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3. The effect of observing high or low pain on the development of central sensitization

Author

Torta, D. M., Meyers, E., Polleunis, K., De Wolf, S., Meulders, A., van den Broeke, E. N., Torta, D. M., Meyers, E., Polleunis, K., De Wolf, S., Meulders, A., and van den Broeke, E. N.

Abstract

It is unknown whether watching other people in high pain increases mechanical hypersensitivity induced by pain. We applied high-frequency electrical stimulation (HFS) on the skin of healthy volunteers to induce pinprick mechanical hypersensitivity. Before HFS participants were randomly allocated to two groups: in the "low pain group", which was the control condition, they wathched a model expressing and reporting lower pain scores, in the "high pain group" the model expressed and reported higher scores. The two videos were selected on the basis of a pilot/observational study that had been conducted before. We tested the differences in perceived intensity of the HFS procedure, in the development of hypersensitivity and the role of fear and empathy. The high pain group reported on average higher pain ratings during HFS. The perceived intensity of hypersensitivity, but not the unpleasantness or length of the area was higher in the high pain group. Our results suggests that watching a person expressing more pain during HFS increases one's own pain ratings during HFS and may weakly facilitate the development of secondary mechanical hypersensitivity, although this latter result needs replication.

Published
2023

9. Perceptual correlates of homosynaptic long-term potentiation in human nociceptive pathways: a replication study.

Author

UCL - SSS/IONS/COSY - Systems & cognitive Neuroscience, van den Broeke, E N, Vanmaele, T, Mouraux, A, Stouffs, A, Biurrun-Manresa, J, Torta, D M, UCL - SSS/IONS/COSY - Systems & cognitive Neuroscience, van den Broeke, E N, Vanmaele, T, Mouraux, A, Stouffs, A, Biurrun-Manresa, J, and Torta, D M

Abstract

Animal studies have shown that high-frequency stimulation (HFS) of peripheral C-fibres induces long-term potentiation (LTP) within spinal nociceptive pathways. The aim of this replication study was to assess if a perceptual correlate of LTP can be observed in humans. In 20 healthy volunteers, we applied HFS to the left or right volar forearm. Before and after applying HFS, we delivered single electrical test stimuli through the HFS electrode while a second electrode at the contra-lateral arm served as a control condition. Moreover, to test the efficacy of the HFS protocol, we quantified changes in mechanical pinprick sensitivity before and after HFS of the skin surrounding both electrodes. The perceived intensity was collected for both electrical and mechanical stimuli. After HFS, the perceived pain intensity elicited by the mechanical pinprick stimuli applied on the skin surrounding the HFS-treated site was significantly higher compared to control site (heterotopic effect). Furthermore, we found a higher perceived pain intensity for single electrical stimuli delivered to the HFS-treated site compared to the control site (homotopic effect). Whether the homotopic effect reflects a perceptual correlate of homosynaptic LTP remains to be elucidated.

Published
2021

13. Central sensitization of nociceptive pathways demonstrated by robot-controlled pinprick-evoked brain potentials.

Author

UCL - SSS/IONS/COSY - Systems & cognitive Neuroscience, van den Broeke, E N, de Hemptinne, P, Mercken, M, Torta, D M, Lambert, J, Mouraux, A, UCL - SSS/IONS/COSY - Systems & cognitive Neuroscience, van den Broeke, E N, de Hemptinne, P, Mercken, M, Torta, D M, Lambert, J, and Mouraux, A

Abstract

The aim of this study was to assess the effect of central sensitization, induced by high frequency electrical stimulation of the skin (HFS), on pinprick-evoked brain potentials (PEPs) using robot-controlled mechanical pinprick stimulation and a stimulus evaluation task. In 16 healthy volunteers HFS was applied to the right volar forearm. Robot- controlled pinprick stimuli (64 mN) were applied before and 20 minutes after HFS to the skin surrounding the area onto which HFS was applied. During pinprick stimulation, the EEG was recorded and the quality of perception and perceived intensity of the pinprick stimuli was collected. After HFS, the skin surrounding the site at which HFS was delivered showed increased mechanical pinprick sensitivity. Both the early-latency negative peak of PEPs and the later-latency peak were significantly increased after HFS. This study shows increased PEPs after HFS when they are elicited by a robot-controlled mechanical pinprick stimulator and participants are engaged in a stimulus evaluation task during pinprick stimulation. This is the first study that shows a significant increase of both PEP peaks, and therefore, it provides a preferred setup for assessing the function of mechanical nociceptive pathways in the context of central sensitization.

Published
2020

16. Role of explicit verbal information in conditioned analgesia

Author

Carlino, E., Torta, D. M. E., Piedimonte, A., Frisaldi, E., Vighetti, S., and Benedetti, F.

Subjects
Adult, Male, Pain Threshold, Analgesics, Brain, Pain, Placebo Effect, Analgesia, Conditioning, Psychological, Female, Humans, Laser-Evoked Potentials, Speech, Young Adult, Pain Management, Psychological, Conditioning
Abstract

The exact role of expectation in conditioned analgesia is still elusive as it is not clear whether conditioning is an automatic process or rather it is cognitively mediated. This study is aimed at understanding the role of explicit verbal information in conditioned analgesia.Two groups of healthy subjects received a conditioning procedure whereby two visual cues were paired with increase and decrease in stimulus intensity. In the 'conditioning/verbal information' group (VER), subjects were informed about the meaning of the cues, whereas no information was given to the second group (noVER). After two conditioning blocks, an evocation session was run in which the stimulus intensity was the same, irrespective of the cues. Pain perception was assessed according to a numerical rating scale from 0 (no pain) to 10 (maximal pain). The N2-P2 component of laser-evoked potentials (LEP) was used as an index of index of brain responses to nociceptive stimuli.In the evocation session, only the VER group reported a decrease in pain rating and LEP amplitude when the cues were presented, suggesting that the visual-analgesic association does not occur without explicit verbal information.In line with the cognitive theory of conditioning, our results indicate that just pairing a cue with different pain stimulus intensities is not sufficient, per se, to produce a learning process. What matters is the informational cognitive content of the cue, i.e. the meaning assigned to the cue itself. These findings may help understand the mechanisms of conditioned analgesia and more in general of learning.

Published
2014

22. Crossing the line of pain: fMRI correlates of crossed-hands analgesia

Author

Torta, D, Diano, M, Costa, T, Gallace, A, Duca, S, Geminiani, G, Cauda, F, Torta, DM, GALLACE, ALBERTO, Geminiani, GC, Cauda, F., Torta, D, Diano, M, Costa, T, Gallace, A, Duca, S, Geminiani, G, Cauda, F, Torta, DM, GALLACE, ALBERTO, Geminiani, GC, and Cauda, F.

Abstract

Crossing the hands over the body midline reduces the perceived intensity of nociceptive stimuli applied to the hands by impairing the ability to localize somatosensory stimuli. The neural basis of this "crossed-hands analgesia" has not been investigated previously, although it has been proposed that the effect may be modulated by multimodal areas. We used functional magnetic resonance imaging to test the hypothesis that crossed-hands analgesia is mediated by higher-order multimodal areas rather than by specific somatosensory ones. Participants lay in the scanner while mechanical painful stimuli were applied to their hands held in either a crossed or uncrossed position. They reported significantly lower perceived intensity of pain when their hands were crossed. Although activations elicited by stimuli applied to the crossed hands revealed significantly greater blood oxygen level-dependent responses in the anterior cingulate cortex, the insula, and the medial frontal gyrus, the blood oxygen level-dependent responses in the superior parietal lobe were greater with the hands uncrossed. Our results provide evidence that crossed-hands analgesia is mediated by higher-order frontoparietal multimodal areas involved in sustaining and updating body and spatial representations. Perspective: We found crossed-hands analgesia to be mediated by multimodal areas, such as the posterior parietal, cingulate, and insular cortices, implicated in space and body representation. Our findings highlight how the perceived intensity of painful stimuli is shaped by how we represent our body and the space surrounding it. © 2013 by the American Pain Society.

