Francesco Giardinelli - Academia.edu (original) (raw)
Papers by Francesco Giardinelli
European Heart Journal Supplements, May 1, 2022
Methods: Single-center retrospective observational study, on all geriatric patients (> 75) who en... more Methods: Single-center retrospective observational study, on all geriatric patients (> 75) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2015 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and Anni), and for the presentation of the risk of mortality at 30 days (sPESI). We analyzed all the blood chemistry and blood gas tests performed upon access to the emergency room. We then had all chest CTs retested by an experienced radiologist. We also analyzed vital parameters and the various shock indexes from these derivatives. We then analyzed whether patients had massive pulmonary embolism or the presence of organ damage (right ventricular dilation, pulmonary artery dilation and presence of pulmonary infarction). Results: We enrolled 247 patients, all in need of hospitalization for acute pulmonary embolism. The average age of 83 with female prevalence (62%). High values of D-Dimer show a strong correlation with the presence of massive pulmonary embolism (p < 0.001) and a correlation, albeit to a lesser degree, with the presence of organ damage (p < 0.01). D-Dimer values show a strong correlation (p < 0.005) even with patients at high risk of short-term mortality (presenting right cardiac ventricular dilation and myocardiospecific enzyme elevation). However, the AUC of the ROC curve is not optimal (0.63; with specificity 63% and sensitivity 62%). They also showed a correlation with the need for hospitalization in the ICU (p < 0.01) and a slight correlation with the length of stay in resuscitation (rho ¼ 0.25; p ¼ 0.05) and hospital stay (rho ¼ 0.20; p < 0.01). Conclusions: D-Dimer values appear to be useful in the severity stratification of patients with pulmonary embolism.
Cardiologia Ambulatoriale, Jun 30, 2017
Surgical technology international, Oct 26, 2016
Transcatheter aortic valve implantation (TAVI) technique represents a real revolution in the fiel... more Transcatheter aortic valve implantation (TAVI) technique represents a real revolution in the field of interventional cardiology and medicine, in particular for the treatment of severe aortic valve stenosis in elderly patients or in patients when the periprocedural risk for the traditional surgical option is considered too high, as an alternative to the traditional aortic valve replacement. Although experience on the valves of the last generation is still limited in terms of time, the data currently available are definitely moving in the direction of a minimum hospital mortality (1%) as well as a drastic reduction in the incidence of complications when compared to the devices of the previous generation. Finally, the evolution of specified materials of the newest generation have greatly enhanced safety and efficacy of TAVI procedures in the last years. In order to ensure the selection of the most appropriate valve and the success of the procedure, the role of cardiac imaging (computed...
European Heart Journal, Aug 1, 2017
Hypertension and basic science / Vascular function as a target of cardiovascular therapy? 559 dur... more Hypertension and basic science / Vascular function as a target of cardiovascular therapy? 559 during OSA). For this pilot study, 10 consecutive patients with RH and history of snoring were enrolled (9 men, mean age 63.8±5.9 years). All patients underwent overnight PSG, electrocardiography and transthoracic echocardiography. Peripheral blood sampling was performed in the morning after the PSG. Total RNA was isolated using RNeasy Mini Kit (QIAGEN). Reverse transcription and real-time polymerase chain reaction were performed using TaqMan ® reagents. Statistical analysis was performed using STATISTICA12 software and Mann-Whitney test. Results: OSA was confirmed in 8 patients. Higher relative levels of miR-210 (OSA vs. non-OSA; 12.97±0.48 vs. 11.27±0.41; p=0.045) and miR-126 (OSA vs. non-OSA; 6.73±0.37 vs. 5.51±0.49; p=0.045) were observed in OSA patients; miR-499 levels did not differ significantly between groups (see Figure-Relative microRNAs expression). Figure 1. Relative microRNAs expression Conclusion: Relative levels of miR-210 and miR-126 are higher in patients with resistant hypertension and OSA compared to those without OSA. If the results are confirmed on the larger set of patients, microRNAs may potentially be used as novel blood-based biomarkers for OSA screening in patients with hypertension.
