Giuseppe Giugliano - Academia.edu (original) (raw)
Papers by Giuseppe Giugliano
PubMed, Feb 1, 2016
Intra-aortic balloon pump (IABP) counterpulsation is the most widely used form of left ventricula... more Intra-aortic balloon pump (IABP) counterpulsation is the most widely used form of left ventricular mechanical support today, with more than 160,000 patients worldwide receiving this therapy annually. Currently, IABP support is indicated in patients with acute left ventricular systolic failure and cardiogenic shock whose management remains particularly complex and still today characterized by high mortality rates. While the available clinical practice guidelines support the indication to IABP placement in acute myocardial infarction (MI) with cardiogenic shock, recent clinical studies have questioned the benefits of IABP in these clinical settings. However, the rate of complications associated to IABP use is high and therefore the eventual IABP benefits must be weighed over the disadvantages. IABP still represents a very important mechanical support, however recent scientific evidences have challenged the value of its use, thus, it will be absolutely necessary to confirm these findings in a definitive RCT. This review will describe the role of IABP in the modern clinical practice.
Journal of Cardiovascular Development and Disease, Apr 10, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Journal of Endovascular Therapy, Jan 10, 2019
To report the 1-year outcomes of the prospective Legflow drug-coated balloon (DCB) registry, whic... more To report the 1-year outcomes of the prospective Legflow drug-coated balloon (DCB) registry, which evaluated the safety and 12-month efficacy of the Legflow balloon in the treatment of femoropopliteal disease. Methods: The Legflow is a new generation of DCB that has a homogenous, stable surface coating incorporating 0.1-µm paclitaxel particles. From January 2014 to June 2016, 139 patients (mean age 67.1±10.8 years; 109 men) were enrolled at 4 European institutions. Seventy-nine (56.8%) patients had claudication, while 60 (43.2%) had critical limb ischemia (CLI). Mean lesion length (MLL) was 90.0±41.2 mm. Eighty (57.6%) patients were treated for de novo lesions (MLL 83.2±41.2 mm), 29 (20.9%) for postangioplasty restenosis (MLL 81.2±30.9 mm), and 30 (21.6%) for in-stent restenosis (MLL 117.0±39.5 mm). The primary outcome measure was freedom from binary restenosis as determined by a peak systolic velocity ratio ≥2.4 on duplex or >50% stenosis on digital subtraction angiography at 12 months. The secondary outcome was freedom from clinically-driven target lesion revascularization (CD-TLR) at 12 months. Results: Technical success was achieved in all the 139 treated patients. During the hospital stay, 3 CLI patients died of wound-related complications and 3 CLI patients underwent urgent TLR due to early occlusion in 2 and stent thrombosis in 1. At 12 months, 4 additional patients died of cardiac disease unrelated to the procedure. Of the 132 patients available for 1-year follow-up, the primary outcome (freedom from restenosis) was obtained in 107 (81.1%) patients. Freedom from CD-TLR was obtained in 110 (83.3%). Of the 25 late restenoses >50%, only 3 asymptomatic patients did not require TLR. Freedom from CD-TLR was higher in claudicants (87.0%) than in CLI patients (78.2%, p=0.20). In patients treated for in-stent restenosis, freedom from TLR at 1 year was 89.2%. Conclusion: These data suggest that the use of a new generation paclitaxel-coated balloon represents a safe and effective therapeutic strategy for femoropopliteal obstructions in different clinical and anatomical settings. These data will need to be confirmed with longer-term follow-up and in randomized controlled trials.
International Journal of Cardiology, 2019
On behalf of the ALADIN-Cardiovascular Study Group 2
European Heart Journal, Jul 11, 2017
Gut microbiota-derived metabolite trimethylamine-N-oxide (TMAO) is emerging as a new potentially ... more Gut microbiota-derived metabolite trimethylamine-N-oxide (TMAO) is emerging as a new potentially important cause of increased cardiovascular risk. The purpose of this meta-analysis was to systematically estimate and quantify the association between TMAO plasma levels, mortality, and major adverse cardio and cerebrovascular events (MACCE).
PubMed, Mar 1, 2019
Carotid revascularization is an effective method of primary and secondary prevention of ischemic ... more Carotid revascularization is an effective method of primary and secondary prevention of ischemic cerebral stroke in patients presenting with extracranial carotid atherosclerosis leading to significant stenosis of the internal carotid artery. Currently, the European guidelines recommend surgical revascularization in all symptomatic patients with >50% stenosis with a documented periprocedural death/stroke risk of <6%. Endovascular revascularization should be considered in symptomatic patients with anatomical and clinical features that contribute to making such patients at high surgical risk. According to the guidelines, revascularization should be considered in patients with >60% stenosis, in the presence of clinical and/or imaging features associated with an increased risk of ipsilateral stroke (in the presence of documented risk of perioperative stroke/death <3% and patient's life expectancy >5 years). In patients with low and/or average surgical risk should be considered carotid endarterectomy, while in patients who are deemed at high surgical risk carotid stenting should be considered.Nowadays, thanks to technological advances and improved operators' experience, carotid stenting can be considered a valuable therapeutic strategy.
