Antonio rizza | University of Pisa (original) (raw)

Papers by Antonio rizza

Journal of Clinical Medicine, Sep 11, 2023

PubMed, Feb 1, 2023

Objective: Type I acute myocardial infarction (AMI) is a life-threatening condition. Time of even... more Objective: Type I acute myocardial infarction (AMI) is a life-threatening condition. Time of event and rescue procedures, and sex-specific differences may play a crucial role. We aimed to investigate chronobiological patterns and sex-specific differences in a cohort of AMI patients referred to a single hub center in Italy. Patients and methods: We considered all patients consecutively admitted for AMI (STEMI) to the Hospital of the Heart, in Massa, Tuscany (a region of Italy), between 2006 to 2018, who underwent interventional procedures. Sex, age, time of hospital admission, outcome (discharged alive/deceased), main comorbidities, and time between symptom onset and emergency medical service (EMS) activation, were analyzed. Chronobiologic analysis was applied according to hour of day, month, and season of the year. Results: Overall 2,522 patients (mean age 64.6±13.1 years, 73% males) were considered. In-hospital death (IHM) occurred in 96 subjects (3.8%). At univariate analysis, deceased subjects were more likely to be female, older, with longer wait for EMS activation and with interventional procedures during night-time. The multivariate analysis identified female sex, age, history of ischemic heart disease, and night-time interventional procedure as independently associated factors to IHM. Chronobiologic analysis showed a pattern with a main morning peak for total sample, males, and females (p=0.00027; p=0.0006); p=0.0121, respectively). Events showed a higher peak in summer, with no differences by sex, but IHM was higher in winter. Females showed a higher delay for EMS activation, compared to males (p<0.001), but with no effects on prognosis. On the contrary, males with a delay showed higher mortality. Conclusions: Great effort should be spent to reduce patient-related delays in interventional procedures, being this issue crucial in both sexes.

PubMed, Jan 10, 2023

IntroductionPostprocedural thrombosis is a rare complication after flow diverting stent (FD) impl... more IntroductionPostprocedural thrombosis is a rare complication after flow diverting stent (FD) implantation for aneurysm treatment with few reported cases in the literature. Management strategies and outcomes associated with this complication have not been reported.MethodsA multicenter retrospective series of cases of acute postprocedural FD thrombosis were compiled and prevalence was calculated based on procedural volumes over a 7 year period. Acute postprocedural FD thrombosis was defined as the development of neurologic deficit with angiographic imaging demonstrating acute thrombus within the index FD stent at least 2 hours following completion of the implantation procedure.ResultsA total of 10 cases of postprocedural thrombosis were identified at five participating centers among a total of 768 patients treated (prevalence 1.3%). Thrombosis occurred a median of 5.5 days after implantation (range 0–83 days). 9/10 patients underwent emergent angiography with intent to perform endovascular reperfusion. A variety of different endovascular treatments were used, including aspiration thrombectomy, retrievable stent thrombectomy, balloon angioplasty, and intra-arterial thrombolytic infusion, without any procedural complications. There were no instances of FD migration, stent kinking, or aneurysm rupture. 90% of patients achieved Thrombolysis in Cerebral Infarction 2B or greater revascularization. Favorable clinical outcomes (modified Rankin Scale score of 0–2) at 3 months were achieved in 88% of patients.ConclusionAcute postprocedural thrombosis of an FD is a rare complication that occurs in approximately 1–2% of patients after aneurysm treatment. Patients presenting with acute postprocedural FD thrombosis should be aggressively managed using large vessel occlusion thrombectomy techniques, as good angiographic and clinical outcomes are possible.