Journal of the American College of Cardiology, 2018
Dual antiplatelet therapy improves angiographic results of primary percutaneous coronary interven... more Dual antiplatelet therapy improves angiographic results of primary percutaneous coronary intervention (pPCI) in patients with STEMI. The new oral P2Y12 inhibitors (P2Y12-I) prasugrel and ticagrelor are the gold-standard drugs because of a faster and more intense effect when compared to clopidogrel.
Reviews on Recent Clinical Trials, 2019
Introduction:Ischemic heart diseases are the major leading cause of death worldwide. Revasculariz... more Introduction:Ischemic heart diseases are the major leading cause of death worldwide. Revascularization procedures dramatically reduced the overall risk for death related to acute coronary syndromes. Two kinds of myocardial revascularization can grossly be outlined: percutaneous coronary intervention (PCI) and surgical coronary artery bypass graft intervention (CABG). The net clinical benefit coming from these two kinds of procedures is still under debate.Methods:We have traced the state-of-the-art background about myocardial revascularization procedures by comparing the most important trials dealing with the evaluation of percutaneous interventions versus a surgical approach to coronary artery diseases.Results:Both PCI and CABG have become effective treatments for revascularization of patients suffering from advanced CAD. The advance in technology and procedural techniques made PCI an attractive and, to some extent, more reliable procedure in the context of CAD. However, there are s...
Journal of Cardiovascular Medicine, 2018
Aims In addition to the transfemoral route, common approaches for transcatheter aortic valve impl... more Aims In addition to the transfemoral route, common approaches for transcatheter aortic valve implantation (TAVI) are the transapical and transaortic ones. Yet, these are associated with morbidity. The transsubclavian approach (TSA) is an alternative to minimize invasiveness. Methods Fifteen consecutive patients underwent TAVI via TSA using the CoreValve Evolut R. The 14F delivery system without sheath was directly introduced into the artery. Results Success was 100%; contrast volume was 99.4 ± 29.58 ml. Patients were extubated after 1.66 ± 0.89 h. Hemoglobin drop was 0.64 ± 0.28 g/dl. There were no complications. Hospital stay was 4.53 ± 1.24 days: 11 patients were discharged home, the remainder to rehabilitation. Conclusion TSA is associated with limited morbidity, early patient mobilization, short hospitalization.
![Research paper thumbnail of [Acute aortic dissection during ineffective attempt of transcatheter implant of a fully resheathable, respositionable and retrievable aortic valve]](https://attachments.academia-assets.com/83559658/thumbnails/1.jpg)
](Giornale italiano di cardiologia (2006), Feb 1, 2017
Aortic injury is a rare but severe complication that may occur during transcatheter aortic valve ... more Aortic injury is a rare but severe complication that may occur during transcatheter aortic valve implantation (TAVI). Few patients with type A dissection are treated surgically because of the high rate of postoperative mortality and neurological complications in this high-risk population; thoracic endovascular aortic repair is rare too, and technically challenging because of the anatomical variations of spiral type A aortic dissection. Sometimes a watchful waiting strategy could be the best solution. We report the case of an acute, extended aortic type A dissection occurred during a TAVI procedure, probably due to the rupture of the dedicated sheath, and conservatively managed.
Heart and vessels, 2018
Takotsubo cardiomyopathy (TTC) is characterized by transient systolic ventricular dysfunction. It... more Takotsubo cardiomyopathy (TTC) is characterized by transient systolic ventricular dysfunction. It is supposed to be caused by a cathecolaminergic wave which leads to myocardial stunning through a massive action on beta2-adrenoreceptor. Moreover, beta2-receptor hyperactivity negatively influences endothelial function. It can be detected by brachial flow mediated dilation (b-FMD) which assesses endothelium regulated vasomotility. The study aim is to analyze the b-FMD variability during hospitalization in 50 patients admitted with TTC. In addition, we investigated a possible correlation between b-FMD at admission and both length of hospital stay (LOHS) and troponin I peak. We detected b-FMD by measuring the hypoxic induced vasoreactivity through assessing brachial artery dilation after 5 min of iatrogenic ischemia obtained by inflating a sphygmomanometer cuff. Artery diameter modifications were assessed by high-resolution ultrasound, and a dedicated software calculated accurately the p...
