Pasquale Palmiero - Academia.edu (original) (raw)

Papers by Pasquale Palmiero

Research paper thumbnail of Primary prevention of cardiovascular diseases in the elderly population

Italian journal of medicine, May 17, 2024

The epidemic of chronic cardiovascular diseases must be managed and prevented. We examine if a sa... more The epidemic of chronic cardiovascular diseases must be managed and prevented. We examine if a sample of 65-75-yearolds knows and practices the right lifestyles to prevent chronic cardiovascular diseases, their habits and risk levels, and whether the paradigm of cardiovascular prevention needs to change. We recruited 153 men (50.2%) and 152 women (49.8%), aged 65-70 for 55% and 71-75 for 45%. Most were overweight (38.2%), obese (28.2%), and normal (33.6%). 67.1% trusted to eat right, and only 20.6% always ate low-salt. 54.4% of our population considers their exercise sufficient, but 83% do not practice it, and 72.3% know the importance of daily exercise. 54.3% consider themselves healthy, but 51% have chronic diseases, including arterial hypertension (37.2%), diabetes (23.1%), heart failure (20.5%), and chronic obstructive bronchopathy (21.8%). Understanding the disease, its effects, and complications, and taking care of one's health can help people live longer and prevent cardiovascular events.

Research paper thumbnail of Left ventricular diastolic function in atrial fibrillation: Methodological implications and clinical considerations

Echocardiography, Apr 1, 2024

Research paper thumbnail of Prevalence and determinants of permanent atrial fibrillation in post-menopausal hypertensive women

Italian Journal of Medicine, Oct 1, 2023

Objective. We studied the prevalence and major predisposing factors of permanent atrial fibrillat... more Objective. We studied the prevalence and major predisposing factors of permanent atrial fibrillation (PAF) in a population of hypertensive post-menopausal (HPMW) women. Materials and Methods. We enrolled 125 consecutive HPMW with PAF, 125 HPMW in sinus rhythm were the control group (CG). Women with valvular heart disease, coronary artery disease, WPW syndrome, left ventricular (LV) ejection fraction <45% and thyroid disorders were excluded. The mean age was similar: 53±3 years for women on PAF and 51±6 for women with sinus rhythm (P<0.45). All women who underwent M-B mode echocardiography, LV mass, function, and left atrial (LA) volume were assessed according to American Society of Echocardiography guidelines. Diabetes was assessed according to American Diabetes Association guidelines. Results. In a population of 8945 consecutive women, 4497 were hypertensive (50.2%) and 125 were on PAF (0.3%). We observed a highly significant difference between the two groups in relation to obesity: 31 (24.8%) in the AF-group and 15 (12%) in CG, Chi-squared 10, P<0.0016, OR 2.8, 95%; to increased LA volume: 37 (29.6%) in AF-group and 13 (10.4%) in CG, Chi-squared 14.4, P<0.0001, OR 3.62, 95%. No difference in diabetes: 30 (24%) in AFgroup and 28 (22.4%) in CG, Chi-squared 0.09, P<0.76, OR 1.09, 95%, and LV diastolic dysfunction (LVDD): 24 (19.2%) in AF-group and 20 (16%) in CG, Chi-squared 0.44, P<0.5, OR 1.25, 95%. In contrast to what was expected LV hypertrophy had a lower incidence of 59 (47.2%) in AF-group than in CG 84 (67.2%), Chi-squared 10.21, P<0.0014, OR 0.44, 95%. Conclusions. The prevalence of PAF in HPMW is not elevated, obesity and increased LA volume are strong determinants of PAF, not depending on age. LVDD, LV hypertrophy, and diabetes status seem not to play a relevant role as PAF determinants.

Research paper thumbnail of Preheart failure: a stage of chronic heart failure

Research paper thumbnail of Co-morbidities in Coronary Artery Disease Post-menopausal Women : Data from Southern Italy

The aim of our study was to determine the “real-world” prevalence of co-morbidities in a Southern... more The aim of our study was to determine the “real-world” prevalence of co-morbidities in a Southern Italian population of postmenopausal women with or without coronary artery disease (CAD) who come to the emergency department for chest pain and suspicion of coronary involvement. 6535 post-menopausal women (mean age: 64 + 9 years) were enrolled in the study. On the base of results of coronary angiography we recognized CAD-group and CADfree group. Congestive heart failure (CHF), stroke and chronic lower respiratory tract diseases (CLRTD), hypertension, diabetes, dizziness or syncope, chronic renal failure, urinary incontinence, >4 medications and/or Warfarin use were detected. Results of our study show that 528 (8.1%) women suffered from CAD. Compared to CAD free group, women with CAD have higher prevalence of CHF (9.1% vs. 1.6%, p=0.02), stroke (6% vs. 0.6%, p<0.01) and CLTRD (6.5% vs. 5.4%, p=0.04). Moreover in CAD population, we found significant higher percentages of patients ...

Research paper thumbnail of 5 Early diagnosis of coronary artery disease in postmenopausal women by arterial stiffness assessment