Published
2013

23. The temporal order judgement of tactile and nociceptive stimuli is impaired by crossing the hands over the body midline

Author

Sambo, C, Torta, D, Gallace, A, Liang, M, Moseley, G, Iannetti, G, Sambo, CF, Torta, DM, GALLACE, ALBERTO, Moseley, GL, Iannetti, GD, Sambo, C, Torta, D, Gallace, A, Liang, M, Moseley, G, Iannetti, G, Sambo, CF, Torta, DM, GALLACE, ALBERTO, Moseley, GL, and Iannetti, GD

Abstract

Crossing the hands over the midline impairs the ability to correctly judge the order of a pair of tactile stimuli, delivered in rapid succession, one to each hand. This impairment, termed crossed-hands deficit, has been attributed to a mismatch between the somatotopic and body-centred frames of reference, onto which somatosensory stimuli are automatically mapped. Whether or not such crossed-hands deficit occurs also when delivering nociceptive stimuli has not been previously investigated. In this study, participants performed a temporal order judgement (TOJ) task in which pairs of either nociceptive or tactile stimuli were delivered, one to each hand, while their arms were either crossed over the body midline or uncrossed. We observed that crossing the hands over the midline significantly decreases the ability to determine the stimulus order when a pair of nociceptive stimuli is delivered to the hands, and that this crossed-hands deficit has a temporal profile similar to that observed for tactile stimuli. These findings suggest that similar mechanisms for integrating somatotopic and body-centred frames of reference underlie the ability to localise both nociceptive and tactile stimuli in space. © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Published
2013

28. The analgesic effect of crossing the arms

Author

Gallace, A, Torta, D, Moseley, G, Iannetti, G, GALLACE, ALBERTO, Torta, DME, Moseley, GL, Iannetti, GD, Gallace, A, Torta, D, Moseley, G, Iannetti, G, GALLACE, ALBERTO, Torta, DME, Moseley, GL, and Iannetti, GD

Abstract

The ability to determine precisely the location of sensory stimuli is fundamental to how we interact with the world; indeed, to our survival. Crossing the hands over the body midline impairs this ability to localize tactile stimuli. We hypothesized that crossing the arms would modulate the intensity of pain evoked by noxious stimulation of the hand. In two separate experiments, we show (1) that the intensity of both laser-evoked painful sensations and electrically-evoked nonpainful sensations were decreased when the arms were crossed over the midline, and (2) that these effects were associated with changes in the multimodal cortical processing of somatosensory information. Critically, there was no change in the somatosensory-specific cortical processing of somatosensory information. Besides studies showing relief of phantom limb pain using mirrors, this is the first evidence that impeding the processes by which the brain localises a noxious stimulus can reduce pain, and that this effect reflects modulation of multimodal neural activities. By showing that the neural mechanisms by which pain emerges from nociception represent a possible target for analgesia, we raise the possibility of novel approaches to the treatment of painful clinical conditions. Crossing the arms over the midline impairs multimodal processing of somatosensory stimuli and induces significant analgesia to noxious hand stimulation. © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Published
2011

39. MEDICAL SCIENCE. GISSI-2: A factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12 490 patients with acute myocardial infarction

Author

Feruglio, G. A., Lotto, A., Rovelli, F., Solinas, P., Tavazzi, L., Tognoni, G., De Vita, C., Franzosi, M. G., Maggiom, A. P., Mauri, F., Volpi, A., Selvini, A., Donato, L., Garattmi, S., Loi, U., Sirchia, G., Ambrosioni, E., Camerini, F., Campolo, L., Donati, M. B., Ferrari, M., Farchi, G., Geraci, E., Mannucci, P. M., Marubini, E., Neri Semeri, G. G., Peto, R., Prati, P. L., Specchia, G., Vecchio, C., Visani, L., Yusuf, S., Mezzanotte, G., Santoro, E., Bruno, M., Cappello, T., Coppini, A., Fincati, F., Mantovani, G., Pangrazzi, J., Pogna, M., Turazza, F. M., Ansehni, M., Barbonaglia, L., Bigi, R., Cavalli, A., Frigerio, M., Giordano, A., Gualtierotti, C., Torta, D., Vinci, P., Bossi, M., Furlanello, F., Braito, E., Giulia, V., Palmieri, M., Majoimo, P., Pinelli, G., Papi, L., Nardelli, A., Capestro, F., Rossi, A., Ricci, D., Mininni, N., Bianco, G., Barbuzzi, S., Plastina, F., Di Giovanna, F., Mereu, D., Giordano, F., Barlotti, R., Loparco, G., Boscarino, S., Ruggeri, G., Anastasi, R., Paciaroni, E., Tomassini, P. F., Purcaro, A., Francesconi, M., Figliolia, S., Tesse, S., Devoti, G., Giometti, R., Teoni, P., Burali, A., Zucconelli, V., Iervoglini, A., Amabili, S., Caratti, C. A., Zola, G., Ferraguto, P., Sagci, G., Rotiroti, D., Genovese, M., Da€™amato, N., Taurino, L., Colonna, L., Bovenzi, F., Messina, D., Sarcina, G., Compostella, L., Cucchini, F., Malacrida, R., Gradel, C., Bridda, A., Pellegrini, P., Acone, L., Bruno, A., Tespili, M., Guaghurrii, G., Casari, A., Bobba, F., Scaramuzzino, G., Berardi, C., De Castro, U., Fulvi, M., Lintner, W., Erlicher, A., Pitscheider, W., Scola Gagliardi, R., Bonizzato, G., Roggero, C., Perrini, A., Tsialtas, D., Straneo, U., Storelli, A., Verrienti, A., Albonico, B., Corradi, L., De Petra, V., Villani, C., Maxia, P., Bianco, A., Crabu, E., Centamore, G., Di Stefano, G., Vancheri, F., Amico, C., Baldini, F., Santopuoli, G., Pantaleoni, A., Contessotto, F., Terlizzi, R., Turchi, E., Teglio, V., Pignatti, F., Aletto, C., Gozzelino, G., Pettinati, G., De Santis, F., Correale, E., Romano, S., Perrotta, R., Tritto, C., May, L., Achilli, G., Suzzi, G., Cemetti, C., Longobardi, R., Somma, G., Palumbo, C., Gallone, P., Sorrentino, F., Dato, A., Della Monica, R., Pagano, L., Alberti, A., Orselli, L., Negrini, M., De Ponti, C., Acito, P., Capelletti, D., Bortolini, F., Coppola, V., Ciglia, C., De Cesare, M., De Lio, U., Maiolino, P., Giannini, R., Niccolini, A., Marinoni, C., Guasconi, C., Sonnino, S., Pagliei, M., Ferrari, G., Politi, A., Galli, M., De Rinaldis, G., Calcagnile, A., Bendinelli, S., Lusetti, L., Mollaioli, M., Cosmi, F., Venneri, N., Feraco, E., Lauro, A., Catelli, P., Poluzzi, C., Distante, S., Pedroni, P., Zampaglione, G., Lumare, R., Bruna, C., De Benedictis, N., Ziacchi, V., Lomanto, B., Riva, D., Bertocchi, P., Tirella, G., Tessitori, M., Bini, A., Peruzzi, F., Maresta, A., Pirazzini, L., Gaggi, S., Frausini, G., Malacame, C., Codeca, L., Cappato, R., Andreoli, L., Bastoni, L. A., Pucci, P., Sarro, F., Vergassola, R., Barchielli, M., De Matteis, D., Carrone, M., Liberati, R., Meniconi, L., Radogna, M., Tallone, M., Ieri, A., Ferreri, A., Guidali, P., Canziani, R., Mariello, F., Minelli, C., Muzio, L., Rota Baldini, M., Lupi, G., Cecchi, A., Giuliano, G., Bellotti, S., Livi, S., Corti, E., Rossi, P., Delfino, R., Iannetti, M., Pastorini, C., Pennesi, A., Di Giacinto, N., Bertolo, L., Slomp, L., Cresti, A., Svetoni, N., Distefano, S., Veneri, L., Moretti, S., Palermo, R., Giovanelli, N., Parchi, C., Dethomads, M., Paparella, N., Carrino, C., Aquaro, G., Idone, P., Marsili, P., Sideri, F., Valerio, A., Tullio, D., Ragazzini, G., Gramenzi, S., De Pasquale, B., Gelfo, P. G., Rosselli, P., De Marchi, E., Greco, M. R., Fazio, A. M., Savoia, M. T., Gerosa, C., Barbiero, M., Barbaresi, F., Volta, G., Da€™urbano, M., Passoni, F., Parola, G., Lanzini, A., Baldini, U., Del Bene, P., Orlandi, M., Oddone, A., Lazzari, M., Ballerini, B., Bozzi, L., Moccetti, T., Bemasconi, E., Sanguinetti, M., Tognoli, T., Bardelli, G., Maggi, A., Turato, R., Piva, M., Izzo, A., Tantalo, L., Rizzi, A., Scilabra, G., Varvaro, F., Colombo, G., Grieco, A., Dovico, E., Belluzzi, F., Casellato, F., Lecchi, G., Maugeri Sacci, C., Consolo, A., Piccolo, E., Zuin, G., Zappa, C., Sanna, G. P., Dossena, M. G., Corsini, C., Lettino, M., Marconi, M., Mafrici, A., Leonardi, G., Moreo, A., Seregni, R., Pastine, I., Casazza, F., Regalia, F., Maggiolini, S., Benenati, P. M., Rigo, R., Pascotto, P., Zanocco, A., Artusi, L., Cappelli, C., Bernardi, C., Pahnieri, M., Zilio, G., Sandri, R., Neri, G., Valagussa, F., Osculati, G., Cira, A., Da€™aniello, L., Piantadosi, F. R., Improta, M., Severino, S., Bisconti, C., Mostacci, M., Randon, L., Boschello, M., Allegri, M., Freggiaro, V., Mureddu, V., Soro, F., Marras, E., Marchi, S. M., De Luca, C., Manetta, M., Dalla Volta, S., Maddalena, F., Donzelli, M., Vitrano, M. G., Canonico, A., Ledda, A., Bellomare, D., Carrubba, A., Da€™antonio, E., Scardulla, C., Raineri, A., Traina, M., La Calce, C., Cirincione, V., Montanar, F., Strizzolo, L., Di Gregorio, D., Mantini, L., Chiriatti, G., Gazzola, U., Rosi, A., Mellini, M., Piazza, R., Micheli, G., Bechi, S., Martines, C., Marchese, D., Bigalli, A., Davini, P., Boem, A., Del Citerna, F., Giomi, A., Codeluppi, P., Negrelli, M., Brieda, M., Charmet, P. A., Petrella, A., Bardazzi, L., Bianco, G. A., Marco, A., Licitra, R., Lettica, G. V., Tumiotto, G., Bosi, S., Spitali, G., Casali, G., Bottoni, N., Parenti, G. F., Triulzi, E., Brighi, F., Benati, A., De Sanctis, A., Mene, A., Pesaresi, A., Bologna, F., Lumia, F., Barbato, G., Milazzotto, F., Proietti, F., Angrisani, G., Azzolini, P., Coppola, E., Trani, Carlo, Masini, V., Rocchi, M., Borgia, M. C., Luciani, C., Vitucci, N. C., Giuliani, P., Tugnoli, F., Vetta, C., Altieri, T., Gimigliano, F., Striano, U., Salituri, S., Zanazzi, G., Zonzin, P., Bugatti, U., Ravera, B., Allemano, P., Reynaud, S., Sanson, A., Milani, L., De Simone, M. V., Villella, A., Grazzini, M., Amidei, S., Ansehni, L., Benza, G., Tagliamonte, A., Messina, V., Etro, M. D., Vivaldi, F., Cortese, R., Ibba, G. V., Sannia, L., Pedrazzini, F., Gazzotti, G. L., Pizzuti, A., Antonielli, E., Becchi, G., Filice, A., Salmoiraghi, A., Caramanno, G., Caporicci, D., Brun, M., Ferrario, G., Giani, P., Ronconi, G., Douglas, S., Bianchi, C., Cucchi, G., Marieni, M., Marcellini, G., Speca, G., Beato, E., Serabni, N., Bazzucchi, M., Coronelli, R., Rossi, L., Basso, G., Presbitero, P., Bevilacqua, R., Pallisco, O., Di Leo, M., Golzio, P. G., Parigi, A., Belli, R., Trinchero, R., Gaschino, G., Barenghi, M., Poggio, G. L., Braschi, G. B., Sciacca, R., Sammartano, A., Braito, G., Cuzzato, V., Frigo, G., Perissinono, F., Galati, A., Accogli, M., Morgera, T., Barbieri, L., Slavich, G. A., Fresco, C., Cuda, A., Liguori, A., Cozzi, A., Caico, S., Alberio, M., Di Marco, G., De Vito, G., Valente, S., Zagatti, G., Zardini, P., Nidasio, G. P., Girardi, P., Mazzini, C., Nava, S., Achilli, A., Bisogno, A., Pasotti, C., Ballestra, A. M., and Giustarini, C.

