Carlo Bonanno - Academia.edu (original) (raw)

Papers by Carlo Bonanno

Research paper thumbnail of Cardiac troponin I as diagnostic and prognostic marker in severe heart failure

Journal of Heart and Lung Transplantation, Jul 1, 2000

Background: Cardiac cell death has been shown to occur in heart failure and has been implicated a... more Background: Cardiac cell death has been shown to occur in heart failure and has been implicated as one of the mechanisms responsible for progression of the disease. Cardiac Troponin I (cTnI) represents a highly sensitive marker for myocardial cell death. Based on previous studies reporting that cTnI may be detected in patients with heart failure, we evaluated the clinical correlates and prognostic implications of detectable cTnI in a consecutive series of patients with severe heart failure. Methods: Thirty-four patients were examined. Upon admission, we measured serum levels of cTnI by conventional immunoenzymatic assay (Stratus Dade II). According to the results of this assay, patients were divided into 2 groups, based on the presence (cTnIϩ) or absence (cTnIϪ) of detectable cTnI. These 2 groups were compared by non-parametric analysis for their clinical characteristics, instrumental findings, and short-term outcome. Results: The cTnIϩ group included 10 patients (29%) with a mean serum cTnI of 0.7 Ϯ 0.3 ng/ml. Compared with the cTnIϪ group, these patients had significantly lower left ventricular ejection fractions (20% Ϯ 5% vs 26% Ϯ 7%, p ϭ 0.023) and a trend for higher systolic pulmonary artery pressure (59 Ϯ 17 mm Hg vs 49 Ϯ 13 mm Hg, p ϭ 0.08). In cTnIϩ patients, the correlation between cTnI levels upon admission and ejection fraction was r ϭ Ϫ0.530 (p ϭ 0.11). We found ischemic etiology was equally present in the 2 groups, whereas we never found histologic signs of acute myocarditis. Other clinical characteristics (functional class, daily diuretic dose, need for intravenous inotropes) were not statistically different in the 2 groups. In cTnIϩ patients who improved after admission, cTnI became undetectable after a few days; in patients with refractory heart failure who were hospitalized until death, cTnI persisted in detectable levels throughout the observation period. Using the Cox proportional hazard model, a positive cTnI was the most powerful predictor of mortality at 3 months (p ϭ 0.013; hazard ratio 6.86; 95% confidence interval 1.32 to 35.4). Conclusions: These observations suggest that cTnI is detected in the blood of 25% to 33% of patients with severe heart failure; its presence may help to identify a high-risk subgroup who faces very poor short-term prognosis.

Research paper thumbnail of Catheter ablation as first-line treatment in patients with atrial fibrillation: a Bayesian network meta-analysis

Europace, May 24, 2023

Funding Acknowledgements: Type of funding sources: None. Introduction: Clinical trials suggest th... more Funding Acknowledgements: Type of funding sources: None. Introduction: Clinical trials suggest that early catheter ablation (CA) can be superior to anti-arrhythmic drugs (AADs) in "naïve" patients with AF. A low power to examine the outcomes, the use of a single technology ablation, and the short follow-up period are significant limitations of the studies. The EARLY-AF (Early Aggressive Invasive Intervention for Atrial Fibrillation) trial recently reported the results over three years of follow-up. Our research aims to update the comparison among different CA technologies with AADs as reference treatment. Interest outcomes included freedom from atrial tachycardia recurrences (ATRs) for efficacy and serious adverse events (AEs) for safety. Methods: A systematic literature search was carried out up to Oct 31, 2022. We considered studies of patients with untreated atrial fibrillation who were enrolled in a trial in which they had been assigned to undergo initial rhythm-control therapy with cryoballoon (CRYO) or radiofrequency (RF) CA in at least one arm or to receive antiarrhythmic drugs (AADs). A Bayesian random-effects network meta-analysis (NMA) model comparing ATRs and AEs among the treatment arms was performed using MetaInsight V 4.0.0 web-based tool. Estimates are presented as Odds Ratio (OR) with a 95% Credible Interval (CrI). The surface under the cumulative ranking area (SUCRA) probabilities was selected to calculate the ranking and hierarchy of the different treatments. The larger SUCRA indicates the greater likelihood of becoming the best intervention. Results: Six randomised control trials (RCTs) and one observational study (OBS) with 1,418 patients (mainly paroxysmal AF) were included. The follow-up period ranged from 12 to 36 months. The NMA demonstrates that ATRs were significantly lower with CRYO (OR [95% CrI], 0.36 [0.17-0.72]) and RF (OR [95% CrI], 0.39 [0.16-0.72]) compared with AADs. No significant difference was observed between CRYO and RF (OR [95% CrI], 1.09 [0.39-2.4]). The higher SUCRA value for CRYO (79%) indicated the likelihood that the treatment is the best, followed by RF (70%) and AADs (8%) (Figure 1). A total of 228 AEs were observed in 1,565 patients. The cumulative AEs associated with RF (OR [95% CrI], 1.31 [0.65-2.72]) and CRYO (OR [95% CrI], 0.72 [0.39-1.29]) were statistically similar in comparison with AADs. The indirect comparison showed no significant difference between the two ablative techniques. The probability of avoiding an AE was highest for CRYO (91%), followed by AADs (45%) and RF (14%) (Figure 2). In both analyses, the assessment of inconsistency for all studies was not significant (P > 0.05). Conclusions: Our NMA demonstrated a lower rate of ATRs in patients treated with CRYO or RF CA than AADs. Furthermore, CA had a safety profile comparable to AADs. These results suggest recommending CA as a first-line treatment when early rhythm control is warranted, mainly in patients with paroxysmal AF.

