Giovanni Perego - Academia.edu (original) (raw)
Papers by Giovanni Perego
International Journal of Cardiology, 2017
Subcutaneous ICD (S-ICD) is a promising option for Hypertrophic Cardiomyopathy (HCM) patients at ... more Subcutaneous ICD (S-ICD) is a promising option for Hypertrophic Cardiomyopathy (HCM) patients at risk of Sudden Cardiac Death (SCD). However, its effectiveness in terminating ventricular arrhythmias in HCM is yet unresolved. Consecutive HCM patients referred for S-ICD implantation were prospectively enrolled. Patients underwent one or two attempts of VF induction by the programmer. Successful conversion was defined as any 65J shock that terminated VF (not requiring rescue shocks). Clinical and instrumental parameters were analyzed to study predictors of conversion failure. Fifty HCM patients (34 males, 40±16years) with a mean BMI of 25.2±4.4kg/m2 were evaluated. Mean ESC SCD risk of was 6.5±3.9% and maximal LV wall thickness (LVMWT) was 26±6mm. In 2/50 patients no arrhythmias were inducible, while in 7 (14%) only sustained ventricular tachycardia was induced and cardioverted. In the remaining 41 (82%) patients, 73 VF episodes were induced (1 episode in 14 and >1 in 27 patients). Of these, 4 (6%) spontaneously converted. In 68/69 (98%) the S-ICD successfully cardioverted, but failed in 1 (2%) patient, who needed rescue defibrillation. This patient was severely obese (BMI 36) and LVMWT of 25mm. VF was re-induced and successfully converted by the 80J reversed polarity S-ICD. Acute DT at 65J at the implant showed the effectiveness of S-ICD in the recognition and termination of VT/VF in all HCM patients except one. Extreme LVH did not affect the performance of the device, whereas severe obesity was likely responsible for the single 65J failure.
Journal of telemedicine and telecare, Jan 20, 2016
The Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in pat... more The Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure (PARTNERS HF) trial elaborated a multiparametric model for prediction of acute decompensation in advanced heart failure patients, based on periodical in office data download from cardiac resynchronisation devices. In this study, we evaluated the ability of the PARTNERS HF criteria to detect initial decompensation in a population of moderate heart failure patients under remote monitoring. We retrospectively applied the PARTNERS HF criteria to 1860 transmissions from 104 patients (median follow up 21 months; range 1-67 months), who were enrolled in our programme of telemedicine after cardiac resynchronisation therapy. We tested the ability of a score based on these criteria to predict any acute clinical decompensation occurring in the 15 days following a transmission. In 441 cases, acute heart failure was diagnosed after the index transmission. The area under the c...
Italian Heart Journal Official Journal of the Italian Federation of Cardiology, Aug 1, 2005
Background. Ventricular resynchronization is a non-pharmacological treatment for advanced heart f... more Background. Ventricular resynchronization is a non-pharmacological treatment for advanced heart failure refractory to drug therapy and with intraventricular conduction delay. We describe the time course of echocardiographic and functional recovery after resynchronization in 31 patients (mean age 67 ± 8 years). Methods. We evaluated NYHA class, echocardiogram, respiratory function, and cardiopulmonary test before pacemaker implantation (baseline), after 1-3 months (short-term evaluation), and 10-15 months afterwards (long-term evaluation, n = 21 patients). Mortality at 1 year was considered. Results. Both at short and long term, patients improved NYHA class, ventricular function, and ventricular volumes. Already at short term, we observed an increase in oxygen consumption at peak exercise (12.6 ± 0.6 vs 10.5 ± 0.5 ml/kg/min), oxygen consumption at anaerobic threshold (9.8 ± 0.6 vs 8.3 ± 0.6 ml/kg/min) and oxygen pulse (8.3 ± 0.5 vs 7.5 ± 0.5 ml/beat). Ventilatory efficacy (VE/VCO 2 slope) and alveolo-capillary diffusion (estimated by the measurement of lung diffusion capacity for carbon monoxide-DLCO) improved only at long term (VE/VCO 2 : 40.7 ± 1.6 vs 45.3 ± 1.8; DLCO: 70.3 ± 2.7 vs 59.4 ± 5.9% of predicted, p = 0.05). The 1-year mortality was 9.7%. Conclusions. Ventricular resynchronization is linked to a fast and prolonged recovery of NYHA class, echocardiographic variables and stress tolerance. The improvement of indexes known to carry a prognostic value confirms that ventricular resynchronization can positively interfere with the evolution of the disease.
