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4. Prognostic significance of serum uric acid in outpatients with chronic heart failure is complex and related to body mass index: Data from the IN-CHF Registry

Author

Baldasseroni, S, Urso, R, Maggioni, Ap, Orso, F, Fabbri, G, Marchionni, N, Tavazzi, L, the IN CHF Investigators: Mezzani, A, Bielli, M, Milanese, G, Ugliengo, G, Pozzi, R, Rabajoli, F, Bosimini, E, Begliuomini, G, Ferrari, A, Barzizza, F, Valsecchi, F, Dadda, F, Faggiano, P, Castiglioni, G, Gibelli, G, Turelli, Al, Belluschi, R, Bianchi, C, Emanuelli, C, Gramenzi, S, Foti, S, Agnelli, D, Mascioli, G, Cazzani, E, Zanelli, E, Domenighini, D, Castelli, C, Moroni, E, Gara, E, Guzzetti, S, Muzzupappa, S, Turiel, M, Cappiello, E, Sandrone, G, Recalcati, F, Valenti, D, Achilli, F, Vincenzi, A, Rusconi, F, Palvarini, M, Ghio, S, Fontana, A, Giusti, A, Scelsi, L, Sebastiani, R, Ceresa, M, Nassiacos, D, Meloni, S, Nicoli, T, Bandini, P, Pedretti, R, Paolucci, M, Amati, L, Ravetta, M, Morandi, F, Provasoli, S, Bertolini, A, Imperiale, D, Agen, W, Planca, E, Quorso, P, Ferro, A, Pedrolli, C, Russo, P, Tarantini, L, Candelpergher, G, Cannarozzo, Pp, De Cian, F, Agnoli, A, Stefanini, Mg, Cacciavillani, L, Boffa, Gm, Mario, L, Renosto, G, Stritoni, P, Varotto, L, Penzo, M, Perini, G, Giuliano, G, Barducci, E, Piazza, R, Albanese, Mc, Fresco, C, Picco, F, Venturini, P, Camerini, A, Griffo, R, Derchi, G, Delfino, L, Pizzorno, L, Mazzantini, S, Torre, F, Orlandi, S, Bertoli, D, Gentile, A, Naccarella, F, Gatti, M, Coluccini, M, Morgagni, G, Alfano, G, Reggianini, L, Sansoni, S, Serra, W, Passerini, F, Del Corso, P, Rusconi, L, Marzaloni, M, Mezzetti, M, Gambarati, Gp, Mariani, Pr, Volterrani, C, Venturi, F, Zambald, G, Casolo, G, Moschi, G, Geri Brandinelli, A, Miracapillo, G, Boni, A, Italiani, G, Vergoni, W, Paci, Am, Lattanzi, F, Reisenhofer, B, Severini, D, Taddei, T, Dalle Luche, A, Comella, A, Gasperini, U, Cocchieri, M, Alunni, G, Bosi, E, Panciarola, R, Maragoni, G, Bardelli, G, Testarmata, P, Pasetti, L, Budini, A, Gabrilelli, D, Coderoni, B, Midi, P, Romaniello, C, Del Sindaco, D, Leggio, F, Terranova, A, Pulignano, G, Pozzar, F, Ansalone, G, Magris, B, Giannantoni, P, Cacciatore, G, Bottero, G, Scaffidi, G, Valtorta, C, Salustri, A, Amadeo, F, Barbato, G, Aspromonte, N, Baldo, V, Baldo, E, Frattaroli, C, Mariani, A, Di Marco, G, Levantesi, G, Potena, Ap, Colonna, N, Montano, A, Sensale, P, Maiolica, O, Somelli, A, Napolitano, F, Provvisiero, P, Bottiglieri, P, Ciriello, N, Angelini, E, Andriulo, C, De Santis, F, Cocco, F, Zecca, A, Pennetta, A, Mariello, F, Magliari, F, De Giorgi, A, Callerame, M, Santoro, V, Pede, S, Renna, A, De Donno, O, De Lorenzi, E, Polimeni, G, Russo, Va, Mangia, R, Truncellito, L, Cariello, Fp, Affinita, M, Perticone, F, Cloro, C, Borelli, D, Matta, M, Lopresti, D, Misuraca, G, Caporale, R, Chiappetta, P, Tripodi, E, Tassone, F, Salituri, S, Errigo, C, Meringolo, G, Donnangelo, L, Canonico, G, Coco, R, Franco, M, Coglitore, A, Donato, A, Di Tano, G, Cento, Domenico, DE GREGORIO, Cesare, Mongiovı, M, Schillaci, Am, Mirto, Ij, Clemenza, F, Ingrillı, F, Cavallaro, A, Aloisi, B, Ledda, G, Rizzo, C, Porcu, M, Salis, S, Pistis, L, Pili, G, Piras, S, Maoddi, I, and Uras, F.

