A. Gavazzi - Academia.edu (original) (raw)
Papers by A. Gavazzi
Arzneimittel-Forschung, 1986
The hemodynamic effects of ibopamine (SB-7505), the orally active 3,4-diisobutyryl ester of N-met... more The hemodynamic effects of ibopamine (SB-7505), the orally active 3,4-diisobutyryl ester of N-methyldopamine, were studied in 12 patients with congestive heart failure (CHF) after acute dosing, after 20 days of maintenance therapy and after 20 days of drug discontinuation. Acute ibopamine administration increased at rest cardiac index (CI p less than 0.05) and stroke work index (SWI p less than 0.05), and reduced pulmonary capillary wedge pressure (PCWP), mean pulmonary arterial pressure (PAP), total systemic (SVR p less than 0.05) and pulmonary vascular resistance (PVR). These beneficial hemodynamic effects were maintained during supine bicycle exercise: CI and SWI increased more markedly (p less than 0.05) and PCWP increased at a lower extent (p less than 0.05) after ibopamine than on control conditions. PVR exhibited a more pronounced decrease (p less than 0.02), while SVR showed superimposable reductions before and after ibopamine. After chronic therapy with the drug, hemodynami...
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
Patients enrolled in a clinical heart transplantation program were evaluated to identify the pred... more Patients enrolled in a clinical heart transplantation program were evaluated to identify the predictors of prognosis in patients with advanced heart disease and to optimize timing of heart transplantation. Three hundred eighty-eight subjects were consecutively evaluated from 1985 through 1989. One hundred eighty-four patients (47.5%) had dilated cardiomyopathy; 164 patients (42.2%) had ischemic heart disease; 34 patients (8.8%) had valvular heart disease, and six patients (1.5%) had miscellaneous disorders. In each patient, 45 different parameters were considered. During follow-up (mean, 8.4 months) 166 patients underwent heart transplantation; 99 patients died (heart failure, 66 patients; sudden death, 26 patients; thromboembolism, two patients; noncardiac causes, five patients). The actuarial survival was 83% at 3 months, 77% at 6 months, 73% at 9 months, 70% at 1 year, and 59% at 2 years. The median survival time was 28 months. Analysis by Cox proportional hazard regression model...
Thrombosis and Haemostasis, 2014
SummaryThe aim was to investigate the perioperative risk of ischaemic and bleeding events in pati... more SummaryThe aim was to investigate the perioperative risk of ischaemic and bleeding events in patients with coronary stents undergoing cardiac and non-cardiac surgery and how these outcomes are affected by the perioperative use of oral antiplatelet therapy. This was a multicentre, retrospective, observational study conducted in patients with coronary stent(s) undergoing cardiac or non-cardiac surgery. The primary efficacy endpoint was the 30-day incidence of major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction (MI) or stroke. The primary safety endpoint was the 30-day incidence of Bleeding Academic Research Consortium (BARC) bleeding ≥ 2. A total of 666 patients were included. Of these, 371 (55.7 %) discontinued their antiplatelet medication(s) (all or partly) before undergoing surgery. At 30 days, patients with perioperative discontinuation of antiplatelet therapy experienced a significantly higher incidence of MACE (7.5 % vs 0.3 %, p...
Journal of Hypertension, 1994
The American Journal of Cardiology, 2006
Prognostic stratification is relevant in clinical decision making in heart failure (HF). Predicto... more Prognostic stratification is relevant in clinical decision making in heart failure (HF). Predictors identified during hospitalization or in clinical trials may be unrepresentative of HF in the community. The aim of this study was to derive and validate, in different clinical settings, a risk stratification model for the prediction of stable HF outcomes. The study included 807 patients, 350 enrolled at discharge from the hospital (44%), 309 in the outpatient clinic (38%), and 148 in the home-care setting (18%). There were 292 patients in the derivation cohort and 515 in the validation cohort. A multivariate logistic analysis was performed to obtain the CardioVascular Medicine Heart Failure (CVM-HF) index. One-year mortality was 20.8% in the derivation cohort and 20.7% in the validation cohort. The CVM-HF index included cardiac conditions and co-morbidities and stratified the 1-year mortality risk as low (death rate 4%), average (32%), high (63%), and very high (96%). The area under the curve of the receiver-operating characteristic curve was 0.844 (95% confidence interval [CI] 0.779 to 0.89) for the derivation cohort and 0.812 (95% CI 0.76 to 0.86) for the validation cohort. Model performance was equally good in the 3 different HF settings. In a subgroup of 409 patients, the CVM-HF index (area under the curve 0.821, 95% CI 0.79 to 0.89) outperformed the most-used prognostic models (the Charlson index and the Heart Failure Risk Scoring System). In conclusion, the CVM-HF index, a novel prognostic model that is easy to derive and applicable to unselected patients, may represent a valuable tool for the prognostication of stable HF outcomes.
