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2. Impact of cardiac sympathetic denervation on electrical storms in patients with cardiomyopathies

Author

V Dusi, M Ruffinazzi, L Pugliese, F Guerrera, A Vicentini, S Savastano, A Greco, R Camporotondo, S Frea, A Vairo, M Imazio, M Tritto, C Raineri, R Rordorf, and G M De Ferrari

Subjects
Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract

Funding Acknowledgements Type of funding sources: None. Background Cardiac Sympathetic Denervation (CSD) has been recently proposed for the treatment of refractory ventricular arrhythmias (VAs) in patients with cardiomyopathy (CMP). A multicentric American case series suggested a greater efficacy of the bilateral (BCSD), compared to the left-side only procedure (LCSD), albeit with a potential impact on chronotropism. The impact of CSD on the risk of electrical storms (ES) in CMP has never been evaluated. Purpose To describe our multicenter experience with CSD in CMP patients with refractory VAs, with a specific focus on ES incidence. Methods Thirty patients with CMP and refractory VAs underwent either LCSD or BCSD between April 2016 and June 2022. Among them, one patient received first LCSD and then right-side CSD due to ES recurrence after LCSD: to properly assess the risk of ES after LCSD and BCSD he was included in both groups, leading to 5 cases of LCSD and 26 cases of BCSD. All patients had a Video-Assisted Thoracoscopic Surgery, in 8 cases with the robotic technique. The main reason (3/5 cases, 60%) to perform LCSD instead of BCSD since the beginning was sinus bradycardia in single ICD lead recipients. Results 87% of pts were male, mean age was 56 ± 16 yrs and mean LVEF 31± 12%; most (n=26, 85%) suffered non-ischemic CMP and 37% were in NYHA class ≥3. Main indications for CSD were refractory polymorphic/fast VAs in 60% of pts and refractory monomorphic VAs in the rest. Except for 5 patients (17%) with previous thyrotoxicosis, the majority were either on amiodarone (n=19, 63%) or on sotalol (n=3, 10%) and 53% had previously undergone ≥1 catheter ablation for VAs. The median follow-up (FU) after CSD was 16 months (IQR 6-42 months). No major complications occurred. Eleven patients (37%) either died during FU (n=8, 27%), mostly due to end-stage heart failure, or underwent heart transplant (n=3, 10%). After CSD, the percentage of patients with ES decreased from 77% to 40% (p Conclusions Our case series of CSD in CMP represents the largest reported in Europe and the first one to evaluate the impact of CSD on electrical storms. The occurrence of electrical storms was more than halved by BCSD confirming the powerful protective effect also on this ominous phenomenon. The greater antiarrhythmic benefit observed among patients with better functional class suggests the opportunity to perform this procedure earlier on in the trajectory of patients with progressive heart failure.

Published
2023
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3. Acute myocarditis associated with desmosomal gene variants

Author

E Ammirati, F Raimondi, N Piriou, S A Mohiddin, M Imazio, G Aquaro, I Olivotto, C M Van De Heyning, G Peretto, M Merlo, S Klaassen, W Poller, E D Adler, P G Camici, and L T Cooper

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background The risk of adverse cardiovascular events in patients with acute myocarditis (AM) and desmosomal gene variants (DGV) remains unknown. Purpose To ascertain the risk of death, ventricular arrhythmias, recurrent myocarditis, and heart failure (main endpoint) in patients with AM and pathogenic or likely pathogenetic DGV. Methods In a retrospective international study from 23 hospitals, 97 patients were included: 36 with AM and DGV (DGV(+)), 25 with AM and negative gene testing (DGV(−)), and 36 AM patients without genetics (w/o genetics). All patients had troponin elevation plus findings consistent with AM on histology or at cardiac magnetic resonance imaging (CMRI). In 86 patients CMRI changes in function and structure were re-assessed at follow-up. Results In the DGV(+) AM group (88.9% DSP variants), median age was 24 years, 91.7% presented with chest pain, and median left ventricular (LV) ejection fraction was 56% on CMRI (p=NS vs. the other 2 groups). Kaplan-Meier curves demonstrated a higher risk of the main endpoint in DGV(+) AM compared to DGV(−) and w/o genetics patients (62.3% vs. 17.5% vs. 5.3% at 5 years respectively; p Conclusions Patients with AM and evidence of DGV have a higher incidence of adverse cardiovascular events compared with AM patients without DGV. Further prospective studies are needed to ascertain if genetic testing might improve risk stratification of patients with AM who are considered at low risk. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Italian Ministry of Health

Published
2022
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4. C64 UNMASKING THE PREVALENCE OF AMYLOID CARDIOMYOPATHY IN THE REAL WORLD: RESULTS FROM PHASE 2 OF AC–TIVE STUDY, AN ITALIAN NATIONWIDE SURVEY

Author

M Merlo, L Pagura, A Porcari, M Cameli, G Vergaro, B Musumeci, E Biagini, M Canepa, L Crotti, M Imazio, C Forleo, F Cappelli, S Favale, G Di Bella, F Dore, F Girardi, D Tomasoni, R Pavasini, V Rella, G Palmiero, M Caiazza, M Albanese, A Igoren Guarrucci, G Branzi, A Caponetti, G Saturi, G La Malfa, A Merlo, A Andreis, F Bruno, F Longo, M Rossi, G Varra‘, R Saro, L Di Ienno, G De Carli, E Giacomin, V Spini, G Limongelli, C Autore, I Olivotto, L Badano, G Parati, S Perlini, M Metra, M Emdin, C Rapezzi, and G Sinagra

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background Clinicians need to identify patients with amyloid cardiomyopathy (AC) at an early stage, due to the availability of disease–modifying therapies. Some echocardiographic findings may rise the suspicion of AC, also in patients with mild or no symptoms, addressing second level diagnostic tests. Aim To investigate the prevalence of AC in consecutive patients ≥55 years undergoing clinically indicated, routine transthoracic echocardiogram in Italy and presenting echocardiographic signs suggestive of AC. Methods This is a prospective multicentric study conducted in Italy. It comprises two phases: 1) a recording phase consisting in a national survey on prevalence of possible echocardiographic red flags of AC in consecutive unselected patients ≥55 years undergoing routine echocardiogram (previously published) and 2) an AC diagnostic phase involving a diagnostic work–up for AC to investigate AC prevalence among patients with at least one echocardiographic red flag (herein presented). Patients that in Phase 1 presented an “AC suggestive” echocardiogram (i.e., at least one red flag of AC in hypertrophic, non–dilated left ventricles with preserved ejection fraction) underwent clinical evaluation, blood and urine tests and scintigraphy with bone tracer. Diagnosis of transthyretin related–AC (ATTR–AC) was made in presence of grade 2–3 Perugini uptake at scintigraphy and absence of monoclonal protein. The study was registered at ClinicalTrials.gov (#NCT04738266). Results Of the 5315 screened echocardiograms, 381 exams (7.2%) were classified as “AC suggestive” and proceeded to Phase 2. 217 patients completed Phase 2 investigations. Main reasons for the 164 non–entering patients into Phase 2 were death (n = 49) and refusal to participate (n = 66). A final diagnosis of AC was made in 62 patients with an estimated prevalence of 28,6% (95% CI: 22,5%–34,7%). ATTR–AC was diagnosed in 51 and AL–AC in 11 patients, ascertaining a prevalence of 23,5% (95% CI: 17,8%–29,2%) and 5,1% (95% CI: 2,2%–8,0%), respectively. Conclusion Among a cohort of consecutive unselected patients ≥55 years with echocardiographic findings suggestive of AC, the prevalence of AC ranged from 23% up to 35%. Although ATTR–AC was predominant, AL–AC was diagnosed in a significant number of cases. Echocardiography has a fundamental role in screening patients, raising the suspicion of disease and orienting diagnostic work–up for AC.

Published
2022
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5. C65 POST–DISCHARGE ARRHYTHMIC RISK STRATIFICATION OF PATIENTS WITH ACUTE MYOCARDITIS AND LIFE–THREATENING VENTRICULAR TACHYARRHYTHMIAS

Author

P Gentile, M Merlo, G Peretto, E Ammirati, S Sala, P Della Bella, G Aquaro, M Imazio, L Potena, J Campodonico, A Foà, A Raafs, M Hazebroek, M Brambatti, A Cercek, G Nucifora, S Shrivastava, F Huang, M Schmidt, D Muser, C Van De Heyning, E Van Craenenbroeck, T Aoki, K Sugimura, H Shimokawa, A Cannatà, J Artico, A Porcari, M Colopi, R Bussani, G Barbati, A Garascia, M Cipriani, P Agostoni, N Pereira, S Heymans, E Adler, P Camici, M Frigerio, and G Sinagra

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Aims The outcomes of patients presenting with acute myocarditis and life–threatening ventricular arrhythmias (LT–VA) are unclear. The aim of this study was to assess the incidence and predictors of recurrent major arrhythmic events (MAEs) after hospital discharge in this patient population. Methods and Results We retrospectively analysed 156 patients (median age 44 years; 77% male) discharged with a diagnosis of acute myocarditis and LT–VA from 16 hospitals worldwide. Diagnosis of myocarditis was based on histology or the combination of increased markers of cardiac injury and cardiac magnetic resonance (CMR) Lake Louise criteria. MAEs were defined as the relapse, after discharge, of sudden cardiac death or successfully defibrillated ventricular fibrillation, or sustained ventricular tachycardia (sVT) requiring implantable cardioverter–defibrillator therapy or synchronized external cardioversion. Median follow–up was 23months [first to third quartile (Q1–Q3) 7–60]. Fifty–eight (37.2%) patients experienced MAEs after discharge, at a median of 8 months (Q1–Q3 2.5–24.0 months; 60.3% of MAEs within the first year). At multivariable Cox analysis, variables independently associated with MAEs were presentation with sVT [hazard ratio (HR) 2.90, 95% confidence interval (CI) 1.38–6.11]; late gadolinium enhancement involving ≥2 myocardial segments (HR 4.51, 95% CI 2.39–8.53), and absence of positive short–tau inversion recovery (STIR) (HR 2.59, 95% CI 1.40–4.79) at first CMR. Conclusions In this international multicentre study, patients discharged free from HTx or LVAD after an acute myocarditis complicated by LT–VA had a recurrence of MAEs during follow–up of 37.2%, after a median time of 8 months. Initial CMR pattern and sVT at presentation stratify the risk of arrhythmia recurrence.

Published
2022
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6. P238 THE HEART LOGIC EXPERIENCE IN OUR CENTER 'SANTA MARIA DELLA MISERICORDIA' HOSPITAL, UDINE

Author

V Favaretto, F Fumarola, C Tioni, D Facchin, M Driussi, M Imazio, and G Sinagra

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background Outpatient monitoring of patients with chronic heart failure (HF) may result in HF exacerbation and subsequent hospitalizations that may be avoided with an early recognition. The HeartLogic (HL) algorithm automatically calculates a daily HF index based on values including heart sounds, markers of ventilation, thoracic impedance, activity and heart rate and recognize an active alert state relative to a configurable threshold. Methods We included 35 patients with HF in optimized medical therapy; the investigational chronic ambulatory data collection was performed via implanted Boston pace–maker, defibrillator or cardiac resynchronization therapy and we analyzed these data since February 2021, ongoing. We established a cut off of HL index of 16 due to the confirmatory trial and we contacted the patients 2 weeks after the threshold exceeding to evaluate their clinical state. Results Preliminary data (until December 2021) showed us 24 alarms in total, of whom 7 were truly heart failure related alarms. These are independent from the values of the HL index reached and the best parameter resulted to be the chest impedance. Measurement of third heart sound was another sensitive but not very specific parameter. The main confounding factor was given by infections, especially related to Covid–19. The therapeutic strategy was predominantly increasing the doses of diuretics. There were no heart failure events in patients without the warning HL index. Discussion The preliminary data showed us how high is the negative predictor factor of the HL index based on our center parameters. We aim to analyze further data to be more accurate and to find the best way to detect heart failure.