PubMed, Nov 1, 2019
Lower extremity arterial disease (LEAD) affects over 200 million people worldwide but, as of toda... more Lower extremity arterial disease (LEAD) affects over 200 million people worldwide but, as of today, is not adequately treated and represents an important cause of morbidity, mortality and disability. Although the use of antithrombotic therapy is recommended to prevent cardiovascular adverse events, patients with LEAD often receive inadequate prescription for antithrombotic agents (antiplatelets and anticoagulants). Historically, the inadequate use of antithrombotic drugs in this clinical setting has been ascribed to the lack of high quality scientific data obtained from clinical trials enrolling patients with LEAD. However, the results of more recent clinical trials support the use of antithrombotic drugs for these patients. The aim of this article is to summarize the available evidence supporting the prescription of antithrombotic agents in patients with LEAD.
European Heart Journal, Aug 1, 2018
On behalf of GULF COAST Background: Beta-blockers (BB) improve cardiovascular outcome after myoca... more On behalf of GULF COAST Background: Beta-blockers (BB) improve cardiovascular outcome after myocardial infarction. However, controversies exist to their long-term efficacy in patients without heart failure (HF), especially in the reperfusion-era Purpose: We sought to assess the outcome associated with BB in acute coronary syndrome (ACS) patients with a left ventricular ejection fraction (LVEF) ≥40%. Methods: The GULF-COAST is a prospective multicenter study of ACS patients recruited from 29 hospitals in 4 Gulf countries. We studied in-hospital mortality in relation to BB use (i) prior to admission and (ii) 24-hour post-admission; and (i) 1-month, 6-month and 12-month mortality and (ii) re-infarction and stroke at 12-month, in relation to BB use on discharge from ACS in patients with LVEF ≥40%. Results: Among the 3980 patients included the GULF-COAST, 2028 had a LVEF≥40%, of whom 55.4% were on BB and 44.6% were not. Mean age was 60 (13) and 66% were males. Prior BB use was associated with lower in-hospital mortality (corrected OR= 0.27, 95% CI [0.09-0.8]), so was BB use 24-hour post admission (corrected OR= 0.18, 95% CI [0.09-0.40]). At discharge, 84.9% were on BB while 15.1% were not. BB were associated with lower 1-month mortality (OR= 0.24, 95% CI [0.09-0.66]), but did not affect mortality at 6 and 12 months (OR= 0.79, 95% CI [0.40-1.98]; OR= 0.87, 95% CI [0.40-1.89]; respectively), neither re-infarction and stroke at 12 months (OR= 1.52, 95% CI [0.35-6.62]; OR= 0.44, 95% CI [0.08-2.30]; respectively), Results were validated in a propensityscore model. Conclusions: In this cohort of ACS, BB improve in-hospital and 1-month mortality in ACS patients with LVEF ≥40%, but have a neutral effect on long-term outcome.
Effetti della rivascolarizzazione percutanea degli arti inferiori sul profilo infiammatorio siste... more Effetti della rivascolarizzazione percutanea degli arti inferiori sul profilo infiammatorio sistemico e sul rischio cardiovascolare dei pazienti affetti da claudicatio intermittens.
European Heart Journal, Aug 1, 2017
Gut microbiota-derived metabolite trimethylamine-N-Oxide (TMAO) is emerging as a new potentially ... more Gut microbiota-derived metabolite trimethylamine-N-Oxide (TMAO) is emerging as a new potentially important cause of increased cardiovascular risk. The purpose of this meta-analysis was to systematically estimate the association between TMAO plasma levels, mortality and major adverse cardiac events. Methods and results: MEDLINE, ISI Web of Science and SCOPUS databases were searched for ad-hoc studies published up to November 2016. The primary endpoint (or outcome) was the incidence of all-cause mortality in studies that reported TMAO levels as a categorical variable. Secondary outcome included: 1) association between major adverse cardiovascular events and TMAO plasma levels, and 2) all-cause mortality in studies reporting TMAO as a continuous variable. A total of 16 clinical trials were included in the study, enrolling 22977 subjects. The mean follow-up in our study population was 4.3±1.6 years. In studies reporting TMAO as a categorical variable, patients with elevated TMAO plasma levels displayed a significantly higher incidence of all-cause mortality (12 studies, 10156 patients,
Data in Brief, Dec 1, 2018
In this article, we report anthropometric, clinical and laboratory data from Autosomal Dominant P... more In this article, we report anthropometric, clinical and laboratory data from Autosomal Dominant Polycystic Kidney Disease (ADPKD) patients with mild to moderate renal dysfunction and normal LV ejection fraction and from age-and sex-matched healthy controls and renal controls. Factors influencing LV untwisting rate in the group of ADPKD patients are also reported. For further interpretation and discussion please refer to the research article "Left ventricular dysfunction in ADPKD and effects of Octreotide-LAR: a cross-sectional and longitudinal sub study of the ALADIN trial" (Spinelli et al., 2018) [1].