European Journal of Heart Failure, 2016
Mitral regurgitation (MR) is a common finding in patients with heart failure with debatable effec... more Mitral regurgitation (MR) is a common finding in patients with heart failure with debatable effects on prognosis. Reduction in MR is one of the mechanisms by which cardiac resynchronization therapy (CRT) exerts its beneficial effects. We investigated the prognostic impact of baseline MR and MR persistence after CRT on outcomes of treated patients.
Journal of Cardiovascular Pharmacology, 2003
The authors performed two studies on the effects of carvedilol on autonomic tone and responsivene... more The authors performed two studies on the effects of carvedilol on autonomic tone and responsiveness in patients with heart failure. In study 1, the autonomic responses of 25 patients (age, 60 years+/-2; New York Heart Association [NYHA] class, 2.6+/-0.5; pVO2, 16.6 mL/Kg/min+/-1.1) treated with angiotensin-converting enzyme inhibitors, diuretics, and carvedilol (38.0 mg/d+/-2.5) were compared to those of 25 patients of similar age, therapy, NYHA class, and pVO2 in whom carvedilol was not yet administered. In study 2, autonomic tone and responsiveness were studied in 20 patients (age, 57 years+/-9; NYHA class, 2.5+/-0.2; pVO2, 15.6 mL/Kg/min+/-3.4), before and 6 months after additional carvedilol treatment (40.0 mg/d+/-12.5). Autonomic evaluation was performed with autoregressive power spectral analysis of RR variability during 10 minutes of supine rest (control), breathing 20 times per minute (vagal stimulus), and standing (sympathetic activation). The ratio between low-frequency (LF) and high-frequency (HF) components of the autospectra indicated the sympathovagal interaction. In study 1, spectral analysis in controls showed sympathetic hyperactivity which was blunted in patients receiving carvedilol (LF/HF ratio: 10.4+/-1.4 vs. 7.0+/-1.1; P<0.05) who responded to vagal and adrenergic stimuli (LF/HF, -35% with regular breathing and 72% standing). In study 2, left ventricular function, volumes, and exercise performance improved with carvedilol (EF, 31%; EDLV volume, -22%; pVO2, 11%; P<0.05). Sympathetic hyperactivity in control was reduced (LF/HF ratio, 4.9+/-0.8 from 7.9+/-1.3; P<0.05), whereas a response to vagal and adrenergic activation on breathing and standing reemerged (LF/HF ratio, -31% during regular breathing and 88% on standing). Therefore, combined autonomic and hemodynamic effects may determine the favorable effects of beta-blockers in heart failure.
Pacing and Clinical Electrophysiology, Sep 1, 2007
European Journal of Heart Failure Supplements, 2008
European Journal of Heart Failure Supplements, 2007
The Modelflow method (MM) requires the recording of the aortic pressure signal, to compute cardia... more The Modelflow method (MM) requires the recording of the aortic pressure signal, to compute cardiac output (CO) by simulating a non-linear three-element model of aortic input impedance. We propose an extended MM to be applied to the intraventricular pressure signal, to obtain an independent estimation of CO in the setting of conductance measurements. Hemodynamic tests were performed in 21 patients
European Journal of Heart Failure Supplements, 2007
Giornale italiano di cardiologia (2006), 2014
Giornale italiano di cardiologia (2006), 2011
European Journal of Heart Failure Supplements, 2007
European Journal of Heart Failure Supplements, 2007
Acta Crystallographica Section B Structural Crystallography and Crystal Chemistry, 1975
Pharmacological Research, 1995
In vitro and in vivo studies have shown both an inhibition and an activation of platelets after t... more In vitro and in vivo studies have shown both an inhibition and an activation of platelets after thrombolysis in acute myocardial infarction. Plasma beta-thromboglobulin, a marker of platelet activity, was evaluated daily during the first week after myocardial infarction in 24 patients who received intravenous streptokinase (group 1) and 26 who did not (group 2). On admission, levels of beta-thromboglobulin, as compared to those in healthy subjects (35 +/- 9 IU/ml), were similarly augmented in group 1 (105 +/- 27 IU/ml) and in group 2 (115 +/- 30 IU/ml); 3 hours later, values averaged 191 +/- 58 IU/ml in group 1 (p < 0.001 vs baseline) and 95 +/- 28 IU/ml in group 2 (not significant vs baseline; p < 0.001 between the two groups). From the second to the seventh day, beta-thromboglobulin augmented in those patients in both groups with postinfarction angina. From day 5 to day 7, patients of group 1 without angina had lower beta-thromboglobulin levels than patients of group 2 who had no symptoms. The lowest levels of platelet activity were observed in group 1 reperfused patients. These data indicate that in myocardial infarction an early platelet activation takes place that is enhanced by thrombolytic treatment; recurrence of angina is associated with persistent activation; in the absence of recurrent angina, thrombolysis can limit late platelet activation.