Published
2023
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7. P123 TRANSCATHETER ABLATION OF SUPRAVENTRICULAR ARRHYTHMIAS IN PATIENTS SUFFERING FROM HYPERTROPHIC CARDIOMYOPATHY: A PROPENSITY SCORE–BASED ANALYSIS

Author

A Pierri, S Albani, A Buongiorno, A Ricotti, S Grossi, C De Rosa, B Mabritto, S Bongioanni, S Luceri, F Negri, G Grilli, D Barbisan, M Burelli, F Biondi, M Cireddu, J Berg, M Musumeci, P Di Donna, P Vianello, A Del Franco, M Scaglione, G Barbati, P Berchialla, V Russo, M Imazio, I Porto, M Canepa, G Peretto, P Francia, C Autore, D Castagno, F Gaita, I Olivotto, M Merlo, G Sinagra, and G Musumeci

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background To date, the prognostic impact of transcatheter ablation (T–Abl) of supraventricular arrhythmias (SA) in HCM patients has not been satisfactorily elucidated. Objectives To assess the impact of T–Abl on clinical outcomes in a large cohort of HCM patients. Methods In this retrospective multicenter study, 570 consecutive HCM patients with SA were enrolled, 425 receiving medical therapy and 145 undergoing T–Abl. 1:1 propensity score matching (PSM) led to the inclusion of 234 patients (117 intervention group, 117 medical group) in the final analysis for endpoint evaluation. The primary outcome was a composite of all–cause mortality, heart transplantation (HT) and worsening heart failure (HF). Additionally, an inverse probability weighted (IPW) model was elaborated. Results At PSM analysis, after a median follow-up of 57.3 months, the primary endpoint occurred in 31 (26.5%) patients in the intervention group vs 38 (32.5%) in the medical group (p=0.871). Thromboembolic strokes and major arrhythmic events in the intervention vs the medical group were 9.4% vs 9.4% (p=0.367) and 5.1 vs 7.7% (p=0.741), respectively. Fewer patients in the intervention vs medical group experienced SA recurrences (64.1% vs 84.6%, p Conclusions At 5–year follow–up, T–Abl does not improve major clinical outcomes in a large cohort of HCM patients. Nevertheless, T–Abl seems to facilitate the maintenance of sinus rhythm and decelerate the progression to permanent SA. Lastly, T–Abl is usually safe in HCM.

Published
2023
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8. Is colchicine safe for cardiovascular indications?

Author

M Imazio, A Andreis, F Piroli, M Casula, E Paneva, S Avondo, and G M De Ferrari

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background Colchicine has an emerging role in the cardiovascular field (e.g. acute and chronic coronary syndromes, pericarditis, atrial fibrillation), although, concerns for side effects, especially gastrointestinal, may limit its prescription. Aims We aimed at evaluating reported side effects of colchicine for cardiovascular indications. Methods We performed a meta-analysis of published randomized controlled trials on colchicine for the treatment of cardiovascular diseases. Random-effects meta-analysis was used to assess the risk of adverse events and drug withdrawal. Publication bias was assessed using the Egger test, and meta-regression was performed to assess sources of heterogeneity. Results Among 14 188 patients, 7136 patients received colchicine while the other 7052 received placebo. The occurrence of any adverse event with colchicine was reported in 15.3 vs. 13.9% patients [relative risk (RR) 1.26, 95% confidence interval (CI) 0.96–1.64, P=0.09, see figure]. Gastrointestinal events were reported in 16.1 vs. 12.2% (RR 2.16, 95% CI 1.50–3.12, P Conclusions Colchicine is associated with increased risk of gastrointestinal events and myalgias, but not of other adverse events. The risk of gastrointestinal events may be avoided with lower dose (0.5 mg/daily) and is inversely related to treatment duration, possibly due to early drug discontinuation or drug tolerance. Funding Acknowledgement Type of funding sources: None.

Published
2021
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9. Beta-blockers to control symptoms in patients with pericarditis

Author

M Imazio, A Andreis, A Agosti, F Piroli, M Casula, E Paneva, S Avondo, G Barberi Squarotti, C Giustetto, and G M De Ferrari

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background Exercise restriction is a non-pharmacological treatment of pericarditis that could reduce symptoms by slowing heart rate (HR). Beta-blockers allow pharmacological control of HR. Aim To explore the possible efficacy of beta-blockers to improve control of symptoms in patients with pericarditis. Methods We analysed consecutive cases with pericarditis referred to our centre. Beta-blockers were prescribed on top of standard anti-inflammatory therapy in symptomatic patients (chest pain and palpitations) with rest HR>75 beats/min. The primary end point was the persistence of pericardial pain at 3 weeks. The secondary end point was the occurrence of recurrent pericarditis at 18 months. Propensity score matching was used to generate 2 cohorts of 101 patients with and without beta-blockers with balanced baseline features. A clinical and echocardiographic follow-up was performed at 3 weeks, 1, 3, 6 months and then every 12 months. Results A total of 347 patients (mean age 53 years, 58% females, 48% with a recurrence, 81% with idiopathic/viral aetiology) were included. Among them, 128 patients (36.9%) were treated with beta-blockers. Peak C-reactive protein values were correlated with heart rate on first observation (r=0.48, p Conclusions The use of beta-blockers on top of standard anti-inflammatory therapies was associated with improved symptom control. Additional studies are warranted to verify the efficacy of these drugs in this setting. Funding Acknowledgement Type of funding sources: None.

Published
2021
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10. Anti-interleukin 1 agents for the treatment of recurrent pericarditis

Author

M Imazio, A Andreis, F Piroli, G Lazaros, M Lewinter, A Klein, and A Brucato

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background Corticosteroid-dependent and colchicine-resistant recurrent pericarditis (RP) is a challenging management problem, in which conventional anti-inflammatory therapy (nonsteroidal anti-inflammatory drugs, colchicine, corticosteroids) is unable to control the disease. Recent data suggest a potential role for anti-interleukin-1 (IL-1) agents for this condition. Purpose This study was designed to assess the safety and efficacy of anti-IL-1 agents in this setting. Methods We performed a systematic review and meta-analysis of randomised controlled trials and observational studies assessing pericarditis recurrences and drug-related adverse events in patients receiving anti-IL-1 drugs for pericarditis. Results The meta-analysis assessed 7 studies including 397 pooled patients with RP. The median age was 42 years, 60% were women and the aetiology was idiopathic in 87%. After a median follow-up of 14 months (IQR,12–39), patients receiving anti-IL-1 agents (anakinra or rilonacept) had a significantly reduction in pericarditis recurrences (incidence rate ratio 0.06, 95% CI 0.03 to 0.14, see figure), compared with placebo and/or standard medical therapy. Anti-IL-1 agents were associated with increased risk of adverse events compared with placebo (risk ratio (RR) 5.38, 95% CI 2.08 to 13.92): injection-site reactions occurred in 15/41 (36.6%) vs. none (RR 14.98, 95% CI 2.09 to 107.09), infections occurred in 13/51 (25.5%) vs. 3/41 (7.3%; RR 3.65, 95% CI 1.23 to 10.85). Anti-IL-1 agents were not associated with increased risk of severe adverse events. Conclusions In patients with RP, anti-IL-1 agents (anakinra and rilonacept) are efficacious for prevention of recurrences, without severe adverse events. Funding Acknowledgement Type of funding sources: None.

Published
2021
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12. A national multicentre study on severe paediatric recurrent idiopathic pericarditis treated with IL-1 blockers: appropriateness of the standard of care and pros and cons of anti-IL-1 treatments

Author

R. Caorsi, A. Insalaco, F. Bovis, G. Martini, M. Cattalini, M. Chinali, A. Rimini, C. Longo, S. Federici, C. Celani, G. Filocamo, R. Consolini, M. C. Maggio, G. Fadanelli, F. Licciardi, M. Romano, B. Teruzzi, A. Taddio, A. Miniaci, F. La Torre, A. De Fanti, G. Cavalli, B. Bigucci, R. Gallizzi, M. Chinello, A. Brucato, M. Imazio, R. Cimaz, F. De Benedetti, M. Gattorno, and R. Caorsi, A. Insalaco, F. Bovis, G. Martini, M. Cattalini, M. Chinali, A. Rimini, C. Longo, S. Federici, C. Celani, G. Filocamo, R. Consolini, M.C. Maggio, G. Fadanelli, F. Licciardi, M. Romano, B. Teruzzi, A. Taddio, A. Miniaci, F. La Torre, A. De Fanti, G. Cavalli, B. Bigucci, R. Gallizzi, M. Chinello, A. Brucato, M. Imazio, R. Cimaz, F. De Benedetti, M. Gattorno

Subjects
Settore MED/38 - Pediatria Generale E Specialistica, Recurrent pericarditis, Non-steroidal anti-inflammatory drugs,colchicine resistance
Abstract

Recurrent pericarditis (RP) is a rare cause of morbidity in children. Non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids and colchicine are the standard of care in adults. Recently, anakinra has been proven to be effective in patients with steroid-dependence and colchicine resistance.

Published
2020

13. Real-World Observations with Dronedarone Compared to Other Anti-Arrhythmic Drugs in Recurrent Atrial Fibrillation

Author

F. Orlando, D. Demarie, M. Imazio, E. Richiardi, R. Belli, and E. Cerrato

Subjects
medicine.medical_specialty, Environmental Engineering, Medical treatment, business.industry, Recurrent atrial fibrillation, Atrial fibrillation, medicine.disease, Industrial and Manufacturing Engineering, Dronedarone, Clinical trial, Pharmacotherapy, Internal medicine, Cardiovascular agent, medicine, Cardiology, Anti arrhythmic, business, medicine.drug
Abstract

Background : Many clinical trials have shown that dronedarone which is a potent ion channels blocker is effective in the prevention of atrial fibrillation (AF) relapses. Objective: The aim of this report is to evaluate the recurrence of AF and safety during therapy with dronedarone.

Published
2015
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14. Poster session Friday 13 December - PM: 13/12/2013, 14:00-18:00 * Location: Poster area

Author

A. Rojek, M. Bekbossynova, J. Onaindia, R. Ferrer Lopez, B. Javani, A. Sharif-Rasslan, N. Al, R. Davies, U. Ikeda, R. Ferreira, A. Cincin, M. Plewka, F. Weidemann, B. Fadel, O. Akgul, Z. Frikha, M. Haghjoo, J. Jensen, G. Agoston, M. Sunbul, R. Strasser, M. Pepi, Y. Fuku, M. Minamisawa, J. Holm, O. Dzikowska Diduch, Y. Pya, J. Macancela Quinones, P. Gaudron, G. Ertl, S. Thivolet, C. Koukoulis, H. Yun, S. Iancovici, D. Capodanno, M. Barthelet, A. Medeiros-Domingo, T. Le Tourneau, A. P. Lee, G. Derumeaux, I. Rodriguez, B. Naegeli, S. Rahmatullah, A. Bayes, H. Schaff, A. M. Caggegi, C. Zito, M. D'alto, R. Favilli, J. Baan, M. Aydin, J. Bonaque Gonzalez, A. Akhundova, I. Cruz, R. Karpov, H. Okura, D. Dequanter, M. T. Grillo, A. Ingvarsson, S. Prasad, A. Dahiya, U. Rosenschein, G. Sinagra, J. Kochanowski, M. Niemann, Y. Saijo, B. Bouma, K. Sveric, Y. Topilsky, M. Ministeri, J. Piek, C. Marinescu, M. Bilik, I. Ikuta, M. Al-Admawi, C. Araujo, D. Trifunovic, S. Onciul, G. Pavlidis, F. Ruiz Lopez, M. Oyumlu, C. Kenny, F. Kayan, C. Ginghina, R. Piatkowski, I. Lekuona Goya, A. Almeida, G. Portugal, H. Motoki, M. Cinteza, B. Seifert, S. Lee, M. Banovic, T. Sakakura, A. Pappalardo, B. Stuart, Y. Chuyasova, T. Yamanaka, N. Roche, C. Wunderlich, X. Arana, L. Ernande, V. Ribeiro, Y. Tanabe, L. Vazdar, Y. Tayyareci, E. Malev, M. Eren, J. Gil, S. Lunghetti, D. Krieger, S. Mangiafico, M. Izumo, D. Cacela, A. Kovacs, A E Van Den Bosch, E. Reffo, P. G. Jorgensen, O. Dubourg, J. Abreu, S. Wang, E. Cervesato, K. Theodoropoulos, N. Ozaydogdu, L. Jung, Y. Kijima, E. Ostenfeld, C. Corsi, M. Florescu, M. Chenilleau, K. Yokota, A. Faeh-Gunz, R. Winter, J. Dreyfus, D. Kang, S. K. Saha, S. Surdulli, L. Abikeyeva, M. Marchel, P. Meregalli, M. Yamat, X. Arana Achaga, C. Shahla, V. Palicka, M. Tanaka, A. Galrinho, K. Endo, M. Saravi, J. Bogaert, H. Oeygarden, S. Okabe, J. Reiken, G. Ionescu, C. Selton-Suty, A. Nunes-Diogo, E. S. Davidsen, E. Kinova, A. Bandeira, Y. Seo, S. Hojberg, G. Siblini, M. Pellegrino, M. Ostojic, J. J. Onaindia Gandarias, M. Pereira, F. Antonini-Canterin, F. Akturk, T. Nakajima, M. Al Fayyadh, S. Herrmann, G. Stellin, M. E. Menting, B. Sasko, J. Song, T. Kurokawa, F. Dipasqua, T. Maruo, M. Geleijnse, H. Triantafyllidi, M. Komeda, R. Praus, V. Nesvetov, M. Fineschi, A. Auricchio, M. Dorobantu, A. Degirmencioglu, E. Laraudogoitia Zaldumbide, S. Velasco Del Castillo, Z. Marcetic, U. Waje-Andreassen, F. Fang, K. Farsalinos, L. Vasina, D. Muraru, M. Faludi, P. Rio, S. Peppes, T. Karaahmet, G. Suermeci, P. Maccarthy, S. Kotsovilis, Y. Akashi, G. Di Salvo, Z. Issa, J. Gibbs, A. Poletti, E. Bonnefoy-Cudraz, A. Madej-Pilarczyk, E. Gerdts, K. Solymossy, P. Kogoj, T. Tomita, M. Lisi, K. Suzuki, S. Sifakis, E.A. Surkova, T. Fritz-Hansen, V. Tritakis, E. Romeo, T. Akesson-Lindow, B. Lasota, A. Florian, M. Maciel, K. Gieszczyk-Strozik, M. Imazio, S. Ozyilmaz, K. Kadota, V. Peric, E. Zencirci, B. Tzvetkov, U. Aguirre Larracoechea, D. Caldeira, Y. Motoyoshi, M. Russo, R. Suri, H. Pintaric, O. Celik, D. Himbert, L. Branco, B. Sun, S. Dzhetybayeva, A. Esen Zencirci, M. Ciurzynski, R. Nunyez, B. Iung, K. Takenaka, A. S. Omran, K. Ozden, J. Argacha, S. Pradel, A. M. Pistritto, M. Pfyffer, C. Dedobbeleer, J. Vojacek, P. Costa, E. Albuquerque, A. Tamadoni, B. Sarubbi, M. Carlsson, R. Mogelvang, G. Oria, K. Kimura, E. Kim, F. Kousathana, A. Mateescu, A. Varga, J. Clerc, M. Noni, S. Kyrzopoulos, S. Andossova, S. Almeida, E. Shkolnik, J. Koyama, M. Daimon, S. Saeed, B. Popescu, M. Tigen, R. Wennemann, C. Venner, M. Guazzi, R. Magalhaes, H. Hayashi, M. Salagianni, A. Kiotsekoglou, A. Baggiano, C. Chao, T. Nakao, H. Becher, R. Zeppellini, J. Marrugat, G. Erente, P. Lancellotti, R. Rimbas, D. M'barek, M. Cameli, Y. Katahira, S. Carerj, C. Grasso, P. Moulin, D. Lavergne, B. Merkely, D. Mahoney, C. Tamburino, W. Kosmala, G. Romagna, T. Potpara, T. Ha, R. Biffanti, C. Dundar, E. Gunyeli, L. Weinert, R. Dworakowski, A. Ferreira, T. 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Fromm, E. Stoupel, D. Ural, R. Pilliere, L. Llobera, W. Kim, M. Sobczak, F. Bandera, S. Oliveira, P. Mills, H. Zemir, E. Oner, S. Sparla, C. Cosgrove, S. Kou, A. Annoni, B. Vujisic-Tesic, M. Hojati, L. Carr, P. Meimoun, A. Jaccard, E. Varotto, N. Bulj, T. Kawata, M. Bulut, G. Dimitriadis, B. Ramondo, V. Voudris, H. Christensen, H. Eguchi, J. Grapsa, P. R. Silva Fazendas Adame, C. Cimadevilla, L. Christensen, M. Cikes, A. Izawa, G. Merchan Ortega, A. Makrigiannakis, M. Forkmann, G. Radegran, P. Dias, A. Faiz, C. Stefopoulos, Y. Vasyuk, A. Akyol, L. Howard, A. Correia, J. Younger, and C. Greis

