclopropanation of Naphthols via Cyclopropene Ring-Opening.
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Baker RJ, Ching J, Hou TR, Franzoni I, and Lautens M
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The dearomatization of 2-naphthols represents a simple method for the construction of complex 3D structures from simple planar starting materials. We describe a cyclopropanation of 2-naphthols that proceeds via cyclopropene ring-opening using rhodium and acid catalysis under mild conditions. The vinyl cyclopropane molecules were formed with high chemoselectivity and scalability, which could be further functionalized at different sites. Both computational and experimental evidence were used to elucidate the reaction mechanism., (© 2021 Wiley-VCH GmbH.)
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- 2022
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7. Enantioselective Total Synthesis of Berkeleyone A and Preaustinoids.
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Zhang Y, Ji Y, Franzoni I, Guo C, Jia H, Hong B, and Li H
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Herein we report the first enantioselective total synthesis of 3,5-dimethylorsellinic acid-derived meroterpenoids (-)-berkeleyone A and its five congeners ((-)-preaustinoids A, A1, B, B1, and B2) in 12-15 steps, starting from commercially available 2,4,6-trihydroxybenzoic acid hydrate. Based upon the recognition of latent symmetry within D-ring, our convergent synthesis features two critical reactions: 1) a symmetry-breaking, diastereoselective dearomative alkylation to assemble the entire carbon core, and 2) a Sc(OTf)
3 -mediated sequential Krapcho dealkoxycarbonylation/carbonyl α-tert-alkylation to forge the intricate bicyclo[3.3.1]nonane framework. We also conducted our preliminary biomimetic investigations and uncovered a series of rearrangements (α-ketol, α-hydroxyl-β-diketone, etc.) responsible for the biomimetic diversification of (-)-berkeleyone A into its five preaustinoid congeners., (© 2021 Wiley-VCH GmbH.)- Published
- 2021
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8. Discovery of Small Molecule Antagonists of the USP5 Zinc Finger Ubiquitin-Binding Domain.
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Mann MK, Franzoni I, de Freitas RF, Tempel W, Houliston S, Smith L, Vedadi M, Arrowsmith CH, Harding RJ, and Schapira M
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- Binding Sites, Crystallography, X-Ray, Dose-Response Relationship, Drug, Drug Evaluation, Preclinical methods, Endopeptidases chemistry, Endopeptidases genetics, Magnetic Resonance Spectroscopy, Protein Domains, Small Molecule Libraries pharmacology, Structure-Activity Relationship, Surface Plasmon Resonance, Zinc Fingers, Endopeptidases metabolism, Protease Inhibitors chemistry, Protease Inhibitors pharmacology, Small Molecule Libraries chemistry, Ubiquitin metabolism
- Abstract
USP5 disassembles unanchored polyubiquitin chains to recycle free monoubiquitin, and is one of the 12 ubiquitin specific proteases featuring a zinc finger ubiquitin-binding domain (ZnF-UBD). This distinct structural module has been associated with substrate positioning or allosteric modulation of catalytic activity, but its cellular function remains unclear. We screened a chemical library focused on the ZnF-UBD of USP5, crystallized hits in complex with the protein, and generated a preliminary structure-activity relationship, which enables the development of more potent and selective compounds. This work serves as a framework for the discovery of a chemical probe to delineate the function of USP5 ZnF-UBD in proteasomal degradation and other ubiquitin signaling pathways in health and disease.
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- 2019
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9. Palladium-Catalyzed Hydride Addition/C-H Bond Activation Cascade: Cycloisomerization of 1,6-Diynes.
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Rodríguez JF, Burton KI, Franzoni I, Petrone DA, Scheipers I, and Lautens M
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The use of ammonium halide salts as metal hydride precursors in a new Pd-catalyzed cycloisomerization of 1,6-diynes, which affords unexplored silylated 2-azafluorenes, is reported. This cascade process includes the addition of a Pd-hydride species to a π-system, intramolecular carbopalladation, and C(sp
2 )-H bond activation. A variety of functional groups are tolerated, and the synthetic utility of the resulting products has been demonstrated by a series of derivatizations.- Published
- 2018
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10. Radical Trifluoromethoxylation of Arenes Triggered by a Visible-Light-Mediated N-O Bond Redox Fragmentation.
