Paolo Emilio Puddu - Academia.edu (original) (raw)

Papers by Paolo Emilio Puddu

Objectives. To study age at death (AD) and its determinants in cohorts of middle-aged men followe... more Objectives. To study age at death (AD) and its determinants in cohorts of middle-aged men followed-up until extinction. Material and Methods. A total of 9063 middle aged men enrolled in 10 cohorts of 6 countries (USA, Finland, the Netherlands, Italy, Greece and Japan) within the Seven Countries Study were examined and then followed-up for 60 years until extinction. AD was computed and a small number of risk factors were tested through multiple linear regression as possibly related to attained AD. Results. AD ranged across cohorts from 71.8 years in East Finland and 80.5 years in Crete with levels roughly lower in the USA and Northern Europe and higher elsewhere. Across cohorts the correlation coefficients of systolic blood pressure (R=-0.58) and of CVD prevalence (R=-0.65) versus average AD were the only significant ones. At individual level in the pool of all cohorts, a multiple linear regression model showed that age, vigorous physical activity, never and ex-smokers were favorably...

Medical Research Archives

Backgrounds and Aims: Simple, long-term epidemiological observations allowed to identify a hetero... more Backgrounds and Aims: Simple, long-term epidemiological observations allowed to identify a heterogeneous group of heart diseases manifested only as heart failure, arrhythmia and blocks in the absence of typical coronary syndromes, that we arbitrarily called initially atypical Coronary Heart Disease (CHD) and then Heart Disease of Uncertain Etiology (HDUE) in 12 published investigations. Methods and Results: This group of heart diseases covered about 20% of all CVD mortality and about 10% of all-cause mortality in population cohorts close to extinction and compared with typical CHD was characterized by a strong association with age and the absence or an inverse association with serum cholesterol, dietary habits and physical activity. Moreover, HDUE appeared at an older age and had a higher age at death. Blood pressure and smoking habits (the latter with some uncertainties) were directly associated with the disease. Old pathology findings had already segregated the large myocardial sc...

British Journal of Medicine and Medical Research, 2013

Digestive and Liver Disease, 2014

Journal of Biomechanics, 2015

A mechanics-based analysis of data from three-dimensional speckle tracking echocardiography is pr... more A mechanics-based analysis of data from three-dimensional speckle tracking echocardiography is proposed, aimed at investigating deformations in myocardium and at assessing shape and function of distinct strain lines corresponding to the principal strain lines of the cardiac tissue. The analysis is based on the application of a protocol of measurement of the endocardial and epicardial principal strain lines, which was already tested on simulated left ventricles. In contrast with similar studies, it is established that endocardial principal strain lines cannot be identified with any structural fibers, not even along the systolic phase and is suggested that it is due to the capacity of the endocardial surface to contrast the dilation of the left ventricle.

International Journal for Numerical Methods in Biomedical Engineering, 2019

In a previous contribution, a new Riemannian shape space, named TPS space, was introduced to perf... more In a previous contribution, a new Riemannian shape space, named TPS space, was introduced to perform statistics on shape data. This space was endowed with a Riemannian metric and a flat connection, with torsion, compatible with the given metric. This connection allows the definition of a Parallel Transport of the deformation compatible with the three‐fold decomposition in spherical, deviatoric, and non‐affine components. Such a parallel transport also conserves the Γ‐energy, strictly related to the total elastic strain energy stored by the body in the original deformation. A new approach is here presented in order to calculate the bending energy on the body alone (body bending energy) and to restrict it exclusively within physical boundaries of objects involved in the deformation analysis. The novelty of this new procedure resides in the fact that we propose a new metric to be preserved during the TPS direct transport. This allows transporting the shape change more coherently with t...

Journal of Cardiovascular Development and Disease

Objectives. To investigate mortalities from three major groups of cardiovascular diseases (CVDs) ... more Objectives. To investigate mortalities from three major groups of cardiovascular diseases (CVDs) in a pooled cohort and followed up until extinction. Materials and Methods. Ten cohorts of men (N = 9063) initially aged 40–59, in six countries, were examined and followed-up for 60 years. The major CVD groups were coronary heart disease (CHD), cerebrovascular diseases (STROKE) and other heart diseases of uncertain etiology (HDUE). Results. Death rates from CHD were higher in countries with high serum cholesterol levels (USA, Finland and The Netherlands) and lower in countries with low cholesterol levels (Italy, Greece and Japan), but the opposite was observed for STROKE and HDUE, which became the most common CVD mortalities in all countries during the last 20 years of follow-up. Systolic blood pressure and smoking habits were, at an individual level, the common risk factors for the three groups of CVD conditions, while serum cholesterol level was the most common risk factor only for CH...