Subjects
Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Medicine (miscellaneous), Hyperuricemia, Models, Biological, Severity of Illness Index, Body Mass Index, chemistry.chemical_compound, Thinness, Internal medicine, Severity of illness, Ambulatory Care, Humans, Medicine, Registries, Mortality, Survival analysis, Aged, Retrospective Studies, Aged, 80 and over, Heart Failure, Nutrition and Dietetics, business.industry, Hazard ratio, Middle Aged, Prognosis, medicine.disease, Survival Analysis, Confidence interval, Uric Acid, Surgery, Italy, chemistry, Heart failure, Cardiology, Uric acid, Female, Cardiology and Cardiovascular Medicine, business, Body mass index
Abstract

In the field of cardiovascular diseases, elevated levels of serum uric acid (UA) reflect a marked activation of the xanthine oxidase pathway with increase in free radicals production; it is often associated with an inflammatory state, oxygen consumption and endothelial dysfunction. All these associations have been also confirmed in heart failure (HF) but the pathophysiological role of UA in this setting is not well understood. The aim of this study was to evaluate the prognostic role of UA in outpatients enrolled in the Italian Registry of Congestive Heart Failure (IN-CHF).All patients met the European Society of Cardiology (ESC) criteria for diagnosis of HF. We considered patients with complete clinical data and UA level available at the baseline and at 1-year follow-up. The study population was composed of 877 patients aged 63 ± 12 years. One-year mortality was 10.8% and dead patients had a higher level of UA than survivors (7.1 mg dl⁻¹ vs 6.6 mg dl⁻¹, p0.0207). In multivariable full model of analysis, UA did not result in an independent predictor of death in overall population, but only in patients with low body mass index (BMI) (≤22 kg m⁻²) (hazard ratio (HR): 2.38, 95% confidence interval (CI) 1.36-4.18). In this subgroup, a statistically significant gradual relationship between UA and survival was detected starting from values higher than 8 mg dl⁻¹.Elevated level of UA is not an independent predictor of mortality in chronic HF, but it markedly worsens outcome if associated with low level of BMI. This association is likely an indicator of chronic inflammatory and catabolic state.

Published
2012
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5. Tight Versus Standard Blood Pressure Control in Patients With Hypertension With and Without Cardiovascular Disease

Author

Reboldi, G, Angeli, F, de Simone, G, Staessen, Ja, Verdecchia, P, Cardio Sis Investigators, Porcellati, C, Fornari, G, Sclavo, Mg, Scherillo, M, Raucci, D, Faggiano, P, Porcu, M, Pistis, L, Vancheri, F, Curcio, M, Ieva, M, Muscella, A, Guerrieri, M, Dembech, C, Gulizia, Mm, Francese, Gm, Perticone, F, Iemma, G, Zanolini, G, Pierdomenico, Sd, Mezzetti, A, Benemio, G, Gattobigio, R, Sacchi, N, Cocchieri, M, Prosciutti, L, Garognoli, O, Pirelli, S, Emanuelli, C, Galeazzi, G, Abrignani, Mg, Lombardo, R, Braschi, Gb, Leoncini, G, Igidbashian, D, Marini, R, Mandorla, S, Buccolieri, M, Picchi, L, Casolo, G, Pardini, M, Galletti, F, Barbato, A, Cavallini, C, Borgioni, C, Sardone, Mg, Cipollini, F, Seghieri, G, Arcangeli, E, Boddi, W, Palermo, C, Lembo, G, Malatino, L, Leonardis, D, Gentile, C, Boccanelli, A, Mureddu, Gf, Colivicchi, F, Uguccioni, M, Zanata, G, Martin, G, Mos, L, Martina, S, Dialti, V, Pede, S, Pede, Sa, Ganau, A, Farina, G, Tripodi, E, Miserrafiti, B, Stornello, M, Valvo, Ev, Proietti, G, Bernardinangeli, M, Poddighe, G, Marras, Ma, Biscottini, B, Panciarola, R, Veglio, Franco, Mulatero, Paolo, Caserta, Ma, Chiatto, M, Cioffi, G, Bonazza, G, Achilli, A, Achilli, P., Reboldi, G, Angeli, F, DE SIMONE, Giovanni, Staessen, Ja, Verdecchia, P., Galletti, Ferruccio, Epidemiologie, RS: CARIM - R3 - Vascular biology, and Health Services Research