Research paper thumbnail of Effects of cardiac resynchronization therapy on disease progression in patients with congestive heart failure

Italian heart journal : official journal of the Italian Federation of Cardiology, 2004

BACKGROUND Cardiac resynchronization therapy (CRT) represents a new therapeutic modality of prove... more BACKGROUND Cardiac resynchronization therapy (CRT) represents a new therapeutic modality of proven efficacy for selected patients with heart failure and ventricular asynchrony. The aim of this study was to assess the effects of CRT on clinical variables and cardiac remodeling in patients with moderate-to-severe congestive heart failure and inter/intraventricular conduction delays. METHODS Thirty-seven patients (32 males, 5 females, mean age 73 +/- 7 years), in NYHA functional class III-IV, with left ventricular ejection fraction (LVEF) < or = 35%, QRS > or = 150 ms, and left ventricular end-diastolic diameter (LVEDD) > or = 55 mm, underwent CRT by biventricular pacing (InSync, InSync III, InSync ICD; Medtronic Inc.). Fourteen (37.8%) had a previous pacemaker, and 11 (29.7%) were in permanent atrial fibrillation. The QRS width, NYHA functional class, LVEDD, left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic volume (LVEDV), left ventricular endsyst...

Research paper thumbnail of P6346The absolute number of strokes saved treating 1,000 patients with transcatheter PFO closure. An updated meta-analysis of RCTs

European Heart Journal, 2018

Stroke prevention, mechanisms & outcome nary artery disease (CAD) or other stroke subtypes. Follo... more Stroke prevention, mechanisms & outcome nary artery disease (CAD) or other stroke subtypes. Follow-up analyses using a GRS in UK Biobank participants demonstrated a consistent null effect on CAD, overall stroke, and atrial fibrillation. Cardioembolic stroke was not reported in UK Biobank, but arterial embolism showed a consistent increased risk (OR = 1.47 per ng/dL; 95% CI = 1.08 to 2.00; p=0.013). To further explore the association with embolism, we investigated the effect of CFT on risk factors for thrombosis. Genetically elevated CFT significantly increased platelet counts (β = 1.5E9 cells per L per ng/dL; 95% CI = 0.8 to 2.2; p=9.8E-6). Conclusion: We identified lifelong genetically elevated free testosterone as increasing risk of cardioembolic stroke, but having no effect on other cardiovascular outcomes. These findings highlight the need for well-powered RCTs of testosterone replacement therapy on these outcomes, and urge caution in the use of testosterone replacement therapy without clear indication or in those at high risk of embolism.

Research paper thumbnail of Isolated First-Degree Atrioventricular Block: A New Indication for Dual-Chamber Pacing?

Cardiac Arrhythmias 1995, 1996

Since the importance of the atrioventricular (AV) interval in cardiac hemodynamics has been reali... more Since the importance of the atrioventricular (AV) interval in cardiac hemodynamics has been realized, first-degree atrioventricular AV block has been considered as one of the possible indications for permanent cardiac pacing.

Research paper thumbnail of Propranolol for severe hemangioma of infancy

Journal of Cardiovascular Medicine, 2011

All three stent components, namely metal strut, polymer and eluted drug, together with the accomp... more All three stent components, namely metal strut, polymer and eluted drug, together with the accompanying oral medication can act as potential antigens and, especially in atopic patients, any other environmental exposure can trigger intracoronary mast cell activation inducing coron-ary spasm and ...

Research paper thumbnail of 229 Combined utilization of right ventricular ejection fraction and pulmonary pressure to stratify patients with left ventricular dysfunction

European Journal of Heart Failure Supplements, 2003

Research paper thumbnail of Signal-averaged electrocardiography in patients with idiopathic ventricular tachycardia in detecting subclinical right ventricular dysfunction

Cardiovascular Reviews Reports, 2000

Although the usefulness of signal-averaged ECG has been clearly documented in different clinical ... more Although the usefulness of signal-averaged ECG has been clearly documented in different clinical settings, less information is presently available regarding diagnostic and/or prognostic significance of this finding in the emerging patient population with ventricular tachycardia and apparently normal hearts. Signal-averaged ECG was recorded in 40 patients with ventricular tachycardia, normal left ventricular function, and normal coronary arteries as a part of a prospective evaluation that included cardiac catheterization and endomyocardial biopsy. The study population consisted of 30 men and 10 women, mean age 43 years (range 12-65) presenting with sustained ventricular tachycardia or repeated nonsustained ventricular tachycardia. Noninvasive evaluation was inconclusive except for the identification of mild, previously unnoticed mitral valve prolapse in seven patients (18%). Conventional signal-averaged ECG revealed a 50% prevalence of ventricular late potentials in this population. This finding was not associated with ventricular tachycardia morphology, inducibility at electrophysiologic study, frequency, and complexity of ventricular arrhythmias during Holter monitoring, or angiographic variables of left ventricular function. Rather, the presence of ventricular late potentials was significantly associated with more severe presenting symptoms (syncope or cardiac arrest: 50% vs. 15%; p=0.043), a lower right ventricular ejection fraction (44±7% vs. 51±10%; p=0.014), and a higher score of interstitial fibrosis detected by morphometric methods (26±3% vs. 17±2%; p=0.024). In long term follow up, one patient with a history of aborted sudden death died in the ventricular late potentials group vs. none in the remaining patients studied. Signal-averaged ECG provides a marker for the presence of mild right ventricular abnormalities in patients with ventricular tachycardia and apparently normal hearts. Also, the prevalence of mitral valve prolapse in this group of patients, which was four times higher than expected according to population-based studies, suggests a common link between these conditions. A positive signal-averaged ECG may orient toward more careful management of this otherwise low risk population.