Herz, 2000
Familial dilated cardiomyopathy (DCM) should be an "evidence-based&q... more Familial dilated cardiomyopathy (DCM) should be an "evidence-based" diagnosis derived from clinical and echocardiographic screening of informed and consenting relatives of index patients, and on the examination of clinical reports for deceased relatives. Most familial dilated cardiomyopathy pedigrees show an autosomal pattern of inheritance. Very few of them are X-linked and matrilinear. Autosomal recessive inheritance is difficult to be assessed in an evidence-based setting. By linkage analysis, several loci, but no disease gene, have been identified. At present, few cases of familial dilated cardiomyopathy can benefit of a molecular diagnosis. The diagnosis of dystrophin defect-related dilated cardiomyopathy is important for patients and families, especially for carrier detection. These patients present X-linked inheritance, dominant cardiac involvement and raised levels of serum creatine phosphokinase. Defects of the glycoprotein complex associated to dystrophin (DAG) are rare skeletal muscle diseases with possible cardiac involvement. Mitochondrial diseases, both pure cardiomyopathies and multiorgan syndromes involving the heart, are associated to defects of mitochondrial DNA genes or of nuclear genes coding for mitochondrial proteins. Barth's syndrome develops in male children with granulocytopenia, dilated cardiomyopathy, and methylglutaconic aciduria. Cardiomyopathies with atrioventricular block are observed in hemochromatosis, Emery-Dreifuss syndrome, desmin storage disease, and in isolated familial dilated cardiomyopathy. Actin defects were recently identified in 2 unrelated patients with familial dilated cardiomyopathy. Desmin defects were also recently identified in 1 familial dilated cardiomyopathy. The overall knowledge, although in progression, is still limited. Clinical family screening identifies familial forms, preclinical cases, and inheritance pattern. By candidate gene screening, the molecular diagnosis can be provided for dystrophin, DAG, mitochondrial DNA, actin and desmin gene defects.
Giornale italiano di cardiologia, 1977
International Journal of Cardiology, 2015
Survival in patients with heart failure in the last two decades has significantly improved, owing... more Survival in patients with heart failure in the last two decades has significantly improved, owing to availability of new drugs, devices, and technologies. However, these new therapeutic tools are often costly and not without attendant risks. Thus, accurate and reproducible risk stratification is required to assess appropriateness of therapy. Although a growing body of evidence has characterized various predictors of poor outcomes, the application of comprehensive prognostic models in clinical practice remains limited. Herein, we critically evaluate the utility of prognostic scores in heart failure, discussing the strategies to select the most efficient and appropriate risk estimator in the individual patient.