Catheterization and Cardiovascular Interventions, Dec 14, 2017
Objectives: The objective of this meta-analysis is to evaluate clinical efficacy of double layere... more Objectives: The objective of this meta-analysis is to evaluate clinical efficacy of double layered mesh covered carotid stent systems in the clinical practice. Background: The need for an increase plaque coverage to decrease the risk of debris dislodgement through the stent struts, following carotid artery stenting (CAS), has brought to the design of a new generation of double layered carotid stents. Several small sized clinical studies evaluating two different devices have been recently published, unfortunately these are not sufficiently powered to test for device related and clinical endpoints and no comparison, between the two available devices, has been reported yet. Methods: Ten studies, enrolling 635 patients, were included in the present meta-analysis. Our study analyzed a composite endpoint of 30-day stroke and death and the occurrence of procedural unsuccess after CAS with the use of two different double layered carotid stent systems. Results: Thirty-day stroke and death rate was quite low (patients 635, event rate 0.02, 95% CI: 0.01-0.04, P < 0.0001). The incidence of procedural unsuccess with these devices was relatively low (patients 635, event rate 0.03, 95% CI: 0.01-0.08, P < 0.0001). When a subgroup analysis was performed, according to the specific subtype of carotid stent, no differences in the occurrence of 30-day death and stroke rate and procedural unsuccess were observed (P 5 0.979). Conclusions: This meta-analysis suggests that dual layered carotid stents could be safely used for the treatment of extracranial carotid artery stenosis, with a relatively low rate of procedural unsuccess, and allow achieving a quite low rate of postprocedural adverse events.
Journal of Nuclear Cardiology, May 13, 2019
Background. Abnormalities of cardiac sympathetic innervation have been demonstrated in Anderson-F... more Background. Abnormalities of cardiac sympathetic innervation have been demonstrated in Anderson-Fabry disease (AFD). We aimed to investigate the relationship between regional left ventricular (LV) denervation and regional function abnormalities. Methods. Twenty-four AFD patients (43.7 ± 12.8 years) were studied by 123 Imetaiodobenzylguanidine (MIBG) cardiac imaging and speckle-tracking echocardiography. Segmental tracer uptake was estimated according to 0 to 4 score, and total defect score (TDS) was calculated for each patient. Results. Segmental longitudinal strain worsened as MIBG uptake score increased (P < 0.001). By ROC analysis, a segmental longitudinal strain > 2 16.2% predicted a segmental MIBG uptake score ‡1, with 79.7% sensitivity and 65.3% specificity. Segmental MIBG uptake defects were found in 13 out 24 AFD patients. LV mass index (60.8 ± 10.1 vs. 41.4 ± 9.8 g/h 2.7), relative wall thickness (0.51 ± 0.06 vs. 0.40 ± 0.06), systolic pulmonary artery pressure (35.2 ± 6.7 vs. 27.2 ± 4.2 mmHg), and longitudinal strain (2 14.3 ± 2.7 vs. 219.4 ± 1.8%) were significantly higher in patients with segmental defect (all P < 0.01). At multivariate linear regression analysis, global longitudinal strain was independently associated with TDS (B = 3.007, 95% confidence interval 1.384 to 4.630, P = 0.001). Conclusions. Reduced cardiac MIBG uptake reflects the severity of cardiac involvement in AFD patients. LV longitudinal function impairment seems to be an earlier disease feature than regional myocardial denervation. (J Nucl Cardiol 2019
Acta Cardiologica, Oct 31, 2009
Chronic aortic dissections are complex lesions with a fairly predictable natural history dependin... more Chronic aortic dissections are complex lesions with a fairly predictable natural history depending on factors such as baseline aortic diameter, the degree of false lumen thrombosis, the presence of a persistent communication, an underlying connective tissue disorder, and the control of hypertension. Medical management with antihypertensive therapy including beta-blockers is the treatment of choice for all stable chronic aortic dissections. Repair is indicated in the case of complications: aortic rupture, malperfusion syndromes, symptomatic dissections, asymptomatic dissections becoming significantly aneurysmal or demonstrating a rapid growth rate. In this regard, serial imaging of the aorta is crucial to detect unstable lesions requiring surgery or an endovascular intervention. As endograft technologies improve endovascular approach may become the future standard of care.