Surgical technology international, 2016
INTRODUCTION Transcatheter aortic valve implantation (TAVI) technique represents a real revolutio... more INTRODUCTION Transcatheter aortic valve implantation (TAVI) technique represents a real revolution in the field of interventional cardiology and medicine, in particular for the treatment of severe aortic valve stenosis in elderly patients or in patients when the periprocedural risk for the traditional surgical option is considered too high, as an alternative to the traditional aortic valve replacement. Although experience on the valves of the last generation is still limited in terms of time, the data currently available are definitely moving in the direction of a minimum hospital mortality (1%) as well as a drastic reduction in the incidence of complications when compared to the devices of the previous generation. Finally, the evolution of specified materials of the newest generation have greatly enhanced safety and efficacy of TAVI procedures in the last years. In order to ensure the selection of the most appropriate valve and the success of the procedure, the role of cardiac imag...
Cardiology Journal
A man aged 74 presented to the Emergency Room with ST-elevation in anterior leads (Fig. 1A, B). A... more A man aged 74 presented to the Emergency Room with ST-elevation in anterior leads (Fig. 1A, B). An urgent coronary angiography revealed the absence of significant coronary stenoses, but did reveal multiple coronary artery fistulas apparently draining into the pulmonary artery (Fig. 1C-F); at the level of left anterior descending (LAD) angio graphy showed a dilated proximal tract, and, downstream from the fistula, a reduced and intermittent flow. Coronary computed tomography angiography confirmed multiple and complex arteriovenous malformations. The patient underwent further invasive evaluations which included a pulmonary to systemic blood flow ratio (Qp/Qs) calculation, intravascular ultrasound scan (IVUS) and fractional flow reserve (FFR) on LAD evaluation. The right heart catheterization detected high pulmonary artery pressure (48/18 mmHg)
Giornale italiano di cardiologia (2006), Feb 1, 2017
Aortic injury is a rare but severe complication that may occur during transcatheter aortic valve ... more Aortic injury is a rare but severe complication that may occur during transcatheter aortic valve implantation (TAVI). Few patients with type A dissection are treated surgically because of the high rate of postoperative mortality and neurological complications in this high-risk population; thoracic endovascular aortic repair is rare too, and technically challenging because of the anatomical variations of spiral type A aortic dissection. Sometimes a watchful waiting strategy could be the best solution. We report the case of an acute, extended aortic type A dissection occurred during a TAVI procedure, probably due to the rupture of the dedicated sheath, and conservatively managed.
Current neurovascular research, Jan 6, 2016
According to the American Heart Association (AHA) , primitive dilated cardiomyopathy (PDCM) is a ... more According to the American Heart Association (AHA) , primitive dilated cardiomyopathy (PDCM) is a "progressive dilation of the left or both ventricles and a depressed contractility in absence of abnormal load conditions ". It evolves in progressive heart-failure. The term "cardiogenic dementia" expresses the intimate connection between heart diseases and cognitive functions. The association between PDCM and the neuropsychological functions is unclear: the main pathophysiological hypotheses are cerebral hypoperfusion and cardiogenic emboli. The aim of this study is to evaluate the impact that the PDCM has on neuropsychological decline and to detect early echocardiographic markers of cognitive impairment. We enrolled 235 patients: 168 suffering from PDCM as sample group and 67 suffering from hypertensive dilated cardiomyopathy (HTCM) as control group. They underwent a cardiology examination and a neuropsychological assessment . A p <0.05 was considered significan...
Coronary Artery Disease, 2015
In recent years, bioresorbable vascular scaffolds (BVS) have been introduced into clinical practi... more In recent years, bioresorbable vascular scaffolds (BVS) have been introduced into clinical practice. The main advantage of BVS is that they overcome the problem of the foreign body in the treated artery. BVS, once placed into narrowed coronary vessels, behave like a conventional drug-eluting stent, but a device that disappears over time can preserve the anatomy and physiology of the treated vessel. The progression of stenosis after stenting has been attributed, at least in part, to inflammation around metallic struts, that, however, disappears gradually when using BVS. BVS have proven to be effective and safe as drug-eluting stents; in fact, the rate of adverse cardiovascular events and scaffold thrombosis in patients is low. The aim of this review article is to provide a comprehensive and updated description of the status of the art on BVS, highlighting the current evidence and future perspectives of this technology.