JMIR Medical Informatics, 2021

BackgroundCongestive heart failure (CHF) is a disease that requires complex management involving ... more BackgroundCongestive heart failure (CHF) is a disease that requires complex management involving multiple medications, exercise, and lifestyle changes. It mainly affects older patients with depression and anxiety, who commonly find management difficult. Existing mobile apps supporting the self-management of CHF have limited features and are inadequately validated.ObjectiveThe HeartMan project aims to develop a personal health system that would comprehensively address CHF self-management by using sensing devices and artificial intelligence methods. This paper presents the design of the system and reports on the accuracy of its patient-monitoring methods, overall effectiveness, and patient perceptions.MethodsA mobile app was developed as the core of the HeartMan system, and the app was connected to a custom wristband and cloud services. The system features machine learning methods for patient monitoring: continuous blood pressure (BP) estimation, physical activity monitoring, and psyc...

Scientific Reports, 2021

This study tested the effectiveness of HeartMan—a mobile personal health system offering decision... more This study tested the effectiveness of HeartMan—a mobile personal health system offering decisional support for management of congestive heart failure (CHF)—on health-related quality of life (HRQoL), self-management, exercise capacity, illness perception, mental and sexual health. A randomized controlled proof-of-concept trial (1:2 ratio of control:intervention) was set up with ambulatory CHF patients in stable condition in Belgium and Italy. Data were collected by means of a 6-min walking test and a number of standardized questionnaire instruments. A total of 56 (34 intervention and 22 control group) participants completed the study (77% male; mean age 63 years, sd 10.5). All depression and anxiety dimensions decreased in the intervention group (p < 0.001), while the need for sexual counselling decreased in the control group (p < 0.05). Although the group differences were not significant, self-care increased (p < 0.05), and sexual problems decreased (p < 0.05) in the in...

Scientific Reports, 2019

This paper proposes a generalized Phase Space Reconstruction (PSR) based Cardiovascular Diseases ... more This paper proposes a generalized Phase Space Reconstruction (PSR) based Cardiovascular Diseases (CVD) classification methodology by exploiting the localized features of the ECG. The proposed methodology first extracts the ECG localized features including PR interval, QRS complex, and QT interval from the continuous ECG waveform using features extraction logic, then the PSR technique is applied to get the phase portraits of all the localized features. Based on the cleanliness and contour of the phase portraits CVD classification will be done. This is first of its kind approach where the localized features of ECG are being taken into considerations unlike the state-of-art approaches, where the entire ECG beats have been considered. The proposed methodology is generic and can be extended to most of the CVD cases. It is verified on the PTBDB and IAFDB databases by taking the CVD including Atrial Fibrillation, Myocardial Infarction, Bundle Branch Block, Cardiomyopathy, Dysrhythmia, and ...

Experimental Physiology, 2019

New Findings What is the central question of this study? Can impaired deformational indicators fo... more New Findings What is the central question of this study? Can impaired deformational indicators for genotype positive for hypertrophic cardiomyopathy in subjects that do not exhibit a left‐ventricular wall hypertrophy condition (G+LVH−) be determined using non‐invasive 3D echocardiography? What is the main finding and its importance? Using 3D‐STE and modern shape analysis, peculiar deformational impairments can be detected in G+LVH− subjects that can be classified with good accuracy. Moreover, the patterns of impairment are located mainly on the apical region in agreement with other evidence coming from previous biomechanical investigations. We propose a non‐invasive procedure for predicting genotype positive for hypertrophic cardiomyopathy (HCM) in subjects that do not exhibit a left‐ventricular wall hypertrophy condition (G+LVH−); the procedure is based on the enhanced analysis of medical imaging from 3D speckle tracking echocardiography (3D‐STE). 3D‐STE, due to its low quality ima...