Subjects
Male, systolic blood pressure, Time Factors, Blood Pressure, Disease, law.invention, Electrocardiography, Randomized controlled trial, cardiovascular disease, law, Prospective Studies, Myocardial infarction, Stroke, Incidence, clinical trial, stroke, 3. Good health, Survival Rate, PROGNOSTIC VALUE, left ventricular geometry, myocardial infarction, CARDIO-SIS, Italy, Cardiology, Female, Hypertrophy, Left Ventricular, hypertrophy, medicine.medical_specialty, hypertension, Randomization, LEFT-VENTRICULAR HYPERTROPHY, Internal medicine, Internal Medicine, medicine, Humans, In patient, LVH, Antihypertensive Agents, Aged, randomized controlled trial, left ventricular, prognosis, J-CURVE PHENOMENON, Proportional hazards model, business.industry, Blood Pressure Determination, medicine.disease, RANDOMIZED-TRIAL, Blood pressure, ARTERIAL-HYPERTENSION, business, Follow-Up Studies
Abstract

An excessive blood pressure (BP) reduction might be dangerous in high-risk patients with cardiovascular disease. In the Studio Italiano Sugli Effetti CARDIOvascolari del Controllo della Pressione Arteriosa SIStolica (Cardio-Sis), 1111 nondiabetic patients with systolic BP ≥150 mm Hg were randomly assigned to a systolic BP target P for interaction=0.82). The main secondary end point, a composite of cardiovascular events and all-cause death, occurred less frequently in the tight than in the standard control group both in patients without (1.47 versus 3.68 patient-years; P =0.016) and with (7.87 versus 11.22 patient-years; P =0.049) previous cardiovascular disease. In a multivariable Cox model, allocation to tight BP control reduced the risk of cardiovascular events to a similar extent in patients with or without overt cardiovascular disease at randomization ( P for interaction=0.43). In conclusion, an intensive treatment aimed to lower systolic BP

Published
2014

6. Age-dependent prognostic significance of atrial fibrillation in outpatients with chronic heart failure: data from the Italian Network on Congestive Heart Failure Registry

Author

Baldasseroni, S, Orso, F, Fabbri, G, De Bernardi, A, Cirrincione, V, Gonzini, L, Fumagalli, S, Marchionni, N, Midi, P, Maggioni, Ap, Mezzani, A, Bielli, M, Milanese, U, Ugliengo, G, Pozzi, R, Rabajoli, F, Bosimini, E, Begliuomini, G, Ferrari, A, Barzizza, F, Valsecchi, Mg, Dadda, F, Faggiano, P, Castiglioni, G, Gibelli, G, Turelli, Al, Belluschi, R, Bianchi, C, Emanuelli, C, Gramenzi, S, Foti, G, Agnelli, D, Mascioli, G, Cazzani, E, Zanelli, E, Domenighini, D, Castelli, C, Moroni, E, Gara, E, Guzzetti, S, Muzzupappa, S, Turiel, M, Cappiello, E, Sandrone, G, Recalcati, F, Valenti, D, Achilli, F, Vincenzi, A, Rusconi, F, Palvarini, M, Ghio, S, Fontana, A, Giusti, A, Scelsi, L, Sebastiani, R, Ceresa, M, Nassiacos, D, Meloni, S, Nicoli, T, Bandini, P, Pedretti, R, Paolucci, M, Amati, L, Ravetta, M, Morandi, F, Provasoli, S, Bertolini, A, Imperiale, D, Agen, W, Planca, E, Quorso, P, Ferro, A, Pedrolli, C, Russo, P, Tarantini, L, Candelpergher, G, Cannarozzo, Pp, De Cian, F, Agnoli, A, Stefanini, Mg, Cacciavillani, L, Boffa, Gm, Mario, L, Renosto, G, Stritoni, P, Varotto, L, Penzo, M, Perini, G, Giuliano, G, Barducci, E, Piazza, R, Albanese, Mc, Fresco, C, Picco, F, Venturini, P, Camerini, A, Griffo, R, Derchi, G, Delfino, L, Pizzorno, L, Mazzantini, S, Torre, F, Orlandi, S, Bertoli, D, Gentile, A, Naccarella, F, Gatti, M, Coluccini, M, Morgagni, G, Alfano, G, Reggianini, L, Sansoni, S, Serra, W, Passerini, F, Del Corso, P, Rusconi, L, Marzaloni, M, Mezzetti, M, Gambarati, Gp, Mariani, Pr, Volterrani, C, Venturi, F, Zambaldi, G, Casolo, G, Moschi, G, Geri Brandinelli, A, Miracapillo, G, Boni, A, Italiani, G, Vergoni, W, Paci, Am, Lattanzi, F, Reisenhofer, B, Severini, D, Taddei, T, Dalle Luche, A, Comella, A, Gasperini, U, Cocchieri, M, Alunni, G, Bosi, E, Panciarola, R, Maragoni, G, Bardelli, G, Testarmata, P, Pasetti, L, Budini, A, Gabrilelli, D, Coderoni, B, Romaniello, C, Del Sindaco, D, Leggio, F, Terranova, A, Pulignano, G, Pozzar, F, Ansalone, G, Magris, B, Giannantoni, P, Cacciatore, G, Bottero, G, Scaffidi, G, Valtorta, C, Salustri, A, Amaddeo, F, Barbato, G, Aspromonte, N, Baldo, V, Baldo, E, Frattaroli, C, Mariani, A, Di Marco, G, Levantesi, G, Potena, Ap, Colonna, N, Montano, A, Sensale, P, Maiolica, P, Somelli, A, Napolitano, F, Provvisiero, P, Bottiglieri, P, Ciriello, N, Angelini, E, Andriulo, C, De Santis, F, Cocco, F, Zecca, A, Pennetta, A, Mariello, F, Magliari, F, De Giorgi, A, Callerame, M, Santoro, V, Pede, S, Renna, A, De Donno, O, De Lorenzi, E, Polimeni, G, Russo, Va, Mangia, R, Truncellito, L, Cariello, Fp, Affinita, M, Perticone, F, Cloro, C, Borelli, D, Matta, M, Lopresti, D, Misuraca, G, Caporale, R, Chiappetta, P, Tripodi, E, Tassone, F, Salituri, S, Errigo, C, Meringolo, G, Donnangelo, L, Canonico, G, Coco, R, Franco, M, Coglitore, A, Donato, A, Di Tano, G, Cento, D, DE GREGORIO, Cesare, Mongiovì, M, Schillaci, Am, Mirto, U, Clemenza, F, Ingrillì, F, Cavallaro, A, Aloisi, B, Ledda, G, Rizzo, C, Porcu, M, Salis, S, Pistis, L, Pili, G, Piras, S, Maoddi, I, and Uras, F.