International Journal of Medical and Pharmaceutical Case Reports, 2015
International Journal of Medical and Pharmaceutical Case Reports, 2015
European Heart Journal Supplements, May 1, 2022
Methods: Single-center retrospective observational study, on all geriatric patients (> 75) who en... more Methods: Single-center retrospective observational study, on all geriatric patients (> 75) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2015 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and Anni), and for the presentation of the risk of mortality at 30 days (sPESI). We analyzed all the blood chemistry and blood gas tests performed upon access to the emergency room. We then had all chest CTs retested by an experienced radiologist. We also analyzed vital parameters and the various shock indexes from these derivatives. We then analyzed whether patients had massive pulmonary embolism or the presence of organ damage (right ventricular dilation, pulmonary artery dilation and presence of pulmonary infarction). Results: We enrolled 247 patients, all in need of hospitalization for acute pulmonary embolism. The average age of 83 with female prevalence (62%). High values of D-Dimer show a strong correlation with the presence of massive pulmonary embolism (p < 0.001) and a correlation, albeit to a lesser degree, with the presence of organ damage (p < 0.01). D-Dimer values show a strong correlation (p < 0.005) even with patients at high risk of short-term mortality (presenting right cardiac ventricular dilation and myocardiospecific enzyme elevation). However, the AUC of the ROC curve is not optimal (0.63; with specificity 63% and sensitivity 62%). They also showed a correlation with the need for hospitalization in the ICU (p < 0.01) and a slight correlation with the length of stay in resuscitation (rho ¼ 0.25; p ¼ 0.05) and hospital stay (rho ¼ 0.20; p < 0.01). Conclusions: D-Dimer values appear to be useful in the severity stratification of patients with pulmonary embolism.
Cardiologia Ambulatoriale, Jun 30, 2017
Surgical technology international, Oct 26, 2016
Transcatheter aortic valve implantation (TAVI) technique represents a real revolution in the fiel... more Transcatheter aortic valve implantation (TAVI) technique represents a real revolution in the field of interventional cardiology and medicine, in particular for the treatment of severe aortic valve stenosis in elderly patients or in patients when the periprocedural risk for the traditional surgical option is considered too high, as an alternative to the traditional aortic valve replacement. Although experience on the valves of the last generation is still limited in terms of time, the data currently available are definitely moving in the direction of a minimum hospital mortality (1%) as well as a drastic reduction in the incidence of complications when compared to the devices of the previous generation. Finally, the evolution of specified materials of the newest generation have greatly enhanced safety and efficacy of TAVI procedures in the last years. In order to ensure the selection of the most appropriate valve and the success of the procedure, the role of cardiac imaging (computed...
European Heart Journal, Aug 1, 2017
Hypertension and basic science / Vascular function as a target of cardiovascular therapy? 559 dur... more Hypertension and basic science / Vascular function as a target of cardiovascular therapy? 559 during OSA). For this pilot study, 10 consecutive patients with RH and history of snoring were enrolled (9 men, mean age 63.8±5.9 years). All patients underwent overnight PSG, electrocardiography and transthoracic echocardiography. Peripheral blood sampling was performed in the morning after the PSG. Total RNA was isolated using RNeasy Mini Kit (QIAGEN). Reverse transcription and real-time polymerase chain reaction were performed using TaqMan ® reagents. Statistical analysis was performed using STATISTICA12 software and Mann-Whitney test. Results: OSA was confirmed in 8 patients. Higher relative levels of miR-210 (OSA vs. non-OSA; 12.97±0.48 vs. 11.27±0.41; p=0.045) and miR-126 (OSA vs. non-OSA; 6.73±0.37 vs. 5.51±0.49; p=0.045) were observed in OSA patients; miR-499 levels did not differ significantly between groups (see Figure-Relative microRNAs expression). Figure 1. Relative microRNAs expression Conclusion: Relative levels of miR-210 and miR-126 are higher in patients with resistant hypertension and OSA compared to those without OSA. If the results are confirmed on the larger set of patients, microRNAs may potentially be used as novel blood-based biomarkers for OSA screening in patients with hypertension.