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Jelier BJ, Tripet PF, Pietrasiak E, Franzoni I, Jeschke G, and Togni A
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A simple trifluoromethoxylation method enables non-directed functionalization of C-H bonds on a range of substrates, providing access to aryl trifluoromethyl ethers. This light-driven process is distinctly different from conventional procedures and occurs through an OCF
3 radical mechanism mediated by a photoredox catalyst, which triggers an N-O bond fragmentation. The pyridinium-based trifluoromethoxylation reagent is bench-stable and provides access to synthetic diversity in lead compounds in an operationally simple manner., (© 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)- Published
- 2018
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11. Identification and Structure-Activity Relationship of HDAC6 Zinc-Finger Ubiquitin Binding Domain Inhibitors.
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Ferreira de Freitas R, Harding RJ, Franzoni I, Ravichandran M, Mann MK, Ouyang H, Lautens M, Santhakumar V, Arrowsmith CH, and Schapira M
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- Catalytic Domain, Crystallography, X-Ray, Humans, Ligands, Models, Molecular, Molecular Structure, Protein Binding, Protein Conformation, Structure-Activity Relationship, Histone Deacetylase 6 antagonists & inhibitors, Histone Deacetylase 6 metabolism, Histone Deacetylase Inhibitors chemistry, Histone Deacetylase Inhibitors pharmacology, Protein Interaction Domains and Motifs drug effects, Ubiquitin metabolism, Zinc Fingers
- Abstract
HDAC6 plays a central role in the recruitment of protein aggregates for lysosomal degradation and is a promising target for combination therapy with proteasome inhibitors in multiple myeloma. Pharmacologically displacing ubiquitin from the zinc-finger ubiquitin-binding domain (ZnF-UBD) of HDAC6 is an underexplored alternative to catalytic inhibition. Here, we present the discovery of an HDAC6 ZnF-UBD-focused chemical series and its progression from virtual screening hits to low micromolar inhibitors. A carboxylate mimicking the C-terminal extremity of ubiquitin, and an extended aromatic system stacking with W1182 and R1155, are necessary for activity. One of the compounds induced a conformational remodeling of the binding site where the primary binding pocket opens up onto a ligand-able secondary pocket that may be exploited to increase potency. The preliminary structure-activity relationship accompanied by nine crystal structures should enable further optimization into a chemical probe to investigate the merit of targeting the ZnF-UBD of HDAC6 in multiple myeloma and other diseases.
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- 2018
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12. Allenylic Carbonates in Enantioselective Iridium-Catalyzed Alkylations.
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Petrone DA, Isomura M, Franzoni I, Rössler SL, and Carreira EM
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An enantioconvergent C(sp
3 )-C(sp3 ) coupling between racemic allenylic electrophiles and alkylzinc reagents has been developed. An Ir/(phosphoramidite,olefin) catalyst provides access to highly enantioenriched allenylic substitution products (93-99% ee) with complete regiocontrol (>50:1 rr in all cases) over the corresponding 1,3-diene isomers which are obtained predominantly when other metal catalysts are emplyed. The synthetic utility of the products obtained was highlighted in a variety of stereoselective transition metal-catalyzed difunctionalization reactions. Furthermore, a combination of experimental and theoretical studies provide support for a putative reaction mechanism wherein enantiodetermining C-C coupling occurs via nucleophilic attack on a highly planarized aryl butadienylium π-system that is coordinated to the Ir center in an η2 -fashion.- Published
- 2018
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13. Exploring the mechanism of the Pd-catalyzed spirocyclization reaction: a combined DFT and experimental study.
