Jorge Salerno Uriarte - Academia.edu (original) (raw)
Papers by Jorge Salerno Uriarte
Journal of Echocardiography, 2019
Journal of the American College of Cardiology, 2006
Europace, 2005
AimsThis multicentre prospective randomised trial was undertaken to evaluate the usefulness of an... more AimsThis multicentre prospective randomised trial was undertaken to evaluate the usefulness of an electrophysiological study (EPS)–guided/implantable cardioverter defibrillator (ICD) strategy in patients at high risk of sudden death (SD) early after myocardial infarction (MI). Previous studies have shown the benefits of such a strategy only in high-risk patients late after MI.
Giornale italiano di cardiologia, 1992
Herzschrittmachertherapie und Elektrophysiologie, 1999
The BEta-blocker STrategy plus Implantable Cardioverter Defibrillator (BEST + ICD) Trial is a mul... more The BEta-blocker STrategy plus Implantable Cardioverter Defibrillator (BEST + ICD) Trial is a multicenter prospective randomized study in which the hypothesis will be tested of whether, in high-risk post-myocardial infarction (MI) patients already treated with &#35-blockers, therapy guided by electrophysiologic study (EPS) will improve survival, compared to conventional therapy. Eligible patients for the study are survivors of a recent MI
Journal of Cardiac Surgery, 2007
Background: Stentless valves have been demonstrated excellent hemodynamic performances favoring t... more Background: Stentless valves have been demonstrated excellent hemodynamic performances favoring the recovery of left ventricular function and the ventricular hypertrophy regression. The aim of the study was to evaluate the early hemodynamic performance of the Shelhigh SuperStentless aortic valve (AV).
Journal of the American College of Cardiology, 2010
Background: The aim of the study was to detect specific anatomical features in the coronary arter... more Background: The aim of the study was to detect specific anatomical features in the coronary artery wall of patients presenting with "normal" arteries and coronary spasm, by a high resolution intracoronary optical coherence tomography (OCT). Methods: To be enrolled patients had to have the following features: recurrent episodes of angina at rest and ECG ischemia, normal angiograms, no signs of early atherosclerosis by intravascular ultrasound (thickness of the coronary wall <1mm) and inducible coronary spasm. Coronary spasm (defined as >30% vessel diameter reduction) was provoked by inhibition of endothelial nitric oxide synthesis through administration of intracoronary acetylcholine (graded doses of 10-6, 10-5 and 10-4 mol/L over 3 minutes at 10-minute intervals). Intracoronary OCT (10-20 micron resolution) imaging, by automatic pull back, was performed in all patients at the site of vasoconstriction and at the adjacent segments as controls. Results: We analyzed OCT 83 images from 15 patients. There were 49 OCT images from sites of vasoconstrictions. Of these, 9 (19.4%) showed a 3-layer structure (intima, media and adventitia) distinctive of a normal artery and the remaining 40 (81.6%) showed early structural atherosclerotic changes (loss of 3-layer structure and thickness of the coronary wall up to 380 micron maximum). OCT images of the control segments (no=34) revealed a 3-layer structure in 5 (14.7%) and early atherosclerotic structural changes in the remaining 29 (76.3%). Nine patients showed early atherosclerotic structural changes at sites of abnormal vasoconstriction and in control vessel segments. Three patients exhibit early structural changes at sites of abnormal vasoconstriction, but not in control vessel segments. The remaining 3 patients showed evidence of a normal 3-layer structure both at sites of abnormal vasoconstriction and in control vessel segments. Conclusions: OCT does not identify a distinctive anatomical feature characterizing those coronary segments having spasm due to inhibition of endothelial nitric oxide synthesis. CORE Metadata, citation and similar papers at core.ac.uk
The American Journal of Cardiology, 1999