Journal of the American College of Cardiology, 2018
Dual antiplatelet therapy improves angiographic results of primary percutaneous coronary interven... more Dual antiplatelet therapy improves angiographic results of primary percutaneous coronary intervention (pPCI) in patients with STEMI. The new oral P2Y12 inhibitors (P2Y12-I) prasugrel and ticagrelor are the gold-standard drugs because of a faster and more intense effect when compared to clopidogrel.
Reviews on Recent Clinical Trials, 2019
Introduction:Ischemic heart diseases are the major leading cause of death worldwide. Revasculariz... more Introduction:Ischemic heart diseases are the major leading cause of death worldwide. Revascularization procedures dramatically reduced the overall risk for death related to acute coronary syndromes. Two kinds of myocardial revascularization can grossly be outlined: percutaneous coronary intervention (PCI) and surgical coronary artery bypass graft intervention (CABG). The net clinical benefit coming from these two kinds of procedures is still under debate.Methods:We have traced the state-of-the-art background about myocardial revascularization procedures by comparing the most important trials dealing with the evaluation of percutaneous interventions versus a surgical approach to coronary artery diseases.Results:Both PCI and CABG have become effective treatments for revascularization of patients suffering from advanced CAD. The advance in technology and procedural techniques made PCI an attractive and, to some extent, more reliable procedure in the context of CAD. However, there are s...
Journal of Cardiovascular Medicine, 2018
Aims In addition to the transfemoral route, common approaches for transcatheter aortic valve impl... more Aims In addition to the transfemoral route, common approaches for transcatheter aortic valve implantation (TAVI) are the transapical and transaortic ones. Yet, these are associated with morbidity. The transsubclavian approach (TSA) is an alternative to minimize invasiveness. Methods Fifteen consecutive patients underwent TAVI via TSA using the CoreValve Evolut R. The 14F delivery system without sheath was directly introduced into the artery. Results Success was 100%; contrast volume was 99.4 ± 29.58 ml. Patients were extubated after 1.66 ± 0.89 h. Hemoglobin drop was 0.64 ± 0.28 g/dl. There were no complications. Hospital stay was 4.53 ± 1.24 days: 11 patients were discharged home, the remainder to rehabilitation. Conclusion TSA is associated with limited morbidity, early patient mobilization, short hospitalization.
Giornale italiano di cardiologia (2006), Feb 1, 2017
Aortic injury is a rare but severe complication that may occur during transcatheter aortic valve ... more Aortic injury is a rare but severe complication that may occur during transcatheter aortic valve implantation (TAVI). Few patients with type A dissection are treated surgically because of the high rate of postoperative mortality and neurological complications in this high-risk population; thoracic endovascular aortic repair is rare too, and technically challenging because of the anatomical variations of spiral type A aortic dissection. Sometimes a watchful waiting strategy could be the best solution. We report the case of an acute, extended aortic type A dissection occurred during a TAVI procedure, probably due to the rupture of the dedicated sheath, and conservatively managed.
Heart and vessels, 2018
Takotsubo cardiomyopathy (TTC) is characterized by transient systolic ventricular dysfunction. It... more Takotsubo cardiomyopathy (TTC) is characterized by transient systolic ventricular dysfunction. It is supposed to be caused by a cathecolaminergic wave which leads to myocardial stunning through a massive action on beta2-adrenoreceptor. Moreover, beta2-receptor hyperactivity negatively influences endothelial function. It can be detected by brachial flow mediated dilation (b-FMD) which assesses endothelium regulated vasomotility. The study aim is to analyze the b-FMD variability during hospitalization in 50 patients admitted with TTC. In addition, we investigated a possible correlation between b-FMD at admission and both length of hospital stay (LOHS) and troponin I peak. We detected b-FMD by measuring the hypoxic induced vasoreactivity through assessing brachial artery dilation after 5 min of iatrogenic ischemia obtained by inflating a sphygmomanometer cuff. Artery diameter modifications were assessed by high-resolution ultrasound, and a dedicated software calculated accurately the p...