JACC: Case Reports, Mar 1, 2022

Ascending aorta pseudoaneurysm is a rare but potentially life-threatening complication of atheros... more Ascending aorta pseudoaneurysm is a rare but potentially life-threatening complication of atherosclerosis, infections, chest trauma, transcatheter or surgical interventions. Due to high surgical risk, percutaneous closure is considered a valuable cost-effective therapeutic alternative. In this setting, 3D printing technology is emerging as a powerful tool to plan transcatheter repair. (Level of Difficulty: Advanced.)

international cardiovascular research journal, Dec 31, 2021

Introduction: Aortic Stenosis (AS) and Abdominal Aortic Aneurysm (AAA) typically affect elderly p... more Introduction: Aortic Stenosis (AS) and Abdominal Aortic Aneurysm (AAA) typically affect elderly patients, both being associated with adverse outcomes if not adequately managed. Notably, these conditions can be present simultaneously in a significant percentage of cases. Choosing the optimal treatment for these patients is challenging and no clear recommendations are available. Yet, simultaneous treatment by the percutaneous intervention, especially in high surgical risk patients, appears attractive. Case Presentation: Herein, three cases of AAA and severe AS treated via Transcatheter Aortic Valve Implantation (TAVI) and Endovascular Aortic Repair (EVAR) within the same procedure have been reported in details for the first time. Conclusions: The results indicated that one-stage intervention was an effective, safe, and feasible treatment for these two pathologies, especially in frail patients.

Journal of Cardiac Surgery, Aug 21, 2022

Journal of Vascular Surgery, Apr 1, 2023

Jacc-cardiovascular Interventions, May 1, 2019

A neurysmatic dilatation of the vascular origin of an aberrant subclavian artery, named a Kommere... more A neurysmatic dilatation of the vascular origin of an aberrant subclavian artery, named a Kommerell diverticulum, is associated with a right-sided aortic arch in up to 50% of cases (1-3). Specifically, in this specific anatomy, the branches originate from the aortic arch in the following order: left common carotid artery, right common carotid artery, right subclavian artery, and aberrant left FI GURE 1 Pre-Procedural Anatomy Cardiac computed tomography (A) and schematic representation (B) of the right-sided aortic arch and of the Kommerell diverticulum before the procedure. LCCA ¼ left common carotid artery; LSA ¼ left subclavian artery; RCCA ¼ right common carotid artery; RSA ¼ right subclavian artery.

Journal of cardiovascular echography, Apr 1, 2024

International Journal of Environmental Research and Public Health, Feb 24, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Scientific Reports, Oct 16, 2023

Aging is the basis for several unfavorable conditions, including cardiovascular diseases (CVDs). ... more Aging is the basis for several unfavorable conditions, including cardiovascular diseases (CVDs). In this sense, regular physical activity (regular PA) has been proven to delay cellular aging and prevent endothelial dysfunction related to CVDs. Despite numerous studies involving athletes, little is known about cellular and molecular mechanisms of regular PA among master athletes. The present study aimed at evaluating the effects of regular PA on local microcirculatory functions in elderly athletes as compared to age-matched sedentary controls. Moreover, molecular/epigenetic mechanisms (nitric oxide, oxidative stress, PGC-1α, SIRT1 and miR29) were also assessed. The results of the present study showed that regular PA significantly increased local blood flow in post-ischemia and postheating conditions, as well as NO plasma concentrations, denoting a better endothelial function/ microcirculatory efficiency. Moreover, athletes presented a greater plasma antioxidant and increased transcriptional levels of the metabolism regulator PGC-1α. Finally, regular PA enhanced plasma level of SIRT1 and miR29, suggested as epigenetic regulators of redox balance and cellular metabolism. In addition, stimulated local blood flow was directly related to plasma antioxidant capacity, and SIRT1 and miR29 levels. Overall, our data confirm the beneficial effects of regular PA on the cardiovascular profile in elderly athletes and shed light on molecular signals involved in the positive adaptations to exercise. Aging is a physiopathological process characterized by a gradual structural and functional decline of the organism over time and lays the basis for several unfavorable conditions including cardiovascular diseases (CVDs) 1. Although the molecular mechanisms underlying aging are still not entirely clear, the process seems to be associated with homeostatic disorders, mitochondrial dysfunction, genetic factors, epigenetic modifications, telomere length, and impaired intracellular signaling pathways 2. From a cardiovascular point of view, arteriosclerosis and endothelial dysfunction are the greatest manifestations of vascular aging. In particular, the first one consists in a progressive arterial stiffness and atherosclerotic processes with lipid oxidation, inflammation, and arterial plaques 1 ; similarly, endothelial dysfunction is defined by an impaired vascular reactivity, but it also involves proinflammatory and prothrombotic state and may contribute also to the development, progression, and clinical complications of atherosclerosis 3,4. These mechanisms have been associated with a higher risk of hypertension, coronary artery diseases, cardiac remodeling, and fibrosis which in turn could cause arrhythmias and heart failure 5. Specifically, with advancing age, endothelial cells undergo cell cycle dysregulation, which is primarily due to a decreased NO bioavailability, as well as inflammatory