Subjects
Male, medicine.medical_specialty, Adrenergic beta-Antagonists, Age dependent, Angiotensin-Converting Enzyme Inhibitors, VENTRICULAR SYSTOLIC DYSFUNCTION, POPULATION-BASED COHORT, Age Distribution, Older patients, Internal medicine, Atrial Fibrillation, Outpatients, medicine, Humans, Pharmacology (medical), Registries, Aged, Heart Failure, business.industry, Network on, Anticoagulants, Atrial fibrillation, Middle Aged, medicine.disease, Prognosis, Death, Sudden, Cardiac, Italy, Heart failure, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Anti-Arrhythmia Agents
Abstract

Objectives: The role of atrial fibrillation (AF) in older patients with heart failure (HF) is controversial because many variables seem to influence their outcome. We investigated the predictivity of AF in 3 age groups of outpatients with HF. Methods: We analyzed 8,178 outpatients enrolled in the Italian Network on Congestive Heart Failure Registry with HF diagnosed according to the European Society of Cardiology criteria. A trained cardiologist established the diagnosis of AF and HF at the entry visit at each center. We stratified the population into 3 age groups, as follows: group A, ≤65 years; group B, 66–75 years, and group C, >75 years. Results: Group A was composed of 4,261 patients, 683 with AF (16.0%); in group B there were 2,651 patients, 638 with AF (24.1%), and group C was composed of 1,266 patients, 412 with AF (32.5%). The 1-year mortality rate was higher in AF patients in all groups. In a multivariate model, AF remained an independent risk factor for death in groups A and B, but not in group C [group A: hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.10–1.81; group B: HR 1.29, 95% CI 1.00–1.67; group C: HR 1.05, 95% CI 0.78–1.43]. Conclusion: The prevalence of AF increased with age and was associated with a higher mortality rate. However, AF independently predicted all-cause mortality only in patients aged ≤75 years.