Monaldi archives for chest disease, Jul 18, 2017
pime pime pime pime p pi im me e EDITRICE Monaldi Archives for Chest Disease 2017; volume 87:844
Monaldi archives for chest disease, Jul 18, 2017
pime pime pime pime p pi im me e EDITRICE Monaldi Archives for Chest Disease 2017; volume 87:840
International Journal of Cardiovascular Imaging, Aug 1, 2017
MBG (p = 0.036) and presence of hematoma (p < 0.001). Hematoma (log-rank test, χ 2 = 9.849; p = 0... more MBG (p = 0.036) and presence of hematoma (p < 0.001). Hematoma (log-rank test, χ 2 = 9.849; p = 0.002) and LV remodeling (log-rank test, χ 2 = 13.770; p < 0.001) were associated to a higher rate of adverse events. Cox analysis identified LV remodeling as the only independent predictor of adverse events (hazard ratio = 3.912; 95% confidence interval, 1.429-10.714; p = 0.008). Intramyocardial dissecting hematoma complicating anterior STEMI is an independent determinant of LV remodeling and is associated to poor prognosis.
European Heart Journal, Aug 1, 2018
severe symptomatic bradycardia or even life threatening asystole occurred which could be immediat... more severe symptomatic bradycardia or even life threatening asystole occurred which could be immediately interrupted by administration of Aminophyllin and Atropine. Remarkably, both patients with asystole showed a 1st degree AV-Block at baseline. Conclusion: In real world cardiology practice, appr. 20% of the patients referred for ischemia testing cannot be adequately physically exercised. Regadenoson for pharmacological stress tests is in general well tolerated with frequent but harmless and transient side effects. Although very rare, life threatening asystole or severe bradycardia (0.08%) may occur but can be rapidly treated with Aminophyllin and Atropine. The official instructions for use mention that a 2nd degree AV-Block is a risk factor for the occurence of asystole. According to our experience, however, also patients with a preexisiting 1st degree AV-Block have an increased risk for developing a life threatening asystole, so the physicians should be aware of this and take precautions like having the antidotes ready and not removing the intravenous needle for 20 minutes after the injection. P585 Hybrid positron emission tomography-magnetic resonance imaging and speckle tracking echocardiography to detect early cardiac involvement function in females carrying alpha-galactosidase a mutation
International Journal of Cardiovascular Imaging, Jan 12, 2021
Dobutamine stress echocardiography (DSE) is sensitive but subjective diagnostic tool to detect in... more Dobutamine stress echocardiography (DSE) is sensitive but subjective diagnostic tool to detect inducible ischemia. Nowadays, speckle tracking allows an objective quantification of regional wall function. We aimed to investigate the feasibility and accuracy of global (GLS) and regional longitudinal strain (RLS) during DSE to detect significant coronary stenosis (SCS). We conducted a prospective observational multicenter study including patients undergoing DSE for suspected SCS. 50 patients with positive DSE underwent coronary angiography. Besides visual regional wall motion score index (WMSI), GLS and RLS were determined at rest and at peak stress by Automated Function Imaging. DSE GLS feasibility was 96%. Among 35 patients with SCS, 12 patients were affected by multivessel disease, 18 had stenosis of left anterior descending artery (LAD), 18 of left circumflex (LCX) and 15 of right coronary artery (RCA). At peak stress, both GLS reduction (p = 0.037) and WMSI worsening (p = 0.04) showed significant agreement with coronary angiography for detecting SCS. When single lesion was considered, peak stress GLS and LAD RLS were lower in the obstructed LAD regions than in normo-perfused territories (17.4 ± 5.5 vs. 20.5 ± 4.4%, p = 0.03; 17.1 ± 7.6 vs. 21.6 ± 5.5%, p < 0.02, respectively). Furthermore, the addition of RLS to regional WMSI was able to improve accuracy in LAD SCS prediction (AUC 0.68, p = 0.037). Conversely, in presence of LCX or RCA SCS, LS was less accurate than WMSI at peak stress. In conclusion, DSE strain analysis is feasible and may improve prediction of LAD SCS, whereas regional WMSI assessment performs better in presence of SCS of LCX and RCA.