Journal of Cardiac Failure, 2009
European Journal of Heart Failure, 2009
European Journal of Heart Failure, 1999
Background: The National Hospital Quality Initiative, endorsed by the Centers for Medicare and Me... more Background: The National Hospital Quality Initiative, endorsed by the Centers for Medicare and Medicaid Services and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), has identified heart failure (HF) as a focus area for quality improvement. HF is a chronic, progressive medical condition that has shown an epidemic increase in prevalence over the last 20 years. St. John Hospital and Medical Center (SJH&MC) has identified the HF core measures as an area for improvement. The Continuing Medical Education (CME) program at SJH&MC has collaborated with the Quality Assurance (QA) department to design a Performance Improvement-Continuing Medical Education (PI-CME) initiative that will serve to both improve compliance with the HF core measures and provide a valuable learning opportunity for physicians. Participation in this PI-CME activity will allow physicians to receive AMA PRA category 1 credit™ as well as meet the JCAHO credentialing requirement in the general competency area of Practice-Based Learning and Improvement (PBLI). Method: The design of the PI-CME initiative for HF involved several key steps: 1) developing a PI-CME plan to address improvement in HF core measure compliance; 2) meeting with key physicians to discuss the concepts of PI-CME and to obtain buy-in; 3) working closely with the QA department to gather relevant baseline and postimplementation data; 4) data analysis and dissemination of findings to participating physicians; and 5) reflective learning based on the findings and reevaluation for purposes of further quality improvement. The CME Specialist, the Director of Medical Education, and the QA Department met to discuss the strategies in place to address the performance gap in the HF core measures at SJH&MC, and how this performance gap might serve as the basis for a physician PI-CME initiative. The PI-CME initiative was designed based upon the QA Department's current mechanism of identifying physicians who have instances of noncompliance with core measures. A pilot group of physicians was identified to participate in the PI-CME activity. With the PI-CME plan developed, meetings with key physicians will be held to discuss the concepts, requirements, and benefits of PI-CME and to obtain buy-in. The initiative will be evaluated by comparing preintervention compliance rates with postimplementation compliance rates within the targeted study group and hospital-wide. Data will be disseminated to participating physicians for the purposes of reflective learning. Conclusion: This initiative will provide a mechanism (PI-CME) for quality improvement that will complement a rule indicator approach currently in use. We believe PI-CME has the important added dimensions of providing participating physicians CME credit, providing PBLI activity applicable toward hospital re-credentialing, and engaging the physician in a more meaningful educational opportunity that involves both active and reflective learning as part of the quality improvement initiative.
European Heart Journal, 2001
European Heart Journal, 2003
Background The European Society of Cardiology (ESC) has published guidelines for the investigatio... more Background The European Society of Cardiology (ESC) has published guidelines for the investigation of patients with suspected heart failure and, if the diagnosis is proven, their subsequent management. Hospitalisation provides a key point of care at which time diagnosis and treatment may be refined to improve outcome for a group of patients with a high morbidity and mortality. However, little international data exists to describe the features and management of such patients. Accordingly, the EuroHeart Failure survey was conducted to ascertain if appropriate tests were being performed with which to confirm or refute a diagnosis of heart failure and how this influenced subsequent management. Methods The survey screened consecutive deaths and discharges during 2000-2001 predominantly from medical wards over a 6-week period in 115 hospitals from 24 countries belonging to the ESC, to identify patients with known or suspected heart failure. Results A total of 46,788 deaths and discharges were screened from which 11,327 (24%) patients were enrolled with suspected or confirmed heart failure. Forty-seven percent of those enrolled were women. Fifty-one percent of women and 30% of men were aged >75 years. Eighty-three percent of patients had a diagnosis of heart failure made on or prior to the index admission. Heart failure was the principal reason for admission in 40%. The great majority of patients (>90%) had had an ECG, chest X-ray, haemoglobin and electrolytes measured as recommended in ESC guidelines, but only 66% had ever had an echocardiogram. Left ventricular ejection fraction had been
Circulation, 1981
One hundred fourteen patients with variant angina performed bicycle exercise stress tests, and we... more One hundred fourteen patients with variant angina performed bicycle exercise stress tests, and were divided into three groups. Group 1 included 37 patients with a normal exercise test. Coronary arteriography revealed absence of significant coronary stenoses in 18 patients, one-vessel disease in 17 and involvement of two or more vessels in two. Group 2 consisted of 40 patients who had ST-segment elevation during or just after exercise. Coronary arteriography in these cases revealed absence of significant coronary stenoses in nine patients, one-vessel disease in 18 and disease of two or more vessels in 13. Group 3 included 37 patients who had ST-segment depression during exercise. Absence of coronary artery disease was found in only two patients, one-vessel disease was found in 19 and disease of two or more vessels was found in 16. Sixty-one patients repeated the exercise test after a mean of 18 months after hospital discharge. Exercise-induced ST-segment elevation was no longer prese...