Canadian Journal of Medicine, 2021

Percutaneous coronary intervention through right radial artery access significantly reduces vascu... more Percutaneous coronary intervention through right radial artery access significantly reduces vascular complications compared to femoral access-an 80-year-old woman presented with non-ST segment elevation acute coronary syndromes (NSTE ACS). Coronary angiography performed using right radial artery access showed left anterior descendent artery disease with multiple stenoses, which was treated percutaneously. Ten minutes after the procedure, the patient presented dyspnea, hypotension, neck edema, and jugular turgor. She was immediately intubated and treated with invasive ventilation, fluid expansion, corticosteroids, and vasopressors. Urgent computerized tomography showed brachiocephalic artery trunk dissection and perforation with extravascular hemorrhage in the mediastinum and neck with venous compression without any sign of aortic, carotid, or subclavian dissection. Two days later, the percutaneous endovascular repair was performed, and a covered self-expanding stent was successfully positioned in the brachiocephalic trunk, sealing the perforation and treating the dissection. The patient progressively recovered and was discharged for rehabilitation. We provided the first report of a brachiocephalic trunk perforation using a radial approach, causing mediastinal and neck hematoma treated with percutaneous endovascular repair showing that vascular complications can be successfully treated percutaneously if be performed by an experienced team.

Gazzetta Medica Italiana Archivio per le Scienze Mediche, 2021

JACC: Case Reports, Jun 1, 2021

A young woman, submitted to aortic coarctation repair in early infancy, was referred with clinica... more A young woman, submitted to aortic coarctation repair in early infancy, was referred with clinical and echocardiographic signs of severe recoarctation. Spiral CT scan confirmed the aortic isthmus obstruction but imaged also a huge aneurysm distal to the coarctation site, from which arose a large aberrant right subclavian artery. In cardiac catheterization, this vessel showed an upper-to-lower flow direction and its closure was deemed mandatory to abolish a major feeding source to the aneurysmal sack. Thus, this anomalous vessel was occluded with an Amplatzer Duct Occluder device and multiple covered Cheatham-Platinum stents were telescopically implanted into the thoracic aorta to dilate the coarctation and exclude the aneurysm. In conclusion, percutaneous transcatheter treatment is feasible, safe, and cost-effective even in aortic arch obstructions with complex anatomic arrangement.

Journal of Cardiology Cases, Feb 1, 2013

Coronary-to-bronchial artery fistulae are the most common found in adulthood and have often been ... more Coronary-to-bronchial artery fistulae are the most common found in adulthood and have often been associated with bronchiectasis and other abnormalities of pulmonary parenchyma. In this study we describe an unusual case in which circumflex coronary artery-to-left bronchial artery fistula was associated with the presence of extensive aneurysmatic dilatation of thoracic arteries. <Learning objective: This report deals with the case of a coronary-to-bronchial artery fistula (CAF) as the cause of atypical angina in a patient with normal coronary arteries. The concomitant finding of aneurysmatic dilatation of thoracic arteries controindicated an invasive approach. Medical therapy with vasodilators and anti-anginal drugs was soon started proving to be efficacious in symptoms relief.>