Research paper thumbnail of Abstract 4006: Spontaneous Dissections of Coronary Arteries (SCAD) and Acute Coronary Syndromes (ACS). Preliminary Results of the Discovery-ACS: A Multicenter Prospective Registry With A Patients-control Group

Circulation, Oct 28, 2008

Research paper thumbnail of Effects of cardiac resynchronization therapy on disease progression in patients with congestive heart failure

Italian heart journal: official journal of the Italian Federation of Cardiology

Cardiac resynchronization therapy (CRT) represents a new therapeutic modality of proven efficacy ... more Cardiac resynchronization therapy (CRT) represents a new therapeutic modality of proven efficacy for selected patients with heart failure and ventricular asynchrony. The aim of this study was to assess the effects of CRT on clinical variables and cardiac remodeling in patients with moderate-to-severe congestive heart failure and inter/intraventricular conduction delays. Thirty-seven patients (32 males, 5 females, mean age 73 +/- 7 years), in NYHA functional class III-IV, with left ventricular ejection fraction (LVEF) < or = 35%, QRS > or = 150 ms, and left ventricular end-diastolic diameter (LVEDD) > or = 55 mm, underwent CRT by biventricular pacing (InSync, InSync III, InSync ICD; Medtronic Inc.). Fourteen (37.8%) had a previous pacemaker, and 11 (29.7%) were in permanent atrial fibrillation. The QRS width, NYHA functional class, LVEDD, left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic volume (LVEDV), left ventricular endsystolic volume (LVESV)...

Research paper thumbnail of 80 Experience on long term outcome of patients treated with cardiac resynchronisation therapy

European Journal of Heart Failure Supplements, 2006

... implantation for MADIT II criteria L. Antonini, V. Pasceri, S. Greco, S. Ma]fatti, M. Russo, ... more ... implantation for MADIT II criteria L. Antonini, V. Pasceri, S. Greco, S. Ma]fatti, M. Russo, A. Varveri, E Colivicchi, M. Santini San Filippo Neri Hospital ... cardiac resynchronisation therapy DJ Fox 1 AP Fitzpatrick 1 RS Khatt ar 1 SG Williams 2 A. Borg 2 MCS Hall 1 , P. Clayton 2, NC ...

Research paper thumbnail of Incessant ventricular tachycardia early after acute myocardial infarction: efficacy of radiofrequency catheter ablation but not of optimal coronary revascularization

Giornale italiano di cardiologia, 1999

Incessant ventricular tachycardia is an arrhythmia refractory to conventional antiarrhythmic trea... more Incessant ventricular tachycardia is an arrhythmia refractory to conventional antiarrhythmic treatment. We describe the case of 55-year-old man who presented incessant ventricular tachycardia in the early post-acute phase of myocardial infarction. Optimal coronary revascularization was not effective, but radiofrequency catheter ablation was able to eliminate the anatomic substrate and clinical arrhythmic recurrence.

Research paper thumbnail of 249 Cardiac resynchronization therapy in patients with atrial fibrillation — a meta-analysis

European Journal of Heart Failure Supplements, 2006

Research paper thumbnail of 5.7 Prevention of early af relapses after electrical cardioversion with bisoprolol

Europace, 2003

INR value achived between 2,5-3,5). We evaluated the results in relation to age, duration of AF, ... more INR value achived between 2,5-3,5). We evaluated the results in relation to age, duration of AF, size of left atrial, left ventricular ejection fraction, and Joules delivered. Results: conversion to sinus rhythm occured in 82 pts (87%) with a mean 2,2±1,7 shocks and effective Joules of 180±92. With initial Joules of 50 success was achieved in 28/94 pts. Of 66 pts receiving cumulative energy 150 Joules, CV was successful in 27/66, of 39 pts receiving cumulative energy 350 Joules, CV was successful in 27/39. The success rates were 30% for the 50 J, 41% for 150 J, and 69% for 350 J. By logistic regression, predictor of success of low-energy shock (50 J) was shorter duration of AF (r=0,51; p<0,01). There were no differences in results related to age, left atrial size and left ventricular ejection fraction. Conclusions: 1. The biphasic shocks for external CV of AF are effective and safe procedure. 2. The energy of 350 J is significantly more effective than 50, and 150 J, and should be considered for CV as the initial energy in pts with longer AF duration. 3. Pts with shorter duration of AF have a higher probability for successful CV with low energy.

Research paper thumbnail of Abstract 5101: ACS in Patients With and Without Spontaneous Dissections of Coronary Arteries: The Discovery Study

Research paper thumbnail of Efficacy and safety of curative catheter ablation for atrial fibrillation

International Journal of Medicine and Medical Sciences, Aug 30, 2009

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Its treatment is sti... more Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Its treatment is still widely debated due to the large variety of therapeutic options. Radiofrequency catheter ablation (RFCA) around pulmonary vein ostia and in left atrium has been proposed as a curative technique to treat AF and is now performed with increasing success worldwide. However, few randomised controlled trials (RCTs) are available. Some of these have been recently published and not yet included in metaanalyses. To address the efficacy and safety of RFCA for curative treatment of AF, we perform a systematic review, in order to provide a more precise estimate of post-procedural atrial tachyarrhythmias (ATs) recurrence, adverse effects and complications. Using electronic databases, we searched for RCTs comparing RFCA with anti-arrhythmic drugs for the management of AF. The efficacy end-point was freedom from ATs (including atrial fibrillation, atrial flutter and atrial tachycardia), following the procedure. The safety end-point was the rate complications and adverse events. The results are reported as relative risk (RR) and 95% confidence interval (CI), calculated using the RevMan software (The Cochrane Collaboration, Copenhagen, 2008). A total of 8 RCTs were identified, including 844 patients. Overall, 98 (23.2%) of 421 patients in the treatment group and 324 (76.6%) of 423 patients in the control group had ATs recurrence. Catheter ablation decreased ATs recurrence by 71% (RR = 0.29, 95% CI 0.20 to 0.41, p<0.00001, with random effects model). Fewer complications and adverse events were reported in the ablation group compared with the control group (RR = 0.72, 95% CI 0.40 to 1.30, p=0.28, with random effects model). In selected patients with AF, RFCA is a relatively efficacious and safe procedure for the curative treatment of AF. Even though the results of this systematic review favoUr ablation therapy, large, well-designed, multicenter RCTs are needed to confirm the efficacy and safety of RFCA for AF.