Published
2010

7. Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis): an open-label randomised trial

Author

Verdecchia, P, Staessen, Ja, Angeli, F, de Simone, G, Achilli, A, Ganau, A, Mureddu, G, Pede, S, Maggioni, Ap, Lucci, D, Reboldi, G, Porcellati, C, Fornari, G, Ceseri, M, Lorimer, A, Repaci, S, Castellani, C, Mazzotta, G, Berioli, S, Jaspers, C, Cucchiara, G, Panzano, C, Sclavo, Mg, Scherillo, M, Raucci, D, Faggiano, P, Porcu, M, Pistis, L, Vancheri, F, Curcio, M, Ieva, M, Muscella, A, Guerrieri, M, Dembech, C, Gulizia, Mm, Francese, Gm, Perticone, F, Iemma, G, Zanolini, G, Pierdomenico, Sd, Mezzetti, A, Benemio, G, Gattobigio, R, Sacchi, N, Cocchieri, M, Prosciutti, L, Garognoli, O, Pirelli, S, Emanuelli, C, Galeazzi, G, Abrignani, Mg, Lombardo, R, Braschi, Gb, Leoncini, G, Igidbashian, D, Marini, R, Mandorla, S, Buccolieri, M, Picchi, L, Casolo, G, Pardini, M, Galletti, F, Barbato, A, Cavallini, C, Borgioni, C, Sardone, Mg, Cipollini, F, Seghieri, G, Arcangeli, E, Boddi, W, Palermo, C, Lembo, G, Malatino, L, Leonardis, D, Gentile, C, Boccanelli, A, Colivicchi, F, Uguccioni, M, Zanata, G, Martin, G, Mos, L, Martina, S, Dialti, V, Pede, Sa, Farina, G, Tripodi, E, Miserrafiti, B, Stornello, M, Valvo, Ev, Proietti, G, Bernardinangeli, M, Poddighe, G, Marras, Ma, Biscottini, B, Panciarola, R, Veglio, Franco, Mulatero, Paolo, Caserta, Ma, Chiatto, M, Cioffi, G, Bonazza, G, and Achilli, P.

Subjects
Male, systolic blood pressure, Hemodynamics, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Left ventricular hypertrophy, ipertensione, trial clinico, ipertrofia cardiaca, law.invention, Electrocardiography, 0302 clinical medicine, Randomized controlled trial, law, Cause of Death, Prevalence, Clinical endpoint, Medicine, 030212 general & internal medicine, Incidence, General Medicine, Aged, Antihypertensive Agents, Cardiovascular Diseases, Drug Therapy, Hypertension, Treatment Outcome, Left Ventricular Hypertrophy, Randomised Controlled Trial, 3. Good health, Italy, anti-hypertensive therapy, Cardiology, Drug Therapy, Combination, Female, Hypertrophy, Left Ventricular, medicine.medical_specialty, Systole, Prehypertension, 03 medical and health sciences, Internal medicine, Diabetes mellitus, Humans, blood pressure control, systoli hypertension, Proportional Hazards Models, Intention-to-treat analysis, business.industry, medicine.disease, Surgery, Logistic Models, Blood pressure, Linear Models, business, Risk Reduction Behavior, Follow-Up Studies
Abstract

The level to which systolic blood pressure should be controlled in hypertensive patients without diabetes remains unknown. We tested the hypothesis that tight control compared with usual control of systolic blood pressure would be beneficial in such patients.In this randomised open-label trial undertaken in 44 centres in Italy, 1111 non-diabetic patients with systolic blood pressure 150 mm Hg or greater were randomly assigned to a target systolic blood pressure of less than 140 mm Hg (usual control; n=553) or less than 130 mm Hg (tight control; n=558). After stratification by centre, we used a computerised random function to allocate patients to either group. Observers who were unaware of randomisation read electrocardiograms and adjudicated events. Open-label agents were used to reach the randomised targets. The primary endpoint was the rate of electrocardiographic left ventricular hypertrophy 2 years after randomisation. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00421863.Over a median follow-up of 2.0 years (IQR 1.93-2.03), systolic and diastolic blood pressure were reduced by a mean of 23.5/8.9 mm Hg (SD 10.6/7.0) in the usual-control group and by 27.3/10.4 mm Hg (11.0/7.5) in the tight-control group (between-group difference 3.8 mm Hg systolic [95% CI 2.4-5.2], p0.0001; and 1.5 mm Hg diastolic [0.6-2.4]; p=0.041). The primary endpoint occurred in 82 of 483 patients (17.0%) in the usual-control group and in 55 of 484 patients (11.4%) of the tight-control group (odds ratio 0.63; 95% CI 0.43-0.91; p=0.013). A composite cardiovascular endpoint occurred in 52 (9.4%) patients in the usual-control group and in 27 (4.8%) in the tight-control group (hazard ratio 0.50, 95% CI 0.31-0.79; p=0.003). Side-effects were rare and did not differ significantly between the two groups.Our findings lend support to a lower blood pressure goal than is recommended at present in non-diabetic patients with hypertension.Boehringer-Ingelheim, Sanofi-Aventis, Pfizer.