European Heart Journal Supplements, Dec 1, 2021

The key role of systemic vascular resistance (SVR) in cardiovascular performance during exercise ... more The key role of systemic vascular resistance (SVR) in cardiovascular performance during exercise has been invasively demonstrated, however no data have been non-invasively obtained by analysing SVR response using cardiopulmonary exercise testing (CPET). To investigate the relationship between SVR at peak, maximum oxygen uptake (VO 2 peak), and its determinants using CPET. Methods and results: 1130 consecutive subjects were enrolled; according to physiology, SVR was determined as the ratio between mean arterial pressure (MAP) and cardiac output (CO). A novel parameter, named oxygen pressure (MAP peak/VO 2 peak) was also created. Mean age was 61 6 12 years and male gender was prevalent (61%); 66% of patients had arterial hypertension, 74% dyslipidaemia, 19% diabetes, 20% had smoking habit, and 26% previous history of cardiovascular (CV) disease. Significant inverse correlations between SVR peak and VO 2 /kg peak (P < 0.001), oxygen pulse (P < 0.001), CV efficiency (P < 0.001), chronotropic response (P < 0.001), and oxygen uptake exaction slope (P < 0.001) were found. Moreover, positive correlation between SVR peak and VE/VCO 2 slope (P < 0.001) was observed. After multivariate analysis, the inverse correlation between peak SVR and peak VO 2 remained significant (P < 0.001). Similar results were found considering oxygen pressure. Conclusions: Low values of SVR at peak exercise, non-invasively evaluated with CPET, are associated with high levels of cardiorespiratory fitness. Oxygen pressure may represent a novel and simple CPET marker of peripheral vascular response to exercise, thereby representing a promising field of research in exercise medicine. 4 Early diagnosis of subclinical left ventricular dysfunction in postmenopausal women with rheumatoid arthritis

Research paper thumbnail of Metabolic syndrome and breast cancer: a dangerous association for postmenopausal women. A postmenopausal women prevention study

Background:Breast cancer(BC) is the most common cancer in women worldwide, the relationship betwe... more Background:Breast cancer(BC) is the most common cancer in women worldwide, the relationship between metabolic syndrome(MetS) and BC needs to be better clarified. Today the early diagnosis of breast cancer(BC) is yet a challenging problem in clinical practice, so the evidence that a well identified population of postmenopausal women, affected by MetS, presents a high risk, of breast cancer occurrence, is useful for breast cancer prevention. Our study aims to assess the prevalence of metabolic syndrome, diagnosed according to current guidelines, in postmenopausal women with breast cancer, and its role as an independent risk factor.Results:MetS rate was significantly higher among women affected by BC:10.1%, 33 women, than CG:5.4%, 18 women, Chi-squared4.8,Odds ratio1.94,c.i.95%,p<0.02. Metabolic cardiomyopathy rate was significantly higher among women affected by BC:5.8%, 18 women, than CG:1.8%, 6 women, Chi-squared6.5,Odds ratio3.2,c.i.95%,p<0.01. Otherwise MetS rate without cardiomyopathy was higher among women affected by BC:4.8%, 15 women, than CG:3.4%, 11 women, but in a not statistically significant way, Chi-squared0.8,Odds ratio1.35,c.i.95%,p<0.36.Conclusion:There was a significant relationship, in our population, between MetS and BC, adding evidence to this controversial association, the relationship was even tighter, when restricted to women affected by metabolic cardiomyopathy; otherwise it, restricted to women affected by MetS, without metabolic cardiomyopathy, was not statistically significant. Since the prevalence of MetS is increasing worldwide, just like the incidence of BC, an intervention is needed to improve physical activity and weight reduction to decrease the MetS rate.

Research paper thumbnail of Low-dose Aspirin for Primary Prevention of Cardiovascular Events in Postmenopausal Women with Type-2 Diabetes: The Prescriptive Approach in the Real World

PubMed, 2021

Background: The long-term efficacy of low-dose aspirin for primary prevention of cardiovascular (... more Background: The long-term efficacy of low-dose aspirin for primary prevention of cardiovascular (CV) events in postmenopausal women with type-2 diabetes is controversial. Therefore, it is recommended only on an individual basis, recommendation of grade C. Methods: We enrolled 275 consecutive postmenopausal women with type-2 diabetes, without an increased bleeding risk and without preexisting CV disease as coronary artery disease, stroke, and peripheral vascular disease, but with a high risk assessed by score >10%, aged 60-69 years. All were receiving aspirin (75-100 mg daily), aspirin group (AG). 170 postmenopausal women with type-2 diabetes and without preexisting cardiovascular (CV) disease, but not on aspirin treatment, despite a high risk assessed by score >10%, were control group (CG). Mean age was 66 ± 4 years for AG and 65 ± 7 years for CG. Our goal was to identify the prevalence of low-dose aspirin prescriptions in these populations according to different clinical conditions. Results: Women with only high risk were 41/275 (15%) on AG and 72/170 (42.3%) on CG, Chi-squared 41, Odds ratio 0.2, c.i. 95%, P < 0.0001. Women affected by metabolic syndrome were 105/275 (38.1%) on AG and 47/170 (27.6%) on CG, Chi-squared 5.1, Odds ratio 1.6, c.i. 95%, P < 0.02. Women affected by metabolic cardiomyopathy were 111/275 (40.3%) on AG and 44/170 (25.9%) on CG, Chi-squared 8, Odds ratio 1.8, c.i. 95%, P < 0.004. Women affected by diabetic cardiomyopathy were 18/275 (6.6%) on AG and 7/170 (4.2%) on CG, Chi-squared 1.2, Odds ratio 16, c.i. 95%, P < 0.2 n.s. Conclusions: Low-dose aspirin in our population is prescribed preferentially in postmenopausal women with type-2 diabetes when affected by metabolic syndrome or metabolic cardiomyopathy, at the opposite women with only high risk have lower chance to receive aspirin.

Research paper thumbnail of Patent foramen ovale and cryptogenic stroke: from studies to clinical practice

International Journal of Clinical Practice, Jul 7, 2016

Over the last two decades the interest on patent foramen ovale (PFO) as a cause of cardioembolism... more Over the last two decades the interest on patent foramen ovale (PFO) as a cause of cardioembolism in cryptogenic stroke has tremendously increased, thanks to the availability of better techniques to diagnose cardiac right‐to‐left shunt by ultrasounds and of percutaneous means of PFO treatment with interventional techniques. Many studies have been published that have attempted to define diagnostic methodology, prognosis, and optimal treatment (pharmacological or percutaneous closure) of PFO patients with cryptogenic stroke. Unfortunately, even today, definitive evidence is still lacking, and clinical management is not consistent among cardiologists.