Journal of Medical Internet Research, 2013
Background: Heart failure patients with implantable defibrillators place a significant burden on ... more Background: Heart failure patients with implantable defibrillators place a significant burden on health care systems. Remote monitoring allows assessment of device function and heart failure parameters, and may represent a safe, effective, and cost-saving method compared to conventional in-office follow-up. Objective: We hypothesized that remote device monitoring represents a cost-effective approach. This paper summarizes the economic evaluation of the Evolution of Management Strategies of Heart Failure Patients With Implantable Defibrillators (EVOLVO) study, a multicenter clinical trial aimed at measuring the benefits of remote monitoring for heart failure patients with implantable defibrillators. Methods: Two hundred patients implanted with a wireless transmission-enabled implantable defibrillator were randomized to receive either remote monitoring or the conventional method of in-person evaluations. Patients were followed for 16 months with a protocol of scheduled in-office and remote follow-ups. The economic evaluation of the intervention was conducted from the perspectives of the health care system and the patient. A cost-utility analysis was performed to measure whether the intervention was cost-effective in terms of cost per quality-adjusted life year (QALY) gained. Results: Overall, remote monitoring did not show significant annual cost savings for the health care system (€1962.78 versus €2130.01; P=.80). There was a significant reduction of the annual cost for the patients in the remote arm in comparison to the standard arm (€291.36 versus €381.34; P=.01). Cost-utility analysis was performed for 180 patients for whom QALYs were available. The patients in the remote arm gained 0.065 QALYs more than those in the standard arm over 16 months, with a cost savings of €888.10 per patient. Results from the cost-utility analysis of the EVOLVO study show that remote monitoring is a cost-effective and dominant solution.
Journal of Clinical Monitoring and Computing, 2007
International Journal of Cardiology, 2017
Subcutaneous ICD (S-ICD) is a promising option for Hypertrophic Cardiomyopathy (HCM) patients at ... more Subcutaneous ICD (S-ICD) is a promising option for Hypertrophic Cardiomyopathy (HCM) patients at risk of Sudden Cardiac Death (SCD). However, its effectiveness in terminating ventricular arrhythmias in HCM is yet unresolved. Consecutive HCM patients referred for S-ICD implantation were prospectively enrolled. Patients underwent one or two attempts of VF induction by the programmer. Successful conversion was defined as any 65J shock that terminated VF (not requiring rescue shocks). Clinical and instrumental parameters were analyzed to study predictors of conversion failure. Fifty HCM patients (34 males, 40±16years) with a mean BMI of 25.2±4.4kg/m2 were evaluated. Mean ESC SCD risk of was 6.5±3.9% and maximal LV wall thickness (LVMWT) was 26±6mm. In 2/50 patients no arrhythmias were inducible, while in 7 (14%) only sustained ventricular tachycardia was induced and cardioverted. In the remaining 41 (82%) patients, 73 VF episodes were induced (1 episode in 14 and >1 in 27 patients). Of these, 4 (6%) spontaneously converted. In 68/69 (98%) the S-ICD successfully cardioverted, but failed in 1 (2%) patient, who needed rescue defibrillation. This patient was severely obese (BMI 36) and LVMWT of 25mm. VF was re-induced and successfully converted by the 80J reversed polarity S-ICD. Acute DT at 65J at the implant showed the effectiveness of S-ICD in the recognition and termination of VT/VF in all HCM patients except one. Extreme LVH did not affect the performance of the device, whereas severe obesity was likely responsible for the single 65J failure.
Journal of telemedicine and telecare, Jan 20, 2016
The Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in pat... more The Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure (PARTNERS HF) trial elaborated a multiparametric model for prediction of acute decompensation in advanced heart failure patients, based on periodical in office data download from cardiac resynchronisation devices. In this study, we evaluated the ability of the PARTNERS HF criteria to detect initial decompensation in a population of moderate heart failure patients under remote monitoring. We retrospectively applied the PARTNERS HF criteria to 1860 transmissions from 104 patients (median follow up 21 months; range 1-67 months), who were enrolled in our programme of telemedicine after cardiac resynchronisation therapy. We tested the ability of a score based on these criteria to predict any acute clinical decompensation occurring in the 15 days following a transmission. In 441 cases, acute heart failure was diagnosed after the index transmission. The area under the c...