Research paper thumbnail of Efficacy and safety of curative catheter ablation for atrial fibrillation

International Journal of Medicine and Medical Sciences, Aug 30, 2009

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Its treatment is sti... more Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Its treatment is still widely debated due to the large variety of therapeutic options. Radiofrequency catheter ablation (RFCA) around pulmonary vein ostia and in left atrium has been proposed as a curative technique to treat AF and is now performed with increasing success worldwide. However, few randomised controlled trials (RCTs) are available. Some of these have been recently published and not yet included in metaanalyses. To address the efficacy and safety of RFCA for curative treatment of AF, we perform a systematic review, in order to provide a more precise estimate of post-procedural atrial tachyarrhythmias (ATs) recurrence, adverse effects and complications. Using electronic databases, we searched for RCTs comparing RFCA with anti-arrhythmic drugs for the management of AF. The efficacy end-point was freedom from ATs (including atrial fibrillation, atrial flutter and atrial tachycardia), following the procedure. The safety end-point was the rate complications and adverse events. The results are reported as relative risk (RR) and 95% confidence interval (CI), calculated using the RevMan software (The Cochrane Collaboration, Copenhagen, 2008). A total of 8 RCTs were identified, including 844 patients. Overall, 98 (23.2%) of 421 patients in the treatment group and 324 (76.6%) of 423 patients in the control group had ATs recurrence. Catheter ablation decreased ATs recurrence by 71% (RR = 0.29, 95% CI 0.20 to 0.41, p<0.00001, with random effects model). Fewer complications and adverse events were reported in the ablation group compared with the control group (RR = 0.72, 95% CI 0.40 to 1.30, p=0.28, with random effects model). In selected patients with AF, RFCA is a relatively efficacious and safe procedure for the curative treatment of AF. Even though the results of this systematic review favoUr ablation therapy, large, well-designed, multicenter RCTs are needed to confirm the efficacy and safety of RFCA for AF.

Research paper thumbnail of Updated meta-analysis on implantable cardioverter defibrillator detection programmingto reduce mortality

Objective: The purpose of this study was to perform a meta-analysis to better gauge the impact of... more Objective: The purpose of this study was to perform a meta-analysis to better gauge the impact of prolonged arrhythmia detection times or high arrhythmia detection rates on ICD shock therapy and other adverse outcomes. Background: Programming long arrhythmia detection time or high arrhythmia detection rate reduce the incidence of implantable cardioverter defibrillator (ICD) shock therapy. However, potential concerns exist regarding the impact on mortality and incidence of syncope. Methods: PUBMED database was systematically searched. We included only randomized, prospective studies that examined the impact of programming longer vs shorter ICD arrhythmia detection times or higher vs lower ICD arrhythmia detection rates on clinical outcomes. Summary estimates of the relative risk (RR) of death, syncope, and total, appropriate and inappropriate shocks were calculated using random effects model. Results: Six studies enrolling 6,543 patients were identified. During a mean/median follow-u...

Research paper thumbnail of Updated meta-analysis on implantable cardioverter defibrillator detection programmingto reduce mortality

Objective: The purpose of this study was to perform a meta-analysis to better gauge the impact of... more Objective: The purpose of this study was to perform a meta-analysis to better gauge the impact of prolonged arrhythmia detection times or high arrhythmia detection rates on ICD shock therapy and other adverse outcomes. Background: Programming long arrhythmia detection time or high arrhythmia detection rate reduce the incidence of implantable cardioverter defibrillator (ICD) shock therapy. However, potential concerns exist regarding the impact on mortality and incidence of syncope. Methods: PUBMED database was systematically searched. We included only randomized, prospective studies that examined the impact of programming longer vs shorter ICD arrhythmia detection times or higher vs lower ICD arrhythmia detection rates on clinical outcomes. Summary estimates of the relative risk (RR) of death, syncope, and total, appropriate and inappropriate shocks were calculated using random effects model. Results: Six studies enrolling 6,543 patients were identified. During a mean/median follow-u...

Research paper thumbnail of Network meta-analysis on patent foramen ovale: is a stroke or atrial fibrillation worse?

Neurological Sciences, 2020

Objective Systematic reviews suggest that patent foramen ovale closure (PFOc) is performed percut... more Objective Systematic reviews suggest that patent foramen ovale closure (PFOc) is performed percutaneously with low complication rates. We did a network meta-analysis (NMA) comparing devices for PFO closures, evaluating safety and efficacy of transcatheter PFOc in preventing neurological events in patients with stroke when compared with medical therapy (MT), and assessing risk of atrial fibrillation (AF). Methods We searched 3 databases (MEDLINE, EMBASE, CENTRAL/CCTR) identifying six randomized controlled trials from 2012 until December 2019. We performed a Bayesian NMA; number-needed-to-treat and number-needed-to-harm were derived by applying the estimated odds ratios (ORs). The likelihood of being helped or harmed (LHH) was evaluated to estimate the risk-effectiveness balance. Results The 3560 patients allocated to PFOc were less subject to a stroke than patients with MT. The overall ORs of PFOc versus MT were 0.41 with fixed-effects, and 0.22 with random-effects model. NMA proves ...