Circulation, 1983
To investigate the mechanism by which nifedipine improves exercise tolerance in patients with cor... more To investigate the mechanism by which nifedipine improves exercise tolerance in patients with coronary artery disease, we studied 14 patients with stable exertional angina and left anterior descending artery disease by measuring great cardiac vein flow (GCVF) and calculating anterior regional coronary resistance (ARCR) during exercise before and after sublingual administration of 20 mg of nifedipine. After nifedipine seven patients (group I) had no increase in exercise capacity and showed a similar magnitude of ST segment depression at peak exercise, while another seven patients (group II) had prolonged exercise duration (p less than .001) with less ST segment depression at peak exercise (p less than .01). Such effects were achieved despite a significant increase in double product, an indirect index of myocardial oxygen consumption. In group I patients no significant change was induced by nifedipine in GCVF or in ARCR either at rest or at peak exercise. In contrast, in group II pati...
The American Journal of Cardiology, 1983
This study describes the results of repeated exercise tests in patients with vasospastic angina p... more This study describes the results of repeated exercise tests in patients with vasospastic angina presenting with this clinical manifestation. We believe that the recognition of variable threshold exertional angina may have important therapeutic implications.
The American Journal of Cardiology, 2000
American Heart Journal, 2000
HRV has prognostic value in patients with idiopathic or ischemic CHF. 9-16 Several studies have i... more HRV has prognostic value in patients with idiopathic or ischemic CHF. 9-16 Several studies have investigated the correlation between HRV and different markers of disease severity such as functional class, plasma neurohormone levels, exercise peak oxygen consumption, and hemodynamic profile. 2,15,17-25 These studies have shown controversial results and are, in some instances at least, limited by factors such as sample size and/or patient heterogeneity as the result of a wide range of disease severity. In most cases, the interest has focused on patients with a moderate left ventricular dysfunction, whereas few data exist concerning patients with severe CHF. Furthermore, although the correlation between HRV and left ventricular systolic and diastolic functions 2,8,17,18,22 has been extensively described, only one study has investigated the potential relation between autonomic activity and right ventricular performance. 25 This latter may have important clinical implications because right ventricular dysfunction has prognostic relevance in severe heart failure. 26,27 Additionally, most studies obtained HRV indexes by 24hour Holter-recorded electrocardiograms, whereas Autonomic dysfunction is associated with and contributes to the progression of chronic heart failure (CHF). High plasma norepinephrine levels, 1 increased sympathetic nerve activity, 2 resetting of the baroreflex control, 3,4 and parasympathetic withdrawal 5 have been reported in patients affected by this syndrome. The counterpart of this information is the recent evidence of the beneficial effects of autonomic modulation by β-blocker agents in CHF. 6 Heart rate variability (HRV) is an accepted reliable noninvasive method for the assessment of the autonomic balance. 7 HRV is depressed in patients with CHF, 8 and
Giornale italiano di cardiologia, 1978
Five patients affected by angina pectoris showed a spontaneous attack of myocardial ischemia in t... more Five patients affected by angina pectoris showed a spontaneous attack of myocardial ischemia in the course of coronary arteriography examination. During the ischemic episode it was shown a severe coronary arterial spasm promptly relieved by nitroglycerin. In these patients the administration of ergonovine maleate induced the same clinical, electrocardiographic and coronariographic patterns of spontaneous ischemic episodes. These data support the hypotesis that the ergonovine maleate administration is a suitable test for detection of the vasospastic pathogenesis in acute myocardial ischemia.
European Journal of Haematology, 2020
Pulmonary hypertension (PH) is commonly reported in Philadelphia‐chromosome negative myeloprolife... more Pulmonary hypertension (PH) is commonly reported in Philadelphia‐chromosome negative myeloproliferative neoplasms (MPNs) including polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF). PH may be diagnosed directly by right heart catheterization (RHC) or estimated by transthoracic echocardiography (TTE). Survival is shortened by PH but despite the potential significance of PH to management and prognosis of MPN, estimates of its prevalence in MPNs vary and risk factors for the condition are poorly established. We performed a systematic review and meta‐analysis of available studies to fill this void.