QJM: An International Journal of Medicine, Mar 4, 2008
PubMed, Feb 1, 2016
Intra-aortic balloon pump (IABP) counterpulsation is the most widely used form of left ventricula... more Intra-aortic balloon pump (IABP) counterpulsation is the most widely used form of left ventricular mechanical support today, with more than 160,000 patients worldwide receiving this therapy annually. Currently, IABP support is indicated in patients with acute left ventricular systolic failure and cardiogenic shock whose management remains particularly complex and still today characterized by high mortality rates. While the available clinical practice guidelines support the indication to IABP placement in acute myocardial infarction (MI) with cardiogenic shock, recent clinical studies have questioned the benefits of IABP in these clinical settings. However, the rate of complications associated to IABP use is high and therefore the eventual IABP benefits must be weighed over the disadvantages. IABP still represents a very important mechanical support, however recent scientific evidences have challenged the value of its use, thus, it will be absolutely necessary to confirm these findings in a definitive RCT. This review will describe the role of IABP in the modern clinical practice.
Journal of Cardiovascular Development and Disease, Apr 10, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Journal of Endovascular Therapy, Jan 10, 2019
To report the 1-year outcomes of the prospective Legflow drug-coated balloon (DCB) registry, whic... more To report the 1-year outcomes of the prospective Legflow drug-coated balloon (DCB) registry, which evaluated the safety and 12-month efficacy of the Legflow balloon in the treatment of femoropopliteal disease. Methods: The Legflow is a new generation of DCB that has a homogenous, stable surface coating incorporating 0.1-µm paclitaxel particles. From January 2014 to June 2016, 139 patients (mean age 67.1±10.8 years; 109 men) were enrolled at 4 European institutions. Seventy-nine (56.8%) patients had claudication, while 60 (43.2%) had critical limb ischemia (CLI). Mean lesion length (MLL) was 90.0±41.2 mm. Eighty (57.6%) patients were treated for de novo lesions (MLL 83.2±41.2 mm), 29 (20.9%) for postangioplasty restenosis (MLL 81.2±30.9 mm), and 30 (21.6%) for in-stent restenosis (MLL 117.0±39.5 mm). The primary outcome measure was freedom from binary restenosis as determined by a peak systolic velocity ratio ≥2.4 on duplex or >50% stenosis on digital subtraction angiography at 12 months. The secondary outcome was freedom from clinically-driven target lesion revascularization (CD-TLR) at 12 months. Results: Technical success was achieved in all the 139 treated patients. During the hospital stay, 3 CLI patients died of wound-related complications and 3 CLI patients underwent urgent TLR due to early occlusion in 2 and stent thrombosis in 1. At 12 months, 4 additional patients died of cardiac disease unrelated to the procedure. Of the 132 patients available for 1-year follow-up, the primary outcome (freedom from restenosis) was obtained in 107 (81.1%) patients. Freedom from CD-TLR was obtained in 110 (83.3%). Of the 25 late restenoses >50%, only 3 asymptomatic patients did not require TLR. Freedom from CD-TLR was higher in claudicants (87.0%) than in CLI patients (78.2%, p=0.20). In patients treated for in-stent restenosis, freedom from TLR at 1 year was 89.2%. Conclusion: These data suggest that the use of a new generation paclitaxel-coated balloon represents a safe and effective therapeutic strategy for femoropopliteal obstructions in different clinical and anatomical settings. These data will need to be confirmed with longer-term follow-up and in randomized controlled trials.
International Journal of Cardiology, 2019
On behalf of the ALADIN-Cardiovascular Study Group 2
European Heart Journal, Jul 11, 2017
Gut microbiota-derived metabolite trimethylamine-N-oxide (TMAO) is emerging as a new potentially ... more Gut microbiota-derived metabolite trimethylamine-N-oxide (TMAO) is emerging as a new potentially important cause of increased cardiovascular risk. The purpose of this meta-analysis was to systematically estimate and quantify the association between TMAO plasma levels, mortality, and major adverse cardio and cerebrovascular events (MACCE).
PubMed, Mar 1, 2019
Carotid revascularization is an effective method of primary and secondary prevention of ischemic ... more Carotid revascularization is an effective method of primary and secondary prevention of ischemic cerebral stroke in patients presenting with extracranial carotid atherosclerosis leading to significant stenosis of the internal carotid artery. Currently, the European guidelines recommend surgical revascularization in all symptomatic patients with >50% stenosis with a documented periprocedural death/stroke risk of <6%. Endovascular revascularization should be considered in symptomatic patients with anatomical and clinical features that contribute to making such patients at high surgical risk. According to the guidelines, revascularization should be considered in patients with >60% stenosis, in the presence of clinical and/or imaging features associated with an increased risk of ipsilateral stroke (in the presence of documented risk of perioperative stroke/death <3% and patient's life expectancy >5 years). In patients with low and/or average surgical risk should be considered carotid endarterectomy, while in patients who are deemed at high surgical risk carotid stenting should be considered.Nowadays, thanks to technological advances and improved operators' experience, carotid stenting can be considered a valuable therapeutic strategy.
