Fulvio Bellocci | Università Cattolica del Sacro Cuore (Catholic University of the Sacred Heart) (original) (raw)
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Papers by Fulvio Bellocci
European Heart Journal, 2012
Patients at risk of sudden cardiac death (SCD) after myocardial infarction (MI) can be offered th... more Patients at risk of sudden cardiac death (SCD) after myocardial infarction (MI) can be offered therapy with implantable cardioverter defibrillators (ICDs). Whether plasma biomarkers can help risk stratify for SCD and ventricular arrhythmias (VT/VF) is unclear. Methods and results The primary objective of the CAMI-GUIDE study is to assess the predictive role of C-reactive protein for SCD or VT/ VF in ischaemic patients with the ejection fraction ,30% and ICDs. Secondary endpoints included all-cause mortality, hospitalizations, and death from heart failure. Additional analyses incorporated cystatin-C and NT-ProBNP in multimarker approach for the prediction of adverse outcomes. A total of 300 patients were enrolled. All-cause mortality at 2 years was 22.6%, mortality from heart failure was 8.3%. Primary endpoint occurred in 17.3%. At a competing risk multivariable analysis adjusted for baseline variables, no significant difference in primary endpoint was found between patients with C-reactive protein ≤3 vs. .3 mg/L [heart rate (HR) 0.91 (0.50-1.64) P ¼ 0.76], while C-reactive protein .3 mg/L was strongly associated with mortality due to heart failure [HR: 3.17 (1.54-6.54) P ¼ 0.002]. NT-proBNP above median was significantly associated with the primary endpoint [adjusted HR: 1.46 (1.020-2.129) P ¼ 0.042]. A risk function, including the three biomarkers, NYHA class and resting HR, allowed stratification of patient mortality risk from 5 to 50%. Conclusion C-reactive protein .3 mg/L is not associated with SCD or fast VT/VF, however, is a strong predictor of HF mortality. Biomarkers combined with clinical markers allow an excellent risk stratification of mortality at 2 years.
Journal of the American College of Cardiology, 2010
Background: implantable cardioverter-defibrillators (ICD) significantly reduce the risk of sudden... more Background: implantable cardioverter-defibrillators (ICD) significantly reduce the risk of sudden death (SD). However, predictors of SD other than ejection fraction (EF) are still lacking. The purpose of the C-reactive Protein Assessment after Myocardial Infarction to Guide Implantation of Defibrillator (CAMI GUIDE) study was to evaluate the role of CRP in predicting SCD in post MI patients scheduled for ICD implantation for primary prevention. Methods: CAMI GUIDE was a multicenter prospective observational study of patients receiving an ICD for primary prevention after MI according to MADIT II criteria. All types of ICD were considered. The primary endpoint was the combined rate of SD or fast ventricular tachycardia/ventricular fibrillation (VF) requiring ICD intervention. Secondary endpoints were total mortality, death and hospitalization for heart failure (HF). Outcomes were evaluated according to baseline CRP, using a 3mg/l cutoff , after two years of follow-up. Results: 294 Pts of which 263 male and 123 NYHA class >II, were enrolled and followed for a median of 23.6 months. 104 patients were implanted with a CRT. Mean age was 68±10yrs; LVEF 26±4%; systolic blood pressure 121±18 mmHg, resting heart rate 71±14 bpm, QRS duration 129±36 ms, median time from MI was 69 months. Total mortality at two years was 20.6%, HF mortality was 7.7% and incidence of primary endpoint was 17.0%. No significant difference in primary endpoint was found between patients with CRP≤3 vs >3 (HR:0.92 [0.52-1.62] p=0.773). In adjusted analysis including age, gender, CRT and NYHA class, presence of biventricular pacing was significantly associated with lower risk of SCD or arrhythmias (HR: 0.48 [0.23-1.98] p=0.045). CRP> 3 mg/l was associated with total mortality (HR: 2.61 [1.47-4.64] p=0.001) and mortality for HF (HR: 6.09 [1.79-20.69] p=0.004). In CRT patients, CRP>3 vs <=3 showed a significant discrimination in primary endpoint (15% vs 1.56%; p=0.0314). Conclusion: In this ICD population, CRP>3 mg/l is not associated with occurrence of SCD or fast VT/VF. However CRP is a predictor of total and HF mortality. Interestingly, CRT reduced the risk of SD and, in this subgroup, CRP was a strong predictor of primary end-point.