Research paper thumbnail of The left ventricle as a mechanical engine

Journal of Cardiovascular Medicine, Mar 1, 2013

The interpretation of the heart as a mechanical engine dates back to the teachings of Leonardo da... more The interpretation of the heart as a mechanical engine dates back to the teachings of Leonardo da Vinci, who was the first to apply the laws of mechanics to the function of the heart. Similar to any mechanical engine, whose performance is proportional to the power generated with respect to weight, the left ventricle can be viewed as a power generator whose performance can be related to left ventricular mass. Stress echocardiography may provide valuable information on the relationship between cardiac performance and recruited left ventricular mass that may be used in distinguishing between adaptive and maladaptive left ventricular remodeling. Peak power output-to-mass, obtained during exercise or pharmacological stress echocardiography, is a measure that reflects the number of watts that are developed by 100 g of left ventricular mass under maximal stimulation. Power output-to-mass may be calculated as left ventricular power output per 100 g of left ventricular mass: 100× left ventricular power output divided by left ventricular mass (W/100 g). A simplified formula to calculate power output-to-mass is as follows: 0.222 × cardiac output (l/min) × mean blood pressure (mmHg)/left ventricular mass (g). When the integrity of myocardial structure is compromised, a mismatch becomes apparent between maximal cardiac power output and left ventricular mass; when this occurs, a reduction of the peak power output-to-mass index is observed.

Research paper thumbnail of Ventricular arrhythmias and left ventricular hypertrophy in essential hypertension

PubMed, Dec 1, 2000

Background: Patients with essential hypertension and/or left ventricular hypertrophy and ventricu... more Background: Patients with essential hypertension and/or left ventricular hypertrophy and ventricular arrhythmias suffer from an increased mortality rate. In all previous studies on hypertension, the criterion for inclusion was diastolic blood pressure > 95 mmHg. This is a low selective threshold. Our study attempted to evaluate the incidence of ventricular arrhythmia in hypertensive patients not receiving pharmacological treatment and diagnosed by 24-h ambulatory blood pressure monitoring (ABPM), therefore using a more selective criterion than WHO guidelines. Methods: Hundred-twenty-height consecutive patients with hypertension diagnosed on the basis of WHO guidelines were screened for 24-h ambulatory blood pressure measurement. Eighty-five (66.4%) presented a 24-h mean blood pressure > 135/85 mmHg. All 85 patients were screened for M-mode, B-mode echocardiography, PW Doppler and 24-h ECG Holter recordings. Results: Sixty patients (70.6%) were affected by left ventricular hypertrophy and 25 were free (29.4%). Thirty-six patients (42.4%) had left ventricular diastolic dysfunction, 49 were free (57.6%). According to Lown and Wolf's classification of ventricular arrhythmia, 20 patients (23.5%) presented Grade I arrhythmia, 5 (5.9%) presented Grade II, 4 (4.7%) Grade III, 9 (10.6%) Grade IVA, 20 (23.5%) Grade IVB, 12 (14.1%) Grade V and 15 patients (17.6%) were free from premature ventricular complexes, namely Grade 0 arrhythmia. Left ventricular hypertrophy was found to correlate significantly with the arrhythmia score, r = 0.552 for p < 0.0001. Moreover, left ventricular diastolic dysfunction correlated significantly with the arrhythmia score, r = 0.495 for p < 0.0001. There was also a good correlation between left ventricular hypertrophy and left ventricular diastolic dysfunction, r = 0.616 for p < 0.0001. Among patients affected by left ventricular diastolic dysfunction and left ventricular hypertrophy, the correlation with the arrhythmia score was even closer, r = 0.586 for p < 0.0007. Conclusions: We conclude that by using a more selective criterion for the diagnosis of hypertension, we can identify patients with a highly significant statistical correlation between left ventricular hypertrophy and ventricular arrhythmia score, and also between diastolic dysfunction and the ventricular arrhythmia score, due to a more severe stage of disease. It is useful to detect those patients affected by ventricular arrhythmias for the primary prevention of major cardiovascular events.

Research paper thumbnail of Cardiovascular prevention in women: an update by the Italian Society of Cardiology working group on ‘Prevention, hypertension and peripheral disease’

Journal of Cardiovascular Medicine, May 1, 2023

The recent pandemic has substantially changed the approach to the prevention of cardiovascular di... more The recent pandemic has substantially changed the approach to the prevention of cardiovascular diseases in women. Women have been significantly impacted by the changes that occurred during the pandemic and the quarantine adopted to prevent the spread of the disease. Changes involved prevention both through the reduction of visits and preventive screening and through social and economic changes. It is necessary to adopt new cardiovascular prevention approaches focused on returning to healthy lifestyles, reducing stress and depression also using modern tools such as telemedicine, mobile phone applications and the web. These tools convey messages in a persuasive way especially in young and adult women. There is less impact of these new tools on older women towards whom it is important to adopt a more traditional approach. This review focuses on the new approach to cardiovascular prevention in women in light of the lifestyle changes recorded during the pandemic and which led to an increase in obesity examines the effects on the cardiovascular system induced by stress and depression and analyses the new high blood pressure guidelines and indications that are specific to women.

Research paper thumbnail of Left ventricular diastolic dysfunction in normotensive postmenopausal women with type 2 diabetes mellitus

Cardiology Journal, Feb 27, 2017

Background: The prevalence of heart failure among diabetic patients is high, also in those with n... more Background: The prevalence of heart failure among diabetic patients is high, also in those with normal blood pressure and without coronary artery disease, even when electrocardiogram (ECG) is normal. The goal of our study was to assess the prevalence of left ventricular diastolic dysfunction (LVDD) among diabetic women (DW) and its correlation with glycosylated hemoglobin (HbA1c) levels, obesity status, and ECG parameters. Methods: A group of 456 consecutive normotensive postmenopausal women affected by type 2 diabetes, diagnosed over 5 years, were enrolled. One hundred normotensive non-diabetic postmenopausal women were included as a control group (CG). Rest ECG and trans-thoracic echocardiogram and Doppler were performed.