PubMed, Nov 1, 2019
Lower extremity arterial disease (LEAD) affects over 200 million people worldwide but, as of toda... more Lower extremity arterial disease (LEAD) affects over 200 million people worldwide but, as of today, is not adequately treated and represents an important cause of morbidity, mortality and disability. Although the use of antithrombotic therapy is recommended to prevent cardiovascular adverse events, patients with LEAD often receive inadequate prescription for antithrombotic agents (antiplatelets and anticoagulants). Historically, the inadequate use of antithrombotic drugs in this clinical setting has been ascribed to the lack of high quality scientific data obtained from clinical trials enrolling patients with LEAD. However, the results of more recent clinical trials support the use of antithrombotic drugs for these patients. The aim of this article is to summarize the available evidence supporting the prescription of antithrombotic agents in patients with LEAD.
European Heart Journal, Aug 1, 2018
On behalf of GULF COAST Background: Beta-blockers (BB) improve cardiovascular outcome after myoca... more On behalf of GULF COAST Background: Beta-blockers (BB) improve cardiovascular outcome after myocardial infarction. However, controversies exist to their long-term efficacy in patients without heart failure (HF), especially in the reperfusion-era Purpose: We sought to assess the outcome associated with BB in acute coronary syndrome (ACS) patients with a left ventricular ejection fraction (LVEF) ≥40%. Methods: The GULF-COAST is a prospective multicenter study of ACS patients recruited from 29 hospitals in 4 Gulf countries. We studied in-hospital mortality in relation to BB use (i) prior to admission and (ii) 24-hour post-admission; and (i) 1-month, 6-month and 12-month mortality and (ii) re-infarction and stroke at 12-month, in relation to BB use on discharge from ACS in patients with LVEF ≥40%. Results: Among the 3980 patients included the GULF-COAST, 2028 had a LVEF≥40%, of whom 55.4% were on BB and 44.6% were not. Mean age was 60 (13) and 66% were males. Prior BB use was associated with lower in-hospital mortality (corrected OR= 0.27, 95% CI [0.09-0.8]), so was BB use 24-hour post admission (corrected OR= 0.18, 95% CI [0.09-0.40]). At discharge, 84.9% were on BB while 15.1% were not. BB were associated with lower 1-month mortality (OR= 0.24, 95% CI [0.09-0.66]), but did not affect mortality at 6 and 12 months (OR= 0.79, 95% CI [0.40-1.98]; OR= 0.87, 95% CI [0.40-1.89]; respectively), neither re-infarction and stroke at 12 months (OR= 1.52, 95% CI [0.35-6.62]; OR= 0.44, 95% CI [0.08-2.30]; respectively), Results were validated in a propensityscore model. Conclusions: In this cohort of ACS, BB improve in-hospital and 1-month mortality in ACS patients with LVEF ≥40%, but have a neutral effect on long-term outcome.
Effetti della rivascolarizzazione percutanea degli arti inferiori sul profilo infiammatorio siste... more Effetti della rivascolarizzazione percutanea degli arti inferiori sul profilo infiammatorio sistemico e sul rischio cardiovascolare dei pazienti affetti da claudicatio intermittens.
European Heart Journal, Aug 1, 2017
Gut microbiota-derived metabolite trimethylamine-N-Oxide (TMAO) is emerging as a new potentially ... more Gut microbiota-derived metabolite trimethylamine-N-Oxide (TMAO) is emerging as a new potentially important cause of increased cardiovascular risk. The purpose of this meta-analysis was to systematically estimate the association between TMAO plasma levels, mortality and major adverse cardiac events. Methods and results: MEDLINE, ISI Web of Science and SCOPUS databases were searched for ad-hoc studies published up to November 2016. The primary endpoint (or outcome) was the incidence of all-cause mortality in studies that reported TMAO levels as a categorical variable. Secondary outcome included: 1) association between major adverse cardiovascular events and TMAO plasma levels, and 2) all-cause mortality in studies reporting TMAO as a continuous variable. A total of 16 clinical trials were included in the study, enrolling 22977 subjects. The mean follow-up in our study population was 4.3±1.6 years. In studies reporting TMAO as a categorical variable, patients with elevated TMAO plasma levels displayed a significantly higher incidence of all-cause mortality (12 studies, 10156 patients,
Data in Brief, Dec 1, 2018
In this article, we report anthropometric, clinical and laboratory data from Autosomal Dominant P... more In this article, we report anthropometric, clinical and laboratory data from Autosomal Dominant Polycystic Kidney Disease (ADPKD) patients with mild to moderate renal dysfunction and normal LV ejection fraction and from age-and sex-matched healthy controls and renal controls. Factors influencing LV untwisting rate in the group of ADPKD patients are also reported. For further interpretation and discussion please refer to the research article "Left ventricular dysfunction in ADPKD and effects of Octreotide-LAR: a cross-sectional and longitudinal sub study of the ALADIN trial" (Spinelli et al., 2018) [1].