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Franzoni I, Yoon H, García-López JA, Poblador-Bahamonde AI, and Lautens M
- Abstract
The mechanism of the palladium-catalyzed spirocyclization of acrylamides has been investigated by density functional theory and experimental studies. The results support a mechanistic pathway that proceeds via oxidative addition, intramolecular carbopalladation, C-H bond activation, and migratory insertion sequence. The M06L/def2-TZVPP//BP86/6-31G(d,p)/LANL2DZ level of theory used and the inclusion of solvent effects provide results in good agreement with the experimental data. The C-H bond activation step proceeds via a concerted outer -sphere metallation deprotonation mechanism that explains the absence of a measurable kinetic isotopic effect. The subsequent intermolecular migratory insertion of arynes is significantly faster than the insertion of internal alkynes. Furthermore, the regioselectivities calculated in the case of unsymmetrical reactants are remarkably close to the experimental values. Evaluation of the potential energy surfaces for specific substrates provides an explanation for the lack of product formation observed experimentally. Finally, the computational and experimental analyses of potential side reactions are also presented and support the initially proposed mechanism.
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- 2017
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14. Small Molecule Antagonists of the Interaction between the Histone Deacetylase 6 Zinc-Finger Domain and Ubiquitin.
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Harding RJ, Ferreira de Freitas R, Collins P, Franzoni I, Ravichandran M, Ouyang H, Juarez-Ornelas KA, Lautens M, Schapira M, von Delft F, Santhakumar V, and Arrowsmith CH
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- Binding Sites, Binding, Competitive, Crystallography, X-Ray, Histone Deacetylase 6 antagonists & inhibitors, Humans, Ligands, Protein Binding, Ubiquitin antagonists & inhibitors, Histone Deacetylase 6 metabolism, Protein Interaction Domains and Motifs drug effects, Ubiquitin metabolism, Zinc Fingers
- Abstract
Inhibitors of HDAC6 have attractive potential in numerous cancers. HDAC6 inhibitors to date target the catalytic domains, but targeting the unique zinc-finger ubiquitin-binding domain (Zf-UBD) of HDAC6 may be an attractive alternative strategy. We developed X-ray crystallography and biophysical assays to identify and characterize small molecules capable of binding to the Zf-UBD and competing with ubiquitin binding. Our results revealed two adjacent ligand-able pockets of HDAC6 Zf-UBD and the first functional ligands for this domain.
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- 2017
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15. Rhodium-Catalyzed Enantioselective Isomerization of meso-Oxabenzonorbornadienes to 1,2-Naphthalene Oxides.
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Yen A, Choo KL, Yazdi SK, Franke PT, Webster R, Franzoni I, Loh CCJ, Poblador-Bahamonde AI, and Lautens M
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Herein we describe a rhodium-catalyzed enantioselective isomerization of meso-oxabicyclic alkenes to 1,2-naphthalene oxides. These potentially useful building blocks can be accessed in moderate to excellent yields with impressive enantioselectivities. Additionally, experimental findings supported by preliminary computations suggest that ring-opening reactions of bridgehead disubstituted oxabicyclic alkenes proceed through the intermediacy of these epoxides and may point to a kinetically and thermodynamically favored reductive elimination as the origin for the observed enantioselectivities., (© 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)
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- 2017
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16. Palladium-Catalyzed Hydrohalogenation of 1,6-Enynes: Hydrogen Halide Salts and Alkyl Halides as Convenient HX Surrogates.
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Petrone DA, Franzoni I, Ye J, Rodríguez JF, Poblador-Bahamonde AI, and Lautens M
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Difficulties associated with handling H
2 and CO in metal-catalyzed processes have led to the development of chemical surrogates to these species. Despite many successful examples using this strategy, the application of convenient hydrogen halide (HX) surrogates in catalysis has lagged behind considerably. We now report the use of ammonium halides as HX surrogates to accomplish a Pd-catalyzed hydrohalogenation of enynes. These safe and practical salts avoid many drawbacks associated with traditional HX sources including toxicity and corrosiveness. Experimental and computational studies support a reaction mechanism involving a crucial E-to-Z vinyl-Pd isomerization and a carbon-halogen bond-forming reductive elimination. Furthermore, rare examples of C(sp3 )-Br and -Cl reductive elimination from Pd(II) as well as transfer hydroiodination using 1-iodobutane as an alternate HI surrogate are also presented.- Published
- 2017
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17. A general Pd-catalyzed α- and γ-benzylation of aldehydes for the formation of quaternary centers.