Research paper thumbnail of Speckle tracking analysis

Journal of Cardiovascular Medicine, May 1, 2016

Speckle tracking echocardiography (STE) is an imaging technique applied to the analysis of left a... more Speckle tracking echocardiography (STE) is an imaging technique applied to the analysis of left atrial function. STE provides a non-Doppler, angle-independent and objective quantification of left atrial myocardial deformation. Data regarding feasibility, accuracy and clinical applications of left atrial strain are rapidly gathering. This review describes the fundamental concepts of left atrial STE, illustrates its pathophysiological background and discusses its emerging role in systemic arterial hypertension.

Research paper thumbnail of An update on hypertensive emergencies and urgencies

Journal of Cardiovascular Medicine, May 1, 2015

Severe acute arterial hypertension is usually defined as 'hypertensive crisis', although 'hyperte... more Severe acute arterial hypertension is usually defined as 'hypertensive crisis', although 'hypertensive emergencies' or 'hypertensive urgencies', as suggested by the Joint National Committee and the European Society of Hypertension, have completely different diagnostic and therapeutic approaches. The prevalence and demographics of hypertensive emergencies and urgencies have changed over the last four decades, but hypertensive emergencies and urgencies are still associated with significant morbidity and mortality. Different scientific societies have repeatedly produced upto-date guidelines; however, the treatment of hypertensive emergencies and urgencies is still inappropriate, with potential clinical implications. This review focuses on hypertensive emergencies and urgencies management and treatment, as suggested by recent data.

Research paper thumbnail of Left Ventricular Diastolic Function in Hypertension: Methodological Considerations and Clinical Implications

Journal of Clinical Medicine Research, 2015

Research paper thumbnail of Early diagnosis of subclinical left ventricular dysfunction in postmenopausal women with rheumatoid arthritis

Clinical Physiology and Functional Imaging, May 2, 2023

ObjectiveHeart failure is the most frequent cause of death among patients affected by rheumatoid ... more ObjectiveHeart failure is the most frequent cause of death among patients affected by rheumatoid arthritis(RA), in which high prevalence is independent of traditional risk factors. An early diagnosis of subclinical heart failure may be made by assessing left ventricular diastolic dysfunction (LVDD) by Doppler Echocardiography. Our study aims to early identify LVDD in RA patients.MethodsWe enrolled 207 consecutive postmenopausal women (PMW) with normal electrocardiography and physical examination with a confirmed diagnosis of RA, for over one year, 200 PMW free from RA served as the control group (CG). All women underwent M‐mode and two‐dimensional Doppler echocardiography.ResultsA total of 72 women were affected by LVDD among 207 women with RA (34.8%), 46 among 200 women in the CG (23%), chi‐squared 6.8, OR 1.8, confidence interval (CI) 95%, p &lt; 0.009. For our RA women, the chance of being affected by LVDD has almost doubled. There were 70 women affected by LVDD among 72 hypertensive women with RA (97.2%). A total of 32 women were affected by LVDD among 98 hypertensive women in the CG (32.7%), chi‐squared 72.1, OR 7.2, CI 95%, p &lt; 0.009. Among hypertensive PMW in our population, the chance of being affected by LVDD has more than tripled. All LVDD subjects had abnormal diastolic function for all different degrees.ConclusionWe propose that PMW, affected by RA, have a significantly higher prevalence than CG of LVDD without clinical evidence of heart disease. Since the prevalence is even higher if they are hypertensive, we suggest a Doppler echocardiography examination for all women with a diagnosis of RA.

Research paper thumbnail of Differential left atrial remodeling in left ventricular diastolic dysfunction and mitral regurgitation

Research paper thumbnail of Increased arterial stiffness diagnosis by echocardiography: An expert opinion of the italian chapter of the international society for cardiovascular ultrasound

World Heart Journal, Dec 1, 2020

Research paper thumbnail of 4 Early diagnosis of subclinical left ventricular dysfunction in postmenopausal women with rheumatoid arthritis

European Heart Journal Supplements, Dec 1, 2021

The key role of systemic vascular resistance (SVR) in cardiovascular performance during exercise ... more The key role of systemic vascular resistance (SVR) in cardiovascular performance during exercise has been invasively demonstrated, however no data have been non-invasively obtained by analysing SVR response using cardiopulmonary exercise testing (CPET). To investigate the relationship between SVR at peak, maximum oxygen uptake (VO 2 peak), and its determinants using CPET. Methods and results: 1130 consecutive subjects were enrolled; according to physiology, SVR was determined as the ratio between mean arterial pressure (MAP) and cardiac output (CO). A novel parameter, named oxygen pressure (MAP peak/VO 2 peak) was also created. Mean age was 61 6 12 years and male gender was prevalent (61%); 66% of patients had arterial hypertension, 74% dyslipidaemia, 19% diabetes, 20% had smoking habit, and 26% previous history of cardiovascular (CV) disease. Significant inverse correlations between SVR peak and VO 2 /kg peak (P < 0.001), oxygen pulse (P < 0.001), CV efficiency (P < 0.001), chronotropic response (P < 0.001), and oxygen uptake exaction slope (P < 0.001) were found. Moreover, positive correlation between SVR peak and VE/VCO 2 slope (P < 0.001) was observed. After multivariate analysis, the inverse correlation between peak SVR and peak VO 2 remained significant (P < 0.001). Similar results were found considering oxygen pressure. Conclusions: Low values of SVR at peak exercise, non-invasively evaluated with CPET, are associated with high levels of cardiorespiratory fitness. Oxygen pressure may represent a novel and simple CPET marker of peripheral vascular response to exercise, thereby representing a promising field of research in exercise medicine. 208 Association between cardiovascular data and the development and progression of mild cognitive impairment: results from the retrospective cohort study