Subjects
Aspirin, medicine.medical_specialty, business.industry, Streptokinase, acute myocardial infarction, General Medicine, Heparin, medicine.disease, Atenolol, Surgery, Anistreplase, Anesthesia, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, medicine, Myocardial infarction, business, Stroke, medicine.drug, Killip class
Abstract

A multicentre, randomised, open trial with a 2 x 2 factorial design was conducted to compare the benefits and risks of two thrombolytic agents, streptokinase (SK, 1·5 MU infused intravenously over 30-60 min) and alteplase (tPA, 100 mg infused intravenously over 3 h) in patients with acute myocardial infarction admitted to coronary care units within 6 h from onset of symptoms. The patients were also randomised to receive heparin (12 500 U subcutaneously twice daily until discharge from hospital, starting 12 h after beginning the tPA or SK infusion) or usual therapy. All patients without specific contraindications were given atenolol (5-10 mg iv) and aspirin (300-325 mg a day). The end-point of the study was the combined estimate of death plus severe left ventricular damage. 12 490 patients were randomised to four treatment groups (SK alone, SK plus heparin, tPA alone, tPA plus heparin). No specific differences between the two thrombolytic agents were detected as regards the combined end-point (tPA 23·1%; SK 22·5%; relative risk 1·04, 95% Cl 0·95-1·13), nor after the addition of heparin to the aspirin treatment (hep 22·7%, no hep 22·9%; RR 0·99, 95% Cl 0·91-1·08). The outcome of patients allocated to the four treatment groups was similar with respect to baseline risk factors such as age, Killip class, hours from onset of symptoms, and site and type of infarct. The rates of major in-hospital cardiac complications (reinfarction, post-infarction angina) were also similar. The incidence of major bleeds was significantly higher in SK and heparin treated patients (respectively, tPA 0·5%, SK 1·0%, RR 0·57, 95% Cl 0·38-0·85; hep 1·0%, no hep 0·6%, RR 1·64, 95% Cl 1·09-2·45), whereas the overall incidence of stroke was similar in all groups. SK and tPA appear equally effective and safe for use in routine conditions of care, in all infarct patients who have no contraindications, with or without post-thrombolytic heparin treatment. The 8·8% hospital mortality of the study population (compared with approximately 13% in the control cohort of the GISSI-1 trial) indicates the beneficial impact of the proven acute treatments for AMI.

Published
1990

40. DETERMINANTS OF 6-MONTH MORTALITY IN SURVIVORS OF MYOCARDIAL-INFARCTION AFTER THROMBOLYSIS - RESULTS OF THE GISSI-2 DATA-BASE