International Journal of Environmental Research and Public Health, 2019

(1) Background: the main objective of this study was to investigate information needs concerning ... more (1) Background: the main objective of this study was to investigate information needs concerning sexual activity and experienced sexual problems in heart failure (HF) patients and, in addition, to examine the association between these sexual problems and health-related quality of life (HRQoL); (2) Methods: in this cross-sectional study, three self-administered questionnaires were distributed to 77 stable ambulatory HF patients to acquire data on HRQoL, sexual problems, and need for counselling; (3) Results: More than half (56.7%) of HF patients experienced a marked decrease or total cessation of sexual activity due to their illness. Additionally, more than one-third perceived a marked decrease or total absence of sexual pleasure (42.5%), interest (32.9%), and constant problems or being unable to perform sexual activity (37.3%). Furthermore, 43.1% of patients experienced an important overall need for counselling concerning sexual activity, with information on relationships (69.2%), symptoms (58.5%), and relaxation (49.2%) being the most desired topics. Multiple linear regression analysis revealed that sexual problems were independently associated with HRQoL, with more sexual problems (t = 3.19, p < 0.01) being related to poor HRQoL; (4) Conclusion: by investigating the experienced problems and counselling needs of HF patients, an alignment between current practice and HF patients' expectations and needs might be obtained.

BMC Cardiovascular Disorders, 2018

Background: Heart failure (HF) is a highly prevalent chronic disease, for which there is no cure ... more Background: Heart failure (HF) is a highly prevalent chronic disease, for which there is no cure available. Therefore, improving disease management is crucial, with mobile health (mHealth) being a promising technology. The aim of the HeartMan study is to evaluate the effect of a personal mHealth system on top of standard care on disease management and health-related quality of life (HRQoL) in HF. Methods: HeartMan is a randomized controlled 1:2 (control:intervention) proof-of-concept trial, which will enrol 120 stable ambulatory HF patients with reduced ejection fraction across two European countries. Participants in the intervention group are equipped with a multi-monitoring health platform with the HeartMan wristband sensor as the main component. HeartMan provides guidance through a decision support system on four domains of disease management (exercise, nutrition, medication adherence and mental support), adapted to the patient's medical and psychological profile. The primary endpoint of the study is improvement in self-care and HRQoL after a six-months intervention. Secondary endpoints are the effects of HeartMan on: behavioural outcomes, illness perception, clinical outcomes and mental state. Discussion: HeartMan is technologically the most innovative HF self-management support system to date. This trial will provide evidence whether modern mHealth technology, when used to its full extent, can improve HRQoL in HF. Trial registration: This trial has been registered on https://clinicaltrials.gov/ct2/show/NCT03497871, on April 13 2018 with registration number NCT03497871.

Journal of Endocrinological Investigation, 2019

Background and aim Evidences suggest that androgen deficiency is associated with sudden cardiac d... more Background and aim Evidences suggest that androgen deficiency is associated with sudden cardiac death (SCD). Our purpose was to analyse some electrocardiographic (ECG) markers of repolarization phase in hypogonadal patients either at baseline or after testosterone replacement therapy (TRT). Patients and Methods Baseline and after 6 months of testosterone replacement therapy, 14 hypogonadal patients and 10 age-matched controls underwent a short-term ECG recordings at rest and immediately after a maximal exercise test. The following ECG parameters have been collected: QTe (the interval between the q wave the end of T wave), QTp (the interval between the q wave and the peak of T wave), and Te (the interval between the peak and the end of T wave). Results At baseline, in the hypogonadal patients, corrected QTe and QTp values were longer at rest than in the controls at rest (p < 0.05), whereas, during the recovery phase, only the QTp remained significantly longer (p < 0.05). After TRT, hypogonadal patients showed an improvement only in Te (p < 0.05). Conversely, any difference between hypogonadal patients and control subjects was found with respect to the markers of temporal dispersion of repolarization phases, except for a worse QTp → Te coherence (p = 0.001) obtained during the recovery phase. Conclusions In conclusion, at rest, hypogonadal patients suffer from a stable increase in the myocardial repolarization phase without an increase in its temporal dispersion and, hence, the SCD risk seems to be low.