JACC: Case Reports, Apr 1, 2022

Vascular Pharmacology, Apr 1, 2018

CARR U; p = 0.041 vs. T0), whereas in the loading group DROM values were not significantly differ... more CARR U; p = 0.041 vs. T0), whereas in the loading group DROM values were not significantly different at T2 (276.2 ± 52.8 CARR U; p = 0.999 vs. T0). Delta DROM, defined as the difference between DROM values at T2 and T0, was −4.1 ± 43.5 CARR U in the loading group and 37.3 ± 41.5 CARR U, respectively (p = 0.019). BAP values were in the overall cohort 2038.3 ± 402.9 μmol/L at T0, 1958.2 ± 294.1 μmol/L at T1, and 1985.8 ± 313.2 μmol/L at T2 (ANOVA p = 0.607). There were no significant differences in BAP values between the 3 time points in either study group. Conclusion: PCI seems to induce a transient increase in DROM levels, but has no significant effect on BAP. Compared with a chronic clopidogrel therapy, the administration of a 600-mg clopidogrel loading dose immediately before the procedure seems to attenuate the increase in DROM levels.

International Journal of Cardiology, Sep 1, 2004

A common point mutation (C677T) in the gene for 5,10-methylenetetrahydrofolate reductase (MTHFR) ... more A common point mutation (C677T) in the gene for 5,10-methylenetetrahydrofolate reductase (MTHFR) is associated with hyperhomocysteinemia, an independent risk factor and a strong predictor of mortality in patients with coronary artery disease (CAD). The aim of this study was to investigate whether C677T polymorphism can be a predictor of major adverse cardiac events after myocardial revascularization. We determined MTHFR genotype in 159 patients with CAD undergoing myocardial revascularization [72 percutaneous transluminal coronary angioplasty (PTCA) and 87 coronary artery bypass graft (CABG)]. Recurrent angina, nonfatal myocardial infarction (MI), target vessel revascularization, heart failure and cardiac death were considered major adverse cardiac events that occurred after discharge from index hospitalization. During the follow-up (6.9+/-0.3 months, mean+/-S.E.M.), the composite endpoint accounted for 25.9%, 11.4% and 4.3% for TT, CT and CC genotype (log-rank statistic 5.2, p=0.02), respectively. Subjects with mutant TT genotype had a threefold increase of any cardiac event (hazard ratio [HR]=3.0; 95% [CI], 1.1-8.1). In multiple-variable regression Cox, predictors of events were TT genotype (HR=2.8; 95% CI, 1.01-7.62, p=0.047), low-ejection fraction&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;40% (HR=4.5; 95% CI, 1.62-12.6, p=0.004) and revascularization procedure (HR=6.1; 95% CI, 1.86-20.34, p=0.003). These data indicate that the TT genotype seems to be significantly associated with major adverse cardiac events after myocardial revascularization in CAD patients, suggesting a potential pathological influence of homocysteine in the clinical outcome.

European Heart Journal Supplements

Regular exercise reduces morbidity and mortality from cardiovascular diseases through cardiac and... more Regular exercise reduces morbidity and mortality from cardiovascular diseases through cardiac and systemic adaptations including the increased coronary blood flow, an improved endothelial function, a slower progression of atherosclerotic processes as well as the stabilization of pre–existing lesions. However, long–term exercise is frequently associated with adverse cardiovascular events in 35–year older subjects because of a cardiac remodeling that predisposes to malignant arrhythmias and to an earlier atherosclerosis. Moreover, in athletes, ischemia is often silent with a higher risk of sudden cardiac death. The purpose of our observational study was to evaluate the efficacy of preparticipation screening in identifying the presence of coronary artery disease (CAD) in a population of asymptomatic master athletes. Between 2018 and 2019, 420 35–year older athletes (mean age: 55 + 17) underwent a preparticipation screening at the University of Pisa. None of them reported cardiovascular...