Catheterization and Cardiovascular Interventions, Dec 14, 2017
Objectives: The objective of this meta-analysis is to evaluate clinical efficacy of double layere... more Objectives: The objective of this meta-analysis is to evaluate clinical efficacy of double layered mesh covered carotid stent systems in the clinical practice. Background: The need for an increase plaque coverage to decrease the risk of debris dislodgement through the stent struts, following carotid artery stenting (CAS), has brought to the design of a new generation of double layered carotid stents. Several small sized clinical studies evaluating two different devices have been recently published, unfortunately these are not sufficiently powered to test for device related and clinical endpoints and no comparison, between the two available devices, has been reported yet. Methods: Ten studies, enrolling 635 patients, were included in the present meta-analysis. Our study analyzed a composite endpoint of 30-day stroke and death and the occurrence of procedural unsuccess after CAS with the use of two different double layered carotid stent systems. Results: Thirty-day stroke and death rate was quite low (patients 635, event rate 0.02, 95% CI: 0.01-0.04, P < 0.0001). The incidence of procedural unsuccess with these devices was relatively low (patients 635, event rate 0.03, 95% CI: 0.01-0.08, P < 0.0001). When a subgroup analysis was performed, according to the specific subtype of carotid stent, no differences in the occurrence of 30-day death and stroke rate and procedural unsuccess were observed (P 5 0.979). Conclusions: This meta-analysis suggests that dual layered carotid stents could be safely used for the treatment of extracranial carotid artery stenosis, with a relatively low rate of procedural unsuccess, and allow achieving a quite low rate of postprocedural adverse events.
Journal of Nuclear Cardiology, May 13, 2019
Background. Abnormalities of cardiac sympathetic innervation have been demonstrated in Anderson-F... more Background. Abnormalities of cardiac sympathetic innervation have been demonstrated in Anderson-Fabry disease (AFD). We aimed to investigate the relationship between regional left ventricular (LV) denervation and regional function abnormalities. Methods. Twenty-four AFD patients (43.7 ± 12.8 years) were studied by 123 Imetaiodobenzylguanidine (MIBG) cardiac imaging and speckle-tracking echocardiography. Segmental tracer uptake was estimated according to 0 to 4 score, and total defect score (TDS) was calculated for each patient. Results. Segmental longitudinal strain worsened as MIBG uptake score increased (P < 0.001). By ROC analysis, a segmental longitudinal strain > 2 16.2% predicted a segmental MIBG uptake score ‡1, with 79.7% sensitivity and 65.3% specificity. Segmental MIBG uptake defects were found in 13 out 24 AFD patients. LV mass index (60.8 ± 10.1 vs. 41.4 ± 9.8 g/h 2.7), relative wall thickness (0.51 ± 0.06 vs. 0.40 ± 0.06), systolic pulmonary artery pressure (35.2 ± 6.7 vs. 27.2 ± 4.2 mmHg), and longitudinal strain (2 14.3 ± 2.7 vs. 219.4 ± 1.8%) were significantly higher in patients with segmental defect (all P < 0.01). At multivariate linear regression analysis, global longitudinal strain was independently associated with TDS (B = 3.007, 95% confidence interval 1.384 to 4.630, P = 0.001). Conclusions. Reduced cardiac MIBG uptake reflects the severity of cardiac involvement in AFD patients. LV longitudinal function impairment seems to be an earlier disease feature than regional myocardial denervation. (J Nucl Cardiol 2019
Acta Cardiologica, Oct 31, 2009
Chronic aortic dissections are complex lesions with a fairly predictable natural history dependin... more Chronic aortic dissections are complex lesions with a fairly predictable natural history depending on factors such as baseline aortic diameter, the degree of false lumen thrombosis, the presence of a persistent communication, an underlying connective tissue disorder, and the control of hypertension. Medical management with antihypertensive therapy including beta-blockers is the treatment of choice for all stable chronic aortic dissections. Repair is indicated in the case of complications: aortic rupture, malperfusion syndromes, symptomatic dissections, asymptomatic dissections becoming significantly aneurysmal or demonstrating a rapid growth rate. In this regard, serial imaging of the aorta is crucial to detect unstable lesions requiring surgery or an endovascular intervention. As endograft technologies improve endovascular approach may become the future standard of care.