Italian Heart Journal Official Journal of the Italian Federation of Cardiology, Aug 1, 2005
Background. Ventricular resynchronization is a non-pharmacological treatment for advanced heart f... more Background. Ventricular resynchronization is a non-pharmacological treatment for advanced heart failure refractory to drug therapy and with intraventricular conduction delay. We describe the time course of echocardiographic and functional recovery after resynchronization in 31 patients (mean age 67 ± 8 years). Methods. We evaluated NYHA class, echocardiogram, respiratory function, and cardiopulmonary test before pacemaker implantation (baseline), after 1-3 months (short-term evaluation), and 10-15 months afterwards (long-term evaluation, n = 21 patients). Mortality at 1 year was considered. Results. Both at short and long term, patients improved NYHA class, ventricular function, and ventricular volumes. Already at short term, we observed an increase in oxygen consumption at peak exercise (12.6 ± 0.6 vs 10.5 ± 0.5 ml/kg/min), oxygen consumption at anaerobic threshold (9.8 ± 0.6 vs 8.3 ± 0.6 ml/kg/min) and oxygen pulse (8.3 ± 0.5 vs 7.5 ± 0.5 ml/beat). Ventilatory efficacy (VE/VCO 2 slope) and alveolo-capillary diffusion (estimated by the measurement of lung diffusion capacity for carbon monoxide-DLCO) improved only at long term (VE/VCO 2 : 40.7 ± 1.6 vs 45.3 ± 1.8; DLCO: 70.3 ± 2.7 vs 59.4 ± 5.9% of predicted, p = 0.05). The 1-year mortality was 9.7%. Conclusions. Ventricular resynchronization is linked to a fast and prolonged recovery of NYHA class, echocardiographic variables and stress tolerance. The improvement of indexes known to carry a prognostic value confirms that ventricular resynchronization can positively interfere with the evolution of the disease.
European Journal of Heart Failure, 2016
Mitral regurgitation (MR) is a common finding in patients with heart failure with debatable effec... more Mitral regurgitation (MR) is a common finding in patients with heart failure with debatable effects on prognosis. Reduction in MR is one of the mechanisms by which cardiac resynchronization therapy (CRT) exerts its beneficial effects. We investigated the prognostic impact of baseline MR and MR persistence after CRT on outcomes of treated patients.
Journal of Cardiovascular Pharmacology, 2003
The authors performed two studies on the effects of carvedilol on autonomic tone and responsivene... more The authors performed two studies on the effects of carvedilol on autonomic tone and responsiveness in patients with heart failure. In study 1, the autonomic responses of 25 patients (age, 60 years+/-2; New York Heart Association [NYHA] class, 2.6+/-0.5; pVO2, 16.6 mL/Kg/min+/-1.1) treated with angiotensin-converting enzyme inhibitors, diuretics, and carvedilol (38.0 mg/d+/-2.5) were compared to those of 25 patients of similar age, therapy, NYHA class, and pVO2 in whom carvedilol was not yet administered. In study 2, autonomic tone and responsiveness were studied in 20 patients (age, 57 years+/-9; NYHA class, 2.5+/-0.2; pVO2, 15.6 mL/Kg/min+/-3.4), before and 6 months after additional carvedilol treatment (40.0 mg/d+/-12.5). Autonomic evaluation was performed with autoregressive power spectral analysis of RR variability during 10 minutes of supine rest (control), breathing 20 times per minute (vagal stimulus), and standing (sympathetic activation). The ratio between low-frequency (LF) and high-frequency (HF) components of the autospectra indicated the sympathovagal interaction. In study 1, spectral analysis in controls showed sympathetic hyperactivity which was blunted in patients receiving carvedilol (LF/HF ratio: 10.4+/-1.4 vs. 7.0+/-1.1; P<0.05) who responded to vagal and adrenergic stimuli (LF/HF, -35% with regular breathing and 72% standing). In study 2, left ventricular function, volumes, and exercise performance improved with carvedilol (EF, 31%; EDLV volume, -22%; pVO2, 11%; P<0.05). Sympathetic hyperactivity in control was reduced (LF/HF ratio, 4.9+/-0.8 from 7.9+/-1.3; P<0.05), whereas a response to vagal and adrenergic activation on breathing and standing reemerged (LF/HF ratio, -31% during regular breathing and 88% on standing). Therefore, combined autonomic and hemodynamic effects may determine the favorable effects of beta-blockers in heart failure.