Author

VOLPI A, DEVITA C, FRANZOSI MG, GERACI E, MAGGIONI AP, MAURI F, NEGRI E, SANTORO E, TAVAZZI L, TOGNONI G, FERUGLIO GA, LOTTO A, ROVELLI F, SOLINAS P, BRUNO M, CAPPELLO T, COPPINI A, FINCATI F, MANTOVANI G, PANGRAZZI J, POGNA M, TURAZZA FM, ANSELMI M, BARBONAGLIA L, BIGI R, CAVALLI A, FRIGERIO M, GIORDANO A, GUALTIEROTTI C, TORTA D, CAROLA R, GIORDANO F, BARLOTTI R, LOPARCO G, VIGLINO GL, RUGGERI G, GIAMUNDO L, DANESI A, PACIARONI E, GAMBINI C, URBANO G, PURCARO A, FRANCESCONI M, FIGLIOLIA S, CANNONE M, ANTOLINI R, DEVOTI G, CRISTALLINI P, PORCIELLO PI, TEONI P, BURALI A, ZUCCONELLI V, DEMATTEIS C, IERVOGLINI A, SCATASTA M, AMABILI S, CARATTI CA, ZOLA G, FERRAGUTO P, SALICI G, CENTARO A, ROTIROTI D, GENOVESE M, GINEVRINO P, DAMATO N, ALTAMURA CM, COLONNA L, CASTELLANETA G, BOVENZI F, MESSINA D, GALANTINO A, CAMPOREALE N, CUCCHINI F, CAMPOSTELLA L, MALACRIDA R, GENONI M, PELLEGRINI P, BRIDDA A, RIGGI L, ACONE L, MOSCATIELLO G, BRUNO A, INVERNIZZI G, TESPILI M, GUAGLIUMI G, CASARI A, ALBANO T, TOMASSINI B, DIBIASE G, SCARAMUZZINO G, RUGGERO S, BRACCHETTI D, DECASTRO U, FULVI M, BRAITO E, ERLICHER A, OBERLECHNER W, GAGLIARDI RS, BIGHIGNOLI L, BONIZZATO G, RIZZI GM, SCAZZINA L, PERRINI A, STRANEO G, STRANEO U, SCIRE A, VERRIENTI A, GUADALUPI M, STORELLI A, ZUCCA L, DABUSTI M, ALBONICO B, DEPETRA V, TABACCHI GC, SCERVINO R, MEREU D, MAXIA P, BIANCO A, CRABU E, MANGIAMELI S, CENTAMORE G, MALFITANO D, AMICO C, VANCHERI F, SANTOPUOLI G, BALDINI F, PANTALEONI A, CONTESSOTTO F, TERLIZZI R, MERIGHI A, TURCHI E, TEGLIO V, PIGNATTI F, PEZZANA A, GOZZOLINO G, GIGLIO M, PETTINATI G, IEVA M, CIRICUGNO S, CORREALE E, ROMANO S, DIFUCCIA A, CASTELLANO B, NATALE A, CERNETTI C, CELEGON L, CANDELPERGHER G, ARIENZO F, RUSSO F, DEVIVO L, MAY L, ACHILLI G, BLASI A, SORRENTINO F, DATO A, GALLONE P, PALUMBO C, DELLAMONICA R, PAGANO L, ALBERTI A, ORSELLI L, DEPONTI C, PARMIGIANI ML, FERRARI M, ACITO P, BUSI F, DELLAVITTORIA G, BELLET C, BORTOLINI F, ROSSI A, CORONA C, BONDI S, NICCOLINI D, GAMBERI G, ARCURI G, MAIOLINO P, CARROZZA A, DELIO U, CAPRETTI G, MARINONI C, GUASCONI C, SONNINO S, PAGLIEI M, FERRARI G, LOMBARDI R, AGNELLI D, DERINALDIS G, CALCAGNILE A, SIGNORELLI S, BENDINELLI S, LUSETTI L, MOLLAIOLI M, COSMI F, PLASTINA F, VENNERI N, FERACO E, CATELLI P, POLUZZI C, DISTANTE S, BIANCHI C, COPPETTI S, ZAMPAGLIONE G, GATTO C, ZURLO R, USLENGHI E, MARGARIA F, MILANESE U, LOMANTO B, ZIACCHI V, RIVA D, BERTOCCHI P, TIRELLA G, DAULERIO M, SAURO G, BINI A, MAZZONI V, POGGI P, MARESTA A, JACOPI F, PATRONCINI A, PUPITA F, GAGGI S, FRAUSINI G, ANTONIOLI GE, MALACARNE C, CODECA L, CAPPATO R, ANDREOLI L, VARACCA S, BUIO E, FAZZINI PF, PUCCI P, SARRO F, VERGASSOLA R, BARCHIELLI M, DEMATTEIS D, CARRONE M, BRUNOZZI LT, MENICONI L, LIBERATI R, RADOGNA M, TALLONE M, CONTE R, IERI A, ZIPOLI A, SANSONI M, CANZIANI R, GUIDALI P, CRISTALLO E, MARIELLO F, MUZIO L, BENVENUTO MR, BALDINI MR, VECCHIO C, CHIARELLA F, FALCIDIENO M, CECCHI A, GIULIANO G, SEU V, PERUGINI P, TOSELLI A, BASSO F, CORTI E, ROSSI P, DELFINO R, CAPONNETTO S, GNECCO G, GHIGLIOTTI G, PENNESI A, LOMBARDI G, RUGGIERI A, BERTOLO L, SLOMP L, LANZETTA T, MAZZARONE L, CRESTI A, BELLODI G, ZUARINI AM, VENERI L, PARCHI C, GIOVANELLI N, NEGRONI S, DETHOMATIS M, BARGHINI A, MARINO E, RICCI D, LEMME P, DIGIACOMO U, AQUARO G, RONZANI G, OTTELLO B, VONTI V, MORETTI S, PALERMO R, MARSILI P, SIDERI F, RAGAZZINI G, GRAMENZI S, BATTISTINI S, DIODATO T, VALERIO A, TUCCI C, DEPASQUALE B, GELFO PG, BERTULLA A, BOLLINI R, DEMARCHI E, BACCA F, DEGIORGI V, LOCATELLI V, SAVOIA MT, FERRACINI C, BARBARESI F, COTOGNI A, FRANCO G, PASSONI F, DURBANO M, MORETTI G, PEROTTI S, CAPRETTI M, DELBENE P, CASCONE M, BALDINI U, ORLANDI M, ODDONE A, CAIZZI V, MASINI G, LAZZARI M, BALLERINI B, BOZZI L, MOCETTI T, BERTOLINI A, PASOTTI E, SANGUINETTI M, MANTOVANI R, TOGNOLI T, MAGGI A, TUSA M, CAMERONI E, GUERRA GP, REGGIANI A, REDAELLI S, GIUSTI S, TANTALO L, RIZZI A, DIGIOVANNI N, GUZZO V, GABRIELE M, COLOMBO G, ALBERZONI A, SALVIOLI G, GALFETTI F, DOVICO E, BELLUZZI F, GOLA E, CASELLATO F, LECCHI G, CONSOLO F, SACCA CB, CONSOLO A, PICCOLO E, GASPARINI G, MASSA D, BELLI C, DOSSENA MG, CORSINI C, SANNA GP, AZZOLLINI M, TRUAZZA F, NADOR F, DEMARTINI M, BOZZI G, SEREGNI R, PASTINE I, MORPURGO M, CASAZZA F, REGALIA F, MAGGIOLINI S, RIGO R, PANCALDI S, POZZETTI D, PASCOTTO P, FRANCESCHI L, DAINESE F, MELINI L, CAPPELLI C, BERNARDI C, PALMIERI M, BORGIONI L, ZILIO G, SANDRI R, ALITTO F, MASARO G, VALAGUSSA F, SCHIAVINA R, RAVESI D, DANIELLO L, PIANTADOSI FR, BARRA P, ROMEO D, MININNI N, SEVERINO S, MOSTACCI M, CASTELLARI M, BANDA D, ROLANDI R, VILLA WD, CARBONE V, ALLEGRI M, FASCIOLO L, PITTALIS M, MUREDDU V, SORO F, DELEDDA MG, MARRAS E, MARCHI SM, DELUCA C, MANETTA M, VOLTA SD, SPERANDEO V, DONZELLI M, VITRANO MG, PITROLO F, LAMONICA S, BELLANCA G, MESSINA G, MIRTO U, RAINERI A, TRAINA M, DIBENEDETTO A, RIBAUDO E, DIFRANCESCO M, RONCHITELLI R, CARONE M, DIGREGORIO D, DIPAOLO G, PASQUALE M, COREA L, COCCHIERI M, ALUNNI G, PAPI L, CHIRIATTI G, LUPETTI M, GAZZOLA U, ARRUZZOLI S, VILLANI GQ, MELLINI M, MADRUZZA L, PIAZZA R, MICHELI G, FRANCHINI C, BECHI S, MARTINES C, MARCHESE D, GABBIA G, BIGALLI A, CIUTI M, CABANI E, DELCITERNA F, ALFIERI A, CHITI M, LONGHINI J, CODELUPPI P, NEGRELLI M, ZANUTTINI D, NICOLOSI GL, MARTIN G, PETRELLA A, BARDAZZI L, BIANCO GA, CELLAMARE G, GIANNELLI F, LICITRA G, LICITRA R, LETTICA GV, TUMIOTTO G, BELLANTI G, BOSI S, CASALI G, MONDUCCI I, BARONE A, PARENTI F, HEYMAN J, COZZI E, BALDACCI G, BACCOS D, BRIGHI F, DESANCTIS A, BOCK R, ROSSI F, AMATI P, SEMPRINI P, NARDELLI A, BOTTERO G, VARTOLO C, MILAZZOTTO F, DICROCE G, DIMARIO F, ANGRISANI G, AZZOLINI P, NEJA CP, MANZOLI U, ROSSI E, TRANI C, MASINI V, SEBASTIANI F, TOPAI M, BORGIA MC, LUCIANI C, FERRI F, DEPAOLA D, CAPURSO S, TUGNOLI F, VETTA C, ALTIERI T, BORZI M, VISCOMI A, STRIANO U, SALITURI S, ZONZIN P, FIORENCIS R, BADIN A, RAVERA B, BALDI C, SILVESTRI F, ALLEMANO P, REYNAUD S, SANSON A, MILANI L, DESIMONE MV, RUSSO A, VILLELLA A, GRAZINI M, AMIDEI S, ANSELMI L, PICCANICOLINO R, MASCELLI G, TAGLIAMONTE A, MESSINA V, TEDESCHI C, BOSSI M, BISIOLI M, TACCHI G, PAGNI G, VIVALDI F, IBBA GV, SANNIA L, PEDRAZZINI F, BAGNI E, FABII S, ALVINO A, ANTONIELLI E, DORONZO B, MARTINENGO E, BECCHI G, SALMOIRAGHI A, DIGIOVANNA F, CARAMANNO G, CAPORICCI D, BRUN M, GIANI P, FERRARIO G, PECI P, RONCONI G, SKOUSE D, GIUSTINIANI S, CUCCHI GF, TAVASCI E, SILVERII A, MARCELLINI G, SPECA G, STANISCIA D, CIMINO A, SERAFINI N, DEBONIS P, CERRUTI P, BAZZUCCHI M, DALPRA F, SPEROTTO C, MOLE GD, BARBANO G, POMARI F, GASCHINO G, PARIGI A, GANDOLFO N, RONDONI F, BRUSCA A, DILEO M, GOLZIO PG, ABRATE M, SCLAVO MG, ROCCI R, POGGIO G, GIANI S, CUZZUCREA D, BRASCHI GB, SCIACCA R, SAMMARTANO A, FURLANELLO F, BRAITO G, CUZZATO V, TOTIS O, FAURETTO F, LEO F, GALATI A, PALMA P, CAMERINI F, MORGERA T, BARBIERI L, SLAVICK GA, FRESCO C, CUDA A, SARNICOLA P, ARZILLO P, BINAGHI G, MACCHI G, CALVERI G, DIMARCO G, LEVANTESI G, PANERAI C, CATURELLI G, FACCHIN L, SARTORE G, ZARDINI P, MARINO P, CARBONIERI E, NAVA S, MAZZINI C, NAVA R, SERRA N, SASSARA M, NICROSINI F, GANDOLFI P, BERGOGNONI G, BALLESTRA AM, VIOLO