Research paper thumbnail of Primary prevention of cardiovascular diseases in the elderly population

Italian journal of medicine, May 17, 2024

The epidemic of chronic cardiovascular diseases must be managed and prevented. We examine if a sa... more The epidemic of chronic cardiovascular diseases must be managed and prevented. We examine if a sample of 65-75-yearolds knows and practices the right lifestyles to prevent chronic cardiovascular diseases, their habits and risk levels, and whether the paradigm of cardiovascular prevention needs to change. We recruited 153 men (50.2%) and 152 women (49.8%), aged 65-70 for 55% and 71-75 for 45%. Most were overweight (38.2%), obese (28.2%), and normal (33.6%). 67.1% trusted to eat right, and only 20.6% always ate low-salt. 54.4% of our population considers their exercise sufficient, but 83% do not practice it, and 72.3% know the importance of daily exercise. 54.3% consider themselves healthy, but 51% have chronic diseases, including arterial hypertension (37.2%), diabetes (23.1%), heart failure (20.5%), and chronic obstructive bronchopathy (21.8%). Understanding the disease, its effects, and complications, and taking care of one's health can help people live longer and prevent cardiovascular events.

Research paper thumbnail of Left ventricular diastolic function in atrial fibrillation: Methodological implications and clinical considerations

Echocardiography, Apr 1, 2024

Research paper thumbnail of Prevalence and determinants of permanent atrial fibrillation in post-menopausal hypertensive women

Italian Journal of Medicine, Oct 1, 2023

Objective. We studied the prevalence and major predisposing factors of permanent atrial fibrillat... more Objective. We studied the prevalence and major predisposing factors of permanent atrial fibrillation (PAF) in a population of hypertensive post-menopausal (HPMW) women. Materials and Methods. We enrolled 125 consecutive HPMW with PAF, 125 HPMW in sinus rhythm were the control group (CG). Women with valvular heart disease, coronary artery disease, WPW syndrome, left ventricular (LV) ejection fraction <45% and thyroid disorders were excluded. The mean age was similar: 53±3 years for women on PAF and 51±6 for women with sinus rhythm (P<0.45). All women who underwent M-B mode echocardiography, LV mass, function, and left atrial (LA) volume were assessed according to American Society of Echocardiography guidelines. Diabetes was assessed according to American Diabetes Association guidelines. Results. In a population of 8945 consecutive women, 4497 were hypertensive (50.2%) and 125 were on PAF (0.3%). We observed a highly significant difference between the two groups in relation to obesity: 31 (24.8%) in the AF-group and 15 (12%) in CG, Chi-squared 10, P<0.0016, OR 2.8, 95%; to increased LA volume: 37 (29.6%) in AF-group and 13 (10.4%) in CG, Chi-squared 14.4, P<0.0001, OR 3.62, 95%. No difference in diabetes: 30 (24%) in AFgroup and 28 (22.4%) in CG, Chi-squared 0.09, P<0.76, OR 1.09, 95%, and LV diastolic dysfunction (LVDD): 24 (19.2%) in AF-group and 20 (16%) in CG, Chi-squared 0.44, P<0.5, OR 1.25, 95%. In contrast to what was expected LV hypertrophy had a lower incidence of 59 (47.2%) in AF-group than in CG 84 (67.2%), Chi-squared 10.21, P<0.0014, OR 0.44, 95%. Conclusions. The prevalence of PAF in HPMW is not elevated, obesity and increased LA volume are strong determinants of PAF, not depending on age. LVDD, LV hypertrophy, and diabetes status seem not to play a relevant role as PAF determinants.

Research paper thumbnail of Preheart failure: a stage of chronic heart failure

Research paper thumbnail of Co-morbidities in Coronary Artery Disease Post-menopausal Women : Data from Southern Italy

The aim of our study was to determine the “real-world” prevalence of co-morbidities in a Southern... more The aim of our study was to determine the “real-world” prevalence of co-morbidities in a Southern Italian population of postmenopausal women with or without coronary artery disease (CAD) who come to the emergency department for chest pain and suspicion of coronary involvement. 6535 post-menopausal women (mean age: 64 + 9 years) were enrolled in the study. On the base of results of coronary angiography we recognized CAD-group and CADfree group. Congestive heart failure (CHF), stroke and chronic lower respiratory tract diseases (CLRTD), hypertension, diabetes, dizziness or syncope, chronic renal failure, urinary incontinence, >4 medications and/or Warfarin use were detected. Results of our study show that 528 (8.1%) women suffered from CAD. Compared to CAD free group, women with CAD have higher prevalence of CHF (9.1% vs. 1.6%, p=0.02), stroke (6% vs. 0.6%, p<0.01) and CLTRD (6.5% vs. 5.4%, p=0.04). Moreover in CAD population, we found significant higher percentages of patients ...

Research paper thumbnail of 5 Early diagnosis of coronary artery disease in postmenopausal women by arterial stiffness assessment