Annals of Medicine, 2017

Objectives: This analysis deals with the ecologic relationships of dietary fatty acids, food grou... more Objectives: This analysis deals with the ecologic relationships of dietary fatty acids, food groups and the Mediterranean Adequacy Index (MAI, derived from 15 food groups) with 50-year allcause mortality rates in 16 cohorts of the Seven Countries Study. Material and methods: A dietary survey was conducted at baseline in cohorts subsamples including chemical analysis of food samples representing average consumptions. Ecologic correlations of dietary variables were computed across cohorts with 50-year all-cause mortality rates, where 97% of men had died. Results: There was a 12-year average age at death population difference between extreme cohorts. In the 1960s the average population intake of saturated (S) and trans (T) fatty acids and hard fats was high in the northern European cohorts while monounsaturated (M), polyunsaturated (P) fatty acids and vegetable oils were high in the Mediterranean areas and total fat was low in Japan. The 50-year all-cause mortality rates correlated (r¼ À0.51 to À0.64) ecologically inversely with the ratios M/S, (M þ P)/(S þ T) and vegetable foods and the ratio hard fats/vegetable oils. Adjustment for high socioeconomic status strengthened (r¼ À0.62 to À0.77) these associations including MAI diet score. Conclusion: The protective fatty acids and vegetable oils are indicators of the low risk traditional Mediterranean style diets. KEY MESSAGES We aimed at studying the ecologic relationships of dietary fatty acids, food groups and the Mediterranean Adequacy Index (MAI, derived from 15 food groups) with 50-year all-cause mortality rates in the Seven Countries Study. The 50-year all-cause mortality rates correlated (r ¼ À0.51 to À0.64) ecologically inversely with the ratios M/S [monounsaturated (M) þ polyunsaturated (P)]/[saturated (S) þ trans (T)] fatty acids and vegetable foods and the ratio hard fats/vegetable oils. After adjustment for high socioeconomic status, associations with the ratios strengthened (r ¼ À0.62 to À0.77) including also the MAI diet score. The protective fatty acids and vegetable oils are indicators of the low risk traditional Mediterranean style diets.

Journal of Cardiovascular Medicine, 2017

Cardiovascular disease (CVD) accounts for more than 17 million deaths per year worldwide. It has ... more Cardiovascular disease (CVD) accounts for more than 17 million deaths per year worldwide. It has been estimated that the influence of lifestyle on CVD mortality amounts to 13.7% for smoking, 13.2% for poor diet, and 12% for inactive lifestyle. These results deeply impact both the healthy status of individuals and their skills in working. The impact of CVD on productivity loss accounts for the 24% in total costs for CVD management. Mediterranean diet (MedD) can positively impact on natural history of CVD. It is characterized by a relatively high consumption of inexpensive and genuine food such as cereals, vegetables, legumes, nuts, fish, fresh fruits, and olive oil as the principal source of fat, low meat consumption and low-tomoderate consumption of milk, dairy products, and wine. Its effects on cardiovascular health are related to the significant improvements in arterial stiffness. Peripheral artery disease, coronary artery disease, and chronic heart failure are all positively influenced by the MedD. Furthermore, MedD lowers the risk of sudden cardiac death due to arrhythmias. The present narrative review aims to analyze the effects of MedD on CVD.

Scientific Reports, 2016

Randomized controlled trials (RCTs) were conflicting to support whether unstable angina versus no... more Randomized controlled trials (RCTs) were conflicting to support whether unstable angina versus non-ST-elevation myocardial infarction (UA/NSTEMI) patients best undergo early invasive or a conservative revascularization strategy. RCTs with cardiac biomarkers, in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from 1975–2013 were reviewed considering all cause mortality, recurrent non-fatal myocardial infarction (MI) and their combination. Follow-up lasted from 6–24 months and the use of routine invasive strategy up to its end was associated with a significantly lower composite of all-cause mortality and recurrent non-fatal MI (Relative Risk [RR] 0.79; 95% confidence interval [CI], 0.70–0.90) in UA/NSTEMI. In NSTEMI, by the invasive strategy, there was no benefit (RR 1.19; 95% CI, 1.03–1.38). In the shorter time period, from randomization to discharge, a routine invasive strategy was associated with significantly higher odds of the combined end-point among UA/NSTEM...