Monaldi archives for chest disease, Jul 18, 2017
pime pime pime pime p pi im me e EDITRICE Monaldi Archives for Chest Disease 2017; volume 87:844
Monaldi archives for chest disease, Jul 18, 2017
pime pime pime pime p pi im me e EDITRICE Monaldi Archives for Chest Disease 2017; volume 87:840
International Journal of Cardiovascular Imaging, Aug 1, 2017
MBG (p = 0.036) and presence of hematoma (p < 0.001). Hematoma (log-rank test, χ 2 = 9.849; p = 0... more MBG (p = 0.036) and presence of hematoma (p < 0.001). Hematoma (log-rank test, χ 2 = 9.849; p = 0.002) and LV remodeling (log-rank test, χ 2 = 13.770; p < 0.001) were associated to a higher rate of adverse events. Cox analysis identified LV remodeling as the only independent predictor of adverse events (hazard ratio = 3.912; 95% confidence interval, 1.429-10.714; p = 0.008). Intramyocardial dissecting hematoma complicating anterior STEMI is an independent determinant of LV remodeling and is associated to poor prognosis.
European Heart Journal, Aug 1, 2018
severe symptomatic bradycardia or even life threatening asystole occurred which could be immediat... more severe symptomatic bradycardia or even life threatening asystole occurred which could be immediately interrupted by administration of Aminophyllin and Atropine. Remarkably, both patients with asystole showed a 1st degree AV-Block at baseline. Conclusion: In real world cardiology practice, appr. 20% of the patients referred for ischemia testing cannot be adequately physically exercised. Regadenoson for pharmacological stress tests is in general well tolerated with frequent but harmless and transient side effects. Although very rare, life threatening asystole or severe bradycardia (0.08%) may occur but can be rapidly treated with Aminophyllin and Atropine. The official instructions for use mention that a 2nd degree AV-Block is a risk factor for the occurence of asystole. According to our experience, however, also patients with a preexisiting 1st degree AV-Block have an increased risk for developing a life threatening asystole, so the physicians should be aware of this and take precautions like having the antidotes ready and not removing the intravenous needle for 20 minutes after the injection. P585 Hybrid positron emission tomography-magnetic resonance imaging and speckle tracking echocardiography to detect early cardiac involvement function in females carrying alpha-galactosidase a mutation
International Journal of Cardiovascular Imaging, Jan 12, 2021
Dobutamine stress echocardiography (DSE) is sensitive but subjective diagnostic tool to detect in... more Dobutamine stress echocardiography (DSE) is sensitive but subjective diagnostic tool to detect inducible ischemia. Nowadays, speckle tracking allows an objective quantification of regional wall function. We aimed to investigate the feasibility and accuracy of global (GLS) and regional longitudinal strain (RLS) during DSE to detect significant coronary stenosis (SCS). We conducted a prospective observational multicenter study including patients undergoing DSE for suspected SCS. 50 patients with positive DSE underwent coronary angiography. Besides visual regional wall motion score index (WMSI), GLS and RLS were determined at rest and at peak stress by Automated Function Imaging. DSE GLS feasibility was 96%. Among 35 patients with SCS, 12 patients were affected by multivessel disease, 18 had stenosis of left anterior descending artery (LAD), 18 of left circumflex (LCX) and 15 of right coronary artery (RCA). At peak stress, both GLS reduction (p = 0.037) and WMSI worsening (p = 0.04) showed significant agreement with coronary angiography for detecting SCS. When single lesion was considered, peak stress GLS and LAD RLS were lower in the obstructed LAD regions than in normo-perfused territories (17.4 ± 5.5 vs. 20.5 ± 4.4%, p = 0.03; 17.1 ± 7.6 vs. 21.6 ± 5.5%, p < 0.02, respectively). Furthermore, the addition of RLS to regional WMSI was able to improve accuracy in LAD SCS prediction (AUC 0.68, p = 0.037). Conversely, in presence of LCX or RCA SCS, LS was less accurate than WMSI at peak stress. In conclusion, DSE strain analysis is feasible and may improve prediction of LAD SCS, whereas regional WMSI assessment performs better in presence of SCS of LCX and RCA.
QJM: An International Journal of Medicine, Mar 4, 2008