C, VOLPI A, DEVITA C, FRANZOSI MG, GERACI E, MAGGIONI AP, MAURI F, NEGRI E, SANTORO E, TAVAZZI L, TOGNONI G, FERUGLIO GA, LOTTO A, ROVELLI F, SOLINAS P, BRUNO M, CAPPELLO T, COPPINI A, FINCATI F, MANTOVANI G, PANGRAZZI J, POGNA M, TURAZZA FM, ANSELMI M, BARBONAGLIA L, BIGI R, CAVALLI A, FRIGERIO M, GIORDANO A, GUALTIEROTTI C, TORTA D, CAROLA R, GIORDANO F, BARLOTTI R, LOPARCO G, VIGLINO GL, RUGGERI G, GIAMUNDO L, DANESI A, PACIARONI E, GAMBINI C, URBANO G, PURCARO A, FRANCESCONI M, FIGLIOLIA S, CANNONE M, ANTOLINI R, DEVOTI G, CRISTALLINI P, PORCIELLO PI, TEONI P, BURALI A, ZUCCONELLI V, DEMATTEIS C, IERVOGLINI A, SCATASTA M, AMABILI S, CARATTI CA, ZOLA G, FERRAGUTO P, SALICI G, CENTARO A, ROTIROTI D, GENOVESE M, GINEVRINO P, DAMATO N, ALTAMURA CM, COLONNA L, CASTELLANETA G, BOVENZI F, MESSINA D, GALANTINO A, CAMPOREALE N, CUCCHINI F, CAMPOSTELLA L, MALACRIDA R, GENONI M, PELLEGRINI P, BRIDDA A, RIGGI L, ACONE L, MOSCATIELLO G, BRUNO A, INVERNIZZI G, TESPILI M, GUAGLIUMI G, CASARI A, ALBANO T, TOMASSINI B, DIBIASE G, SCARAMUZZINO G, RUGGERO S, BRACCHETTI D, DECASTRO U, FULVI M, BRAITO E, ERLICHER A, OBERLECHNER W, GAGLIARDI RS, BIGHIGNOLI L, BONIZZATO G, RIZZI GM, SCAZZINA L, PERRINI A, STRANEO G, STRANEO U, SCIRE A, VERRIENTI A, GUADALUPI M, STORELLI A, ZUCCA L, DABUSTI M, ALBONICO B, DEPETRA V, TABACCHI GC, SCERVINO R, MEREU D, MAXIA P, BIANCO A, CRABU E, MANGIAMELI S, CENTAMORE G, MALFITANO D, AMICO C, VANCHERI F, SANTOPUOLI G, BALDINI F, PANTALEONI A, CONTESSOTTO F, TERLIZZI R, MERIGHI A, TURCHI E, TEGLIO V, PIGNATTI F, PEZZANA A, GOZZOLINO G, GIGLIO M, PETTINATI G, IEVA M, CIRICUGNO S, CORREALE E, ROMANO S, DIFUCCIA A, CASTELLANO B, NATALE A, CERNETTI C, CELEGON L, CANDELPERGHER G, ARIENZO F, RUSSO F, DEVIVO L, MAY L, ACHILLI G, BLASI A, SORRENTINO F, DATO A, GALLONE P, PALUMBO C, DELLAMONICA R, PAGANO L, ALBERTI A, ORSELLI L, DEPONTI C, PARMIGIANI ML, FERRARI M, ACITO P, BUSI F, DELLAVITTORIA G, BELLET C, BORTOLINI F, ROSSI A, CORONA C, BONDI S, NICCOLINI D, GAMBERI G, ARCURI G, MAIOLINO P, CARROZZA A, DELIO U, CAPRETTI G, MARINONI C, GUASCONI C, SONNINO S, PAGLIEI M, FERRARI G, LOMBARDI R, AGNELLI D, DERINALDIS G, CALCAGNILE A, SIGNORELLI S, BENDINELLI S, LUSETTI L, MOLLAIOLI M, COSMI F, PLASTINA F, VENNERI N, FERACO E, CATELLI P, POLUZZI C, DISTANTE S, BIANCHI C, COPPETTI S, ZAMPAGLIONE G, GATTO C, ZURLO R, USLENGHI E, MARGARIA F, MILANESE U, LOMANTO B, ZIACCHI V, RIVA D, BERTOCCHI P, TIRELLA G, DAULERIO M, SAURO G, BINI A, MAZZONI V, POGGI P, MARESTA A, JACOPI F, PATRONCINI A, PUPITA F, GAGGI S, FRAUSINI G, ANTONIOLI GE, MALACARNE C, CODECA L, CAPPATO R, ANDREOLI L, VARACCA S, BUIO E, FAZZINI PF, PUCCI P, SARRO F, VERGASSOLA R, BARCHIELLI M, DEMATTEIS D, CARRONE M, BRUNOZZI LT, MENICONI L, LIBERATI R, RADOGNA M, TALLONE M, CONTE R, IERI A, ZIPOLI A, SANSONI M, CANZIANI R, GUIDALI P, CRISTALLO E, MARIELLO F, MUZIO L, BENVENUTO MR, BALDINI MR, VECCHIO C, CHIARELLA F, FALCIDIENO M, CECCHI A, GIULIANO G, SEU V, PERUGINI P, TOSELLI A, BASSO F, CORTI E, ROSSI P, DELFINO R, CAPONNETTO S, GNECCO G, GHIGLIOTTI G, PENNESI A, LOMBARDI G, RUGGIERI A, BERTOLO L, SLOMP L, LANZETTA T, MAZZARONE L, CRESTI A, BELLODI G, ZUARINI AM, VENERI L, PARCHI C, GIOVANELLI N, NEGRONI S, DETHOMATIS M, BARGHINI A, MARINO E, RICCI D, LEMME P, DIGIACOMO U, AQUARO G, RONZANI G, OTTELLO B, VONTI V, MORETTI S, PALERMO R, MARSILI P, SIDERI F, RAGAZZINI G, GRAMENZI S, BATTISTINI S, DIODATO T, VALERIO A, TUCCI C, DEPASQUALE B, GELFO PG, BERTULLA A, BOLLINI R, DEMARCHI E, BACCA F, DEGIORGI V, LOCATELLI V, SAVOIA MT, FERRACINI C, BARBARESI F, COTOGNI A, FRANCO G, PASSONI F, DURBANO M, MORETTI G, PEROTTI S, CAPRETTI M, DELBENE P, CASCONE M, BALDINI U, ORLANDI M, ODDONE A, CAIZZI V, MASINI G, LAZZARI M, BALLERINI B, BOZZI L, MOCETTI T, BERTOLINI A, PASOTTI E, SANGUINETTI M, MANTOVANI R, TOGNOLI T, MAGGI A, TUSA M, CAMERONI E, GUERRA GP, REGGIANI A, REDAELLI S, GIUSTI S, TANTALO L, RIZZI A, DIGIOVANNI N, GUZZO V, GABRIELE M, COLOMBO G, ALBERZONI A, SALVIOLI G, GALFETTI F, DOVICO E, BELLUZZI F, GOLA E, CASELLATO F, LECCHI G, CONSOLO F, SACCA CB, CONSOLO A, PICCOLO E, GASPARINI G, MASSA D, BELLI C, DOSSENA MG, CORSINI C, SANNA GP, AZZOLLINI M, TRUAZZA F, NADOR F, DEMARTINI M, BOZZI G, SEREGNI R, PASTINE I, MORPURGO M, CASAZZA F, REGALIA F, MAGGIOLINI S, RIGO R, PANCALDI S, POZZETTI D, PASCOTTO P, FRANCESCHI L, DAINESE F, MELINI L, CAPPELLI C, BERNARDI C, PALMIERI M, BORGIONI L, ZILIO G, SANDRI R, ALITTO F, MASARO G, VALAGUSSA F, SCHIAVINA R, RAVESI D, DANIELLO L, PIANTADOSI FR, BARRA P, ROMEO D, MININNI N, SEVERINO S, MOSTACCI M, CASTELLARI M, BANDA D, ROLANDI R, VILLA WD, CARBONE V, ALLEGRI M, FASCIOLO L, PITTALIS M, MUREDDU V, SORO F, DELEDDA MG, MARRAS E, MARCHI SM, DELUCA C, MANETTA M, VOLTA SD, SPERANDEO V, DONZELLI M, VITRANO MG, PITROLO F, LAMONICA S, BELLANCA G, MESSINA G, MIRTO U, RAINERI A, TRAINA M, DIBENEDETTO A, RIBAUDO E, DIFRANCESCO M, RONCHITELLI R, CARONE M, DIGREGORIO D, DIPAOLO G, PASQUALE M, COREA L, COCCHIERI M, ALUNNI G, PAPI L, CHIRIATTI G, LUPETTI M, GAZZOLA U, ARRUZZOLI S, VILLANI GQ, MELLINI M, MADRUZZA L, PIAZZA R, MICHELI G, FRANCHINI C, BECHI S, MARTINES C, MARCHESE D, GABBIA G, BIGALLI A, CIUTI M, CABANI E, DELCITERNA F, ALFIERI A, CHITI M, LONGHINI J, CODELUPPI P, NEGRELLI M, ZANUTTINI D, NICOLOSI GL, MARTIN G, PETRELLA A, BARDAZZI L, BIANCO GA, CELLAMARE G, GIANNELLI F, LICITRA G, LICITRA R, LETTICA GV, TUMIOTTO G, BELLANTI G, BOSI S, CASALI G, MONDUCCI I, BARONE A, PARENTI F, HEYMAN J, COZZI E, BALDACCI G, BACCOS D, BRIGHI F, DESANCTIS A, BOCK R, ROSSI F, AMATI P, SEMPRINI P, NARDELLI A, BOTTERO G, VARTOLO C, MILAZZOTTO F, DICROCE G, DIMARIO F, ANGRISANI G, AZZOLINI P, NEJA CP, MANZOLI U, ROSSI E, TRANI C, MASINI V, SEBASTIANI F, TOPAI M, BORGIA MC, LUCIANI C, FERRI F, DEPAOLA D, CAPURSO S, TUGNOLI F, VETTA C, ALTIERI T, BORZI M, VISCOMI A, STRIANO U, SALITURI S, ZONZIN P, FIORENCIS R, BADIN A, RAVERA B, BALDI C, SILVESTRI F, ALLEMANO P, REYNAUD S, SANSON A, MILANI L, DESIMONE MV, RUSSO A, VILLELLA A, GRAZINI M, AMIDEI S, ANSELMI L, PICCANICOLINO R, MASCELLI G, TAGLIAMONTE A, MESSINA V, TEDESCHI C, BOSSI M, BISIOLI M, TACCHI G, PAGNI G, VIVALDI F, IBBA GV, SANNIA L, PEDRAZZINI F, BAGNI E, FABII S, ALVINO A, ANTONIELLI E, DORONZO B, MARTINENGO E, BECCHI G, SALMOIRAGHI A, DIGIOVANNA F, CARAMANNO G, CAPORICCI D, BRUN M, GIANI P, FERRARIO G, PECI P, RONCONI G, SKOUSE D, GIUSTINIANI S, CUCCHI GF, TAVASCI E, SILVERII A, MARCELLINI G, SPECA G, STANISCIA D, CIMINO A, SERAFINI N, DEBONIS P, CERRUTI P, BAZZUCCHI M, DALPRA F, SPEROTTO C, MOLE GD, BARBANO G, POMARI F, GASCHINO G, PARIGI A, GANDOLFO N, RONDONI F, BRUSCA A, DILEO M, GOLZIO PG, ABRATE M, SCLAVO MG, ROCCI R, POGGIO G, GIANI S, CUZZUCREA D, BRASCHI GB, SCIACCA R, SAMMARTANO A, FURLANELLO F, BRAITO G, CUZZATO V, TOTIS O, FAURETTO F, LEO F, GALATI A, PALMA P, CAMERINI F, MORGERA T, BARBIERI L, SLAVICK GA, FRESCO C, CUDA A, SARNICOLA P, ARZILLO P, BINAGHI G, MACCHI G, CALVERI G, DIMARCO G, LEVANTESI G, PANERAI C, CATURELLI G, FACCHIN L, SARTORE G, ZARDINI P, MARINO P, CARBONIERI E, NAVA S, MAZZINI C, NAVA R, SERRA N, SASSARA M, NICROSINI F, GANDOLFI P, BERGOGNONI G, BALLESTRA AM, and VIOLO C