Arzneimittel-Forschung, 1986
The hemodynamic effects of ibopamine (SB-7505), the orally active 3,4-diisobutyryl ester of N-met... more The hemodynamic effects of ibopamine (SB-7505), the orally active 3,4-diisobutyryl ester of N-methyldopamine, were studied in 12 patients with congestive heart failure (CHF) after acute dosing, after 20 days of maintenance therapy and after 20 days of drug discontinuation. Acute ibopamine administration increased at rest cardiac index (CI p less than 0.05) and stroke work index (SWI p less than 0.05), and reduced pulmonary capillary wedge pressure (PCWP), mean pulmonary arterial pressure (PAP), total systemic (SVR p less than 0.05) and pulmonary vascular resistance (PVR). These beneficial hemodynamic effects were maintained during supine bicycle exercise: CI and SWI increased more markedly (p less than 0.05) and PCWP increased at a lower extent (p less than 0.05) after ibopamine than on control conditions. PVR exhibited a more pronounced decrease (p less than 0.02), while SVR showed superimposable reductions before and after ibopamine. After chronic therapy with the drug, hemodynami...
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
Patients enrolled in a clinical heart transplantation program were evaluated to identify the pred... more Patients enrolled in a clinical heart transplantation program were evaluated to identify the predictors of prognosis in patients with advanced heart disease and to optimize timing of heart transplantation. Three hundred eighty-eight subjects were consecutively evaluated from 1985 through 1989. One hundred eighty-four patients (47.5%) had dilated cardiomyopathy; 164 patients (42.2%) had ischemic heart disease; 34 patients (8.8%) had valvular heart disease, and six patients (1.5%) had miscellaneous disorders. In each patient, 45 different parameters were considered. During follow-up (mean, 8.4 months) 166 patients underwent heart transplantation; 99 patients died (heart failure, 66 patients; sudden death, 26 patients; thromboembolism, two patients; noncardiac causes, five patients). The actuarial survival was 83% at 3 months, 77% at 6 months, 73% at 9 months, 70% at 1 year, and 59% at 2 years. The median survival time was 28 months. Analysis by Cox proportional hazard regression model...
Thrombosis and Haemostasis, 2014
SummaryThe aim was to investigate the perioperative risk of ischaemic and bleeding events in pati... more SummaryThe aim was to investigate the perioperative risk of ischaemic and bleeding events in patients with coronary stents undergoing cardiac and non-cardiac surgery and how these outcomes are affected by the perioperative use of oral antiplatelet therapy. This was a multicentre, retrospective, observational study conducted in patients with coronary stent(s) undergoing cardiac or non-cardiac surgery. The primary efficacy endpoint was the 30-day incidence of major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction (MI) or stroke. The primary safety endpoint was the 30-day incidence of Bleeding Academic Research Consortium (BARC) bleeding ≥ 2. A total of 666 patients were included. Of these, 371 (55.7 %) discontinued their antiplatelet medication(s) (all or partly) before undergoing surgery. At 30 days, patients with perioperative discontinuation of antiplatelet therapy experienced a significantly higher incidence of MACE (7.5 % vs 0.3 %, p...
Journal of Hypertension, 1994
The American Journal of Cardiology, 2006
Prognostic stratification is relevant in clinical decision making in heart failure (HF). Predicto... more Prognostic stratification is relevant in clinical decision making in heart failure (HF). Predictors identified during hospitalization or in clinical trials may be unrepresentative of HF in the community. The aim of this study was to derive and validate, in different clinical settings, a risk stratification model for the prediction of stable HF outcomes. The study included 807 patients, 350 enrolled at discharge from the hospital (44%), 309 in the outpatient clinic (38%), and 148 in the home-care setting (18%). There were 292 patients in the derivation cohort and 515 in the validation cohort. A multivariate logistic analysis was performed to obtain the CardioVascular Medicine Heart Failure (CVM-HF) index. One-year mortality was 20.8% in the derivation cohort and 20.7% in the validation cohort. The CVM-HF index included cardiac conditions and co-morbidities and stratified the 1-year mortality risk as low (death rate 4%), average (32%), high (63%), and very high (96%). The area under the curve of the receiver-operating characteristic curve was 0.844 (95% confidence interval [CI] 0.779 to 0.89) for the derivation cohort and 0.812 (95% CI 0.76 to 0.86) for the validation cohort. Model performance was equally good in the 3 different HF settings. In a subgroup of 409 patients, the CVM-HF index (area under the curve 0.821, 95% CI 0.79 to 0.89) outperformed the most-used prognostic models (the Charlson index and the Heart Failure Risk Scoring System). In conclusion, the CVM-HF index, a novel prognostic model that is easy to derive and applicable to unselected patients, may represent a valuable tool for the prognostication of stable HF outcomes.