The Beta-blocker Strategy plus Implantable Cardioverter Defibrillator (BEST-ICD) Trial is a multi... more The Beta-blocker Strategy plus Implantable Cardioverter Defibrillator (BEST-ICD) Trial is a multicenter prospective randomized trial that started in June 1998, in 95 centers in Italy and Germany. The trial will test the hypothesis whether, in high-risk post myocardial infarction (MI) patients already treated with beta blockers, electrophysiologic study (EPS)-guided therapy (including the prophylactic implantation of implantable cardioverter defibrillator [ICD] in inducible patients) will improve survival compared with conventional therapy. Patients eligible for the study are survivors of recent MI (&amp;amp;amp;amp;amp;gt; or = 5 and &amp;amp;amp;amp;amp;lt; or = 21 days), aged &amp;amp;amp;amp;amp;lt; or = 80 years, with left ventricular ejection fraction &amp;amp;amp;amp;amp;lt; or = 35% and &amp;amp;amp;amp;amp;gt; or = 1 of the following additional risk factors: (1) ventricular premature beats &amp;amp;amp;amp;amp;gt; or = 10/hour; (2) decreased heart rate variability (standard deviation of unusual RR intervals &amp;amp;amp;amp;amp;lt; 70 msec); and (3) presence of ventricular late potentials. Furthermore, all enrolled patients must be able to tolerate at least 25 mg of metoprolol per day. These patients constitute about 9% of all patients with recent MI and are expected to have a 2-year all-cause mortality &amp;amp;amp;amp;amp;gt; 25% of which 50% is anticipated to be from sudden death. The main criteria of exclusion from the study are (1) a history of sustained ventricular arrhythmia; (2) documentation of nonsustained ventricular tachycardia during the screening phase; and (3) the need for myocardial revascularization and contraindications or intolerance to beta-blocker therapy. Eligible patients will be randomized to 2 different therapeutic strategies: conventional strategy or EPS/ICD strategy. Patients allocated to the EPS/ICD strategy will undergo further risk stratification, and electrophysiologically inducible patients (approximately 35%) will receive prophylactic ICDs, in addition to the conventional therapy, whereas noninducible patients will be only conventionally treated. The primary endpoint of the study will be death from all causes. By hypothesizing a 30% reduction in the 2-year mortality (from 20% to 14%) in the EPS/ICD group compared with conventionally treated patients, 1,200 patients will have to be included. A triangular, 2-sided sequential design with preset boundaries, for a 5% significance level and 90% power to detect a reduction in 2-year mortality from 20% to 14%, will be used to permit early termination of the trial if the strategy is found to be efficacious, no difference, or inefficacious.
Heart
ObjectiveThe advantage of beta-blockers has been postulated in patients with Takotsubo syndrome (... more ObjectiveThe advantage of beta-blockers has been postulated in patients with Takotsubo syndrome (TTS) given the pathophysiological role of catecholamines. We hypothesised that beta-blocker treatment after discharge may improve the long-term clinical outcome in this patient population.MethodsThis was an observational, multicentre study including consecutive patients with TTS diagnosis prospectively enrolled in the Takotsubo Italian Network (TIN) register from January 2007 to December 2018. TTS was diagnosed according to the TIN, Heart Failure Association and InterTAK Diagnostic Criteria. The primary study outcome was the occurrence of all-cause death at the longest available follow-up; secondary outcomes were TTS recurrence, cardiac and non-cardiac death.ResultsThe study population included 825 patients (median age: 72.0 (63.0–78.0) years; 91.9 % female): 488 (59.2%) were discharged on beta-blockers and 337 (40.8%) without beta-blockers. The median follow-up was 24.0 months. The adju...
JACC. Cardiovascular imaging, 2014
We are grateful to Drs. Yalcinkaya and Celik for their interest in the results of our study [(1)]... more We are grateful to Drs. Yalcinkaya and Celik for their interest in the results of our study [(1)][1]. The diagnosis of Tako-Tsubo cardiomyopathy (TTC) is sometimes challenging, and a detailed knowledge of this peculiar syndrome is required. Recently, our group proposed a revised form of the current
JACC. Cardiovascular imaging, 2014
JACC: Cardiovascular Imaging, 2014
The purpose of this study was to determine clinical and echocardiographic correlates of acute hea... more The purpose of this study was to determine clinical and echocardiographic correlates of acute heart failure, cardiogenic shock and in-hospital mortality in a large cohort of tako-tsubo cardiomyopathy (TTC) patients. B AC K G R O U N D Despite good long-term prognosis, life-threatening complications due to hemodynamic instability can occur early in TTC patients. M E T H O D S The study population consisted of 227 patients (66.2 AE 12.2 years of age; females, 90.3%) enrolled in the Tako-tsubo Italian Network, undergoing transthoracic two-dimensional echocardiography C O N C L U S I O N S Echocardiographic parameters provide additional information compared to other variables routinely used in clinical practice to identify patients at higher risk of hemodynamic deterioration and poor in-hospital outcome, allowing prompt institution of appropriate pharmacological treatment and adequate mechanical support.