Pacing and Clinical Electrophysiology, Sep 1, 2007
European Journal of Heart Failure Supplements, 2008
European Journal of Heart Failure Supplements, 2007
The Modelflow method (MM) requires the recording of the aortic pressure signal, to compute cardia... more The Modelflow method (MM) requires the recording of the aortic pressure signal, to compute cardiac output (CO) by simulating a non-linear three-element model of aortic input impedance. We propose an extended MM to be applied to the intraventricular pressure signal, to obtain an independent estimation of CO in the setting of conductance measurements. Hemodynamic tests were performed in 21 patients
European Journal of Heart Failure Supplements, 2007
Giornale italiano di cardiologia (2006), 2014
Giornale italiano di cardiologia (2006), 2011
European Journal of Heart Failure Supplements, 2007
European Journal of Heart Failure Supplements, 2007
Acta Crystallographica Section B Structural Crystallography and Crystal Chemistry, 1975
Pharmacological Research, 1995
In vitro and in vivo studies have shown both an inhibition and an activation of platelets after t... more In vitro and in vivo studies have shown both an inhibition and an activation of platelets after thrombolysis in acute myocardial infarction. Plasma beta-thromboglobulin, a marker of platelet activity, was evaluated daily during the first week after myocardial infarction in 24 patients who received intravenous streptokinase (group 1) and 26 who did not (group 2). On admission, levels of beta-thromboglobulin, as compared to those in healthy subjects (35 +/- 9 IU/ml), were similarly augmented in group 1 (105 +/- 27 IU/ml) and in group 2 (115 +/- 30 IU/ml); 3 hours later, values averaged 191 +/- 58 IU/ml in group 1 (p < 0.001 vs baseline) and 95 +/- 28 IU/ml in group 2 (not significant vs baseline; p < 0.001 between the two groups). From the second to the seventh day, beta-thromboglobulin augmented in those patients in both groups with postinfarction angina. From day 5 to day 7, patients of group 1 without angina had lower beta-thromboglobulin levels than patients of group 2 who had no symptoms. The lowest levels of platelet activity were observed in group 1 reperfused patients. These data indicate that in myocardial infarction an early platelet activation takes place that is enhanced by thrombolytic treatment; recurrence of angina is associated with persistent activation; in the absence of recurrent angina, thrombolysis can limit late platelet activation.
Journal of Medical Internet Research, 2013
Background: Heart failure patients with implantable defibrillators place a significant burden on ... more Background: Heart failure patients with implantable defibrillators place a significant burden on health care systems. Remote monitoring allows assessment of device function and heart failure parameters, and may represent a safe, effective, and cost-saving method compared to conventional in-office follow-up. Objective: We hypothesized that remote device monitoring represents a cost-effective approach. This paper summarizes the economic evaluation of the Evolution of Management Strategies of Heart Failure Patients With Implantable Defibrillators (EVOLVO) study, a multicenter clinical trial aimed at measuring the benefits of remote monitoring for heart failure patients with implantable defibrillators. Methods: Two hundred patients implanted with a wireless transmission-enabled implantable defibrillator were randomized to receive either remote monitoring or the conventional method of in-person evaluations. Patients were followed for 16 months with a protocol of scheduled in-office and remote follow-ups. The economic evaluation of the intervention was conducted from the perspectives of the health care system and the patient. A cost-utility analysis was performed to measure whether the intervention was cost-effective in terms of cost per quality-adjusted life year (QALY) gained. Results: Overall, remote monitoring did not show significant annual cost savings for the health care system (€1962.78 versus €2130.01; P=.80). There was a significant reduction of the annual cost for the patients in the remote arm in comparison to the standard arm (€291.36 versus €381.34; P=.01). Cost-utility analysis was performed for 180 patients for whom QALYs were available. The patients in the remote arm gained 0.065 QALYs more than those in the standard arm over 16 months, with a cost savings of €888.10 per patient. Results from the cost-utility analysis of the EVOLVO study show that remote monitoring is a cost-effective and dominant solution.
Journal of Clinical Monitoring and Computing, 2007