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medicine.medical_specialty, business.industry, medicine, Radiology, Nuclear Medicine and imaging, Medical physics, General Medicine, Session (computer science), Cardiology and Cardiovascular Medicine, business
Published
2013
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15. Prognostic Impact of Diabetes and Prediabetes on Survival Outcomes in Patients With Chronic Heart Failure: A Post-Hoc Analysis of the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) Trial

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Marco Dauriz, Giovanni Targher, Pier Luigi Temporelli, Donata Lucci, Lucio Gonzini, Gian Luigi Nicolosi, Roberto Marchioli, Gianni Tognoni, Roberto Latini, Franco Cosmi, Luigi Tavazzi, Aldo Pietro Maggioni, Simona Barlera, Maria Grazia Franzosi, Aldo P. Maggioni, Maurizio Porcu, Salim Yusuf, Fulvio Camerini, Jay N. Cohn, Adriano Decarli, Bertram Pitt, Peter Sleight, Philip A. Poole‐Wilson, Enrico Geraci, Marino Scherillo, Gianna Fabbri, Barbara Bartolomei, Daniele Bertoli, Franco Cobelli, Claudio Fresco, Antonietta Ledda, Giacomo Levantesi, Cristina Opasich, Franco Rusconi, Gianfranco Sinagra, Fabio Turazza, Alberto Volpi, Martina Ceseri, Gianluca Alongi, Antonio Atzori, Filippo Bambi, Desiree Bastarolo, Francesca Bianchini, Iacopo Cangioli, Vittoriana Canu, Concetta Caporusso, Gabriele Cenni, Laura Cintelli, Michele Cocchio, Alessia Confente, Eva Fenicia, Giorgio Friso, Marco Gianfriddo, Gianluca Grilli, Beatrice Lazzaro, Giuseppe Lonardo, Alessia Luise, Rachele Nota, Mariaelena Orlando, Rosaria Petrolo, Chiara Pierattini, Valeria Pierota, Alessandro Provenzani, Velia Quartuccio, Anna Ragno, Chiara Serio, Alvise Spolaor, Arianna Tafi, Elisa Tellaroli, Stefano Ghio, Elisa Ghizzardi, Serge Masson, Lella Crociati, Maria Teresa La Rovere, Ugo Corrà, Andrea Finzi, Marco Gorini, Valentina Milani, Giampietro Orsini, Elisa Bianchini, Silvia Cabiddu, Ilaria Cangioli, Laura Cipressa, Maria Lucia Cipressa, Giuseppina Di Bitetto, Barbara Ferri, Luisa Galbiati, Andrea Lorimer, Carla Pera, Paola Priami, Antonella Vasamì, T. Moccetti, M.G. Rossi, E. Pasotti, F. Vaghi, P. Roncarolo, M.T. Zunino, F. Matta, E. Actis Perinetto, F. Gaita, G. Azzaro, M. Zanetta, A.M. Paino, U. Parravicini, D. Vegis, R. Conte, P. Ferraro, A. De Bernardi, S. Morelloni, M. Fagnani, P. Greco Lucchina, L. Montagna, E. Bellone, D. Sappè, F. Ferraro, M. Delucchi, S.G. Reynaud, M. Dore, A. La Brocca, N. Massobrio, L. Bo, R. Trinchero, M. Imazio, G. Brocchi, A. Nejrotti, L. Rissone, S. Gabasio, C. Zocchi, S. Randazzo, A. Crenna, P. Giannuzzi, E. Bonanomi, A. Mezzani, M. De Marchi, G. Begliuomini, C.A. Gianonatti, A. Gavazzi, A. Grosu, L. Dei Cas, S. Nodari, P. Garyfallidis, A. Bertoletti, C. Bonifazi, S. Arisi, F. Mascaro, M. Fraccarollo, S. Dell'Orto, M. Sfolcini, F. Bortolini, D. Raccagni, A. Turelli, M. Santarone, E. Miglierina, L. Sormani, R. Jemoli, F. Tettamanti, S. Pirelli, C. Bianchi, S. Verde, M. Mariani, V. Ziacchi, A. Ferrazza, A. Russo, M. Bortolotti, G.F. Pasini, A. Volpi, K.N. Jones, D. Cuzzucrea, G. Gullace, C. Carbone, A. Granata, S. De Servi, G. Del Rosso, C. Inserra, E. Renaldini, C. Zappa, M. Moretti, R. Zanini, M. Ferrari, E. Moroni, A. Cei, C. Lissi, E. Dovico, C. Fiorentini, P. Palermo, B. Brusoni, M. Negrini, J. Heyman, G.B. Danzi, A. Finzi, M. Frigerio, F. Turazza, L. Beretta, A. Sachero, F. Casazza, L. Squadroni, F. Lombardi, L. Marano, A. Margonato, G. Fragasso, O.C. Febo, E. Aiolfi, F. Olmetti, A. Grieco, V. Antonazzo, G. Specchia, A. Mortara, F. Robustelli, M.G. Songini, C. Schweiger, A. Frisinghelli, M. Palvarini, C. Campana, L. Scelsi, N. Ajmone Marsan, F. Cobelli, A. Gualco, C. Opasich, S. De Feo, R. Mazzucco, M.A. Iannone, T. Diaco, D. Zaniboni, G. Milanesi, D. Nassiacos, S. Meloni, P. Giani, T. Nicoli, C. Malinverni, A. Gusmini, L. Pozzoni, G. Bisiani, P. Margaroli, A. Schizzarotto, A. Daverio, G. Occhi, N. Partesana, P. Bandini, M.G. Rosella, S. Giustiniani, G. Cucchi, R. Pedretti, R. Raimondo, R. Vaninetti, A. Fedele, I. Ghezzi, E. Rezzonico, J.A. Salerno Uriarte, F. Morandi, F. Salvucci, C. Valenti, G. Graziano, M. Romanò, C. Cimminiello, I. Mangone, M. Lombardo, P. Quorso, G. Marinoni, M. Breghi, M. Erckert, A. Dienstl, G. Mirante Marini, C. Stefenelli, G. Cioffi, E. Buczkowska, A. Bonanome, F. Bazzanini, L. Parissenti, C. Serafini, G. Catania, L. Tarantini, G. Rigatelli, S. Boni, A. Pasini, E. Masini, A.A. Zampiero, M. Zanchetta, L. Franceschetto, P. Delise, C. Marcon, A. Sacchetta, L. Borgese, L. Artusi, P. Casolino, F. Corbara, A. Banzato, M. Barbiero, M.P. Aldegheri, R. Bazzucco, G. Crivellenti, A. Raviele, C. Zanella, P. Pascotto, P. Sarto, S. Milan, E. Barbieri, P. Girardi, W. Dalla Villa, J. Dalle Mule, M.L. Di Sipio, R. Cazzin, D. Milan, P. Zonzin, M. Carraro, R. Rossi, E. Carbonieri, I. Rossi, P. Stritoni, P. Meneghetti, G. Risica, P.L. Tenderini, C. Vassanelli, L. Zanolla, G. Perini, G. Brighetti, R. Chiozza, G. Giuliano, R. Gortan, R. Cesanelli, G.L. Nicolosi, R. Piazza, L. Mos, O. Vriz, D. Pavan, G. Pascottini, E. Alberti, M. Werren, L. Solinas, G. Sinagra, F. Longaro, P. Fioretti, M.C. Albanese, D. Miani, R. Gianrossi, A. Pende, P. Rubartelli, O. Magaia, S. Domenicucci, D. Caruso, A.S. Faraguti, L. Magliani, F. Miccoli, G. Guglielmino, D. Bertoli, A. Cantarelli, S. Orlandi, A. Vallebona, A. Pozzati, G. Brega, L.G. Pancaldi, R. Vandelli, S. Urbinati, M.G. Poci, M. Zoli, G.M. Costa, U. Guiducci, G. Zobbi, F. Tartagni, A. Tisselli, A. Gentili, P. Pieri, E. Cagnetta, S. Bendinelli, A. Barbieri, R. Conti, R. Ferrari, F. Merlini, A. Fucili, P. Moruzzi, E. Buia, M. Galvani, D. Ferrini, G. Baggioni, P. Yiannacopulu, G. Canè, A. Bonfiglioli, R. Zandomeneghi, L. Brugioni, A. Giannini, R. Di Ruvo, M. Giuliani, L. Rusconi, P. Del Corso, G. Piovaccari, F. Bologna, P. Venturi, F. Melandri, E. Bagni, L. Bolognese, R. Perticucci, A. Zuppiroli, M. Nannini, N. Consoli, P. Petrone, C. Pipitò, L. Colombi, D. Bernardi, P.R. Mariani, R. Testa, F. Mazzinghi, F. Cosmi, D. Cosmi, A. Zipoli, A. Cecchi, G. Castelli, M. Ciaccheri, F. Mori, F. Pieri, P. Valoti, D. Chiarantini, G.M. Santoro, C. Minneci, F. Marchi, M. Milli, G. Zambaldi, A.A. Brandinelli Geri, M. Cipriani, M. Alessandri, S. Severi, S. Stefanelli, A. Comella, R. Poddighe, A. Digiorgio, M. Carluccio, S. Berti, A. Rizza, V. Bonatti, V. Molendi, A. Brancato, N. D'Aprile, G. Giappichini, S. Del Vecchio, G. Mantini, F. De Tommasi, G. Meucci, M. Cordoni, S. Bechi, L. Barsotti, P. Baldini, M. Romei, G. Scopelliti, G. Lauri, F. Pestelli, F. Furiozzi, M. Cocchieri, D. Severini, F. Patriarchi, P. Chiocchi, M. Buccolieri, S. Martinelli, A. Wee, F. Angelici, M. Bernardinangeli, G. Proietti, B. Biscottini, R. Panciarola, L. Marinacci, G.P. Perna, D. Gabrielli, A. Moraca, L. Moretti, L. Partemi, G. Gregori, R. Amici, G. Patteri, P. Capone, E. Savini, G.L. Morgagni, L. Paccaloni, F. Pezzuoli, S. Carincola, S. Papi, S. De Crescentini, P. Gerardi, P. Midi, E. Gallenzi, G. Pajes, C. Mancone, V. Di Spirito, M. Di Gennaro, S. Calcagno, S. Toscano, S. Antonicoli, F. Carta, G. Giorgi, F. Comito, E. Daniele, O. Ciarla, P.G. Gelfo, A. Acquaviva, D. Testa, G. Testa, F.A. Pagliaro, F. Russo, F. Vetta, I. Marchese, G. Di Sciascio, A. D'Ambrosio, F. Leggio, D. Del Sindaco, A. Lacchè, A. Avallone, M.P. Risa, P. Azzolini, E. Baldo, E. Giovannini, G. Pulignano, C. Tondo, E. Picchio, E. ani, P. Tanzi, F. Pozzar, F. Farnetti, M. Azzarito, M. Santini, A. Varveri, G. Ferraiuolo, C. Valtorta, A. Gaspardone, G. Barbato, V. Ceci, N. Aspromonte, F. Bellocci, C. Colizzi, F. Fedele, F.I. Perez, A. Galati, A. Rossetti, A. Mainella, D. etta, C. Matteucci, G. Busi, A. De Angelis, G. Farina, A. Granatelli, F. Leone, F. Frasca, R. Di Giovambattista, G. Castellani, G. Massaro, G. Mastrogiuseppe, A. Vacri, F. De Sanctis, M. Cioli, S. Di Luzio, C. Napoletano, L.L. Piccioni, G. De Simone, A. Ottaviano, V. Mazza, C. Spedaliere, D. Staniscia, E. Calgione, G. De Marco, T. Chiacchio, T. Di Napoli, S. Romanzi, G. Salvatore, P. Golino, A. Palermo, F. Mascia, A. Vetrano, A. Vinciguerra, L. Caliendo, R. Longobardi, G. De Caro, R. Di Nola, F. Piemonte, D. Prinzi, P. De Rosa, V. De Rosa, F. Riello, V. Capuano, G. Vecchio, M. Landi, S. Amato, M. Garofalo, M. D'Avino, P. Sensale, O. Maiolica, R. Santoro, P. Caso, D. Miceli, N. Maurea, U. Bianchi, C. Crispo, M. Chiariello, P. Perrone Filardi, L. Russo, N. Capuano, G. Ungaro, G. Vergara, F. Scafuro, G. D'Angelo, C. Campaniello, P. Bottiglieri, A. Volpe, R. Battista, L. De Risi, G. Cardillo, G. Sibilio, A.P. Marino, F. Silvestri, P. Predotti, A. Iervoglini, C. De Matteis, P. Sarnicola, M.M. Matarazzo, S. Baldi, V. Iuliano, C. Astarita, P. Cuccaro, A. Liguori, G. Liguori, G. Gregorio, L. Petraglia, G. Antonelli, G. Amodio, I. De Luca, D. Traversa, G. Franchini, M.L. Lenti, D. Cavallari, C. D'Agostino, G. Scalera, C.M. Altamura, M. Russo, A.R. Mascolo, G. Pettinati, S.A. Ciricugno, D. Scrutinio, A. Passantino, D. Mastrangelo, A. Di Masi, R. De Carne, M. Cannone, F. Dibiase, M. Pensato, F. Loliva, F. 