Surgical technology international, 2016
INTRODUCTION Transcatheter aortic valve implantation (TAVI) technique represents a real revolutio... more INTRODUCTION Transcatheter aortic valve implantation (TAVI) technique represents a real revolution in the field of interventional cardiology and medicine, in particular for the treatment of severe aortic valve stenosis in elderly patients or in patients when the periprocedural risk for the traditional surgical option is considered too high, as an alternative to the traditional aortic valve replacement. Although experience on the valves of the last generation is still limited in terms of time, the data currently available are definitely moving in the direction of a minimum hospital mortality (1%) as well as a drastic reduction in the incidence of complications when compared to the devices of the previous generation. Finally, the evolution of specified materials of the newest generation have greatly enhanced safety and efficacy of TAVI procedures in the last years. In order to ensure the selection of the most appropriate valve and the success of the procedure, the role of cardiac imag...
Cardiology Journal
A man aged 74 presented to the Emergency Room with ST-elevation in anterior leads (Fig. 1A, B). A... more A man aged 74 presented to the Emergency Room with ST-elevation in anterior leads (Fig. 1A, B). An urgent coronary angiography revealed the absence of significant coronary stenoses, but did reveal multiple coronary artery fistulas apparently draining into the pulmonary artery (Fig. 1C-F); at the level of left anterior descending (LAD) angio graphy showed a dilated proximal tract, and, downstream from the fistula, a reduced and intermittent flow. Coronary computed tomography angiography confirmed multiple and complex arteriovenous malformations. The patient underwent further invasive evaluations which included a pulmonary to systemic blood flow ratio (Qp/Qs) calculation, intravascular ultrasound scan (IVUS) and fractional flow reserve (FFR) on LAD evaluation. The right heart catheterization detected high pulmonary artery pressure (48/18 mmHg)
Giornale italiano di cardiologia (2006), Feb 1, 2017
Aortic injury is a rare but severe complication that may occur during transcatheter aortic valve ... more Aortic injury is a rare but severe complication that may occur during transcatheter aortic valve implantation (TAVI). Few patients with type A dissection are treated surgically because of the high rate of postoperative mortality and neurological complications in this high-risk population; thoracic endovascular aortic repair is rare too, and technically challenging because of the anatomical variations of spiral type A aortic dissection. Sometimes a watchful waiting strategy could be the best solution. We report the case of an acute, extended aortic type A dissection occurred during a TAVI procedure, probably due to the rupture of the dedicated sheath, and conservatively managed.
Current neurovascular research, Jan 6, 2016
According to the American Heart Association (AHA) , primitive dilated cardiomyopathy (PDCM) is a ... more According to the American Heart Association (AHA) , primitive dilated cardiomyopathy (PDCM) is a "progressive dilation of the left or both ventricles and a depressed contractility in absence of abnormal load conditions ". It evolves in progressive heart-failure. The term "cardiogenic dementia" expresses the intimate connection between heart diseases and cognitive functions. The association between PDCM and the neuropsychological functions is unclear: the main pathophysiological hypotheses are cerebral hypoperfusion and cardiogenic emboli. The aim of this study is to evaluate the impact that the PDCM has on neuropsychological decline and to detect early echocardiographic markers of cognitive impairment. We enrolled 235 patients: 168 suffering from PDCM as sample group and 67 suffering from hypertensive dilated cardiomyopathy (HTCM) as control group. They underwent a cardiology examination and a neuropsychological assessment . A p <0.05 was considered significan...
Coronary Artery Disease, 2015
In recent years, bioresorbable vascular scaffolds (BVS) have been introduced into clinical practi... more In recent years, bioresorbable vascular scaffolds (BVS) have been introduced into clinical practice. The main advantage of BVS is that they overcome the problem of the foreign body in the treated artery. BVS, once placed into narrowed coronary vessels, behave like a conventional drug-eluting stent, but a device that disappears over time can preserve the anatomy and physiology of the treated vessel. The progression of stenosis after stenting has been attributed, at least in part, to inflammation around metallic struts, that, however, disappears gradually when using BVS. BVS have proven to be effective and safe as drug-eluting stents; in fact, the rate of adverse cardiovascular events and scaffold thrombosis in patients is low. The aim of this review article is to provide a comprehensive and updated description of the status of the art on BVS, highlighting the current evidence and future perspectives of this technology.
International Journal of Medical and Pharmaceutical Case Reports, 2015
International Journal of Medical and Pharmaceutical Case Reports, 2015