European Heart Journal Supplements, Dec 1, 2021

The key role of systemic vascular resistance (SVR) in cardiovascular performance during exercise ... more The key role of systemic vascular resistance (SVR) in cardiovascular performance during exercise has been invasively demonstrated, however no data have been non-invasively obtained by analysing SVR response using cardiopulmonary exercise testing (CPET). To investigate the relationship between SVR at peak, maximum oxygen uptake (VO 2 peak), and its determinants using CPET. Methods and results: 1130 consecutive subjects were enrolled; according to physiology, SVR was determined as the ratio between mean arterial pressure (MAP) and cardiac output (CO). A novel parameter, named oxygen pressure (MAP peak/VO 2 peak) was also created. Mean age was 61 6 12 years and male gender was prevalent (61%); 66% of patients had arterial hypertension, 74% dyslipidaemia, 19% diabetes, 20% had smoking habit, and 26% previous history of cardiovascular (CV) disease. Significant inverse correlations between SVR peak and VO 2 /kg peak (P < 0.001), oxygen pulse (P < 0.001), CV efficiency (P < 0.001), chronotropic response (P < 0.001), and oxygen uptake exaction slope (P < 0.001) were found. Moreover, positive correlation between SVR peak and VE/VCO 2 slope (P < 0.001) was observed. After multivariate analysis, the inverse correlation between peak SVR and peak VO 2 remained significant (P < 0.001). Similar results were found considering oxygen pressure. Conclusions: Low values of SVR at peak exercise, non-invasively evaluated with CPET, are associated with high levels of cardiorespiratory fitness. Oxygen pressure may represent a novel and simple CPET marker of peripheral vascular response to exercise, thereby representing a promising field of research in exercise medicine. 4 Early diagnosis of subclinical left ventricular dysfunction in postmenopausal women with rheumatoid arthritis

Research paper thumbnail of Metabolic syndrome and breast cancer: a dangerous association for postmenopausal women. A postmenopausal women prevention study

Background:Breast cancer(BC) is the most common cancer in women worldwide, the relationship betwe... more Background:Breast cancer(BC) is the most common cancer in women worldwide, the relationship between metabolic syndrome(MetS) and BC needs to be better clarified. Today the early diagnosis of breast cancer(BC) is yet a challenging problem in clinical practice, so the evidence that a well identified population of postmenopausal women, affected by MetS, presents a high risk, of breast cancer occurrence, is useful for breast cancer prevention. Our study aims to assess the prevalence of metabolic syndrome, diagnosed according to current guidelines, in postmenopausal women with breast cancer, and its role as an independent risk factor.Results:MetS rate was significantly higher among women affected by BC:10.1%, 33 women, than CG:5.4%, 18 women, Chi-squared4.8,Odds ratio1.94,c.i.95%,p<0.02. Metabolic cardiomyopathy rate was significantly higher among women affected by BC:5.8%, 18 women, than CG:1.8%, 6 women, Chi-squared6.5,Odds ratio3.2,c.i.95%,p<0.01. Otherwise MetS rate without cardiomyopathy was higher among women affected by BC:4.8%, 15 women, than CG:3.4%, 11 women, but in a not statistically significant way, Chi-squared0.8,Odds ratio1.35,c.i.95%,p<0.36.Conclusion:There was a significant relationship, in our population, between MetS and BC, adding evidence to this controversial association, the relationship was even tighter, when restricted to women affected by metabolic cardiomyopathy; otherwise it, restricted to women affected by MetS, without metabolic cardiomyopathy, was not statistically significant. Since the prevalence of MetS is increasing worldwide, just like the incidence of BC, an intervention is needed to improve physical activity and weight reduction to decrease the MetS rate.

Research paper thumbnail of Low-dose Aspirin for Primary Prevention of Cardiovascular Events in Postmenopausal Women with Type-2 Diabetes: The Prescriptive Approach in the Real World

PubMed, 2021

Background: The long-term efficacy of low-dose aspirin for primary prevention of cardiovascular (... more Background: The long-term efficacy of low-dose aspirin for primary prevention of cardiovascular (CV) events in postmenopausal women with type-2 diabetes is controversial. Therefore, it is recommended only on an individual basis, recommendation of grade C. Methods: We enrolled 275 consecutive postmenopausal women with type-2 diabetes, without an increased bleeding risk and without preexisting CV disease as coronary artery disease, stroke, and peripheral vascular disease, but with a high risk assessed by score >10%, aged 60-69 years. All were receiving aspirin (75-100 mg daily), aspirin group (AG). 170 postmenopausal women with type-2 diabetes and without preexisting cardiovascular (CV) disease, but not on aspirin treatment, despite a high risk assessed by score >10%, were control group (CG). Mean age was 66 ± 4 years for AG and 65 ± 7 years for CG. Our goal was to identify the prevalence of low-dose aspirin prescriptions in these populations according to different clinical conditions. Results: Women with only high risk were 41/275 (15%) on AG and 72/170 (42.3%) on CG, Chi-squared 41, Odds ratio 0.2, c.i. 95%, P < 0.0001. Women affected by metabolic syndrome were 105/275 (38.1%) on AG and 47/170 (27.6%) on CG, Chi-squared 5.1, Odds ratio 1.6, c.i. 95%, P < 0.02. Women affected by metabolic cardiomyopathy were 111/275 (40.3%) on AG and 44/170 (25.9%) on CG, Chi-squared 8, Odds ratio 1.8, c.i. 95%, P < 0.004. Women affected by diabetic cardiomyopathy were 18/275 (6.6%) on AG and 7/170 (4.2%) on CG, Chi-squared 1.2, Odds ratio 16, c.i. 95%, P < 0.2 n.s. Conclusions: Low-dose aspirin in our population is prescribed preferentially in postmenopausal women with type-2 diabetes when affected by metabolic syndrome or metabolic cardiomyopathy, at the opposite women with only high risk have lower chance to receive aspirin.

Research paper thumbnail of Patent foramen ovale and cryptogenic stroke: from studies to clinical practice

International Journal of Clinical Practice, Jul 7, 2016

Over the last two decades the interest on patent foramen ovale (PFO) as a cause of cardioembolism... more Over the last two decades the interest on patent foramen ovale (PFO) as a cause of cardioembolism in cryptogenic stroke has tremendously increased, thanks to the availability of better techniques to diagnose cardiac right‐to‐left shunt by ultrasounds and of percutaneous means of PFO treatment with interventional techniques. Many studies have been published that have attempted to define diagnostic methodology, prognosis, and optimal treatment (pharmacological or percutaneous closure) of PFO patients with cryptogenic stroke. Unfortunately, even today, definitive evidence is still lacking, and clinical management is not consistent among cardiologists.