IRBM, 2014

Standard 12-lead (S12) system and Mason-Likar 12-lead (ML12) system despite of being most accepta... more Standard 12-lead (S12) system and Mason-Likar 12-lead (ML12) system despite of being most acceptable systems for clinical usage are not the preferred lead systems for remote monitoring (RM) applications. Usually RM applications involve wireless transmission of signals and a 2-3 lead system is preferred for bandwidth and storage limitations and data transmission time. Generally, ECG compression techniques are applied for the same, however, compression ratio (CR) depends on the number of channels and decreases with the increase in number of channels. Thus, it facilitates the usage of a 2-3 lead system. However, a reduced lead (RL) system with 2-3 leads may be inadequate for the information desired by the cardiologists who are accustomed to S12 or ML12 system pertaining to its decades old usage. In this paper, we attempt to provide solution to both technical and non-technical limitations of RM applications. We reconstruct S12 and ML12 systems from Reduced 3-lead (R3L) system comprising of basis leads I, II, V2 using personalized or patient-specific transformation. Two separate investigations have been carried out for S12 and ML12 with their corresponding R3L systems comprising of their respective basis leads. PhysioNet PTBDB and INCARTDB after wavelet based preprocessing were used in this investigation. R 2 statistics, correlation (rx) and regression (bx) coefficients were used to evaluate reconstructed signal against the original signal and the mean values obtained were 96.53%, 0.982 and 0.968 (S12) and 96.53%, 0.982 and 0.968 (ML12) respectively. R3L system reduces number of leads and electrodes from 12 and 10 to 3 and 5 respectively, lowers bandwidth and storage requirements, data transmission time and increases CR. The study shows that basis leads obtained from S12 outperforms the basis leads of ML12 for reconstruction of precordial leads.

Circulation, 1988

To gain insight into the differences in antiarrhythmic potential of right vs left stellate gangli... more To gain insight into the differences in antiarrhythmic potential of right vs left stellate ganglionectomy, 72 dogs were randomized to either unilateral stellectomy or second intercostal space thoracotomy and left circumflex coronary arteriovenous pedicle occlusion was performed, without vagotomy, a mean of 8 weeks later under anesthesia. The type and timing of ventricular ectopic beats, including both nonsustained and sustained ventricular tachycardia and ventricular fibrillation, were investigated. Several covariates, including postischemic electrocardiographic changes, were considered. Both right and left stellate ganglionectomy reduced the incidence of early (0 to 10 min) (p = .004 and p = .001, respectively) and total (0 to 60 min) (p = .009 and p = .008, respectively) ischemia-induced ventricular fibrillation, and improved outcome (p = .0013 and p = .0012, respectively). Early sustained ventricular tachycardia was similarly reduced (p = .02) in both stellectomized groups. By co...

Depending on the location type (venous access, pocket, lead and generator) it is possible to diss... more Depending on the location type (venous access, pocket, lead and generator) it is possible to dissect several different clinical presentations of complications related to PM implantation which occur, more frequently, in the immediate post-operative course. 2.1 Venous access-related complications Pneumothorax. This complication occurs uncommonly and is directly related to operator experience, the difficulty of the subclavian puncture, and is almost eliminated using the cephalic cut-down technique. However, these traditional comparisons may become obsolete as the axillary vein cannulation technique (Martin et al., 1996) threatens to eliminate this controversy. Pneumothorax is often asymptomatic and noted on routine follow-up plain chest radiograph, but occasionally it requires active medical treatment including intercostal chest drain and aspiration. Aggarwal et al. (1995, 1996) reported a large series of 1088 consecutive patients; pneumotorax represented an overall rate of 1.9% of subclavian insertions. There was no significant difference in the pneumothorax rate between dual chamber (n = 12, 2.1%) and single chamber (n=7, 1.4%). Pneumothorax required active medical treatment in 8 patients (0 8%); 5 patients had an intercostal chest drain inserted and 3 were treated by aspiration. A further 11 patients (1.0%) developed an insignificant pneumothorax (< 10% of pulmonary field in chest x-ray film with no symptoms or progression in subsequent chest radiograph). More recently, Zhan et al. (2008) collected over 67000 patients and presented similar rates. Finally, Pakarinen et al. (2010) also concluded, in a retrospective 1-year single-centre survey, that short-term implantation-related www.intechopen.com