Research paper thumbnail of Cardiac troponin I as diagnostic and prognostic marker in severe heart failure

Journal of Heart and Lung Transplantation, Jul 1, 2000

Background: Cardiac cell death has been shown to occur in heart failure and has been implicated a... more Background: Cardiac cell death has been shown to occur in heart failure and has been implicated as one of the mechanisms responsible for progression of the disease. Cardiac Troponin I (cTnI) represents a highly sensitive marker for myocardial cell death. Based on previous studies reporting that cTnI may be detected in patients with heart failure, we evaluated the clinical correlates and prognostic implications of detectable cTnI in a consecutive series of patients with severe heart failure. Methods: Thirty-four patients were examined. Upon admission, we measured serum levels of cTnI by conventional immunoenzymatic assay (Stratus Dade II). According to the results of this assay, patients were divided into 2 groups, based on the presence (cTnIϩ) or absence (cTnIϪ) of detectable cTnI. These 2 groups were compared by non-parametric analysis for their clinical characteristics, instrumental findings, and short-term outcome. Results: The cTnIϩ group included 10 patients (29%) with a mean serum cTnI of 0.7 Ϯ 0.3 ng/ml. Compared with the cTnIϪ group, these patients had significantly lower left ventricular ejection fractions (20% Ϯ 5% vs 26% Ϯ 7%, p ϭ 0.023) and a trend for higher systolic pulmonary artery pressure (59 Ϯ 17 mm Hg vs 49 Ϯ 13 mm Hg, p ϭ 0.08). In cTnIϩ patients, the correlation between cTnI levels upon admission and ejection fraction was r ϭ Ϫ0.530 (p ϭ 0.11). We found ischemic etiology was equally present in the 2 groups, whereas we never found histologic signs of acute myocarditis. Other clinical characteristics (functional class, daily diuretic dose, need for intravenous inotropes) were not statistically different in the 2 groups. In cTnIϩ patients who improved after admission, cTnI became undetectable after a few days; in patients with refractory heart failure who were hospitalized until death, cTnI persisted in detectable levels throughout the observation period. Using the Cox proportional hazard model, a positive cTnI was the most powerful predictor of mortality at 3 months (p ϭ 0.013; hazard ratio 6.86; 95% confidence interval 1.32 to 35.4). Conclusions: These observations suggest that cTnI is detected in the blood of 25% to 33% of patients with severe heart failure; its presence may help to identify a high-risk subgroup who faces very poor short-term prognosis.

Research paper thumbnail of Catheter ablation as first-line treatment in patients with atrial fibrillation: a Bayesian network meta-analysis

Europace, May 24, 2023

Funding Acknowledgements: Type of funding sources: None. Introduction: Clinical trials suggest th... more Funding Acknowledgements: Type of funding sources: None. Introduction: Clinical trials suggest that early catheter ablation (CA) can be superior to anti-arrhythmic drugs (AADs) in "naïve" patients with AF. A low power to examine the outcomes, the use of a single technology ablation, and the short follow-up period are significant limitations of the studies. The EARLY-AF (Early Aggressive Invasive Intervention for Atrial Fibrillation) trial recently reported the results over three years of follow-up. Our research aims to update the comparison among different CA technologies with AADs as reference treatment. Interest outcomes included freedom from atrial tachycardia recurrences (ATRs) for efficacy and serious adverse events (AEs) for safety. Methods: A systematic literature search was carried out up to Oct 31, 2022. We considered studies of patients with untreated atrial fibrillation who were enrolled in a trial in which they had been assigned to undergo initial rhythm-control therapy with cryoballoon (CRYO) or radiofrequency (RF) CA in at least one arm or to receive antiarrhythmic drugs (AADs). A Bayesian random-effects network meta-analysis (NMA) model comparing ATRs and AEs among the treatment arms was performed using MetaInsight V 4.0.0 web-based tool. Estimates are presented as Odds Ratio (OR) with a 95% Credible Interval (CrI). The surface under the cumulative ranking area (SUCRA) probabilities was selected to calculate the ranking and hierarchy of the different treatments. The larger SUCRA indicates the greater likelihood of becoming the best intervention. Results: Six randomised control trials (RCTs) and one observational study (OBS) with 1,418 patients (mainly paroxysmal AF) were included. The follow-up period ranged from 12 to 36 months. The NMA demonstrates that ATRs were significantly lower with CRYO (OR [95% CrI], 0.36 [0.17-0.72]) and RF (OR [95% CrI], 0.39 [0.16-0.72]) compared with AADs. No significant difference was observed between CRYO and RF (OR [95% CrI], 1.09 [0.39-2.4]). The higher SUCRA value for CRYO (79%) indicated the likelihood that the treatment is the best, followed by RF (70%) and AADs (8%) (Figure 1). A total of 228 AEs were observed in 1,565 patients. The cumulative AEs associated with RF (OR [95% CrI], 1.31 [0.65-2.72]) and CRYO (OR [95% CrI], 0.72 [0.39-1.29]) were statistically similar in comparison with AADs. The indirect comparison showed no significant difference between the two ablative techniques. The probability of avoiding an AE was highest for CRYO (91%), followed by AADs (45%) and RF (14%) (Figure 2). In both analyses, the assessment of inconsistency for all studies was not significant (P > 0.05). Conclusions: Our NMA demonstrated a lower rate of ATRs in patients treated with CRYO or RF CA than AADs. Furthermore, CA had a safety profile comparable to AADs. These results suggest recommending CA as a first-line treatment when early rhythm control is warranted, mainly in patients with paroxysmal AF.