European Heart Journal, 2008
Circulation, 2009
Background— D-dimer has been reported to be elevated in acute aortic dissection. Potential use as... more Background— D-dimer has been reported to be elevated in acute aortic dissection. Potential use as a “rule-out” marker has been suggested, but concerns remain given that it is elevated in other acute chest diseases, including pulmonary embolism and ischemic heart disease. We evaluated the diagnostic performance of D-dimer testing in a study population of patients with suspected aortic dissection. Methods and Results— In this prospective multicenter study, 220 patients with initial suspicion of having acute aortic dissection were enrolled, of whom 87 were diagnosed with acute aortic dissection and 133 with other final diagnoses, including myocardial infarction, angina, pulmonary embolism, and other uncertain diagnoses. D-dimer was markedly elevated in patients with acute aortic dissection. Analysis according to control disease, type of dissection, and time course showed that the widely used cutoff level of 500 ng/mL for ruling out pulmonary embolism also can reliably rule out aortic d...
Circulation, 2010
We thank Dr Hugli for his interest in our article. Dr Hugli raises issues that were discussed in ... more We thank Dr Hugli for his interest in our article. Dr Hugli raises issues that were discussed in the article that may benefit from being readdressed in this response. The most notable issue centers on the pretest probability of acute aortic dissection, which is a prerequisite for the estimation of diagnostic measures and their clinical usefulness. We still do not have a firm understanding of this value because sufficient data are not available (eg, prevalence rates and/or clinical decision rules/tools) to calculate it. Having stated that, however, our study was, to the best of our knowledge, the first to determine the prevalence of acute aortic dissection in patients suspected of having this disease. Our earlier study showed a prevalence of 25%, 1 and the described study was Ϸ40%. 2 Because our conditions were limited to tertiary centers that see and treat aortic dissection routinely and thus likely have increased awareness to this disease, we noted that these figures are most likely higher than those that will be seen in the community setting. Thus, we described likelihood ratios rather than predictive values because the latter is affected by prevalence. Dr Hugli's second issue concerns clinical spectrum. Our study and its findings were based on patients with suspected acute aortic dissection and not chest pain in general; thus, caution is needed in the generalization of our findings beyond the tested parameters of patients with acute aortic dissection presenting to mainly tertiary centers. Furthermore, on the topic of selection and verification bias, results of D-dimer measurements were not made available to the treating physician; therefore, this bias was not applicable to the present study. We disagree with the reasoning that examination of consecutive cases may have caused selection bias but rather assert that this allowed a more unbiased selection process. Although our present findings are limited to the described conditions, we believe that D-dimer is useful at present and that our findings, as an initial step, will help make possible the actual clinical use of D-dimer for acute aortic dissection and provide a diagnostic algorithm to optimize the use of imaging tests in these settings. We expect our findings to serve as a "working hypothesis" to be tested in more general settings such as in patients presenting with chest pain in general and in extension to the community setting (eg, nontertiary centers, healthcare systems) and further in studies that address usefulness of diagnostic strategies that incorporate both biochemical and imaging tests. We envision that a clinical algorithm will be developed that assigns patients to clinical risk groups that will help distinguish between high-risk patients who go directly to imaging and moderate-risk groups and identify lower-risk groups in which D-dimer may emerge as a rule-out screening measure.