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A., Cipriani, M., Alessandri, M., Severi, S., Stefanelli, S., Comella, A., Poddighe, R., Digiorgio, A., Carluccio, M., Berti, S., Rizza, A., Bonatti, V., Molendi, V., Brancato, A., D'Aprile, N., Giappichini, G., Del Vecchio, S., Mantini, G., De Tommasi, F., Meucci, G., Cordoni, M., Bechi, S., Barsotti, L., Baldini, P., Romei, M., Scopelliti, G., Lauri, G., Pestelli, F., Furiozzi, F., Cocchieri, M., Severini, D., Patriarchi, F., Chiocchi, P., Buccolieri, M., Martinelli, S., Wee, A., Angelici, F., Bernardinangeli, M., Proietti, G., Biscottini, B., Panciarola, R., Marinacci, L., Perna, G. P., Gabrielli, D., Moraca, A., Moretti, L., Partemi, L., Gregori, G., Amici, R., Patteri, G., Capone, P., Savini, E., Morgagni, G. L., Paccaloni, L., Pezzuoli, F., Carincola, S., Papi, S., De Crescentini, S., Gerardi, P., Midi, P., Gallenzi, E., Pajes, G., Mancone, C., Di Spirito, V., Di Gennaro, M., Calcagno, S., Toscano, S., Antonicoli, S., Carta, F., Giorgi, G., Comito, F., Daniele, E., Ciarla, O., Gelfo, P. G., Acquaviva, A., Testa, D., Testa, G., Pagliaro, F. A., Russo, F., Vetta, F., Marchese, I., Di Sciascio, G., D'Ambrosio, A., Leggio, F., Del Sindaco, D., Lacchè, A., Avallone, A., Risa, M. P., Azzolini, P., Baldo, E., Giovannini, E., Pulignano, G., Tondo, C., Picchio, E., Biffani, E., Tanzi, P., Pozzar, F., Farnetti, F., Azzarito, M., Santini, M., Varveri, A., Ferraiuolo, G., Valtorta, C., Gaspardone, A., Barbato, G., Ceci, V., Aspromonte, N., Bellocci, F., Colizzi, C., Fedele, F., Perez, F. I., Galati, A., Rossetti, A., Mainella, A., Ciuffetta, D., Matteucci, C., Busi, G., De Angelis, A., Farina, G., Granatelli, A., Leone, F., Frasca, F., Di Giovambattista, R., Castellani, G., Massaro, G., Mastrogiuseppe, G., Vacri, A., De Sanctis, F., Cioli, M., Di Luzio, S., Napoletano, C., Piccioni, L. L., De Simone, G., Ottaviano, A., Mazza, V., Spedaliere, C., Staniscia, D., Calgione, E., De Marco, G., Chiacchio, T., Di Napoli, T., Romanzi, S., Salvatore, G., Golino, P., Palermo, A., Mascia, F., Vetrano, A., Vinciguerra, A., Caliendo, L., Longobardi, R., De Caro, G., Di Nola, R., Piemonte, F., Prinzi, D., De Rosa, P., De Rosa, V., Riello, F., Capuano, V., Vecchio, G., Landi, M., Amato, S., Garofalo, M., D'Avino, M., Sensale, P., Maiolica, O., Santoro, R., Caso, P., Miceli, D., Maurea, N., Bianchi, U., Crispo, C., Chiariello, M., Perrone Filardi, P., Russo, L., Capuano, N., Ungaro, G., Vergara, G., Scafuro, F., D'Angelo, G., Campaniello, C., Bottiglieri, P., Volpe, A., Battista, R., De Risi, L., Cardillo, G., Sibilio, G., Marino, A. P., Silvestri, F., Predotti, P., Iervoglini, A., De Matteis, C., Sarnicola, P., Matarazzo, M. M., Baldi, S., Iuliano, V., Astarita, C., Cuccaro, P., Liguori, A., Liguori, G., Gregorio, G., Petraglia, L., Antonelli, G., Amodio, G., De Luca, I., Traversa, D., Franchini, G., Lenti, M. L., Cavallari, D., D'Agostino, C., Scalera, G., Altamura, C. M., Russo, M., Mascolo, A. R., Pettinati, G., Ciricugno, S. A., Scrutinio, D., Passantino, A., Mastrangelo, D., Di Masi, A., De Carne, R., Cannone, M., Dibiase, F., Pensato, M., Loliva, F., Trapani, F., Panettieri, I., Leone, L., Di Biase, M., Carrone, M., Gallone, V., Cocco, F., Costantini, M., Tritto, C., Cavalieri, F., Stella, L., Magliari, F., Callerame, M., De Giorgi, A., Pellegrino, L., Correra, M., Portulano, V., Nisi, G. L., Grassi, G., Cristallo, E., De Laura, D., Salerno, C., Fanelli, R., Villella, M., Pede, S., Renna, A., De Lorenzi, E., Urso, L., Lenti, V., Peluso, A., Baldi, N., Polimeni, G., Palma, P., Lauletta, R., Tagliamonte, E., Cirillo, T., Silvestri, B., Centonze, G., D'Alessandro, B., Truncellito, L., Mecca, D., Petruzzi, M. A., Coviello, R. O. M., Lopizzo, A., Chiaffitelli, M., Barbuzzi, S., Gubelli, S., Germinario, G., Cosentino, N., Mingrone, A., Vico, R., Borrello, G., Mazza, M. L., Cimino, R., Galasso, D., Cassadonte, F., Talarico, U., Perticone, F., Cassano, S., Catapano, F., Calemme, S., Feraco, E., Cloro, C., Misuraca, G., Caporale, R., Vigna, L., Spagnuolo, V., De Rosa, F., Spadafora, G., Zampaglione, G., Russo, R., Schipani, F. A., Ferragina, A. F., Stranieri, D., Musca, G., Carpino, C., Bencardino, P., Raimondo, F., Musacchio, D., Pulitanò, G., Ruggeri, A., Provenzano, A., Salituri, S., Musolino, M., Calandruccio, S., Marrari, A., Tripodi, E., Scali, R., Anastasio, L., Arone, A., Aragona, P., Donnangelo, L., Comito, M. G. A., Bilotta, F., Vaccaro, I., Rametta, R., Ventura, V., Bonvegna, A., Alì, A., Cinnirella, C., Raineri, M., Pompeo, F., Cascio Ingurgio, N., Carini, V., Coco, R., Giunta, G., Leonardi, G., Randazzo, V., Di Blasi, V., Tamburino, C., Russo, G., Mangiameli, S., Cardillo, R., Castelli, D., Inserra, V., Arena, A., Gulizia, M. M., Raciti, S., Rapisarda, G., Romano, R., Prestifilippo, P., Braschi, G. B., Ledda, G., Terrazzino, R., De Caro, M., Scilabra, G., Graffagnino, B., Grassi, R., Di Tano, G., Scimone, G. F., Vasquez, L., Coppolino, C., Casale, A., Castelli, M., D'Urso, G., D'Antonio, E., Lo Presti, L., Badalamenti, E., Conti, P., Sanfilippo, N., Cirrincione, V., Cinà, M. T., Cusimano, G., Taormina, A., Giuliano, P., Bajardi, A., Mandalà, V., Canonico, A., Geraci, G., Sabella, F. P., Enia, F., Floresta, A. M., Lo Cascio, I., Gumina, D., Cavallaro, A., Piccione, G., Ferrante, R., Blandino, M., Iudicello, M. S., Mossuti, E., Romano, G., Lombardo, L., Monastra, P., Di Vincenzo, D., Porcu, M., Orrù, P., Muscas, F., Giardina, G., Corda, M., Locci, G., Podda, A., Ledda, M., Siddi, P., Lai, C., Pili, G., Mercuro, G., Mureddu, G., Ganau, A., Meloni, G., Poddighe, G., Sanna, G., Barlera, Simona, Franzosi, Maria Grazia, Porcu, Maurizio, Yusuf, Salim, Camerini, Fulvio, Cohn, Jay N., Decarli, Adriano, Pitt, Bertram, Sleight, Peter, Poole-Wilson, Philip A., Geraci, Enrico, Scherillo, Marino, Fabbri, Gianna, Bartolomei, Barbara, Bertoli, Daniele, Cobelli, Franco, Fresco, Claudio, Ledda, Antonietta, Levantesi, Giacomo, Opasich, Cristina, Rusconi, Franco, Sinagra, Gianfranco, Turazza, Fabio, Volpi, Alberto, Ceseri, Martina, Alongi, Gianluca, Atzori, Antonio, Bambi, Filippo, Bastarolo, Desiree, Bianchini, Francesca, Cangioli, Iacopo, Canu, Vittoriana, Caporusso, Concetta, Cenni, Gabriele, Cintelli, Laura, Cocchio, Michele, Confente, Alessia, Fenicia, Eva, Friso, Giorgio, Gianfriddo, Marco, Grilli, Gianluca, Lazzaro, Beatrice, Lonardo, Giuseppe, Luise, Alessia, Nota, Rachele, Orlando, Mariaelena, Petrolo, Rosaria, Pierattini, Chiara, Pierota, Valeria, Provenzani, Alessandro, Quartuccio, Velia, Ragno, Anna, Serio, Chiara, Spolaor, Alvise, Tafi, Arianna, Tellaroli, Elisa, Ghio, Stefano, Ghizzardi, Elisa, Masson, Serge, Crociati, Lella, La Rovere, Maria Teresa, Corrà, Ugo, Di Giulio, Paola, Finzi, Andrea, Gorini, Marco, Milani, Valentina, Orsini, Giampietro, Bianchini, Elisa, Cabiddu, Silvia, Cangioli, Ilaria, Cipressa, Laura, Cipressa, Maria Lucia, Di Bitetto, Giuseppina, Ferri, Barbara, Galbiati, Luisa, Lorimer, Andrea, Pera, Carla, Priami, Paola, and Vasamì, Antonella