Research paper thumbnail of The left ventricle as a mechanical engine

Journal of Cardiovascular Medicine, Mar 1, 2013

The interpretation of the heart as a mechanical engine dates back to the teachings of Leonardo da... more The interpretation of the heart as a mechanical engine dates back to the teachings of Leonardo da Vinci, who was the first to apply the laws of mechanics to the function of the heart. Similar to any mechanical engine, whose performance is proportional to the power generated with respect to weight, the left ventricle can be viewed as a power generator whose performance can be related to left ventricular mass. Stress echocardiography may provide valuable information on the relationship between cardiac performance and recruited left ventricular mass that may be used in distinguishing between adaptive and maladaptive left ventricular remodeling. Peak power output-to-mass, obtained during exercise or pharmacological stress echocardiography, is a measure that reflects the number of watts that are developed by 100 g of left ventricular mass under maximal stimulation. Power output-to-mass may be calculated as left ventricular power output per 100 g of left ventricular mass: 100× left ventricular power output divided by left ventricular mass (W/100 g). A simplified formula to calculate power output-to-mass is as follows: 0.222 × cardiac output (l/min) × mean blood pressure (mmHg)/left ventricular mass (g). When the integrity of myocardial structure is compromised, a mismatch becomes apparent between maximal cardiac power output and left ventricular mass; when this occurs, a reduction of the peak power output-to-mass index is observed.

Research paper thumbnail of Ventricular arrhythmias and left ventricular hypertrophy in essential hypertension

PubMed, Dec 1, 2000

Background: Patients with essential hypertension and/or left ventricular hypertrophy and ventricu... more Background: Patients with essential hypertension and/or left ventricular hypertrophy and ventricular arrhythmias suffer from an increased mortality rate. In all previous studies on hypertension, the criterion for inclusion was diastolic blood pressure > 95 mmHg. This is a low selective threshold. Our study attempted to evaluate the incidence of ventricular arrhythmia in hypertensive patients not receiving pharmacological treatment and diagnosed by 24-h ambulatory blood pressure monitoring (ABPM), therefore using a more selective criterion than WHO guidelines. Methods: Hundred-twenty-height consecutive patients with hypertension diagnosed on the basis of WHO guidelines were screened for 24-h ambulatory blood pressure measurement. Eighty-five (66.4%) presented a 24-h mean blood pressure > 135/85 mmHg. All 85 patients were screened for M-mode, B-mode echocardiography, PW Doppler and 24-h ECG Holter recordings. Results: Sixty patients (70.6%) were affected by left ventricular hypertrophy and 25 were free (29.4%). Thirty-six patients (42.4%) had left ventricular diastolic dysfunction, 49 were free (57.6%). According to Lown and Wolf's classification of ventricular arrhythmia, 20 patients (23.5%) presented Grade I arrhythmia, 5 (5.9%) presented Grade II, 4 (4.7%) Grade III, 9 (10.6%) Grade IVA, 20 (23.5%) Grade IVB, 12 (14.1%) Grade V and 15 patients (17.6%) were free from premature ventricular complexes, namely Grade 0 arrhythmia. Left ventricular hypertrophy was found to correlate significantly with the arrhythmia score, r = 0.552 for p < 0.0001. Moreover, left ventricular diastolic dysfunction correlated significantly with the arrhythmia score, r = 0.495 for p < 0.0001. There was also a good correlation between left ventricular hypertrophy and left ventricular diastolic dysfunction, r = 0.616 for p < 0.0001. Among patients affected by left ventricular diastolic dysfunction and left ventricular hypertrophy, the correlation with the arrhythmia score was even closer, r = 0.586 for p < 0.0007. Conclusions: We conclude that by using a more selective criterion for the diagnosis of hypertension, we can identify patients with a highly significant statistical correlation between left ventricular hypertrophy and ventricular arrhythmia score, and also between diastolic dysfunction and the ventricular arrhythmia score, due to a more severe stage of disease. It is useful to detect those patients affected by ventricular arrhythmias for the primary prevention of major cardiovascular events.

Research paper thumbnail of Cardiovascular prevention in women: an update by the Italian Society of Cardiology working group on ‘Prevention, hypertension and peripheral disease’

Journal of Cardiovascular Medicine, May 1, 2023

The recent pandemic has substantially changed the approach to the prevention of cardiovascular di... more The recent pandemic has substantially changed the approach to the prevention of cardiovascular diseases in women. Women have been significantly impacted by the changes that occurred during the pandemic and the quarantine adopted to prevent the spread of the disease. Changes involved prevention both through the reduction of visits and preventive screening and through social and economic changes. It is necessary to adopt new cardiovascular prevention approaches focused on returning to healthy lifestyles, reducing stress and depression also using modern tools such as telemedicine, mobile phone applications and the web. These tools convey messages in a persuasive way especially in young and adult women. There is less impact of these new tools on older women towards whom it is important to adopt a more traditional approach. This review focuses on the new approach to cardiovascular prevention in women in light of the lifestyle changes recorded during the pandemic and which led to an increase in obesity examines the effects on the cardiovascular system induced by stress and depression and analyses the new high blood pressure guidelines and indications that are specific to women.

Research paper thumbnail of Left ventricular diastolic dysfunction in normotensive postmenopausal women with type 2 diabetes mellitus

Cardiology Journal, Feb 27, 2017

Background: The prevalence of heart failure among diabetic patients is high, also in those with n... more Background: The prevalence of heart failure among diabetic patients is high, also in those with normal blood pressure and without coronary artery disease, even when electrocardiogram (ECG) is normal. The goal of our study was to assess the prevalence of left ventricular diastolic dysfunction (LVDD) among diabetic women (DW) and its correlation with glycosylated hemoglobin (HbA1c) levels, obesity status, and ECG parameters. Methods: A group of 456 consecutive normotensive postmenopausal women affected by type 2 diabetes, diagnosed over 5 years, were enrolled. One hundred normotensive non-diabetic postmenopausal women were included as a control group (CG). Rest ECG and trans-thoracic echocardiogram and Doppler were performed.