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Franzoni I, Guénée L, and Mazet C
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- Benzyl Compounds chemistry, Catalysis, Molecular Structure, Aldehydes chemistry, Benzyl Compounds chemical synthesis, Organometallic Compounds chemistry, Palladium chemistry
- Abstract
A palladium-catalyzed benzylation of α-branched aldehydes has been developed using benzyl methyl carbonates. The method gives access to congested quaternary centers in the vicinity of one of the most sensitive carbonyl functionalities and displays unprecedented generality with respect to both coupling partners. Evidence for the direct involvement of a Pd-η(3)-benzyl intermediate is provided. Extension of this strategy to the γ-benzylation of α,β-unsaturated aldehydes is further demonstrated.
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- 2015
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18. Role of plaque calcification regulators osteoprotegerin and matrix Gla-proteins in stable angina and acute myocardial infarction.
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Margonato A, Gorla R, Macchi A, Buzzetti F, Franzoni I, Pedrigi MC, Rosa I, Sirtori M, Villa I, and Rubinacci A
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- Aged, Angina, Stable diagnostic imaging, Biomarkers blood, Bone Density, Calcinosis, Coronary Angiography, Coronary Artery Disease blood, Coronary Artery Disease diagnostic imaging, Diabetic Angiopathies blood, Humans, Male, Middle Aged, Myocardial Infarction diagnostic imaging, Matrix Gla Protein, Angina, Stable blood, Calcium-Binding Proteins blood, Extracellular Matrix Proteins blood, Myocardial Infarction blood, Osteoprotegerin blood
- Abstract
Aim: To assess serum levels of the plaque calcification regulators osteoprotegerin (OPG) and Matrix Gla-proteins (MGP) in individuals with stable angina and acute myocardial infarction submitted to coronary angiography and their relation to coronary artery disease burden., Methods: The study included 40 individuals affected by ST-elevation myocardial infarction (STEMI) and 40 individuals with stable angina who all underwent coronary angiography, with evaluation of the extent of coronary artery disease by Syntax Score calculation and measurement of serum OPG and MGP levels. Osteoporosis was excluded by femoral and vertebral computerized bone mineralometry., Results: Serum OPG and MGP levels were respectively 3.87 ± 1.07 pmol/l and 6.80 ± 2.43 nmol/l in the stable angina group, 7.57 ± 1.5 pmol/l and 7.18 ± 1.93 nmol/l in the STEMI group (P < 0.01 and P = 0.33, respectively). Pearson correlation coefficient for OPG and Syntax Score, MGP and Syntax score was respectively 0.79 (P < 0.01) and 0.18 (P = 0.22) in the stable angina group, -0.03 (P = 0.43) and 0.10 (P = 0.5) in the STEMI group.Serum OPG and MGP levels were respectively 5.52 ± 1.02 pmol/l and 7.56 ± 1.42 nmol/l in diabetics, 4.3 ± 0.8 pmol/l and 6.52 ± 1.14 nmol/l in nondiabetics (P < 0.05; P < 0.05)., Conclusion: OPG, in a relatively small group of patients with stable angina, correlates proportionally with the extent of coronary artery disease (CAD), as evaluated by the Syntax Score. Higher serum OPG levels can be observed in individuals with STEMI regardless of CAD burden. As for MGP, a potential role as marker of plaque calcification remains unproven.
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- 2015
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19. Recent trends in Pd-catalyzed remote functionalization of carbonyl compounds.
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Franzoni I and Mazet C
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- Aldehydes chemistry, Amides chemistry, Catalysis, Ketones chemistry, Molecular Structure, Aldehydes chemical synthesis, Amides chemical synthesis, Ketones chemical synthesis, Organometallic Compounds chemistry, Palladium chemistry
- Abstract
Recent advances in the palladium-catalyzed remote functionalization of carbonyl derivatives are highlighted in this review. The structure of the article is based on the three strategies that have emerged in recent years as the most viable tactics to construct C(sp(3))-C, C(sp(3))-N or C(sp(3))-O bonds at a distance of at least three carbon atoms from the carbonyl functionality. The specific aspects of each of these approaches are discussed in detail (reaction conditions, substrate scope and limitations). As the reading progresses, their complementarity should also appear clearly.