Research paper thumbnail of Effects of cardiac resynchronization therapy on disease progression in patients with congestive heart failure

Italian heart journal : official journal of the Italian Federation of Cardiology, 2004

BACKGROUND Cardiac resynchronization therapy (CRT) represents a new therapeutic modality of prove... more BACKGROUND Cardiac resynchronization therapy (CRT) represents a new therapeutic modality of proven efficacy for selected patients with heart failure and ventricular asynchrony. The aim of this study was to assess the effects of CRT on clinical variables and cardiac remodeling in patients with moderate-to-severe congestive heart failure and inter/intraventricular conduction delays. METHODS Thirty-seven patients (32 males, 5 females, mean age 73 +/- 7 years), in NYHA functional class III-IV, with left ventricular ejection fraction (LVEF) < or = 35%, QRS > or = 150 ms, and left ventricular end-diastolic diameter (LVEDD) > or = 55 mm, underwent CRT by biventricular pacing (InSync, InSync III, InSync ICD; Medtronic Inc.). Fourteen (37.8%) had a previous pacemaker, and 11 (29.7%) were in permanent atrial fibrillation. The QRS width, NYHA functional class, LVEDD, left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic volume (LVEDV), left ventricular endsyst...

Research paper thumbnail of P6346The absolute number of strokes saved treating 1,000 patients with transcatheter PFO closure. An updated meta-analysis of RCTs

European Heart Journal, 2018

Stroke prevention, mechanisms & outcome nary artery disease (CAD) or other stroke subtypes. Follo... more Stroke prevention, mechanisms & outcome nary artery disease (CAD) or other stroke subtypes. Follow-up analyses using a GRS in UK Biobank participants demonstrated a consistent null effect on CAD, overall stroke, and atrial fibrillation. Cardioembolic stroke was not reported in UK Biobank, but arterial embolism showed a consistent increased risk (OR = 1.47 per ng/dL; 95% CI = 1.08 to 2.00; p=0.013). To further explore the association with embolism, we investigated the effect of CFT on risk factors for thrombosis. Genetically elevated CFT significantly increased platelet counts (β = 1.5E9 cells per L per ng/dL; 95% CI = 0.8 to 2.2; p=9.8E-6). Conclusion: We identified lifelong genetically elevated free testosterone as increasing risk of cardioembolic stroke, but having no effect on other cardiovascular outcomes. These findings highlight the need for well-powered RCTs of testosterone replacement therapy on these outcomes, and urge caution in the use of testosterone replacement therapy without clear indication or in those at high risk of embolism.

Research paper thumbnail of Isolated First-Degree Atrioventricular Block: A New Indication for Dual-Chamber Pacing?

Cardiac Arrhythmias 1995, 1996

Since the importance of the atrioventricular (AV) interval in cardiac hemodynamics has been reali... more Since the importance of the atrioventricular (AV) interval in cardiac hemodynamics has been realized, first-degree atrioventricular AV block has been considered as one of the possible indications for permanent cardiac pacing.

Research paper thumbnail of Propranolol for severe hemangioma of infancy

Journal of Cardiovascular Medicine, 2011

All three stent components, namely metal strut, polymer and eluted drug, together with the accomp... more All three stent components, namely metal strut, polymer and eluted drug, together with the accompanying oral medication can act as potential antigens and, especially in atopic patients, any other environmental exposure can trigger intracoronary mast cell activation inducing coron-ary spasm and ...

Research paper thumbnail of 229 Combined utilization of right ventricular ejection fraction and pulmonary pressure to stratify patients with left ventricular dysfunction

European Journal of Heart Failure Supplements, 2003

Research paper thumbnail of Signal-averaged electrocardiography in patients with idiopathic ventricular tachycardia in detecting subclinical right ventricular dysfunction

Cardiovascular Reviews Reports, 2000

Although the usefulness of signal-averaged ECG has been clearly documented in different clinical ... more Although the usefulness of signal-averaged ECG has been clearly documented in different clinical settings, less information is presently available regarding diagnostic and/or prognostic significance of this finding in the emerging patient population with ventricular tachycardia and apparently normal hearts. Signal-averaged ECG was recorded in 40 patients with ventricular tachycardia, normal left ventricular function, and normal coronary arteries as a part of a prospective evaluation that included cardiac catheterization and endomyocardial biopsy. The study population consisted of 30 men and 10 women, mean age 43 years (range 12-65) presenting with sustained ventricular tachycardia or repeated nonsustained ventricular tachycardia. Noninvasive evaluation was inconclusive except for the identification of mild, previously unnoticed mitral valve prolapse in seven patients (18%). Conventional signal-averaged ECG revealed a 50% prevalence of ventricular late potentials in this population. This finding was not associated with ventricular tachycardia morphology, inducibility at electrophysiologic study, frequency, and complexity of ventricular arrhythmias during Holter monitoring, or angiographic variables of left ventricular function. Rather, the presence of ventricular late potentials was significantly associated with more severe presenting symptoms (syncope or cardiac arrest: 50% vs. 15%; p=0.043), a lower right ventricular ejection fraction (44±7% vs. 51±10%; p=0.014), and a higher score of interstitial fibrosis detected by morphometric methods (26±3% vs. 17±2%; p=0.024). In long term follow up, one patient with a history of aborted sudden death died in the ventricular late potentials group vs. none in the remaining patients studied. Signal-averaged ECG provides a marker for the presence of mild right ventricular abnormalities in patients with ventricular tachycardia and apparently normal hearts. Also, the prevalence of mitral valve prolapse in this group of patients, which was four times higher than expected according to population-based studies, suggests a common link between these conditions. A positive signal-averaged ECG may orient toward more careful management of this otherwise low risk population.