Subjects
Blood Glucose, Male, Glycated Hemoglobin A, heart failure, Kaplan-Meier Estimate, prediabetes, 030204 cardiovascular system & hematology, time factors, Settore MED/11, cause of death, 0302 clinical medicine, Glycemic control, prediabetic state, Cause of Death, italy, middle aged, Prevalence, 80 and over, double-blind method, blood glucose, risk factors, 030212 general & internal medicine, Prediabetes, Rosuvastatin Calcium, humans, rosuvastatin calcium, Cause of death, Original Research, Metabolic Syndrome, Aged, 80 and over, adult, Chronic heart failure, Diabetes mellitus, Heart failure, Mortality, Cardiology and Cardiovascular Medicine, Hazard ratio, chronic heart failure, diabetes mellitus, glycemic control, mortality, Treatment Outcome, Adolescent, Biomarkers, Chronic Disease, Diabetes Mellitus, Fatty Acids, Omega-3, Double-Blind Method, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hospitalization, Heart Failure, Italy, Prediabetic State, Risk Assessment, Proportional Hazards Models, Risk Factors, Time Factors, risk assessment, Middle Aged, kaplan-meier estimate, aged, female, Prediabete, young adult, Female, omega-3, Human, hospitalization, Adult, medicine.medical_specialty, Diabetes mellitu, proportional hazards models, Time Factor, hydroxymethylglutaryl-coa reductase inhibitors, prevalence, fatty acids, 03 medical and health sciences, Young Adult, male, Internal medicine, Post-hoc analysis, glycated hemoglobin a, medicine, Intensive care medicine, Aged, Glycated Hemoglobin, Proportional hazards model, business.industry, Risk Factor, biomarkers, Biomarker, medicine.disease, Clinical trial, adolescent, Proportional Hazards Model, treatment outcome, aged, 80 and over, chronic disease, fatty acids, omega-3, cardiology and cardiovascular medicine, Hydroxymethylglutaryl-CoA Reductase Inhibitor, business
Abstract

Background The independent prognostic impact of diabetes mellitus ( DM ) and prediabetes mellitus (pre‐ DM ) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre‐ DM on survival outcomes in the GISSI ‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) trial. Methods and Results We assessed the risk of all‐cause death and the composite of all‐cause death or cardiovascular hospitalization over a median follow‐up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI ‐ HF trial, who were stratified by presence of DM (n=2852), pre‐ DM (n=2013), and non‐ DM (n=2070) at baseline. Compared with non‐ DM patients, those with DM had remarkably higher incidence rates of all‐cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non‐ DM patients and those with pre‐ DM . Cox regression analysis showed that DM , but not pre‐ DM , was associated with an increased risk of all‐cause death (adjusted hazard ratio, 1.43; 95% CI , 1.28–1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI , 1.13–1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all‐cause death: adjusted hazard ratio, 1.21; 95% CI , 1.02–1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI , 1.01–1.29, respectively). Conclusions Presence of DM was independently associated with poor long‐term survival outcomes in patients with chronic heart failure. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 00336336.

Published
2017
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16. Contents Vol. 124, 2013

Author

Zhi-cheng Xiao, Rashmi Chikarmane, Sevket Balta, Xiao-long Yin, Rui Yan Ma, Druck Reinhardt Druck Basel, Allison Jay, Jenny Öhman, Kristina Torngren, I. Burazor, Dan Yang, Janet Poulik, Y. Adler, Jacek J. Preibisz, David Erlinge, Satz Mengensatzproduktion, Zhihong Liu, Luís Paiva, Zong Ying Yang, H. Olgun Kucuk, John C. Somberg, S. Demirkol, Ana Faustino, Rui Providência, Ying Bin Xiao, Zhao Jian, Mehmet Ali Sahin, Fahri Gurkan Yesil, Axel T. Kleinsasser, Shubin Qiao, Jiansong Yuan, Shi Chen, Ming Zhang, Ugur Kucuk, Magne Brekke, S. Balta, Sait Demirkol, G. Markel, Murat Tavlasoglu, Xue-feng Guang, Xue Feng Wang, Zihe Yang, Hai-long Dai, Vinod K. Misra, Yue Guo, Johan Larsson, Mustafa Kurkluoglu, U. Kucuk, Lin Chen, Hanna Salmi, M. Imazio, Yong Li, Zekeriya Arslan, Sérgio Barra, Janos Molnar, and Karl H. Lindner

Subjects
Traditional medicine, business.industry, Medicine, Pharmacology (medical), Cardiology and Cardiovascular Medicine, business
Published
2013
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17. Recurrent pericarditis

Author

M. Imazio, A. Battaglia, L. Gaido, and F. Gaita

Subjects
Treatment Outcome, Aspirin, Adrenal Cortex Hormones, Recurrence, Anti-Inflammatory Agents, Non-Steroidal, Gastroenterology, Internal Medicine, Humans, Pericarditis, Prognosis
Abstract

Recurrent pericarditis is the most troublesome complication of pericarditis occurring in 15 to 30% of cases. The pathogenesis is often presumed to be immune-mediated although a specific rheumatologic diagnosis is commonly difficult to find. The clinical diagnosis is based on recurrent pericarditis chest pain and additional objective evidence of disease activity (e.g. pericardial rub, ECG changes, pericardial effusion, elevation of markers of inflammation, and/or imaging evidence of pericardial inflammation by CT or cardiac MR). The mainstay of medical therapy for recurrent pericarditis is aspirin or a non-steroidal anti-inflammatory drug (NSAID) plus colchicine. Second-line therapy is considered after failure of such treatments and it is generally based on low to moderate doses of corticosteroids (e.g. prednisone 0.2 to 0.5 mg/kg/day or equivalent) plus colchicine. More difficult cases are treated with combination of aspirin or NSAID, colchicine and corticosteroids. Refractory cases are managed by alternative medical options, including azathioprine, or intravenous human immunoglobulins or biological agents (e.g. anakinra). When all medical therapies fail, the last option may be surgical by pericardiectomy to be recommended in well-experienced centres. Despite a significant impairment of the quality of life, the most common forms of recurrent pericarditis (usually named as "idiopathic recurrent pericarditis" since without a well-defined etiological diagnosis) have good long-term outcomes with a negligible risk of developing constriction and rarely cardiac tamponade during follow-up. The present article reviews current knowledge on the definition, diagnosis, aetiology, therapy and prognosis of recurrent pericarditis with a focus on the more recent available literature.

Published
2016

19. Diagnostic issues in the clinical management of pericarditis

Author

M, Imazio, D H, Spodick, A, Brucato, R, Trinchero, G, Markel, and Y, Adler

Subjects
Chest Pain, Biopsy, Pericardiocentesis, Bacterial Infections, Pericarditis, Tuberculous, Prognosis, Pericardial Effusion, Heart Neoplasms, Electrocardiography, Myocarditis, Recurrence, Risk Factors, Virus Diseases, Acute Disease, Humans, Pericarditis, Triage, Pericardium
Abstract

To review the current major diagnostic issues on the diagnosis of acute and recurrent pericarditis.To review the current available evidence, we performed a through search of several evidence-based sources of information, including Cochrane Database of Systematic Reviews, Clinical Evidence, Evidence-based guidelines from National Guidelines Clearinghouse and a comprehensive Medline search with the MeSH terms 'pericarditis', 'etiology' and 'diagnosis'.The diagnosis of pericarditis is based on clinical criteria including symptoms, presence of specific physical findings (rubs), electrocardiographical changes and pericardial effusion. Although the aetiology may be varied, most cases are idiopathic or viral, even after an extensive diagnostic evaluation. In such cases, the course is often benign following anti-inflammatory treatment, and management would be not affected by a more precise diagnostic evaluation. A triage of pericarditis can be safely performed on the basis of the clinical and echocardiographical presentation. Specific diagnostic tests are not warranted if no specific aetiologies are suspected on the basis of the epidemiological background, history and presentation. High-risk features associated with specific aetiologies or complications include: fever38 degrees C, subacute onset, large pericardial effusion, cardiac tamponade, lack of response to aspirin or a NSAID.A targeted diagnostic evaluation is warranted in acute and recurrent pericarditis, with a specific aetiological search to rule out tuberculous, purulent or neoplastic pericarditis, as well as pericarditis related to a systemic disease, in selected patients according to the epidemiological background, presentation and clinical suspicion.

Published
2010

20. Management of heart failure in elderly people

Author

M, Imazio, A, Cotroneo, G, Gaschino, A, Chinaglia, P, Gareri, R, Lacava, T D, Voci, and R, Trinchero

Subjects
Heart Failure, Male, Patient Care Team, Aging, Evidence-Based Medicine, Adrenergic beta-Antagonists, Age Factors, Cardiac Pacing, Artificial, Comorbidity, Middle Aged, Atrial Fibrillation, Humans, Female, Aged
Abstract

To review currently available knowledge on presentation, clinical features and management of heart failure (HF) in elderly people.To review currently available evidence, we performed a thorough search of several evidence-based sources of information, including Cochrane Database of Systematic Reviews, Clinical Evidence, Evidence-based guidelines from National Guidelines Clearinghouse and a comprehensive MEDLINE search with the MeSH terms: 'heart failure', 'elderly' and 'management'.A number of features of ageing may predispose elderly people to HF, and may impair the ability to respond to injuries. Another hallmark of elderly patients is the increasing prevalence of multiple coexisting chronic conditions and geriatric syndromes that may complicate the clinical presentation and evolution of HF. Although diagnosis may be challenging, because atypical symptoms and presentations are common, and comorbid conditions may mimic or complicate the clinical picture, diagnostic criteria do not change in elderly people. Drug treatment is not significantly different from that recommended in younger patients, and largely remains empiric, because clinical trials have generally excluded elderly people and patients with comorbid conditions. Disease management programmes may have the potential to reduce morbidity and mortality for patients with HF.Heart failure is the commonest reason for hospitalisation and readmission among older adults. HF shows peculiar features in elderly people, and is usually complicated by comorbidities, presenting a significant financial burden worldwide, nevertheless elderly people have been generally excluded from clinical trials, and thus management largely remains empiric and based on evidence from younger age groups.

Published
2007

21. Omega-3 polyunsatured fatty acids role in postmyocardial infarction therapy

Author

M, Imazio, D, Forno, C, Quaglia, and R, Trinchero

Subjects
Fatty Acids, Omega-3, Myocardial Infarction, Animals, Humans, Anti-Arrhythmia Agents
Abstract

Largely initiated by studies among Eskimos in the early 1970s, great attention has been given to possible effects of omega-3 polyunsatured fatty acids (PUFA) in cardiovascular diseases. A series of positive effects on pathogenetic mechanisms of cardiovascular disease has been discovered from laboratory studies in cell cultures, animal models and in humans. omega-3 PUFA can reduce platelets and leucocytes activities as well as plasma triglycerides. Moreover they can have antiarrhythmic properties. Nowadays patients who experienced myocardial infarction have decreased risk of total and cardiovascular mortality by treatment with omega-3 PUFA (1 g daily). This effect is present irrespective of high or low fish intake or simultaneous intake of other drugs for secondary prevention of coronary heart disease. Mainly on the basis of GISSI Prevention trial results, dietary supplementation with omega-3 PUFA is now recommended as a new component of secondary prevention after myocardial infarction in national and international guidelines.

Published
2003

22. Mitral valve prolapse. Comparison between valvular repair and replacement in severe mitral regurgitation

Author

B, Gramaglia, M, Imazio, L, Checco, M, Villani, M, Morea, M, Di Summa, R, Bonamini, E, Rosettani, and L, Mangiardi

Subjects
Heart Valve Prosthesis Implantation, Male, Reoperation, Mitral Valve Prolapse, Mitral Valve Insufficiency, Endocarditis, Bacterial, Middle Aged, Ventricular Function, Left, Survival Rate, Postoperative Complications, Treatment Outcome, Humans, Mitral Valve, Female, Aged, Retrospective Studies
Abstract

The aim of this study was to analyse long term results of mitral valve repair of degenerative mitral regurgitation compared to valve replacement.A hundred-twenty-five consecutive patients with severe mitral valve insufficiency who underwent cardiac surgery from January 1987 to December 1995 were included in the study. Mean age was 55+/-16 years (77 males, 48 females). Mitral repair was performed in 62 patients and mitral valve was replaced in 63 patients. Mean follow-up was 5 years. The repair procedures were based on quadrangular resection of the posterior leaflet, chordal replacement and transposition. Annuloplasty was performed in 100% of cases. The technique of valve replacement was conventional with complete excision of the valve in the majority of cases.Operative mortality following valve repair was 1.6%, no death occurred in the prosthesic group. In the repair group overall survival and re-operation rate were respectively 95.2% and 6.5%, while in the replacement group were 93.7% and 7.9%. No endocarditis and thromboembolic accidents were observed following valvuloplasty, while in the prostheses 6.3% of patients had endocarditis and 1.6% had a thromboembolic event. Mild or moderate left ventricular dysfunction was present in 5 patients after valvuloplasty and in 9 patients with prostheses.Considering these results we conclude that, in patients with severe degenerative mitral insufficiency, mitral valve repair is warranted whenever it is possible. The advantages given by maintaining the native valve suggest that surgery should be considered in asymptomatic patients before the occurrence of the left ventricular dysfunction.