- Published
- 2014
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20. Comparison of incidence and predictors of left bundle branch block after transcatheter aortic valve implantation using the CoreValve versus the Edwards valve.
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Franzoni I, Latib A, Maisano F, Costopoulos C, Testa L, Figini F, Giannini F, Basavarajaiah S, Mussardo M, Slavich M, Taramasso M, Cioni M, Longoni M, Ferrarello S, Radinovic A, Sala S, Ajello S, Sticchi A, Giglio M, Agricola E, Chieffo A, Montorfano M, Alfieri O, and Colombo A
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- Aged, Aortic Valve surgery, Bradycardia epidemiology, Bradycardia etiology, Bundle-Branch Block epidemiology, Cardiac Catheterization, Chi-Square Distribution, Electrocardiography, Female, Humans, Incidence, Logistic Models, Male, Predictive Value of Tests, Treatment Outcome, Aortic Valve Stenosis surgery, Bundle-Branch Block etiology, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation adverse effects
- Abstract
Conduction disorders and permanent pacemaker implantation are common complications in patients who undergo transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the incidence and clinical significance of new bundle branch block in patients who underwent TAVI with the Medtronic CoreValve Revalving System (MCRS) or the Edwards SAPIEN valve (ESV). Data from 238 patients with no previous pacemaker implantation, left bundle branch block (LBBB) or right bundle branch block at baseline electrocardiography who underwent TAVI with either MCRS (n = 87) or ESV (n = 151) bioprostheses from 2007 to 2011 were analyzed. New-onset LBBB occurred in 26.5% patients (n = 63): 13.5% with the ESV (n = 20) and 50.0% with the MCRS (n = 43) (p = 0.001). Permanent pacemaker implantation was required in 12.7% of patients (n = 8) because of complete atrioventricular block (ESV n = 2, MCRS n = 4), LBBB and first degree atrioventricular block (MCRS n = 1) and new-onset LBBB associated with sinus bradycardia (MCRS n = 1). At discharge, LBBB persisted in 8.6% of ESV patients (n = 13) and 32.2% of MCRS patients (n = 28) (p = 0.001). On multivariate analysis, the only predictor of LBBB was MCRS use (odds ratio 7.2, 95% confidence interval 2.9 to 17.4, p <0.001). Persistent new-onset LBBB at discharge was not associated with overall (log-rank p = 0.42) or cardiovascular (log-rank p = 0.46) mortality. New-onset right bundle branch block was documented in 4.6% of patients (n = 11), with no statistically significant differences between the ESV and MCRS. In conclusion, new-onset LBBB is a frequent intraventricular conduction disturbance after TAVI with a higher incidence with the MCRS compared with the ESV. LBBB persists in most patients, but in this cohort, it was not a predictor of overall or cardiovascular mortality or permanent pacemaker implantation., (Copyright © 2013 Elsevier Inc. All rights reserved.)
- Published
- 2013
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21. A 'clover' coronary artery: role of coronary computed tomography to indicate optimal treatment in aneurysmal coronary artery disease.
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Gorla R, Macchi A, Franzoni I, Spagnolo P, and Margonato A
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- Angina Pectoris etiology, Coronary Aneurysm drug therapy, Coronary Angiography, Coronary Artery Disease drug therapy, Echocardiography, Stress, Humans, Male, Middle Aged, Risk Assessment, Coronary Aneurysm diagnostic imaging, Coronary Artery Disease diagnostic imaging, Tomography, X-Ray Computed methods
- Abstract
We report the case of a 61-year-old man referred to our department for exertional angina with a history of tri-vessel aneurysmal coronary artery disease. Exercise stress echocardiography was positive for inferior wall hypokinesia. Coronary computed tomography (CT) provided a more accurate characterization of the coronary aneurysms. It detected a laminated thrombus of the proximal left anterior descending and a clover-like aneurysmal dissection of the proximal right coronary artery, which questioned the feasibility of coronary angioplasty. So, the patient was treated with medical therapy only. This case confirmed the importance of coronary CT as diagnostic tool for procedural risk assessment and definition of the most appropriate treatment in patients with coronary aneurysms.