Herz, 2000
Familial dilated cardiomyopathy (DCM) should be an "evidence-based&q... more Familial dilated cardiomyopathy (DCM) should be an "evidence-based" diagnosis derived from clinical and echocardiographic screening of informed and consenting relatives of index patients, and on the examination of clinical reports for deceased relatives. Most familial dilated cardiomyopathy pedigrees show an autosomal pattern of inheritance. Very few of them are X-linked and matrilinear. Autosomal recessive inheritance is difficult to be assessed in an evidence-based setting. By linkage analysis, several loci, but no disease gene, have been identified. At present, few cases of familial dilated cardiomyopathy can benefit of a molecular diagnosis. The diagnosis of dystrophin defect-related dilated cardiomyopathy is important for patients and families, especially for carrier detection. These patients present X-linked inheritance, dominant cardiac involvement and raised levels of serum creatine phosphokinase. Defects of the glycoprotein complex associated to dystrophin (DAG) are rare skeletal muscle diseases with possible cardiac involvement. Mitochondrial diseases, both pure cardiomyopathies and multiorgan syndromes involving the heart, are associated to defects of mitochondrial DNA genes or of nuclear genes coding for mitochondrial proteins. Barth's syndrome develops in male children with granulocytopenia, dilated cardiomyopathy, and methylglutaconic aciduria. Cardiomyopathies with atrioventricular block are observed in hemochromatosis, Emery-Dreifuss syndrome, desmin storage disease, and in isolated familial dilated cardiomyopathy. Actin defects were recently identified in 2 unrelated patients with familial dilated cardiomyopathy. Desmin defects were also recently identified in 1 familial dilated cardiomyopathy. The overall knowledge, although in progression, is still limited. Clinical family screening identifies familial forms, preclinical cases, and inheritance pattern. By candidate gene screening, the molecular diagnosis can be provided for dystrophin, DAG, mitochondrial DNA, actin and desmin gene defects.
Giornale italiano di cardiologia, 1977
International Journal of Cardiology, 2015
Survival in patients with heart failure in the last two decades has significantly improved, owing... more Survival in patients with heart failure in the last two decades has significantly improved, owing to availability of new drugs, devices, and technologies. However, these new therapeutic tools are often costly and not without attendant risks. Thus, accurate and reproducible risk stratification is required to assess appropriateness of therapy. Although a growing body of evidence has characterized various predictors of poor outcomes, the application of comprehensive prognostic models in clinical practice remains limited. Herein, we critically evaluate the utility of prognostic scores in heart failure, discussing the strategies to select the most efficient and appropriate risk estimator in the individual patient.