Published
1999

23. [Differences in pharmacologic treatment after acute myocardial infarction. The role of treatment effectiveness]

Author

M, Bobbio, M, Imazio, M, Tidu, P, Presbitero, R, Trinchero, and A, Brusca

Subjects
Male, Electrocardiography, Time Factors, Acute Disease, Myocardial Infarction, Humans, Cardiovascular Agents, Female, Middle Aged, Drug Prescriptions, Ventricular Function, Left, Aged
Abstract

Despite growing interest concerning the prescription of different drugs in different clinical settings, no explanatory variables have been determined. The aim of this study was to verify if there are any differences in drug prescription at the time of hospital release following myocardial infarction and if any of these differences can be explained by scientific evidence concerning treatment efficacy.All drugs prescribed to 430 patients discharged from three different cardiology departments after acute myocardial infarction were analyzed. Based on current scientific evidence, it has been, ascertained that aspirin, beta-blockers and ACE-inhibitors can be prescribed unless contraindicate whereas anticoagulants, nitrates and calcium antagonists should be prescribed only in specific clinical conditions. The odd ratio of prescription of each drug among the three cardiology departments was calculated and adjusted for any clinical and test result variables that can specifically affect drug prescription.Different clinical characteristics of the patients discharged from the three cardiology departments are the following: mean age ranges from 60 to 66 years (p0.001), the incidence of non-Q myocardial infarction ranges from 23 to 45% (p0.001), post infarction angina ranges from 6 to 15% (p = 0.016), left ventricular failure ranges from 6 to 13% (p = 0.003) and arrhythmia ranges from 5 to 18% (p = 0.007). The adjusted odd ratio for clinical and test results variables showed that prescriptions were similar for ACE-inhibitors (odd ratio 1.3; 95% confidence interval from 0.6 to 3.2), aspirin (OR 2.2; 95% confidence interval from 0.8 to 5.5), beta-blockers (OR 2.2, 95% confidence interval from 0.9 to 5.5) and oral anticoagulants (1.6; 95% confidence interval from 0.6 to 4.5). Instead, there is a statistically significant difference in the prescription of nitrates (OR 4.4; 95% confidence interval from 1.6 to 12.3) and of calcium antagonists (OR 5.4%, 95% confidence interval from 1.0 to 12.5).Evidence based drug efficacy after acute myocardial infarction seems to establish a uniform pattern of drug prescription in different cardiology departments.

Published
1997

24. Paleoindian Cave Dwellers in the Amazon : The Peopling of the Americas

Author

Kathy Schick, J. A. Holman, M. Lima da Costa, James K. Feathers, William K. Barnett, J. Sliva, Anna Curtenius Roosevelt, Hélène Valladas, Norbert Mercier, C. Lopes Machado, A. Henderson, M. Michab, Nicholas Toth, M. Imazio da Silveira, B. Chernoff, D. S. Reese, IRAMAT-Centre de recherche en physique appliquée à l’archéologie (IRAMAT-CRP2A), Institut de Recherches sur les Archéomatériaux (IRAMAT), Université d'Orléans (UO)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Montaigne-Université de Technologie de Belfort-Montbeliard (UTBM)-Université d'Orléans (UO)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Montaigne-Université de Technologie de Belfort-Montbeliard (UTBM), Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Field Museum of Natural History [Chicago, USA], Federal University of Para - Universidade Federal do Pará - UFPA [Belém, Brazil] (UFPA), Reserva Florestal de Linhares - Réserve forestière de Linhares, Centre des Faibles Radioactivités, Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), University of Washington [Seattle], American Museum of Natural History (AMNH), Museu Paraense Emílio Goeldi [Belém, Brésil] (MPEG), Universidade de São Paulo = University of São Paulo (USP), New York Botanical Garden (NYBG), Center for Desert Archaeology, Tucson (AZ), Michigan State University [East Lansing], Michigan State University System, Indiana State University, and Université de Technologie de Belfort-Montbeliard (UTBM)-Université d'Orléans (UO)-Université Bordeaux Montaigne (UBM)-Centre National de la Recherche Scientifique (CNRS)-Université de Technologie de Belfort-Montbeliard (UTBM)-Université d'Orléans (UO)-Université Bordeaux Montaigne (UBM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
[SDU.OCEAN]Sciences of the Universe [physics]/Ocean, Atmosphere, 010506 paleontology, geography, Multidisciplinary, geography.geographical_feature_category, 060102 archaeology, Pleistocene, [SHS.ARCHEO]Humanities and Social Sciences/Archaeology and Prehistory, Amazon rainforest, Foraging, Humid subtropical climate, 06 humanities and the arts, 15. Life on land, 01 natural sciences, Archaeology, law.invention, Prehistory, Paleontology, Cave, law, 0601 history and archaeology, Radiocarbon dating, [SDU.ENVI]Sciences of the Universe [physics]/Continental interfaces, environment, ComputingMilieux_MISCELLANEOUS, 0105 earth and related environmental sciences
Abstract

International audience; A Paleoindian campsite has been uncovered in stratified prehistoric deposits in Caverna da Pedra Pintada at Monte Alegre in the Brazilian Amazon. Fifty-six radiocarbon dates on carbonized plant remains and 13 luminescence dates on lithics and sediment indicate a late Pleistocene age contemporary with North American Paleoindians. Paintings, triangular bifacial spear points, and other tools in the cave document a culture distinct from North American cultures. Carbonized tree fruits and wood and faunal remains reveal a broad-spectrum economy of humid tropical forest and riverine foraging. The existence of this and related cultures east of the Andes changes understanding of the migrations and ecological adaptations of early foragers.

Published
1996
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26. Eighth Millennium Pottery from a Prehistoric Shell Midden in the Brazilian Amazon

Author

Rupert A. Housley, M. Imazio da Silveira, S. Maranca, Randall S. Johnson, and Anna Curtenius Roosevelt

Subjects
Western hemisphere, Multidisciplinary, Faculty of Science\Geography, Amazon rainforest, Tropics, Fishing village, Archaeology, law.invention, Midden, Prehistory, Paleontology, Geography, Research Groups and Centres\Geography\Centre for Quaternary Research, law, Radiocarbon dating, Pottery
Abstract

The earliest pottery yet found in the Western Hemisphere has been excavated from a prehistoric shell midden near Santarem in the lower Amazon, Brazil. Calibrated accelerator radiocarbon dates on charcoal, shell, and pottery and a thermoluminescence date on pottery from the site fall from about 8000 to 7000 years before the present. The early fishing village is part of a long prehistoric trajectory that contradicts theories that resource poverty limited cultural evolution in the tropics.

Published
1992

33. Outcomes of acute pericarditis with an inflammatory phenotype.

Author

Imazio M, Brucato A, Lazaros G, Andreis A, Mascolo R, Berra S, Lazarou E, Tsioufis C, Solano A, and Collini V

Abstract

Background: Patients with pericarditis may show elevation of C-reactive protein (CRP) and pericardial effusion at presentation. There are limited data on the prognostic implications of this inflammatory phenotype., Objectives: Aim of the present study is to evaluate the outcome of the inflammatory phenotype in a cohort of patients with acute pericarditis., Methods: Observational cohort study of consecutive adult patients with acute pericarditis in 4 referral centers for pericarditis (Athens, Milan, Turin, Udine)., Results: Our cohort included 918 patients with acute pericarditis (median age of 56, IQR 28 years, 55.6 % females). The etiology of pericarditis was respectively idiopathic in 82.1 %, post-cardiac injury syndrome in 9.3 %, and systemic inflammatory disease in 4.9 % of cases. CRP elevation was detected at presentation in 778 cases (84.7 %), an inflammatory phenotype (CRP elevation and pericardial effusion) was found in 557 patients (60.7 %). Baseline medical therapy included a NSAID in 74.9 %, colchicine 70.9 %, and corticosteroids 25.1 % of cases. After a mean follow-up of 22.5 months, patients with an inflammatory phenotype had a higher recurrence rate at 18 months (respectively 46.0 % vs. 31.0 %; p < 0.0001), and a shorter recurrence-free survival (Log-rank p = 0.0001). In multivariable analysis the inflammatory phenotype presentation was independently associated with an increased risk of recurrences (OR 2.005, 95 % CI 1.454 to 2.765; p < 0.0001)., Conclusions: The inflammatory phenotype of presentation of acute pericarditis is associated with an increased risk of recurrences, highlighting the importance of timely individualized therapy and close follow-up for these patients., Competing Interests: Declaration of competing interest None., (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)

Published
2025
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34. Duration of Disease and Long-Term Outcomes in Patients With Difficult-To-Treat Recurrent Pericarditis: A Chronic Condition Treated With Nonsteroidal Anti-Inflammatory Drugs, Colchicine, Corticosteroids, and Anti-Interleukin-1 Agents.

Author

Ceriani E, Agozzino F, Berra S, Gidaro A, Bindi P, Pavarani A, Macchi S, Vena L, Moda F, Sicignano LL, Murace CA, Gerardino L, Verrecchia E, De Carlini CC, Maestroni S, Marinaro G, Bizzi E, Brucato A, and Imazio M

Abstract

Objective: We aimed to investigate the remission rate and disease duration in idiopathic or post-cardiac injury pericarditis and risk factors for disease duration and anti-interleukin-1 (IL-1) agent discontinuation., Methods: This was a multicenter, longitudinal, observational study including 370 patients (51.4% female). The remission rate was the proportion of patients who stopped all pericarditis-related therapies for at least 6 months without recurrences., Results: The median follow-up was 4.9 (interquartile range [IQR] 2.8-8.4) years, and the median age at the end of follow-up was 49 (IQR 37-60) years. A median of 1.1 (IQR 0.6-1.9) recurrences/year and 0.4 (IQR 0.1-0.9) hospitalizations/year were recorded. The remission rate at follow-up was 34.0%, 7% per year. Disease duration was shorter for patients in remission (3.1 years, IQR 1.6-6.2 years) than for those still receiving treatment (4 years, IQR 2.2-7.8; P = 0.02). Use of "guidelines-based therapy" (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.25-2.73; P = 0.02) and colchicine use at first attack (HR 1.51, 95% CI 1.02-2.23; P = 0.038) were protective factors, whereas steroid use was associated with longer disease duration (HR 0.53, 95% CI 0.35-0.81; P = 0.003). Corticosteroids were used in 77.3% of patients, with a median duration of therapy of 1.1 (IQR 0.4-2.6) years. Anakinra was used in 25.9% with a median duration of therapy of 2.4 (IQR 0.9-5.0) years; only 19.8% were able to stop anakinra at the end of observation period., Conclusion: This study reports the largest and longest follow-up in patients with recurrent pericarditis. Guideline adherence from the first attack is associated with a shorter course. The disease was long and impacting in terms of recurrences and hospitalizations, often requiring a long-term treatment, in particular with anti-IL-1 agents., (© 2025 The Author(s). ACR Open Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Published
2025
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35. Update on the diagnosis and treatment of pericardial diseases: a position paper of the Italian Society of Cardiology in collaboration with the study group on cardiomyopathies and pericardial diseases.

Author

Imazio M, Collini V, Aimo A, Autore C, Bauce B, Biagini E, Cappelli F, Castelletti S, D'Ascenzi F, De Gregorio C, Limongelli G, Marzo F, Merlo M, Musumeci B, Paolillo S, Tini G, Pedrinelli R, Filardi PP, and Sinagra G

Subjects
Humans, Cardiology standards, Cardiomyopathies therapy, Cardiomyopathies diagnosis, Italy, Societies, Medical, Pericarditis therapy, Pericarditis diagnosis
Abstract

The knowledge of pericardial diseases has now improved, including prospective and retrospective cohort studies focusing on the pathogenesis, diagnosis, treatment, and outcomes. The complex interplay between genetic predisposition (especially for autoinflammatory conditions), inflammation, and autoimmunity is now known to trigger recurrences of pericarditis. Moreover, diagnostic capabilities have improved with the implementation of multimodality imaging, particularly cardiac magnetic resonance (CMR), to detect and monitor pericardial inflammation, to allow diagnosis in more complicated cases, and tailor the duration of therapy based on objective parameters. A new class of drugs, the anti-IL-1 agents, have been introduced for patients with an inflammatory phenotype of presentation, and not responding to conventional anti-inflammatory therapies, including NSAID, colchicine, and corticosteroids. At present, the clinical management of pericardial diseases is definitely on the road of evidence-based medicine with new ongoing European guidelines focusing on the spectrum of inflammatory myocardial and pericardial syndromes., (Copyright © 2024 Italian Federation of Cardiology - I.F.C. All rights reserved.)