Subjects
cardiovascular diseases
Abstract

Background. Current knowledge of risk assessment in survivors of myocardial infarction is largely based on data gathered before the advent of thrombolysis. It must be determined whether and to what extent available information and proposed criteria of prognostication are applicable in the thrombolytic era. Methods and Results. We reassessed risk prediction in the 10 219 survivors of myocardial infarction with follow-up data available (ie, 98% of the total) who had been enrolled in the GISSI-2 trial, relying on a set of prespecified variables. The 3.5% 6-month all-cause mortality rate of these patients compared with the higher value of 4.6% found in the corresponding GISSI-1 cohort, originally allocated to streptokinase therapy, indicates a 24% reduction in postdischarge 6-month mortality. On multivariate analysis (Cox model), the following variables were predictors of 6-month all-cause mortality: ineligibility for exercise test for both cardiac (relative risk [RR], 3.30; 95% confidence interval [CI], 2.36-4.62) and noncardiac reasons (RR, 3.28; 95% CI, 2.23-4.72), early left ventricular failure (RR, 2.41; 95% Cl, 1.87-3.09), echocardiographic evidence of recovery phase left ventricular dysfunction (RR, 2.30; 95% CI, 1.78-2.98), advanced (more than 70 years) age (RR, 1.81; 95% Cl, 1.43 -2.30), electrical instability (ie, frequent and/or complex ventricular arrhythmias) (RR, 1.70; 95% Cl, 1.32-2.19), late left ventricular failure (RR, 1.54; 95% Cl, 1.17-2.03), previous myocardial infarction (RR, 1.47; 95% CI, 1.14-1.89), and a history of treated hypertension (RR, 1.32; 95% Cl, 1.05-1.65). Early post-myocardial infarction angina, a positive exercise test, female sex, history of angina, history of insulin-dependent diabetes, and anterior site of myocardial infarction were not risk predictors. On further multivariate analysis, performed on 8315 patients with the echocardiographic indicator of left ventricular dysfunction available, only previous myocardial infarction was not retained as an independent risk predictor. Conclusions. A decline in 6-month mortality of myocardial infarction survivors, seen within 6 hours of symptom onset, has been observed in recent years. Ineligibility for exercise test, early left ventricular failure, and recovery-phase left ventricular dysfunction are the most powerful (RR, >2) predictors of 6-month mortality among patients recovering from myocardial infarction after thrombolysis. Qualitative variables reflecting residual myocardial ischemia do not appear to be risk predictors. The lack of an independent adverse influence of early post-myocardial infarction angina on 6-month survival represents a major difference between this study and those of the prethrombolytic era.