Journal of Cardiac Failure, 2009
European Journal of Heart Failure, 2009
European Journal of Heart Failure, 1999
Background: The National Hospital Quality Initiative, endorsed by the Centers for Medicare and Me... more Background: The National Hospital Quality Initiative, endorsed by the Centers for Medicare and Medicaid Services and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), has identified heart failure (HF) as a focus area for quality improvement. HF is a chronic, progressive medical condition that has shown an epidemic increase in prevalence over the last 20 years. St. John Hospital and Medical Center (SJH&MC) has identified the HF core measures as an area for improvement. The Continuing Medical Education (CME) program at SJH&MC has collaborated with the Quality Assurance (QA) department to design a Performance Improvement-Continuing Medical Education (PI-CME) initiative that will serve to both improve compliance with the HF core measures and provide a valuable learning opportunity for physicians. Participation in this PI-CME activity will allow physicians to receive AMA PRA category 1 credit™ as well as meet the JCAHO credentialing requirement in the general competency area of Practice-Based Learning and Improvement (PBLI). Method: The design of the PI-CME initiative for HF involved several key steps: 1) developing a PI-CME plan to address improvement in HF core measure compliance; 2) meeting with key physicians to discuss the concepts of PI-CME and to obtain buy-in; 3) working closely with the QA department to gather relevant baseline and postimplementation data; 4) data analysis and dissemination of findings to participating physicians; and 5) reflective learning based on the findings and reevaluation for purposes of further quality improvement. The CME Specialist, the Director of Medical Education, and the QA Department met to discuss the strategies in place to address the performance gap in the HF core measures at SJH&MC, and how this performance gap might serve as the basis for a physician PI-CME initiative. The PI-CME initiative was designed based upon the QA Department's current mechanism of identifying physicians who have instances of noncompliance with core measures. A pilot group of physicians was identified to participate in the PI-CME activity. With the PI-CME plan developed, meetings with key physicians will be held to discuss the concepts, requirements, and benefits of PI-CME and to obtain buy-in. The initiative will be evaluated by comparing preintervention compliance rates with postimplementation compliance rates within the targeted study group and hospital-wide. Data will be disseminated to participating physicians for the purposes of reflective learning. Conclusion: This initiative will provide a mechanism (PI-CME) for quality improvement that will complement a rule indicator approach currently in use. We believe PI-CME has the important added dimensions of providing participating physicians CME credit, providing PBLI activity applicable toward hospital re-credentialing, and engaging the physician in a more meaningful educational opportunity that involves both active and reflective learning as part of the quality improvement initiative.
European Heart Journal, 2001
European Heart Journal, 2003
Background The European Society of Cardiology (ESC) has published guidelines for the investigatio... more Background The European Society of Cardiology (ESC) has published guidelines for the investigation of patients with suspected heart failure and, if the diagnosis is proven, their subsequent management. Hospitalisation provides a key point of care at which time diagnosis and treatment may be refined to improve outcome for a group of patients with a high morbidity and mortality. However, little international data exists to describe the features and management of such patients. Accordingly, the EuroHeart Failure survey was conducted to ascertain if appropriate tests were being performed with which to confirm or refute a diagnosis of heart failure and how this influenced subsequent management. Methods The survey screened consecutive deaths and discharges during 2000-2001 predominantly from medical wards over a 6-week period in 115 hospitals from 24 countries belonging to the ESC, to identify patients with known or suspected heart failure. Results A total of 46,788 deaths and discharges were screened from which 11,327 (24%) patients were enrolled with suspected or confirmed heart failure. Forty-seven percent of those enrolled were women. Fifty-one percent of women and 30% of men were aged >75 years. Eighty-three percent of patients had a diagnosis of heart failure made on or prior to the index admission. Heart failure was the principal reason for admission in 40%. The great majority of patients (>90%) had had an ECG, chest X-ray, haemoglobin and electrolytes measured as recommended in ESC guidelines, but only 66% had ever had an echocardiogram. Left ventricular ejection fraction had been
Circulation, 1981
One hundred fourteen patients with variant angina performed bicycle exercise stress tests, and we... more One hundred fourteen patients with variant angina performed bicycle exercise stress tests, and were divided into three groups. Group 1 included 37 patients with a normal exercise test. Coronary arteriography revealed absence of significant coronary stenoses in 18 patients, one-vessel disease in 17 and involvement of two or more vessels in two. Group 2 consisted of 40 patients who had ST-segment elevation during or just after exercise. Coronary arteriography in these cases revealed absence of significant coronary stenoses in nine patients, one-vessel disease in 18 and disease of two or more vessels in 13. Group 3 included 37 patients who had ST-segment depression during exercise. Absence of coronary artery disease was found in only two patients, one-vessel disease was found in 19 and disease of two or more vessels was found in 16. Sixty-one patients repeated the exercise test after a mean of 18 months after hospital discharge. Exercise-induced ST-segment elevation was no longer prese...