Published
2025
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37. Longitudinal cardiac magnetic resonance imaging following clinical response to rilonacept and prior to recurrence upon treatment suspension: a RHAPSODY subgroup analysis.

Author

Cremer PC, Brucato A, Insalaco A, Lin D, Luis SA, Kwon DH, Jellis CL, Clair J, Curtis A, Wang S, Klein AL, Imazio M, and Paolini JF

Subjects
Adult, Female, Humans, Male, Middle Aged, Longitudinal Studies, Recurrence, Treatment Outcome, Magnetic Resonance Imaging, Cine methods, Pericarditis diagnostic imaging, Pericarditis drug therapy, Recombinant Fusion Proteins therapeutic use
Abstract

Aims: In the Phase 3 trial, RHAPSODY, rilonacept effectively resolved active pericarditis recurrences, and long-term treatment led to sustained pericarditis recurrence risk reduction. Prior analysis suggested association between higher late gadolinium enhancement (LGE) at baseline and more rapid recurrence upon rilonacept suspension after 12 weeks of treatment. This subgroup analysis assessed the utility of longitudinal serial cardiac magnetic resonance (CMR) imaging for tracking clinical improvement and predicting post-treatment cessation outcomes to help guide clinical decision-making., Methods and Results: At an 18-month decision milestone (18MDM) in the RHAPSODY long-term extension, investigators decided if patients would continue rilonacept, suspend rilonacept for off-treatment observation, or discontinue the study. Pericardial thickness, pericardial oedema (T2-short tau inversion recovery, T2-STIR), and LGE were determined at baseline and 18MDM by an imaging core lab blinded to clinical data, and pericarditis recurrence was investigator-assessed. CMR results in patients with data at both baseline and 18MDM (n = 13) showed that pericardial thickness, T2-STIR, and LGE were reduced during rilonacept treatment. Among patients with CMR data who suspended rilonacept at the 18MDM (n = 7), five (71%) had a pericarditis recurrence within 1-4 months of rilonacept suspension, despite all having had none/trace LGE (n = 7) and negative T2-STIR (n = 7) at the 18MDM and two having received prophylactic colchicine., Conclusion: Continued clinical improvement during prolonged rilonacept treatment corresponded with improvement on CMR, including reduced pericardial thickness, resolution of pericardial oedema, and resolution of LGE. However, none/trace LGE at 18MDM while on treatment did not predict absence of pericarditis recurrence upon subsequent rilonacept suspension in this size-limited subgroup., Competing Interests: Conflict of interest: P.C.C. grants and personal fees from Kiniksa Pharmaceuticals; grants from Novartis Pharmaceuticals; and personal fees from SOBI Pharmaceuticals outside the submitted work. A.B.: unrestricted research grant from SOBI and ACARPIA; travel and accommodation for advisory committee from SOBI and Kiniksa. A.I.: travel and accommodation for advisory committee from SOBI. D.L.: advisory board for Kiniksa Pharmaceuticals. S.A.L.: consultant for Kiniksa Pharmaceuticals, Cardiol Therapeutics and Medtronic. D.H.K.: funding from the National Heart, Lung, and Blood Institute of the National Institute of Health. C.L.J.: none. M.I.: scientific advisory board for Kiniksa Pharmaceuticals. A.L.K.: research grant and scientific advisory boards for Kiniksa Pharmaceuticals and Cardiol Therapeutics, scientific advisory board for Pfizer, consultant to Kiniksa Pharmaceuticals. A.C., J.C., and S.W.: employees of Kiniksa Pharmaceuticals. J.F.P.: employee and shareholder of Kiniksa Pharmaceuticals; inventor on patents/patent applications covering the use of rilonacept for the treatment of recurrent pericarditis., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Published
2024
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39. [Diagnostic-therapeutic care pathways for patients with cardiac amyloidosis - SIC/ANMCO Consensus document. Edited by the Italian Cardiac Amyloidosis Network (RIAC)].

Author

Porcari A, Chimenti C, Merlo M, Musca F, Vergaro G, Iacoviello M, Aimo A, Di Lenarda A, Canepa M, Cappelli F, Cipriani A, Di Bella G, Forleo C, Imazio M, Limongelli G, Longhi S, Musumeci B, Obici L, Perfetto F, Perlini S, Serenelli M, Tomasoni D, Vagnarelli F, Merlini G, Palladini G, Metra M, Colivicchi F, Indolfi C, Grimaldi M, Perrone Filardi P, Emdin M, Sinagra G, and Oliva F

Subjects
Humans, Italy, Prognosis, Critical Pathways, Immunoglobulin Light-chain Amyloidosis diagnosis, Immunoglobulin Light-chain Amyloidosis therapy, Amyloidosis diagnosis, Amyloidosis therapy, Cardiomyopathies diagnosis, Cardiomyopathies therapy
Abstract

The perspective on cardiac amyloidosis has deeply changed over the last 10 years following major advances in diagnosis and treatment options. This heterogeneous disease requires the interaction among experts of different specialties and subspecialties. Suspicion of disease, timely recognition and confirmation of final diagnosis, prognostic stratification, overall management and therapeutic strategies represent ongoing challenges in the clinical setting. Missing or delayed diagnosis may have significant impact on patient outcome, especially in light-chain amyloidosis. The present inter-society consensus document aims to provide a standardized approach to the diagnosis of cardiac amyloidosis in Italy, and to discuss the challenging clinical scenarios encountered in routine activity for cardiologists and physicians of different specialties dealing with patients with suspected or established cardiac amyloidosis. This document may be adapted to the setting of each specific region.

Published
2024
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40. Prognostic value of electroanatomic-guided endomyocardial biopsy in patients with myocarditis, arrhythmogenic cardiomyopathy and non dilated left ventricular cardiomyopathy.

Author

Narducci ML, Scacciavillani R, Nano RL, Bisignani A, D'Alessandris N, Inzani F, Tiziano FD, Perna F, Bencardino G, Burzotta F, Pelargonio G, and Imazio M

Subjects
Humans, Male, Female, Middle Aged, Adult, Prospective Studies, Prognosis, Follow-Up Studies, Myocardium pathology, Magnetic Resonance Imaging, Cine methods, Biopsy methods, Cardiomyopathies diagnostic imaging, Cardiomyopathies pathology, Cardiomyopathies diagnosis, Arrhythmogenic Right Ventricular Dysplasia diagnosis, Arrhythmogenic Right Ventricular Dysplasia physiopathology, Arrhythmogenic Right Ventricular Dysplasia diagnostic imaging, Myocarditis pathology, Myocarditis diagnostic imaging, Myocarditis diagnosis
Abstract

A wide variety of non-invasive and invasive techniques for SCD risk stratification in non ischemic cardiomyopathy (NICM) have been proposed, including left ventricular (LV) ejection fraction, QRS duration, late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) and invasive electrophysiologic study with or without three-dimensional electroanatomic mapping (3D-EAM), to identify and characterize the arrhythmogenic substrate. There is still no clear consensus on the risk stratification in this clinical setting. The aim of our study is to characterize the 3D-EAM substrate in patients with the same clinical presentation of unexplained complex VAs and NICM using CMR, three-dimensional electranatomic mapping (3D-EAM) in association with endomyocardial biopsy (EMB) and genetic screening, as a more precise and early diagnostic assessment may provide important subsequent prognostic impact. The study was designed as a prospective multi-center observational evaluation and the patient follow-up was scheduled at 6 months interval. We enrolled 125 patients distinct into four different group by complete diagnostic work-up: myocarditis, non-dilated left ventricular cardiomyopathy, arrhythmogenic cardiomyopathy and control group. The four groups were compared in terms of clinical, imaging and 3D-EAM data. At multivariate analysis sustained VT/VF on admission [HR: 3.64 (1.79-7.4), p < 0.001], total bipolar scar area of left and right ventricle detected by 3D-EAM [HR: 2.24 (1.13-4.49), p = 0.02], histological diagnosis of myocarditis by 3D-EAM guided endomyocardial biopsy (EBM) [HR: 2.79 (1.04-7.44), p = 0.01] were independent predictors of complex VAs or death at follow-up. 3D-EAM guided EMB represent not only a valid diagnostic tool to identify the arrhythmogenic substrate in patients with NICM and ventricular arrhythmic phenotype but also an important predictor of complex Vas at long term follow-up., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

Published
2024
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41. State of the art and perspectives of gene therapy in heart failure. A scientific statement of the Heart Failure Association of the ESC, the ESC Council on Cardiovascular Genomics and the ESC Working Group on Myocardial & Pericardial Diseases.

Author

Van Linthout S, Stellos K, Giacca M, Bertero E, Cannata A, Carrier L, Garcia-Pavia P, Ghigo A, González A, Haugaa KH, Imazio M, Lopes LR, Most P, Pollesello P, Schunkert H, Streckfuss-Bömeke K, Thum T, Tocchetti CG, Tschöpe C, van der Meer P, van Rooij E, Metra M, Rosano GMC, and Heymans S

Abstract

Gene therapy has recently become a reality in the treatment of cardiovascular diseases. Strategies to modulate gene expression using antisense oligonucleotides or small interfering RNA are proving to be safe and effective in the clinic. Adeno-associated viral vector-based gene delivery and CRISPR-Cas9-based genome editing have emerged as efficient strategies for gene delivery and repair in humans. Overall, gene therapy holds the promise not only of expanding current treatment options, but also of intervening in previously untackled causal disease mechanisms with little side effects. This scientific statement provides a comprehensive overview of the various modalities of gene therapy used to treat heart failure and some of its risk factors, and their application in the clinical setting. It discusses specifically the possibilities of gene therapy for hereditary heart diseases and (non)-genetic heart failure. Furthermore, it addresses safety and clinical trial design issues and challenges for future regulatory strategies., (© 2024 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Published
2024
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42. Recurrent pericarditis in older adults: Clinical and laboratory features and outcome.

Author

Bizzi E, Cavaleri F, Mascolo R, Conte E, Maggiolini S, Decarlini CC, Maestroni S, Collini V, Sicignano LL, Verrecchia E, Manna R, Pancrazi M, Trotta L, Lopalco G, Malandrino D, Pallini G, Catenazzi S, Carrozzo L, Emmi G, Lazaros G, Brucato A, and Imazio M

Subjects
Humans, Male, Female, Aged, Retrospective Studies, Middle Aged, Age Factors, Adult, Aged, 80 and over, Comorbidity, Colchicine therapeutic use, Pericarditis diagnosis, Pericarditis epidemiology, Recurrence
Abstract

Background: Current guidelines for the diagnosis and treatment of pericarditis refer to the general adult population. Few and fragmentary data regarding recurrent pericarditis in older adults exist., Objective of the Study: Given the absence of specific data in scientific literature, we hypothesized that there might be clinical, laboratory and outcome differences between young adults and older adults affected by idiopathic recurrent pericarditis., Materials and Methods: We performed an international multicentric retrospective cohort study analyzing data from patients affected by recurrent pericarditis (idiopathic or post-cardiac injury) and referring to tertiary referral centers. Clinical, laboratory, and outcome data were compared between patients younger than 65 years (controls) and patients aged 65 or older., Results: One hundred and thirty-three older adults and 142 young adult controls were enrolled. Comorbidities, including chronic kidney diseases, atrial fibrillation, and diabetes, were more present in older adults. The presenting symptom was dyspnea in 54.1% of the older adults versus 10.6% in controls (p < 0.001); pain in 32.3% of the older adults versus 80.3% of the controls (p < 0.001). Fever higher than 38°C was present in 33.8% versus 53.5% (p = 0.001). Pleural effusion was more prevalent in the older adults (55.6% vs 34.5%, p < 0.001), as well as severe pericardial effusion (>20 mm) (24.1% vs 12.7%, p = 0.016) and pericardiocentesis (16.5% vs 8.5%, p = 0.042). Blood leukocyte counts were significantly lower in the older adults (mean + SE: 10,227 + 289/mm 3 vs 11,208 + 285/mm 3 , p = 0.016). Concerning therapies, NSAIDS were used in 63.9% of the older adults versus 80.3% in the younger (p = 0.003), colchicine in 76.7% versus 87.3% (p = 0.023), corticosteroids in 49.6% versus 26.8% (p < 0.001), and anakinra in 14.3% versus 23.9% (p = 0.044)., Conclusions: Older adults affected by recurrent pericarditis show a different clinical pattern, with more frequent dyspnea, pleural effusion, severe pericardial effusion, and lower fever and lower leukocyte count, making the diagnosis sometimes challenging. They received significantly less NSAIDs and colchicine, likely due to comorbidities; they were also treated less commonly with anti-IL1 agents, and more frequently with corticosteroids., (© 2024 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Published
2024
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43. Genetic variants in patients with recurrent pericarditis.