Research paper thumbnail of Abstract 4006: Spontaneous Dissections of Coronary Arteries (SCAD) and Acute Coronary Syndromes (ACS). Preliminary Results of the Discovery-ACS: A Multicenter Prospective Registry With A Patients-control Group

Circulation, Oct 28, 2008

Research paper thumbnail of Effects of cardiac resynchronization therapy on disease progression in patients with congestive heart failure

Italian heart journal: official journal of the Italian Federation of Cardiology

Cardiac resynchronization therapy (CRT) represents a new therapeutic modality of proven efficacy ... more Cardiac resynchronization therapy (CRT) represents a new therapeutic modality of proven efficacy for selected patients with heart failure and ventricular asynchrony. The aim of this study was to assess the effects of CRT on clinical variables and cardiac remodeling in patients with moderate-to-severe congestive heart failure and inter/intraventricular conduction delays. Thirty-seven patients (32 males, 5 females, mean age 73 +/- 7 years), in NYHA functional class III-IV, with left ventricular ejection fraction (LVEF) < or = 35%, QRS > or = 150 ms, and left ventricular end-diastolic diameter (LVEDD) > or = 55 mm, underwent CRT by biventricular pacing (InSync, InSync III, InSync ICD; Medtronic Inc.). Fourteen (37.8%) had a previous pacemaker, and 11 (29.7%) were in permanent atrial fibrillation. The QRS width, NYHA functional class, LVEDD, left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic volume (LVEDV), left ventricular endsystolic volume (LVESV)...

Research paper thumbnail of 80 Experience on long term outcome of patients treated with cardiac resynchronisation therapy

European Journal of Heart Failure Supplements, 2006

... implantation for MADIT II criteria L. Antonini, V. Pasceri, S. Greco, S. Ma]fatti, M. Russo, ... more ... implantation for MADIT II criteria L. Antonini, V. Pasceri, S. Greco, S. Ma]fatti, M. Russo, A. Varveri, E Colivicchi, M. Santini San Filippo Neri Hospital ... cardiac resynchronisation therapy DJ Fox 1 AP Fitzpatrick 1 RS Khatt ar 1 SG Williams 2 A. Borg 2 MCS Hall 1 , P. Clayton 2, NC ...

Research paper thumbnail of Incessant ventricular tachycardia early after acute myocardial infarction: efficacy of radiofrequency catheter ablation but not of optimal coronary revascularization

Giornale italiano di cardiologia, 1999

Incessant ventricular tachycardia is an arrhythmia refractory to conventional antiarrhythmic trea... more Incessant ventricular tachycardia is an arrhythmia refractory to conventional antiarrhythmic treatment. We describe the case of 55-year-old man who presented incessant ventricular tachycardia in the early post-acute phase of myocardial infarction. Optimal coronary revascularization was not effective, but radiofrequency catheter ablation was able to eliminate the anatomic substrate and clinical arrhythmic recurrence.

Research paper thumbnail of 249 Cardiac resynchronization therapy in patients with atrial fibrillation — a meta-analysis

European Journal of Heart Failure Supplements, 2006

Research paper thumbnail of 5.7 Prevention of early af relapses after electrical cardioversion with bisoprolol

Europace, 2003

INR value achived between 2,5-3,5). We evaluated the results in relation to age, duration of AF, ... more INR value achived between 2,5-3,5). We evaluated the results in relation to age, duration of AF, size of left atrial, left ventricular ejection fraction, and Joules delivered. Results: conversion to sinus rhythm occured in 82 pts (87%) with a mean 2,2±1,7 shocks and effective Joules of 180±92. With initial Joules of 50 success was achieved in 28/94 pts. Of 66 pts receiving cumulative energy 150 Joules, CV was successful in 27/66, of 39 pts receiving cumulative energy 350 Joules, CV was successful in 27/39. The success rates were 30% for the 50 J, 41% for 150 J, and 69% for 350 J. By logistic regression, predictor of success of low-energy shock (50 J) was shorter duration of AF (r=0,51; p<0,01). There were no differences in results related to age, left atrial size and left ventricular ejection fraction. Conclusions: 1. The biphasic shocks for external CV of AF are effective and safe procedure. 2. The energy of 350 J is significantly more effective than 50, and 150 J, and should be considered for CV as the initial energy in pts with longer AF duration. 3. Pts with shorter duration of AF have a higher probability for successful CV with low energy.

Research paper thumbnail of Abstract 5101: ACS in Patients With and Without Spontaneous Dissections of Coronary Arteries: The Discovery Study

Research paper thumbnail of Efficacy and safety of curative catheter ablation for atrial fibrillation

International Journal of Medicine and Medical Sciences, Aug 30, 2009

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Its treatment is sti... more Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Its treatment is still widely debated due to the large variety of therapeutic options. Radiofrequency catheter ablation (RFCA) around pulmonary vein ostia and in left atrium has been proposed as a curative technique to treat AF and is now performed with increasing success worldwide. However, few randomised controlled trials (RCTs) are available. Some of these have been recently published and not yet included in metaanalyses. To address the efficacy and safety of RFCA for curative treatment of AF, we perform a systematic review, in order to provide a more precise estimate of post-procedural atrial tachyarrhythmias (ATs) recurrence, adverse effects and complications. Using electronic databases, we searched for RCTs comparing RFCA with anti-arrhythmic drugs for the management of AF. The efficacy end-point was freedom from ATs (including atrial fibrillation, atrial flutter and atrial tachycardia), following the procedure. The safety end-point was the rate complications and adverse events. The results are reported as relative risk (RR) and 95% confidence interval (CI), calculated using the RevMan software (The Cochrane Collaboration, Copenhagen, 2008). A total of 8 RCTs were identified, including 844 patients. Overall, 98 (23.2%) of 421 patients in the treatment group and 324 (76.6%) of 423 patients in the control group had ATs recurrence. Catheter ablation decreased ATs recurrence by 71% (RR = 0.29, 95% CI 0.20 to 0.41, p<0.00001, with random effects model). Fewer complications and adverse events were reported in the ablation group compared with the control group (RR = 0.72, 95% CI 0.40 to 1.30, p=0.28, with random effects model). In selected patients with AF, RFCA is a relatively efficacious and safe procedure for the curative treatment of AF. Even though the results of this systematic review favoUr ablation therapy, large, well-designed, multicenter RCTs are needed to confirm the efficacy and safety of RFCA for AF.