Published
2009

8. Improving practice patters in heart failure through a national cardiological network: The case of ACE-inhibitors

Author

Porcu, M., Opasich, C., Scherillo, M., Lucci, D., Maria, R., Di Tano, G., Maggioni, A. P., Scaffidi, G., Valtorta, C., Salustri, A., Amaddeo, F., Barbato, G., Aspromonte, N., Renzi, M., Mantini, L., Frattaroli, C., Mariani, A., Di Marco, G., Levantesi, G., Colonna, N., Montano, A., Di Maggio, O., Toscano, G., Capuano, V., Sensale, P., Maiolica, O., Nicola Maurea, Miceli, D., Somelli, A., Napolitano, F., Provvisiero, P., Di Muro, M. R., Bottiglieri, P., Rufolo, F., Ciriello, N., Angelini, E., Andriulo, C., Santis, F., Cocco, F., Zecca, A., Pennetta, A., Mariello, F., Magliari, F., Giorgi, A., Santoro, V., Pede, S., Renna, A., Donno, O., Lorenzi, E., Polimeni, G., Russo, V. A., Mangia, R., Cariello, F. P., Affinita, M., Perticone, F., Cloro, C., Misuraca, G., Caporale, R., Chiappetta, P., Tripodi, E., Tassone, F., Salituri, S., Errigo, C., Meringolo, G., Donnangelo, L., Canonico, G., Coco, R., Franco, M., Coglitore, A., Donato, A., Cento, D., Gregorio, C., Mongiovì, M., Schillaci, A. M., Mirto, U., Clemenza, F., Ingrillì, F., Aloisi, B., Dadea, M., Pistis, L., Pili, G., Piras, S., and Maoddi, I.

9. A low pulse pressure is an independent predictor of mortality in heart failure: Data from a large nationwide cardiology database (IN-CHF registry)

Author

Schillaci, Giuseppe, Di Luzio, Silvia, Coluccini, Mario, Gonzini, Lucio, Porcu, Maurizio, Pozzar, Francesco, Maggioni, Aldo P, Investigators, Mezzani, A, Bielli, M, Milanese, U, Ugliengo, G, Pozzi, R, Rabajoli, F, Bosimini, E, Begliuomini, G, Ferrari, A, Barzizza, F, Valsecchi, Mg, Dadda, F, Faggiano, P, Castiglioni, G, Gibelli, G, Turelli, Al, Belluschi, R, Bianchi, C, Emanuelli, C, Gramenzi, S, Foti, G, Agnelli, D, Mascioli, G, Cazzani, E, Zanelli, E, Domenighini, D, Castelli, C, Moroni, E, Gara, S, Guzzetti, S, Muzzupappa, S, Turiel, M, Cappiello, E, Sandrone, G, Recalcati, F, Valenti, D, Achilli, F, Vincenzi, A, Rusconi, F, Palvarini, M, Ghio, S, Fontana, A, Giusti, A, Scelsi, L, Sebastiani, R, Ceresa, M, Nassiacos, D, Meloni, S, Nicoli, T, Bandini, P, Pedretti, R, Paolucci, M, Amati, L, Ravetta, M, Morandi, F, Provasoli, S, Bertolini, A, Imperiale, D, Agen, W, Planca, E, Quorso, P, Ferro, A, Pedrolli, C, Russo, P, Tarantini, L, Candelpergher, G, Cannarozzo, Pp, De Cian, F, Agnoli, A, Stefanini, Mg, Cacciavillani, L, Boffa, Gm, Mario, L, Renosto, G, Stritoni, P, Varotto, L, Penzo, M, Perini, G, Giuliano, G, Barducci, E, Piazza, R, Albanese, Mc, Fresco, C, Picco, F, Venturini, P, Camerini, A, Griffo, R, Derchi, G, Delfino, L, Pizzorno, L, Mazzantini, S, Torre, F, Orlandi, S, Bertoli, D, Gentile, A, Naccarella, F, Gatti, M, Coluccini, M, Morgagni, G, Alfano, G, Reggianini, L, Sansoni, S, Serra, W, Passerini, F, Del Corso, P, Rusconi, L, Marzaloni, M, Mezzetti, M, Gambarati, Gp, Mariani, Pr, Volterrani, C, Venturi, F, Zambaldi, G, Casolo, G, Moschi, G, Geri Brandinelli, G, Miracapillo, G, Boni, A, Italiani, G, Vergoni, W, Paci, Ap, Lattanzi, F, Reisenhofer, B, Severini, D, Taddei, T, Dalle Luche, A, Comella, A, Gasperini, U, Cocchieri, M, Alunni, G, Bosi, E, Panciarola, R, Maragoni, G, Bardelli, G, Testarmata, P, Pasetti, L, Budini, A, Gabrielli, D, Coderoni, B, Midi, P, Romaniello, C, Del Sindaco, D, Leggio, F, Terranova, A, Pulignano, G, Pozzar, P, Ansalone, G, Magris, B, Giannantoni, P, Cacciatore, G, Bottero, G, Scaffidi, G, Valtorta, C, Salustri, A, Amaddeo, F, Barbato, G, Aspromonte, N, Baldo, V, Baldo, E, Frattaroli, C, Mariani, A, Di Marco, G, Levantesi, G, Potena, Ap, Colonna, N, Montano, A, Sensale, P, Maiolica, O, Somelli, A, Napolitano, F, Provvisiero, P, Bottiglieri, P, Ciriello, N, Angelini, E, Andriulo, C, De Santis, F, Cocco, F, Pennetta, A, Mariello, F, Magliari, F, De Giorgi, A, Callerame, M, Santoro, V, Pede, S, Renna, A, De Donno, O, De Lorenzi, E, Polimeni, V, Russo, Va, Mangia, R, Truncellito, L, Cariello, Fp, Affinita, M, Perticone, F, Cloro, C, Borelli, D, Matta, M, Lopresti, D, Misuraca, A, Caporale, R, Chiappetta, P, Tripodi, E, Tassone, F, Salituri, S, Errigo, C, Meringolo, G, Donnangelo, L, Canonico, G, Coco, R, Franco, M, Coglitore, A, Donato, A, Di Tano, G, Cento, D, DE GREGORIO, Cesare, Mongiovì, M, Schillaci, Am, Mirto, U, Clemenza, F, Ingrillì, F, Cavallaro, A, Aloisi, B, Ledda, G, Rizzo, C, Porcu, M, Salis, S, Pistis, L, Pili, G, Piras, S, Maoddi, I, and Uras, F.