Circulation, 1983
To investigate the mechanism by which nifedipine improves exercise tolerance in patients with cor... more To investigate the mechanism by which nifedipine improves exercise tolerance in patients with coronary artery disease, we studied 14 patients with stable exertional angina and left anterior descending artery disease by measuring great cardiac vein flow (GCVF) and calculating anterior regional coronary resistance (ARCR) during exercise before and after sublingual administration of 20 mg of nifedipine. After nifedipine seven patients (group I) had no increase in exercise capacity and showed a similar magnitude of ST segment depression at peak exercise, while another seven patients (group II) had prolonged exercise duration (p less than .001) with less ST segment depression at peak exercise (p less than .01). Such effects were achieved despite a significant increase in double product, an indirect index of myocardial oxygen consumption. In group I patients no significant change was induced by nifedipine in GCVF or in ARCR either at rest or at peak exercise. In contrast, in group II pati...
The American Journal of Cardiology, 1983
This study describes the results of repeated exercise tests in patients with vasospastic angina p... more This study describes the results of repeated exercise tests in patients with vasospastic angina presenting with this clinical manifestation. We believe that the recognition of variable threshold exertional angina may have important therapeutic implications.
The American Journal of Cardiology, 2000
American Heart Journal, 2000
HRV has prognostic value in patients with idiopathic or ischemic CHF. 9-16 Several studies have i... more HRV has prognostic value in patients with idiopathic or ischemic CHF. 9-16 Several studies have investigated the correlation between HRV and different markers of disease severity such as functional class, plasma neurohormone levels, exercise peak oxygen consumption, and hemodynamic profile. 2,15,17-25 These studies have shown controversial results and are, in some instances at least, limited by factors such as sample size and/or patient heterogeneity as the result of a wide range of disease severity. In most cases, the interest has focused on patients with a moderate left ventricular dysfunction, whereas few data exist concerning patients with severe CHF. Furthermore, although the correlation between HRV and left ventricular systolic and diastolic functions 2,8,17,18,22 has been extensively described, only one study has investigated the potential relation between autonomic activity and right ventricular performance. 25 This latter may have important clinical implications because right ventricular dysfunction has prognostic relevance in severe heart failure. 26,27 Additionally, most studies obtained HRV indexes by 24hour Holter-recorded electrocardiograms, whereas Autonomic dysfunction is associated with and contributes to the progression of chronic heart failure (CHF). High plasma norepinephrine levels, 1 increased sympathetic nerve activity, 2 resetting of the baroreflex control, 3,4 and parasympathetic withdrawal 5 have been reported in patients affected by this syndrome. The counterpart of this information is the recent evidence of the beneficial effects of autonomic modulation by β-blocker agents in CHF. 6 Heart rate variability (HRV) is an accepted reliable noninvasive method for the assessment of the autonomic balance. 7 HRV is depressed in patients with CHF, 8 and
Giornale italiano di cardiologia, 1978
Five patients affected by angina pectoris showed a spontaneous attack of myocardial ischemia in t... more Five patients affected by angina pectoris showed a spontaneous attack of myocardial ischemia in the course of coronary arteriography examination. During the ischemic episode it was shown a severe coronary arterial spasm promptly relieved by nitroglycerin. In these patients the administration of ergonovine maleate induced the same clinical, electrocardiographic and coronariographic patterns of spontaneous ischemic episodes. These data support the hypotesis that the ergonovine maleate administration is a suitable test for detection of the vasospastic pathogenesis in acute myocardial ischemia.
European Journal of Haematology, 2020
Pulmonary hypertension (PH) is commonly reported in Philadelphia‐chromosome negative myeloprolife... more Pulmonary hypertension (PH) is commonly reported in Philadelphia‐chromosome negative myeloproliferative neoplasms (MPNs) including polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF). PH may be diagnosed directly by right heart catheterization (RHC) or estimated by transthoracic echocardiography (TTE). Survival is shortened by PH but despite the potential significance of PH to management and prognosis of MPN, estimates of its prevalence in MPNs vary and risk factors for the condition are poorly established. We performed a systematic review and meta‐analysis of available studies to fill this void.