Research paper thumbnail of Efficacy and safety of curative catheter ablation for atrial fibrillation

International Journal of Medicine and Medical Sciences, Aug 30, 2009

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Its treatment is sti... more Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Its treatment is still widely debated due to the large variety of therapeutic options. Radiofrequency catheter ablation (RFCA) around pulmonary vein ostia and in left atrium has been proposed as a curative technique to treat AF and is now performed with increasing success worldwide. However, few randomised controlled trials (RCTs) are available. Some of these have been recently published and not yet included in metaanalyses. To address the efficacy and safety of RFCA for curative treatment of AF, we perform a systematic review, in order to provide a more precise estimate of post-procedural atrial tachyarrhythmias (ATs) recurrence, adverse effects and complications. Using electronic databases, we searched for RCTs comparing RFCA with anti-arrhythmic drugs for the management of AF. The efficacy end-point was freedom from ATs (including atrial fibrillation, atrial flutter and atrial tachycardia), following the procedure. The safety end-point was the rate complications and adverse events. The results are reported as relative risk (RR) and 95% confidence interval (CI), calculated using the RevMan software (The Cochrane Collaboration, Copenhagen, 2008). A total of 8 RCTs were identified, including 844 patients. Overall, 98 (23.2%) of 421 patients in the treatment group and 324 (76.6%) of 423 patients in the control group had ATs recurrence. Catheter ablation decreased ATs recurrence by 71% (RR = 0.29, 95% CI 0.20 to 0.41, p<0.00001, with random effects model). Fewer complications and adverse events were reported in the ablation group compared with the control group (RR = 0.72, 95% CI 0.40 to 1.30, p=0.28, with random effects model). In selected patients with AF, RFCA is a relatively efficacious and safe procedure for the curative treatment of AF. Even though the results of this systematic review favoUr ablation therapy, large, well-designed, multicenter RCTs are needed to confirm the efficacy and safety of RFCA for AF.

Research paper thumbnail of Updated meta-analysis on implantable cardioverter defibrillator detection programmingto reduce mortality

Objective: The purpose of this study was to perform a meta-analysis to better gauge the impact of... more Objective: The purpose of this study was to perform a meta-analysis to better gauge the impact of prolonged arrhythmia detection times or high arrhythmia detection rates on ICD shock therapy and other adverse outcomes. Background: Programming long arrhythmia detection time or high arrhythmia detection rate reduce the incidence of implantable cardioverter defibrillator (ICD) shock therapy. However, potential concerns exist regarding the impact on mortality and incidence of syncope. Methods: PUBMED database was systematically searched. We included only randomized, prospective studies that examined the impact of programming longer vs shorter ICD arrhythmia detection times or higher vs lower ICD arrhythmia detection rates on clinical outcomes. Summary estimates of the relative risk (RR) of death, syncope, and total, appropriate and inappropriate shocks were calculated using random effects model. Results: Six studies enrolling 6,543 patients were identified. During a mean/median follow-u...

Research paper thumbnail of Updated meta-analysis on implantable cardioverter defibrillator detection programmingto reduce mortality

Objective: The purpose of this study was to perform a meta-analysis to better gauge the impact of... more Objective: The purpose of this study was to perform a meta-analysis to better gauge the impact of prolonged arrhythmia detection times or high arrhythmia detection rates on ICD shock therapy and other adverse outcomes. Background: Programming long arrhythmia detection time or high arrhythmia detection rate reduce the incidence of implantable cardioverter defibrillator (ICD) shock therapy. However, potential concerns exist regarding the impact on mortality and incidence of syncope. Methods: PUBMED database was systematically searched. We included only randomized, prospective studies that examined the impact of programming longer vs shorter ICD arrhythmia detection times or higher vs lower ICD arrhythmia detection rates on clinical outcomes. Summary estimates of the relative risk (RR) of death, syncope, and total, appropriate and inappropriate shocks were calculated using random effects model. Results: Six studies enrolling 6,543 patients were identified. During a mean/median follow-u...

Research paper thumbnail of Network meta-analysis on patent foramen ovale: is a stroke or atrial fibrillation worse?

Neurological Sciences, 2020

Objective Systematic reviews suggest that patent foramen ovale closure (PFOc) is performed percut... more Objective Systematic reviews suggest that patent foramen ovale closure (PFOc) is performed percutaneously with low complication rates. We did a network meta-analysis (NMA) comparing devices for PFO closures, evaluating safety and efficacy of transcatheter PFOc in preventing neurological events in patients with stroke when compared with medical therapy (MT), and assessing risk of atrial fibrillation (AF). Methods We searched 3 databases (MEDLINE, EMBASE, CENTRAL/CCTR) identifying six randomized controlled trials from 2012 until December 2019. We performed a Bayesian NMA; number-needed-to-treat and number-needed-to-harm were derived by applying the estimated odds ratios (ORs). The likelihood of being helped or harmed (LHH) was evaluated to estimate the risk-effectiveness balance. Results The 3560 patients allocated to PFOc were less subject to a stroke than patients with MT. The overall ORs of PFOc versus MT were 0.41 with fixed-effects, and 0.22 with random-effects model. NMA proves ...