Cardiologia (Rome, Italy), 1999
Journal of Cardiovascular Electrophysiology, 2005
European Journal of Heart Failure, 2008
Background: Diabetes mellitus is an independent risk factor for increased morbidity and mortality... more Background: Diabetes mellitus is an independent risk factor for increased morbidity and mortality in heart failure (HF) patients. Aims: To compare functional and structural improvement, as well as long-term outcome, between diabetic and non-diabetic HF patients treated with cardiac resynchronization therapy (CRT). Methods: We compared response to CRT in 141 diabetic and 214 non-diabetic consecutive patients. Major events were; death from any cause, urgent heart transplantation and implantation of a left ventricular (LV) assist device. Frequencies of hospitalisation and defibrillator (CRT-D) discharges were also analyzed. Results: CRT was able to significantly improve functional capacity, ventricular geometry and neurohumoral imbalance in both diabetic and nondiabetic patients over a median follow-up time of 34 months. Overall event-free survival was similar in diabetic and non-diabetic patients (HR 1.23, p = 0.363), as was survival free from CRT-D interventions (HR 1.72; p = 0.115) and hospitalisations (HR 1.12; p = 0.500). On multivariable analysis, NYHA class IV (p = 0.002), low LV ejection fraction (p = 0.002), absence of beta-blocker therapy (p b 0.001), impaired renal function (p = 0.003), presence of an epicardial lead (p = 0.025), but not diabetes (p = 0.821) were associated with a poor outcome after CRT. Conclusions: Diabetic HF patients treated with CRT had a very favourable functional and survival outcome, which was comparable to nondiabetic patients.
Europace, 2005
Background: To atrial fibrillation catheter ablation a second transseptal puncture is usually adv... more Background: To atrial fibrillation catheter ablation a second transseptal puncture is usually advocated to perform the procedure. Aim: To report a retrospective data about a single transseptal puncture for AF ablation. Methods: A thousand patients were recruited in whom ablation of (AF) was performed. After the transseptal puncture a guidewire was then anchored in the LSPV and the transseptal assembly pulls back to the right atrium. Then a catheter was advanced approaching the septum parallel to the guidewire and guiding the crossing. After the catheter was positioned in the left atrium, the transseptal system was advanced to the left atrium over the guidewire. Results: In 5/1000 (0.5 %) cases a second transseptal puncture was required. Neither complications of the transseptal were reported nor were catheter properly manoeuvred. In a year follow up no persistent atrial defect were observed. Conclusions: This data on a large cohort of pts shows that single transseptal puncture AF ablation is a highly successful and safe maneuver with a very low morbidity in the majority of pts. This can avoid potential complications related to a second transseptal puncture.
Journal of Echocardiography, 2019
Journal of the American College of Cardiology, 2006
Europace, 2005
AimsThis multicentre prospective randomised trial was undertaken to evaluate the usefulness of an... more AimsThis multicentre prospective randomised trial was undertaken to evaluate the usefulness of an electrophysiological study (EPS)–guided/implantable cardioverter defibrillator (ICD) strategy in patients at high risk of sudden death (SD) early after myocardial infarction (MI). Previous studies have shown the benefits of such a strategy only in high-risk patients late after MI.
Giornale italiano di cardiologia, 1992
Herzschrittmachertherapie und Elektrophysiologie, 1999
The BEta-blocker STrategy plus Implantable Cardioverter Defibrillator (BEST + ICD) Trial is a mul... more The BEta-blocker STrategy plus Implantable Cardioverter Defibrillator (BEST + ICD) Trial is a multicenter prospective randomized study in which the hypothesis will be tested of whether, in high-risk post-myocardial infarction (MI) patients already treated with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#35-blockers, therapy guided by electrophysiologic study (EPS) will improve survival, compared to conventional therapy. Eligible patients for the study are survivors of a recent MI
Journal of Cardiac Surgery, 2007
Background: Stentless valves have been demonstrated excellent hemodynamic performances favoring t... more Background: Stentless valves have been demonstrated excellent hemodynamic performances favoring the recovery of left ventricular function and the ventricular hypertrophy regression. The aim of the study was to evaluate the early hemodynamic performance of the Shelhigh SuperStentless aortic valve (AV).