Research paper thumbnail of Speckle tracking analysis

Journal of Cardiovascular Medicine, May 1, 2016

Speckle tracking echocardiography (STE) is an imaging technique applied to the analysis of left a... more Speckle tracking echocardiography (STE) is an imaging technique applied to the analysis of left atrial function. STE provides a non-Doppler, angle-independent and objective quantification of left atrial myocardial deformation. Data regarding feasibility, accuracy and clinical applications of left atrial strain are rapidly gathering. This review describes the fundamental concepts of left atrial STE, illustrates its pathophysiological background and discusses its emerging role in systemic arterial hypertension.

Research paper thumbnail of An update on hypertensive emergencies and urgencies

Journal of Cardiovascular Medicine, May 1, 2015

Severe acute arterial hypertension is usually defined as 'hypertensive crisis', although 'hyperte... more Severe acute arterial hypertension is usually defined as 'hypertensive crisis', although 'hypertensive emergencies' or 'hypertensive urgencies', as suggested by the Joint National Committee and the European Society of Hypertension, have completely different diagnostic and therapeutic approaches. The prevalence and demographics of hypertensive emergencies and urgencies have changed over the last four decades, but hypertensive emergencies and urgencies are still associated with significant morbidity and mortality. Different scientific societies have repeatedly produced upto-date guidelines; however, the treatment of hypertensive emergencies and urgencies is still inappropriate, with potential clinical implications. This review focuses on hypertensive emergencies and urgencies management and treatment, as suggested by recent data.

Research paper thumbnail of Left Ventricular Diastolic Function in Hypertension: Methodological Considerations and Clinical Implications

Journal of Clinical Medicine Research, 2015

Research paper thumbnail of Early diagnosis of subclinical left ventricular dysfunction in postmenopausal women with rheumatoid arthritis

Clinical Physiology and Functional Imaging, May 2, 2023

ObjectiveHeart failure is the most frequent cause of death among patients affected by rheumatoid ... more ObjectiveHeart failure is the most frequent cause of death among patients affected by rheumatoid arthritis(RA), in which high prevalence is independent of traditional risk factors. An early diagnosis of subclinical heart failure may be made by assessing left ventricular diastolic dysfunction (LVDD) by Doppler Echocardiography. Our study aims to early identify LVDD in RA patients.MethodsWe enrolled 207 consecutive postmenopausal women (PMW) with normal electrocardiography and physical examination with a confirmed diagnosis of RA, for over one year, 200 PMW free from RA served as the control group (CG). All women underwent M‐mode and two‐dimensional Doppler echocardiography.ResultsA total of 72 women were affected by LVDD among 207 women with RA (34.8%), 46 among 200 women in the CG (23%), chi‐squared 6.8, OR 1.8, confidence interval (CI) 95%, p &lt; 0.009. For our RA women, the chance of being affected by LVDD has almost doubled. There were 70 women affected by LVDD among 72 hypertensive women with RA (97.2%). A total of 32 women were affected by LVDD among 98 hypertensive women in the CG (32.7%), chi‐squared 72.1, OR 7.2, CI 95%, p &lt; 0.009. Among hypertensive PMW in our population, the chance of being affected by LVDD has more than tripled. All LVDD subjects had abnormal diastolic function for all different degrees.ConclusionWe propose that PMW, affected by RA, have a significantly higher prevalence than CG of LVDD without clinical evidence of heart disease. Since the prevalence is even higher if they are hypertensive, we suggest a Doppler echocardiography examination for all women with a diagnosis of RA.

Research paper thumbnail of Differential left atrial remodeling in left ventricular diastolic dysfunction and mitral regurgitation

Research paper thumbnail of Increased arterial stiffness diagnosis by echocardiography: An expert opinion of the italian chapter of the international society for cardiovascular ultrasound

World Heart Journal, Dec 1, 2020

Research paper thumbnail of 4 Early diagnosis of subclinical left ventricular dysfunction in postmenopausal women with rheumatoid arthritis

European Heart Journal Supplements, Dec 1, 2021

The key role of systemic vascular resistance (SVR) in cardiovascular performance during exercise ... more The key role of systemic vascular resistance (SVR) in cardiovascular performance during exercise has been invasively demonstrated, however no data have been non-invasively obtained by analysing SVR response using cardiopulmonary exercise testing (CPET). To investigate the relationship between SVR at peak, maximum oxygen uptake (VO 2 peak), and its determinants using CPET. Methods and results: 1130 consecutive subjects were enrolled; according to physiology, SVR was determined as the ratio between mean arterial pressure (MAP) and cardiac output (CO). A novel parameter, named oxygen pressure (MAP peak/VO 2 peak) was also created. Mean age was 61 6 12 years and male gender was prevalent (61%); 66% of patients had arterial hypertension, 74% dyslipidaemia, 19% diabetes, 20% had smoking habit, and 26% previous history of cardiovascular (CV) disease. Significant inverse correlations between SVR peak and VO 2 /kg peak (P < 0.001), oxygen pulse (P < 0.001), CV efficiency (P < 0.001), chronotropic response (P < 0.001), and oxygen uptake exaction slope (P < 0.001) were found. Moreover, positive correlation between SVR peak and VE/VCO 2 slope (P < 0.001) was observed. After multivariate analysis, the inverse correlation between peak SVR and peak VO 2 remained significant (P < 0.001). Similar results were found considering oxygen pressure. Conclusions: Low values of SVR at peak exercise, non-invasively evaluated with CPET, are associated with high levels of cardiorespiratory fitness. Oxygen pressure may represent a novel and simple CPET marker of peripheral vascular response to exercise, thereby representing a promising field of research in exercise medicine. 208 Association between cardiovascular data and the development and progression of mild cognitive impairment: results from the retrospective cohort study