Subjects
Adult, Male, medicine.medical_specialty, Blood Pressure, Independent predictor, Low pulse pressure, Predictive Value of Tests, Internal medicine, Humans, Medicine, Aged, Female, Follow-Up Studies, Heart Failure, Italy, Middle Aged, Pulse, Registries, Stroke Volume, business.industry, medicine.disease, Heart failure, Cardiology, Cardiology and Cardiovascular Medicine, business
Abstract

A high pulse pressure (PP) predicts cardiovascular mortality in hypertension and in the elderly. We analyzed the data from the Italian Network of Congestive Heart Failure Registry to test the prognostic role of PP in patients with heart failure.A total of 8660 patients with heart failure (mean age 64 +/- 12 years, 73% male) were divided into four groups according to their PP (40, 40-49, 50-59, andor = 60 mmHg), and followed prospectively.After 1 year, 995 patients (11.5%) died. Both the mean arterial pressure and systolic blood pressure were found to be inversely associated with mortality at univariate and multivariate analyses. An inverse univariate relation was observed between PP and all-cause mortality. An excess mortality risk in the lowest PP group (odds ratio 1.40, 95% confidence interval 1.09-1.79 vs the highest PP group) was confirmed in a multivariate analysis which took into account the effect of several other variables, including mean arterial pressure. Similar findings were obtained for cardiovascular mortality. When we replaced systolic blood pressure with mean arterial pressure in the model, PP did not retain its independent prognostic role, possibly because of the high co-linearity between these two variables (r = 0.87).For any given level of mean arterial pressure, a low PP is an independent predictor of all-cause and cardiovascular death in patients with heart failure. The association may be partly related to the strong influence of low systolic blood pressure on mortality. Different pathophysiological mechanisms may underlie the opposite prognostic significance of PP in hypertension and heart failure.

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10. [Appropriateness of the request for preoperative cardiological evaluation in non-cardiac surgery: 8-year experience in a high-volume cardiological center].

Author

Pilleri A, Pistis L, Valentino L, Cocco D, Deidda M, and Scorcu G

Subjects
Adult, Aged, Female, Humans, Male, Middle Aged, Preoperative Care, Retrospective Studies, Risk Assessment, Atrial Fibrillation, Cardiology, Heart Diseases surgery
Abstract