- Published
- 2013
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22. Stent thrombosis after kissing balloons.
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Curran H, Takagi K, Chieffo A, Foglieni C, Latib A, Montorfano M, Bernelli C, Buchanan GL, Franzoni I, and Colombo A
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- Humans, Male, Middle Aged, Angioplasty, Balloon, Coronary adverse effects, Myocardial Infarction surgery, Stents adverse effects, Thrombosis etiology
- Published
- 2012
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23. Unrepaired tetralogy of fallot in an 85-year-old man.
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Gorla R, Macchi A, Franzoni I, Rosa I, Buzzetti F, Pavon AG, and Margonato A
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- Aged, 80 and over, Atrial Fibrillation etiology, Disease Progression, Echocardiography, Humans, Hypertension, Pulmonary, Male, Mitral Valve Insufficiency etiology, Pulmonary Edema etiology, Tetralogy of Fallot diagnosis, Tetralogy of Fallot therapy, Treatment Outcome, Ventricular Outflow Obstruction etiology, Tetralogy of Fallot complications
- Abstract
Tetralogy of Fallot is the most common cyanotic congenital heart defect and accounts for about 5% of all congenital cardiopathies. The definitive treatment modality for tetralogy of Fallot is reparative surgery, which is recommended to be performed by the time of diagnosis. Without surgical repair, most patients would die during their childhood. In the past, survival data indicated that 66% of persons with tetralogy of Fallot not surgically treated lived until the age of 1, 49% lived until the age of 3, and 24% lived until the age of 10. We now present a rare case of a man with unrepaired tetralogy of Fallot who survived until the age of 85. He presented to our emergency room for dyspnea and palpitations due to a new-onset high-frequency atrial fibrillation and acute heart failure; transthoracic echocardiography showed the presence of tetralogy of Fallot. By consulting the scientific literature, we can say that this is the second patient who survived more than 80 years without surgical intervention., (© 2012 Wiley Periodicals, Inc.)
- Published
- 2012
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24. An unusual case of acute coronary syndrome late after stent implantation.
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Gorla R, Macchi A, Franzoni I, Rosa I, Buzzetti F, Pedrigi MC, and Margonato A
- Abstract
We report a case of a 66-year-old Caucasian male who presented to our department with unstable angina in July 2011. He had a medical history of trivessel coronary artery disease and underwent several percutaneous coronary interventions (2003, 2004, and 2006). The latest coronary angiography, performed in January 2011, showed mild intimal hyperplasia within the proximal left anterior descending segment, treated with a sirolimus-eluting stent in 2003. On admission, electrocardiogram was positive for a recent acute coronary syndrome, so the patient underwent coronary angiography, which showed proximal left anterior descending stent thrombosis, occurred eight years after drug-eluting stent implantation. Intravascular ultrasound revealed a soft plaque rupture within the stented segment, which was the cause of stent thrombosis. So the lack of endothelialization over stent struts is not the only mechanism determining acute coronary syndromes late after stent implantation. In-stent neoatherosclerosis, frequently disregarded, is another possible actor especially of very late thrombotic events. However, the pathogenesis of this phenomenon has not been clearly established.
- Published
- 2012
- Full Text
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25. Coronary angiography and angioplasty in a patient with an iliac artery volvolus.
- Author
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Franzoni I, Baratto F, Macchi A, Rosa I, Buzzetti F, and Margonato A
- Abstract
A 70-year-old Caucasian male underwent to percutaneous revascularization through arterial iliac "volvolus" by extralong direct stenting using a long 8 french introducer with an optimal angiographic result and clinical outcome.
- Published
- 2010
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