42. GISSI-3 - EFFECTS OF LISINOPRIL AND TRANSDERMAL GLYCERYL TRINITRATE SINGLY AND TOGETHER ON 6-WEEK MORTALITY AND VENTRICULAR-FUNCTION AFTER ACUTE MYOCARDIAL-INFARCTION

Author

Devita, C., Fazzini, P. F., Geraci, E., Tavazzi, L., Tognoni, G., Vecchio, C., Boeri, R., Damico, G., Loi, U., Marubini, E., Pagliaro, L., Rovelli, F., Franzosi, M. G., Latini, R., Maggioni, A. P., Mauri, F., Volpi, A., Barlera, S., Negri, E., Nicolis, E., Santoro, E., Santoro, L., Bonfanti, E., Capello, T., Casati, A., Corato, A., Gardinale, E., Negrini, M., Nobili, A., Staszewsky, L., Tavanelli, M., Torta, D., Gambelli, G., Moroni, L., Pellanda, J. J., Pietropaolo, F., Balli, E., Barbieri, A., Bechi, S., Carrone, M., Catanzaro, M., Fasciolo, L., Fresco, C., Ghiani, A., Iacuitti, G., Ledda, A., Levantesi, G., Pasini, P., Peci, P., Pizzetti, F., Sagone, A., Turazza, F., Villella, A., Villella, M., Braggio, N., Disertori, M., Frezzati, S., Garattini, S., Marino, P., Maseri, A., Mazzotta, G., Nicolosi, G., Pirelli, S., Sanna, G. P., Valagussa, F., Dargie, H. J., Peto, R., Pocock, S., Sleight, P., Yusuf, S., Giordano, F., Varlese, A., Loparco, G., Iberti, V., Giamundo, L., Anastasi, R., Paciaroni, E., Raffaeli, S., Purcaro, A., Ciampani, N., Rita, E., Cuccaroni, G., Baldinelli, A., Altieri, A., Giornetti, R., Azzaro, G., Ferraguto, P., Salici, G., Laconi, E., Tiburzi, F. M., Bernardi, D., Lunardi, M., Colonna, L., Bovenzi, F., Amodio, F., Sarcina, G., Carpagnano, A., Matera, A., Malacrida, R., Rigotti, R., Dallemule, J., Debiasi, A., Bridda, A., Invernizzi, G., Piti, A., Colombo, L., Tomassini, B., Biasia, R., Solda, P., Scaramuzzino, G., Mirri, A., Bracchetti, D., Decastro, U., Lintner, W., Erlicher, A., Gronda, M., Devecchi, P., Gagliardi, R. S., Battistoni, N., Storelli, A., Guadalupi, M., Nadovezza, S., Zuffiano, D., Depetra, V., Scervino, R., Tabacchi, G., Dessalvi, F., Scorcu, G., Giardina, G., Raffo, M., Boi, W., Cammalleri, G., Gruttadauria, G., Baldini, F., Paolone, P., Pantaleoni, A., Contessotto, F., Deconti, F., Pignatti, F., Frignani, A., Ivaldi, M., Aletto, C., Pettinati, G., Ciricugno, A., Muscella, A., Correale, E., Romano, S., Dandrea, D., Murena, E., Longobardi, R., Dimartino, N., Paolini, E., Gaddi, P., Calvelli, C., Dulcetti, F., Galassi, A., Coco, R., Coppola, A., Centamore, G., Calabrese, G., Sgalambro, G., Circo, A., Raciti, S., Dellamonica, R., Malinconico, M., Deponti, C., Parmigiani, M. L., Bellet, C., Bortolini, F., Buffoli, L., Tiberi, A., Ferrari, A., Rossi, A., Ciglia, C., Dicenso, M., Mangiarotti, E., Ornaghi, M., Do, V., Spapperi, D., Maiolino, P., Delio, U., Carrozza, A., Marinoni, C., Guasconi, C., Sandro Sonnino, Pagliei, M., Ferrari, G., Politi, A., Delazzaro, M., Rinaldis, G., Calcagnile, A., Lusetti, L., Bendinelli, S., Mollaioli, M., Cosmi, F., Plastina, F., Misuraca, G., Serafini, O., Venneri, N., Catelli, P., Poluzzi, C., Bergamaschi, G., Fadin, M. B., Dechiara, F., Zampaglione, G., Elia, M., Racca, E., Meinardi, F., Casasso, F., Bertocchi, P., Donzelli, W., Pessina, S., Tirella, G., Sauro, G., Tessitori, M., Bini, A., Bartoletti, A., Agnelli, D., Zagami, A., Andreoli, L., Bastoni, L., Pucci, P., Santini, A., Buonamici, P. G., Filice, M., Badolati, S., Zerauchek, M., Dematteis, D., Maulucci, G., Dantuono, C., Liberti, R., Menicono, L., Mattoli, A., Tallone, M., Divita, G., Manca, G., Licci, E., Canziani, R., Guidali, P., Rancan, E., Mariello, F., Pennetta, A., Minelli, C., Baldini, M. R., Cazzani, E., Romano, M., Bellotti, P., Camerini, A., Davi, R., Piazza, R., Musso, G., Rossi, P., Giacchero, C., Seu, V., Toselli, A., Digiacinto, N., Dicio, G., Spanghero, M., Cresti, A., Svetoni, N., Bruno, G., Distefano, S., Giovanelli, N., Fini, M., Dethomatis, M., Pandini, R., Carrino, C., Giammaria, M., Pistelli, P., Ronzani, G., Ottello, B., Melappioni, A., Zappelli, L., Marsili, P., Scimia, A., Ragazzini, G., Gramenzi, S., Motto, A., Tullio, D., Tucci, D., Rosselli, P., Gaggioli, G., Bollini, R., Fazio, A. M., Russo, R., Bossi, M., Savoia, M., Valsecchi, M. A., Barbaresi, F., Barbiero, M., Bonofiglio, C., Gemelli, M., Bonaglia, M., Bossoni, E., Lanzini, A., Delbene, P., Cascone, M., Orlandi, M., Oddone, A., Sallazzo, V., Panuccio, D., Cane, G., Moccetti, T., Pasotti, E., Tognoli, T., Caravita, L., Maggi, A., Bardelli, G. C., Tusa, M., Maggi, G., Guerra, G. P., Reggiani, A., Izzo, A., Colombo, G., Foti, F., Consolo, F., Arrigo, F., Sacca, A. M., Mafrici, A., Alberti, A., Belli, C., Dossena, M. G., Spinola, A., Casiraghi, M. G., Azzollini, M., Pozzoni, L., Salmoirago, E., Massironi, L., Sala, R., Bressi, R., Rigo, R., Cappelli, S., Malavasi, V., Pascotto, P., Pasqual, A. S., Sarto, P., Sani, F., Tosoni, D., Spinnler, M. T., Persico, D., Orsi, R., Lugliengo, V., Parolini, V., Zilio, G., Sandri, R., Neri, G., Alitto, F., Petri, D., Cusa, E. N., Mazzitelli, L., Piantadosi, F. R., Daniello, L., Polimeno, S., Mininni, N., Greco, R., Bisconti, C., Cucchiari, C., Dallavilla, W., Randon, L., Allegri, M., Marchi, S. M., Sanna, E., Deluca, C., Manetta, M., Dallavolta, S., Maddalena, F., Donzelli, M., Pulisano, U., Dimaria, B., Celona, G., Marchi, S., Vivirito, A., Carrubba, A., Lamalfa, R. G., Schicchi, R., Bellanca, G., Battaglia, A., Cirrincione, V., Ribaudo, E., Strizzolo, L., Carone, M., Digregorio, D., Mantini, L., Corea, L., Cocchieri, M., Notaristefano, A., Catanese, C., Faleburle, M., Sgarbi, E., Cesaroni, P., Baldini, P. M., Papi, L., Lavarini, L., Lorenzini, M., Tarditi, V., Menara, N., Conti, M., Ferro, M., Gianotti, A., Crivello, R., Micheli, G., Conti, U., Cabani, E., Davini, P., Delciterna, F., Giomi, A., Alfieri, A., Chiti, M., Codeluppi, P., Smerieri, O., Dinapoli, T., Capozzoli, M. R., Topi, P. L., Paperini, L., Topi, A., Zanuttini, D., Nicolosi, G. L., Visentin, P., Charmet, P. A., Petrella, A., Bardazzi, L., Nassi, F., Bianco, G. A., Cellammare, G., Licitra, R., Cintolo, C., Spadola, V., Guarrella, L., Casali, G., Monducci, I., Zobbi, G., Guiducci, U., Cerri, P., Violi, E., Rovelli, G., Triulzi, E., Rusconi, L., Sabattini, R., Desanctis, A., Bock, R., Orazi, S., Palmieri, M., Rossi, F., Pesaresi, A., Cioppi, F., Palamara, A., Mancini, P., Ferraiuolo, G., Azzolini, P., Neja, C. P., Risa, M. P., Borgia, M. C., Borgia, C., Zanchi, E., Risa, A. L., Colace, F., Tozzi, Q., Jesi, A. P., Tassoni, G., Vitucci, N. C., Lironcurti, C., Altieri, T., Viscomi, A., Striano, U., Salituri, S., Tarantino, F., Girardini, D., Zonzin, P., Roncon, L., Ferrarese, E., Ravera, B., Bugatti, U., Padula, G., Gigantino, A., Allemano, P., Reynaud, S., Fanelli, R., Derito, V., Croce, A., Galli, M., Bertoli, D., Vivaldi, F., Pedrazzini, F., Barani, R., Dileo, M., Doronzo, B., Gambarati, G. P., Zobbi, M., Caramanno, G., Craparo, F. G., Giani, P., Antongiovanni, G. B., Grasso, V., Mossuti, E., Rosella, M. G., Skouse, D., Giustiniani, S., Cucchi, G., Conti, E., Fagagnini, L., Pardi, L., Core, A., Staniscia, D., Serafini, N., Cerruti, P., Bazzucchi, M., Petrucci, G., Trinchero, R., Cecchi, E., Demarie, D., Brusasco, G., Gandolfo, N., Saviolo, R., Bergerone, S., Bergandi, G., Barbieri, D., Mina, E., Biondo, G. B., Ledda, G., Trapani, G., Frigo, G., Benettin, A., Galati, A., Accogli, M., Feruglio, G. A., Gianfagna, P., Prelli, L., Giamperi, M., Gheller, G., Cudali, A., Liguori, G., Dimarco, G., Bottari, E., Valente, S., Giglioli, C., Ramoscello, G., Rizzi, G. M., Pellinghelli, G., Perrini, A., Deluca, F., Savelli, S., Capezzuto, A., Gandolfi, P., Bergognoni, G., Ballestra, A. M., and Violo, C.