Journal of the American College of Cardiology, 2010
Background: The aim of the study was to detect specific anatomical features in the coronary arter... more Background: The aim of the study was to detect specific anatomical features in the coronary artery wall of patients presenting with "normal" arteries and coronary spasm, by a high resolution intracoronary optical coherence tomography (OCT). Methods: To be enrolled patients had to have the following features: recurrent episodes of angina at rest and ECG ischemia, normal angiograms, no signs of early atherosclerosis by intravascular ultrasound (thickness of the coronary wall <1mm) and inducible coronary spasm. Coronary spasm (defined as >30% vessel diameter reduction) was provoked by inhibition of endothelial nitric oxide synthesis through administration of intracoronary acetylcholine (graded doses of 10-6, 10-5 and 10-4 mol/L over 3 minutes at 10-minute intervals). Intracoronary OCT (10-20 micron resolution) imaging, by automatic pull back, was performed in all patients at the site of vasoconstriction and at the adjacent segments as controls. Results: We analyzed OCT 83 images from 15 patients. There were 49 OCT images from sites of vasoconstrictions. Of these, 9 (19.4%) showed a 3-layer structure (intima, media and adventitia) distinctive of a normal artery and the remaining 40 (81.6%) showed early structural atherosclerotic changes (loss of 3-layer structure and thickness of the coronary wall up to 380 micron maximum). OCT images of the control segments (no=34) revealed a 3-layer structure in 5 (14.7%) and early atherosclerotic structural changes in the remaining 29 (76.3%). Nine patients showed early atherosclerotic structural changes at sites of abnormal vasoconstriction and in control vessel segments. Three patients exhibit early structural changes at sites of abnormal vasoconstriction, but not in control vessel segments. The remaining 3 patients showed evidence of a normal 3-layer structure both at sites of abnormal vasoconstriction and in control vessel segments. Conclusions: OCT does not identify a distinctive anatomical feature characterizing those coronary segments having spasm due to inhibition of endothelial nitric oxide synthesis. CORE Metadata, citation and similar papers at core.ac.uk
The American Journal of Cardiology, 1999
The Beta-blocker Strategy plus Implantable Cardioverter Defibrillator (BEST-ICD) Trial is a multi... more The Beta-blocker Strategy plus Implantable Cardioverter Defibrillator (BEST-ICD) Trial is a multicenter prospective randomized trial that started in June 1998, in 95 centers in Italy and Germany. The trial will test the hypothesis whether, in high-risk post myocardial infarction (MI) patients already treated with beta blockers, electrophysiologic study (EPS)-guided therapy (including the prophylactic implantation of implantable cardioverter defibrillator [ICD] in inducible patients) will improve survival compared with conventional therapy. Patients eligible for the study are survivors of recent MI (&amp;amp;amp;amp;amp;gt; or = 5 and &amp;amp;amp;amp;amp;lt; or = 21 days), aged &amp;amp;amp;amp;amp;lt; or = 80 years, with left ventricular ejection fraction &amp;amp;amp;amp;amp;lt; or = 35% and &amp;amp;amp;amp;amp;gt; or = 1 of the following additional risk factors: (1) ventricular premature beats &amp;amp;amp;amp;amp;gt; or = 10/hour; (2) decreased heart rate variability (standard deviation of unusual RR intervals &amp;amp;amp;amp;amp;lt; 70 msec); and (3) presence of ventricular late potentials. Furthermore, all enrolled patients must be able to tolerate at least 25 mg of metoprolol per day. These patients constitute about 9% of all patients with recent MI and are expected to have a 2-year all-cause mortality &amp;amp;amp;amp;amp;gt; 25% of which 50% is anticipated to be from sudden death. The main criteria of exclusion from the study are (1) a history of sustained ventricular arrhythmia; (2) documentation of nonsustained ventricular tachycardia during the screening phase; and (3) the need for myocardial revascularization and contraindications or intolerance to beta-blocker therapy. Eligible patients will be randomized to 2 different therapeutic strategies: conventional strategy or EPS/ICD strategy. Patients allocated to the EPS/ICD strategy will undergo further risk stratification, and electrophysiologically inducible patients (approximately 35%) will receive prophylactic ICDs, in addition to the conventional therapy, whereas noninducible patients will be only conventionally treated. The primary endpoint of the study will be death from all causes. By hypothesizing a 30% reduction in the 2-year mortality (from 20% to 14%) in the EPS/ICD group compared with conventionally treated patients, 1,200 patients will have to be included. A triangular, 2-sided sequential design with preset boundaries, for a 5% significance level and 90% power to detect a reduction in 2-year mortality from 20% to 14%, will be used to permit early termination of the trial if the strategy is found to be efficacious, no difference, or inefficacious.