Background: In the last decades the population undergoing non-cardiac surgery has become more numerous and complex. Cardiovascular perioperative complications represent at least one third of the perioperative deaths. Despite the pivotal role of the cardiologist in the perioperative management, current guidelines are often hardly useful in different settings of clinical practice. Local clinical protocols contribute to fill these gaps, to define the role of each specialist in the perioperative context and to achieve the best medical outcome., Methods: This single-center retrospective study analyzes the background of 33 463 preoperatory cardiologic visits, the adherence to scientific evidence in our institute and the impact of the implementation of a shared clinical protocol (CP) in terms of reduction of inappropriate requests of cardiological evaluations., Results: Among all the patients, the mean age was 59 ± 18 years, 52.8% were male. Hypertension was the most prevalent disease followed by diabetes, chronic coronary syndrome and atrial fibrillation. The "low-risk surgery" category was the most represented (56.2%) and the vast majority of patients (70.1%) was totally free from predictors of perioperative cardiovascular events. After the introduction of the CP, the number of inappropriate evaluations decreased by 32%, mainly in the low-risk category. However, despite the overall reduction, almost two thirds of the evaluations were still deemed inappropriate according to the CP, mostly (82.9%) in the low-risk category and to a lesser degree (55%) in the moderate/high-risk category., Conclusions: The inappropriate use of the resources resulted in disappointing organizational performance, poor assistance quality and a huge number of inappropriate preoperatory evaluations. The implementation of a CP, developed on the basis of the local needs, is a useful tool to enhance the organizational standards for the cardiological evaluation of patients undergoing non-cardiac surgery. Regular verifications, a widespread knowledge of the guidelines and a more efficient system of management and surveillance may improve the appropriateness of these evaluations.

Published
2022
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11. Preoperative assessment of cardiovascular risk in patients undergoing noncardiac surgery: the Orion study.

Author

Scorcu G, Pilleri A, Contu P, Faggiano P, Floris R, Mereu A, Pistis L, Sessego R, Valentino L, and Sardu C

Subjects
Aged, Cohort Studies, Female, Glomerular Filtration Rate physiology, Humans, Male, Middle Aged, Perioperative Period, Predictive Value of Tests, Preoperative Period, Prospective Studies, Risk Assessment, Risk Factors, Surgical Procedures, Operative trends, Cardiovascular Diseases complications, Heart Failure epidemiology, Postoperative Complications epidemiology, Surgical Procedures, Operative adverse effects
Abstract

In patients undergoing noncardiac surgery risk indices can estimate patients' perioperative risk of major cardiovascular complications. The indexes currently in use were derived from observational studies that are now outdated with respect to the current clinical context. We undertook a prospective, observational, cohort study to derive, validate, and compare a new risk index with established risk indices. We evaluated 7335 patients (mean age 63±13 years) who underwent noncardiac surgery. Based on prospective data analysis of 4600 patients (derivation cohort) we developed an Updated Cardiac Risk Score (UCRS), and validated the risk score on 2735 patients (validation cohort). Four variables (i.e. the UCRS) were significantly associated with the risk of a major perioperative cardiovascular events: high-risk surgery, preoperative estimate glomerular filtration rate <30 ml/min/1.73 m2, age ≥75 years, and history of heart failure. Based on the UCRS we created risk classes 1,2,3 and 4 and their corresponding 30-day risk of a major cardiovascular complication was 0.8% [95% confidence interval (CI) 0.5-1.7], 2.5 (95% CI 1.6-5.6), 8.7 (95% CI 5.2-18.9) and 27.2 (95% CI 11.8-50.3), respectively. No significant differences were found between the derivation and validation cohorts. Receiver operating characteristic (ROC) curves demonstrate a high predictive performance of the new index, with greater power to discriminate between the various classes of risk than the indexes currently used. The high predictive performance and simplicity of the UCRS make it suitable for wide-scale use in preoperative cardiac risk assessment of patients undergoing noncardiac surgery.

Published
2020
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12. [Sudden death from lipomatous hamartoma of the heart].

Author

Calamida R, Dessalvi F, Pistis L, and Catani G

Subjects
Autopsy, Diagnosis, Differential, Fatal Outcome, Female, Hamartoma complications, Heart Neoplasms complications, Heart Septum, Humans, Lipoma complications, Middle Aged, Death, Sudden, Cardiac etiology, Hamartoma diagnosis, Heart Neoplasms diagnosis, Lipoma diagnosis
Abstract

The authors report a case of a patient arrived at their observation in cardiogenic shock. The ECG showed extreme bradycardia refractory to resuscitation manoeuvres. The autopsy showed a lipomatous hamartoma in the interatrial septum. The lipomatous hamartoma is a primitive cardiac tumor, very rare, with an usually asymptomatic course but with severe prognosis. The authors emphasize that clinical presentation can be aspecific and resembling several other diseases, and early identification can be achieved only by 2D echo-cardiography or nuclear magnetic resonance imaging.

Published
1996

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