43. Six-month effects of early treatment with lisinopril and transdermal glyceryl trinitrate singly and together withdrawn six weeks after acute myocardial infarction: The GISSI-3 trial

Author

Devita, C., Fazzini, Pf, Geraci, E., Tavazzi, L., Tognoni, G., Vecchio, C., Boeri, R., Damico, G., Loi, U., Marubini, E., Pagliaro, L., Rovelli, F., Franzosi, Mg, Latini, R., Maggioni, Ap, Mauri, F., Volpi, A., Barlera, S., Eva Negri, Nicolis, E., Santoro, E., Santoro, L., Ascione, A., Bonfanti, E., Capello, T., Casati, A., Corato, A., Gardinale, E., Negrini, M., Nobili, A., Staszewsky, L., Tavanelli, M., Torta, D., Zuanetti, G., Gambelli, G., Moroni, L., Pellanda, Jj, Pietropaolo, F., Balli, E., Barbieri, A., Bechi, S., Carrone, M., Catanzaro, M., Fasciolo, L., Fresco, C., Ghiani, A., Iacuitti, G., Ledda, A., Levantesi, G., Pasini, P., Peci, P., Pizzetti, F., Sagone, A., Turazza, F., Villella, A., Villella, M., Braggio, N., Disertori, M., Frezzati, S., Garattini, S., Marino, P., Maseri, A., Mazzotta, G., Nicolosi, G., Pirelli, S., Sanna, Gp, Valagussa, F., Dargie, Hj, Peto, R., Pocock, S., Sleight, P., and Yusuf, S.

49. The temporal order judgement of tactile and nociceptive stimuli is impaired by crossing the hands over the body midline

Author

G.L. Moseley, Chiara F. Sambo, Gian Domenico Iannetti, Meng Liang, Alberto Gallace, Diana Torta, Sambo, CF, Torta, DM, Gallace, A, Liang, M, Moseley, GL, Ianetti, GD, Sambo, C, Torta, D, Moseley, G, and Iannetti, G

Subjects
Adult, Male, Nociception, media_common.quotation_subject, Posture, Stimulus (physiology), Somatosensory system, Functional Laterality, Tactile stimuli, touch, Physical Stimulation, Perception, Humans, nociception, media_common, frames of reference, Space perception, Clinical neurology, pain, touch, spatial processing, TOJ, nociception, Anesthesiology and Pain Medicine, Touch Perception, Neurology, Touch, Space Perception, Female, Neurology (clinical), Psychology, Neuroscience, somatotopy
Abstract

Crossing the hands over the midline impairs the ability to correctly judge the order of a pair of tactile stimuli, delivered in rapid succession, one to each hand. This impairment, termed crossed-hands deficit, has been attributed to a mismatch between the somatotopic and body-centred frames of reference, onto which somatosensory stimuli are automatically mapped. Whether or not such crossed-hands deficit occurs also when delivering nociceptive stimuli has not been previously investigated. In this study, participants performed a temporal order judgement (TOJ) task in which pairs of either nociceptive or tactile stimuli were delivered, one to each hand, while their arms were either crossed over the body midline or uncrossed. We observed that crossing the hands over the midline significantly decreases the ability to determine the stimulus order when a pair of nociceptive stimuli is delivered to the hands, and that this crossed-hands deficit has a temporal profile similar to that observed for tactile stimuli. These findings suggest that similar mechanisms for integrating somatotopic and body-centred frames of reference underlie the ability to localise both nociceptive and tactile stimuli in space. © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Published
2013

50. Crossing the Line of Pain: fMRI Correlates of Crossed-Hands Analgesia

Author

Franco Cauda, Giuliano Geminiani, Alberto Gallace, Diana Torta, Sergio Duca, Matteo Diano, Tommasco Costa, Torta, D, Diano, M, Costa, T, Gallace, A, Duca, S, Geminiani, G, and Cauda, F

Subjects
Adult, Male, Pain Threshold, Pain, Somatosensory system, Functional Laterality, Young Adult, Physical Stimulation, Image Processing, Computer-Assisted, medicine, Humans, pain, fMRI, nociception, spatial processing, Anterior cingulate cortex, Pain Measurement, Brain Mapping, medicine.diagnostic_test, business.industry, Perspective (graphical), Parietal lobe, Brain, Medial frontal gyrus, Hand, Magnetic Resonance Imaging, Healthy Volunteers, Oxygen, Anesthesiology and Pain Medicine, Nociception, medicine.anatomical_structure, Neurology, Female, Neurology (clinical), Analgesia, Functional magnetic resonance imaging, business, Neuroscience, Insula
Abstract

Crossing the hands over the body midline reduces the perceived intensity of nociceptive stimuli applied to the hands by impairing the ability to localize somatosensory stimuli. The neural basis of this "crossed-hands analgesia" has not been investigated previously, although it has been proposed that the effect may be modulated by multimodal areas. We used functional magnetic resonance imaging to test the hypothesis that crossed-hands analgesia is mediated by higher-order multimodal areas rather than by specific somatosensory ones. Participants lay in the scanner while mechanical painful stimuli were applied to their hands held in either a crossed or uncrossed position. They reported significantly lower perceived intensity of pain when their hands were crossed. Although activations elicited by stimuli applied to the crossed hands revealed significantly greater blood oxygen level-dependent responses in the anterior cingulate cortex, the insula, and the medial frontal gyrus, the blood oxygen level-dependent responses in the superior parietal lobe were greater with the hands uncrossed. Our results provide evidence that crossed-hands analgesia is mediated by higher-order frontoparietal multimodal areas involved in sustaining and updating body and spatial representations. Perspective: We found crossed-hands analgesia to be mediated by multimodal areas, such as the posterior parietal, cingulate, and insular cortices, implicated in space and body representation. Our findings highlight how the perceived intensity of painful stimuli is shaped by how we represent our body and the space surrounding it. © 2013 by the American Pain Society.

Published
2013

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