Heart
ObjectiveThe advantage of beta-blockers has been postulated in patients with Takotsubo syndrome (... more ObjectiveThe advantage of beta-blockers has been postulated in patients with Takotsubo syndrome (TTS) given the pathophysiological role of catecholamines. We hypothesised that beta-blocker treatment after discharge may improve the long-term clinical outcome in this patient population.MethodsThis was an observational, multicentre study including consecutive patients with TTS diagnosis prospectively enrolled in the Takotsubo Italian Network (TIN) register from January 2007 to December 2018. TTS was diagnosed according to the TIN, Heart Failure Association and InterTAK Diagnostic Criteria. The primary study outcome was the occurrence of all-cause death at the longest available follow-up; secondary outcomes were TTS recurrence, cardiac and non-cardiac death.ResultsThe study population included 825 patients (median age: 72.0 (63.0–78.0) years; 91.9 % female): 488 (59.2%) were discharged on beta-blockers and 337 (40.8%) without beta-blockers. The median follow-up was 24.0 months. The adju...
JACC. Cardiovascular imaging, 2014
We are grateful to Drs. Yalcinkaya and Celik for their interest in the results of our study [(1)]... more We are grateful to Drs. Yalcinkaya and Celik for their interest in the results of our study [(1)][1]. The diagnosis of Tako-Tsubo cardiomyopathy (TTC) is sometimes challenging, and a detailed knowledge of this peculiar syndrome is required. Recently, our group proposed a revised form of the current
JACC. Cardiovascular imaging, 2014
JACC: Cardiovascular Imaging, 2014
The purpose of this study was to determine clinical and echocardiographic correlates of acute hea... more The purpose of this study was to determine clinical and echocardiographic correlates of acute heart failure, cardiogenic shock and in-hospital mortality in a large cohort of tako-tsubo cardiomyopathy (TTC) patients. B AC K G R O U N D Despite good long-term prognosis, life-threatening complications due to hemodynamic instability can occur early in TTC patients. M E T H O D S The study population consisted of 227 patients (66.2 AE 12.2 years of age; females, 90.3%) enrolled in the Tako-tsubo Italian Network, undergoing transthoracic two-dimensional echocardiography C O N C L U S I O N S Echocardiographic parameters provide additional information compared to other variables routinely used in clinical practice to identify patients at higher risk of hemodynamic deterioration and poor in-hospital outcome, allowing prompt institution of appropriate pharmacological treatment and adequate mechanical support.
European Heart Journal, 2008
Circulation, 2009
Background— D-dimer has been reported to be elevated in acute aortic dissection. Potential use as... more Background— D-dimer has been reported to be elevated in acute aortic dissection. Potential use as a “rule-out” marker has been suggested, but concerns remain given that it is elevated in other acute chest diseases, including pulmonary embolism and ischemic heart disease. We evaluated the diagnostic performance of D-dimer testing in a study population of patients with suspected aortic dissection. Methods and Results— In this prospective multicenter study, 220 patients with initial suspicion of having acute aortic dissection were enrolled, of whom 87 were diagnosed with acute aortic dissection and 133 with other final diagnoses, including myocardial infarction, angina, pulmonary embolism, and other uncertain diagnoses. D-dimer was markedly elevated in patients with acute aortic dissection. Analysis according to control disease, type of dissection, and time course showed that the widely used cutoff level of 500 ng/mL for ruling out pulmonary embolism also can reliably rule out aortic d...