Author

Imazio M, Faletra F, Zucco J, Mio C, Carraro M, Gava AM, De Biasio M, Damante G, and Collini V

Subjects
Humans, Female, Male, Adult, Retrospective Studies, Middle Aged, Young Adult, Adolescent, Genetic Variation, Phenotype, Risk Factors, NLR Family, Pyrin Domain-Containing 3 Protein genetics, Pericarditis genetics, Recurrence, Genetic Predisposition to Disease, Exome Sequencing
Abstract

Aims: Presence of family cases and multiple recurrences of pericarditis suggest the existence of a possible genetic background in at least 10% of cases. The aim of the present study is to describe the genetic landscape of a cohort of patients with multiple recurrences (at least two recurrences)., Methods: Retrospective cohort study of consecutive adult patients referred for at least two episodes of recurrences in a tertiary referral centre. Genetic testing was performed by whole exome sequencing (WES)., Results: Our cohort included 108 consecutive patients with recurrent pericarditis [median age 32 years, interquartile range (IQR) 18.5; 67.6% females, all Caucasian, idiopathic aetiology in 71.1%] with a median number of recurrences of 5 (IQR 2). Overall, 16 patients (14.8%) had variants in genes related to the inflammatory response. Eleven variants were located in genes already associated with recurrent pericarditis (NLRP3, TNFRSF1A and MEFV) and five in inflammation/immunodeficiency-related genes (IFIH1, NFKBIA, JAK1, NOD2 and ALPK1). Furthermore, we identified 10 patients with variants located in genes associated with conduction system-related diseases, and 22 variants in 21 patients with genes associated with heart structural-related diseases., Conclusion: In this first observational study using WES to assess genetic variants in patients with multiple recurrences of pericarditis, about 15% of patients bore at least one variant that may be related to the disease. These findings highlight the importance of addressing the role of genetic predisposition in recurrent pericarditis. Moreover, 28.7% of patients carry variants in different cardiac genes, worthy of a deeper investigation., (Copyright © 2024 Italian Federation of Cardiology - I.F.C. All rights reserved.)

Published
2024
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44. One stage extraction and reimplantation of ICD/PM in patients with CIED related endocarditis and spondiloscitis due to E. faecalis treated with double beta-lactam combination: ampicillin plus ceftobiprole.

Author

Narducci ML, Pecori D, Imazio M, Rebellato L, Geminiani M, Bontempo G, Martini L, Giuliano S, and Tascini C

Subjects
Humans, Male, Prosthesis-Related Infections microbiology, Prosthesis-Related Infections drug therapy, Defibrillators, Implantable, Pacemaker, Artificial adverse effects, Pacemaker, Artificial microbiology, Aged, Drug Therapy, Combination, Device Removal, Ampicillin therapeutic use, Ampicillin administration & dosage, Anti-Bacterial Agents therapeutic use, Anti-Bacterial Agents administration & dosage, Enterococcus faecalis drug effects, Enterococcus faecalis isolation & purification, Cephalosporins therapeutic use, Cephalosporins administration & dosage, Endocarditis, Bacterial microbiology, Endocarditis, Bacterial drug therapy, Gram-Positive Bacterial Infections microbiology, Gram-Positive Bacterial Infections drug therapy
Abstract

The time of re-implantation of removed CIED for local infection or endocarditis has been debated because no randomized studies are available. Many authors prefer to delay reimplantation to the time of blood culture negative or clinical stability. In this case report we describe the case of E. faecalis CIED endocarditis treated with the combination ampicillin plus ceftobiprole and one-stage removal and re-implantation with early follow-up without relapse of infection. In case of E. faecalis infection, we hypothesize that ampicillin plus ceftobiprole combination might have bactericidal and anti-biofilm activity, therefore allowing one state re-implantation without relapse.

Published
2024

46. [Complex Issues in the Management of Pericarditis. In Anticipation of the Release of Updated Recommendations of the European Society of Cardiology].

Author

Imazio M, Sukmarova ZN, and Nasonov EL

Subjects
Humans, COVID-19 epidemiology, Disease Management, Europe, SARS-CoV-2, Cardiology, Pericarditis therapy, Pericarditis diagnosis, Practice Guidelines as Topic, Societies, Medical
Abstract

With the advent of new diagnostic and therapeutic methods, the management of pericarditis has not become an easier task. The well-studied, but currently rare tuberculosis, bacterial and malignant forms have been joined by pericarditis associated with infection or vaccination against SARS-CoV-2. While 2-3 years ago, cardiologists had to recall the schedule of managing acute viral pericarditis, today its complications are often encountered, including chronic, recurrent, effusive or constrictive pericarditis. The European guidelines were updated 10 years ago and are expected to be issued within the next year. We posed the most pressing questions on the management of pericarditis to the coordinator of the 2015 European Society of Cardiology (ESC) guidelines [1], who will also chair the 2025 ESC guidelines on myocarditis and pericarditis, one of the most cited scientists in the field of inflammatory diseases of the pericardium, Massimo Imazio. He is a Professor in the Department of Cardiology and Anatomy at the University of Turin, runs a school on pericarditis, and has initiated fundamental research of this pathology. We presented his answers with comments of the co-author in the form of a short interview.

Published
2024
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47. Comparison of Oral Procainamide and Mexiletine Treatment of Recurrent and Refractory Ventricular Tachyarrhythmias.

Author

Toniolo M, Muser D, Mugnai G, Rebellato L, Daleffe E, Bilato C, and Imazio M

Abstract

Background: Antiarrhythmic therapy for recurrent ventricular arrhythmias (VAs) in patients having undergone catheter ablation and in whom amiodarone and/or beta-blockers were ineffective or contraindicated is a controversial issue. Purpose: The present study sought to compare the efficacy and tolerability of oral procainamide and mexiletine in patients with recurrent ventricular arrhythmias when the standard therapy strategy failed. Methods: All patients with an implantable cardioverter defibrillator (ICD) treated with oral procainamide or mexiletine for recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) in two cardiology divisions between January 2010 and January 2020 were enrolled. Patients were divided into group A (oral procainamide) and group B (mexiletine) and the two groups were compared to each other. The primary endpoint was the efficacy of therapy; the secondary endpoint was the discontinuation of therapy. All events that occurred during procainamide or mexiletine treatment were compared with a matched duration period before the initiation of the therapy. Antiarrhythmic therapy was considered effective when a ≥80% reduction of the sustained ventricular arrhythmias burden recorded by the ICD was achieved. Results: A total of 68 consecutive patients (61 males, 89.7%; mean age 74 ± 10 years) were included in this retrospective analysis. After a median follow-up of 19 months, 38 (56%) patients had a significant reduction in the VA burden. After multivariable adjustment, therapy with procainamide was independently associated with an almost 3-fold higher efficacy on VA suppression compared to mexiletine (HR 2.54, 95% CI 1.06-6.14, p = 0.03). Only three patients (9%) treated with procainamide presented severe side effects (dyspnea or hypotension) requiring discontinuation of therapy compared with six patients (18%) treated with mexiletine who interrupted therapy because of severe side effects ( p = 0.47). Conclusions: Compared to mexiletine, oral procainamide had a higher efficacy for the treatment of recurrent and refractory VAs, and showed a good profile of tolerability.

Published
2024
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48. Anakinra-Dependent Recurrent Pericarditis: The Role of the R202Q Variant of the MEFV Gene.

Author

Andreis A, Dossi FC, De Ferrari GM, Alunni G, and Imazio M

Abstract

Background : the role of the R202Q (c.605G>A, p.Arg202Gln) missense variant of the MEFV gene has been debated as either a benign polymorphism or a potentially pathogenic mutation. We report and discuss here the case of a young female with corticosteroid-dependent recurrent pericarditis carrying the homozygous R202Q variant, exhibiting distinctive clinical features possibly influenced by this genetic variant. Methods : a 30-year-old woman with a previous diagnosis of cancer and recent respiratory infection presented with severe pleuritic chest pain, hypotension, tachycardia, and fever. Initial diagnostic evaluation indicated cardiac tamponade, and emergent pericardiocentesis was performed. Despite initial treatment with NSAIDs, colchicine, and corticosteroids, the patient experienced multiple recurrences. Genetic testing identified homozygous R202Q variant in the MEFV gene. Given the corticosteroid dependency and recurrent nature of her condition, IL-1 inhibitor anakinra was introduced, leading to significant improvement, although tapering below 150 mg per week failed to prevent recurrences. Results : the introduction of anakinra resulted in rapid symptom relief and resolution of pericardial effusion. However, attempts to taper or discontinue anakinra led to pericarditis recurrences. Ultimately, a maintenance dose of 50 mg every three days was established, which maintained remission for 18 months without recurrence. Despite multiple tapering attempts, further reduction in anakinra dosage was unsuccessful without triggering relapses. Conclusions : the R202Q variant, although typically considered benign, may contribute to an autoinflammatory phenotype resembling familial Mediterranean fever. This case underscores the potential pathogenicity of the homozygous R202Q variant in recurrent pericarditis and its responsiveness to IL-1 inhibition. In patients with corticosteroid-dependent recurrent pericarditis, genetic testing for the R202Q variant should be considered when anti-IL-1 drugs cannot be withdrawn. Further studies are warranted to elucidate the variant's role in pericardial inflammation and guide personalized treatment strategies.

Published
2024
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49. The 2023 new European guidelines on infective endocarditis: main novelties and implications for clinical practice.

Author

Imazio M

Subjects
Humans, Antibiotic Prophylaxis standards, Cardiac Surgical Procedures standards, Cardiology standards, Decision Making, Shared, Europe, Risk Factors, Anti-Bacterial Agents therapeutic use, Endocarditis diagnosis, Endocarditis microbiology, Endocarditis therapy, Practice Guidelines as Topic
Abstract

The 2023 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis update the previous 2015 guidelines with main novelties in five areas: (1) antibiotic prevention for high-risk patients, and prevention measures for intermediate-risk and high-risk patients; (2) diagnosis with emphasis on multimodality imaging to assess cardiac lesions of infective endocarditis' (3) antibiotic therapy allowing an outpatient antibiotic treatment for stabilized, uncomplicated cases; (4) cardiac surgery with an emphasis on early intervention without delay for complicated cases; and (5) shared management decision by the endocarditis team. Most evidence came from observational studies and expert opinions. The guidelines strongly support a patient-centred approach with a shared decision process by a multidisciplinary team that should be implemented either in tertiary referral centres, becoming heart valve centres, and referral centres. A continuous sharing of data is warranted in the hospitals' network between heart valve centres, which are used for referrals for complicated cases of infective endocarditis, and referral centres, which should be able to manage uncomplicated cases of infective endocarditis., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Italian Federation of Cardiology.)

Published
2024
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50. The impact of the European Society of Cardiology guidelines and whole exome sequencing on genetic testing in hereditary cardiac diseases.

Author

Mio C, Zucco J, Fabbro D, Bregant E, Baldan F, Allegri L, D'Elia AV, Collini V, Imazio M, Damante G, and Faletra F

Subjects
Humans, Female, Male, Adult, Heart Diseases genetics, Heart Diseases diagnosis, Middle Aged, Cardiology standards, Cardiology methods, Europe, Genetic Predisposition to Disease, Adolescent, Aged, Young Adult, Child, Practice Guidelines as Topic, Exome genetics, Child, Preschool, Cardiomyopathies genetics, Cardiomyopathies diagnosis, Genetic Testing methods, Genetic Testing standards, Exome Sequencing
Abstract

In the last decade, an incredible improvement has been made in elucidating the genetic bases of cardiomyopathies. Here we report the impact of either the European Society of Cardiology (ESC) guidelines or the use of whole exome sequencing (WES) in terms of a number of variants of uncertain significance (VUS) and missed diagnoses in a series of 260 patients affected by inherited cardiac disorders. Samples were analyzed using a targeted gene panel of 128 cardiac-related genes and/or WES in a subset of patients, with a three-tier approach. Analyzing (i) only a subset of genes related to the clinical presentation, strictly following the ESC guidelines, 20.77% positive test were assessed. The incremental diagnostic rate for (ii) the whole gene panel, and (iii) the WES was 4.71% and 11.67%, respectively. The diverse analytical approaches increased the number of VUSs and incidental findings. Indeed, the use of WES highlights that there is a small percentage of syndromic conditions that standard analysis would not have detected. Moreover, the use of targeted sequencing coupled with "narrow" analytical approach prevents the detection of variants in actionable genes that could allow for preventive treatment. Our data suggest that genetic testing might aid clinicians in the diagnosis of inheritable cardiac disorders., (© 2024 The Author(s). Clinical Genetics published by John Wiley & Sons Ltd.)

Published
2024
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