Circulation, 2010
We thank Dr Hugli for his interest in our article. Dr Hugli raises issues that were discussed in ... more We thank Dr Hugli for his interest in our article. Dr Hugli raises issues that were discussed in the article that may benefit from being readdressed in this response. The most notable issue centers on the pretest probability of acute aortic dissection, which is a prerequisite for the estimation of diagnostic measures and their clinical usefulness. We still do not have a firm understanding of this value because sufficient data are not available (eg, prevalence rates and/or clinical decision rules/tools) to calculate it. Having stated that, however, our study was, to the best of our knowledge, the first to determine the prevalence of acute aortic dissection in patients suspected of having this disease. Our earlier study showed a prevalence of 25%, 1 and the described study was Ϸ40%. 2 Because our conditions were limited to tertiary centers that see and treat aortic dissection routinely and thus likely have increased awareness to this disease, we noted that these figures are most likely higher than those that will be seen in the community setting. Thus, we described likelihood ratios rather than predictive values because the latter is affected by prevalence. Dr Hugli's second issue concerns clinical spectrum. Our study and its findings were based on patients with suspected acute aortic dissection and not chest pain in general; thus, caution is needed in the generalization of our findings beyond the tested parameters of patients with acute aortic dissection presenting to mainly tertiary centers. Furthermore, on the topic of selection and verification bias, results of D-dimer measurements were not made available to the treating physician; therefore, this bias was not applicable to the present study. We disagree with the reasoning that examination of consecutive cases may have caused selection bias but rather assert that this allowed a more unbiased selection process. Although our present findings are limited to the described conditions, we believe that D-dimer is useful at present and that our findings, as an initial step, will help make possible the actual clinical use of D-dimer for acute aortic dissection and provide a diagnostic algorithm to optimize the use of imaging tests in these settings. We expect our findings to serve as a "working hypothesis" to be tested in more general settings such as in patients presenting with chest pain in general and in extension to the community setting (eg, nontertiary centers, healthcare systems) and further in studies that address usefulness of diagnostic strategies that incorporate both biochemical and imaging tests. We envision that a clinical algorithm will be developed that assigns patients to clinical risk groups that will help distinguish between high-risk patients who go directly to imaging and moderate-risk groups and identify lower-risk groups in which D-dimer may emerge as a rule-out screening measure.
Cardiologia (Rome, Italy), 1999
Journal of Cardiovascular Electrophysiology, 2005
European Journal of Heart Failure, 2008
Background: Diabetes mellitus is an independent risk factor for increased morbidity and mortality... more Background: Diabetes mellitus is an independent risk factor for increased morbidity and mortality in heart failure (HF) patients. Aims: To compare functional and structural improvement, as well as long-term outcome, between diabetic and non-diabetic HF patients treated with cardiac resynchronization therapy (CRT). Methods: We compared response to CRT in 141 diabetic and 214 non-diabetic consecutive patients. Major events were; death from any cause, urgent heart transplantation and implantation of a left ventricular (LV) assist device. Frequencies of hospitalisation and defibrillator (CRT-D) discharges were also analyzed. Results: CRT was able to significantly improve functional capacity, ventricular geometry and neurohumoral imbalance in both diabetic and nondiabetic patients over a median follow-up time of 34 months. Overall event-free survival was similar in diabetic and non-diabetic patients (HR 1.23, p = 0.363), as was survival free from CRT-D interventions (HR 1.72; p = 0.115) and hospitalisations (HR 1.12; p = 0.500). On multivariable analysis, NYHA class IV (p = 0.002), low LV ejection fraction (p = 0.002), absence of beta-blocker therapy (p b 0.001), impaired renal function (p = 0.003), presence of an epicardial lead (p = 0.025), but not diabetes (p = 0.821) were associated with a poor outcome after CRT. Conclusions: Diabetic HF patients treated with CRT had a very favourable functional and survival outcome, which was comparable to nondiabetic patients.
Europace, 2005
Background: To atrial fibrillation catheter ablation a second transseptal puncture is usually adv... more Background: To atrial fibrillation catheter ablation a second transseptal puncture is usually advocated to perform the procedure. Aim: To report a retrospective data about a single transseptal puncture for AF ablation. Methods: A thousand patients were recruited in whom ablation of (AF) was performed. After the transseptal puncture a guidewire was then anchored in the LSPV and the transseptal assembly pulls back to the right atrium. Then a catheter was advanced approaching the septum parallel to the guidewire and guiding the crossing. After the catheter was positioned in the left atrium, the transseptal system was advanced to the left atrium over the guidewire. Results: In 5/1000 (0.5 %) cases a second transseptal puncture was required. Neither complications of the transseptal were reported nor were catheter properly manoeuvred. In a year follow up no persistent atrial defect were observed. Conclusions: This data on a large cohort of pts shows that single transseptal puncture AF ablation is a highly successful and safe maneuver with a very low morbidity in the majority of pts. This can avoid potential complications related to a second transseptal puncture.