Journal of the American College of Cardiology, 2010
Background: implantable cardioverter-defibrillators (ICD) significantly reduce the risk of sudden... more Background: implantable cardioverter-defibrillators (ICD) significantly reduce the risk of sudden death (SD). However, predictors of SD other than ejection fraction (EF) are still lacking. The purpose of the C-reactive Protein Assessment after Myocardial Infarction to Guide Implantation of Defibrillator (CAMI GUIDE) study was to evaluate the role of CRP in predicting SCD in post MI patients scheduled for ICD implantation for primary prevention.
Journal of the American College of Cardiology, Feb 24, 2009
We evaluated the diagnostic contribution and the therapeutic and prognostic implications of 3-dim... more We evaluated the diagnostic contribution and the therapeutic and prognostic implications of 3-dimensional electroanatomic mapping (EAM)-guided endomyocardial biopsy (EMB) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).
Bollettino Della Societa Italiana Di Cardiologia, Feb 1, 1975
Journal of Interventional Cardiac Electrophysiology, Feb 15, 2008
A 65-year-old man was referred for atrial fibrillation ablation to our center. Routine pre-proced... more A 65-year-old man was referred for atrial fibrillation ablation to our center. Routine pre-procedure transthoracic and transoesophageal echocardiography and cardiac computed tomography examinations showed a normal interatrial septum and fossa ovalis anatomy. Access to left atrium was initially planned using a conventional transseptal needle puncture. During the procedure, several consecutive attempts in conjunction with intracardiac echocardiography support, failed to cross the septum. The procedure was then successfully carried out using a specifically designed radiofrequency transseptal catheter.
The American Journal of Cardiology, 2004
The term "heart rate turbulence" (HRT) indicates the physiologic changes in the sinus cycle that ... more The term "heart rate turbulence" (HRT) indicates the physiologic changes in the sinus cycle that follow a ventricular premature complex; impaired HRT denotes abnormalities in cardiac autonomic function. To investigate whether HRT is impaired in patients with stable coronary artery disease (CAD), we studied 29 patients with documented CAD and frequent (>30/hour) ventricular premature complexes on Holter monitoring and 31 patients with frequent ventricular arrhythmias but normal hearts (NH-VA). HRT and heart rate variability analyses were analyzed on 24-hour Holter recordings. HRT variables differed significantly between the 2 groups (turbulence onset ؊0.20 ؎ 1.7% vs ؊0.67 ؎ 2.2%, p ؍ 0.00001; turbulence slope 2.83 ؎ 1.9 vs 10.83 ؎ 7.4 ms/RR, p ؍ 0.0001 in patients with CAD and NH-VA, respectively). The difference was independent of a history of previous myocardial infarction, left ventricular function, and age. Top quartile turbulence onset values (>؊0.26%) and bottom quartile turbulence slope values (<2.12 ms/RR) had similar predictive power in discriminating between patients with CAD and NH-VA (positive predictive value 86.7%, negative predictive value 64.4% for both). Among heart rate variables, bottom quartile SD of all RR intervals values (<96.3 ms) only had the same power of HRT variables in discriminating between patients with CAD and NH-VA. Thus, our data show that HRT variables are impaired in patients with CAD patients versus those with NH-VA, indicating abnormalities in the control of short-term cardiac autonomic mechanisms resulting in decreased vagal activity with likely predominant sympathetic activity. ᮊ2004 by Excerpta Medica, Inc.
Jama the Journal of the American Medical Association, 2009
... Isabelle C. Van Gelder, MD, PhD icvan.gelder{at}thorax ... Letters Section Editor: Robert M. ... more ... Isabelle C. Van Gelder, MD, PhD icvan.gelder{at}thorax ... Letters Section Editor: Robert M. Golub, MD, Senior Editor. References. ... Related letters. Letters Treatment With Amiodarone to Prevent Atrial Fibrillation: Pasquale Santangeli,; Antonio Dello Russo,; Fulvio Bellocci. JAMA . ...
Frontiers in Bioscience, 2013
Obstructive sleep apnea syndrome (OSAS) is a highly prevalent disorder. Important risk factors fo... more Obstructive sleep apnea syndrome (OSAS) is a highly prevalent disorder. Important risk factors for this disease are represented by obesity, male gender, smoking, some endocrinological disturbances, alcohol intake, use of benzodiazepines, and craniofacial alterations. It is well known that OSAS is a frequent comorbidity as well as a relevant risk factor for cardiovascular diseases (CVD), especially in patients with hypertension, coronary artery disease (CAD), arrhythmias, and heart failure. Furthermore, therapy with continuous positive airway pressure devices (CPAP) has been shown to significantly reduce the incidence of serious cardiovascular consequences. Interactions between OSAS and the cardiovascular system (CVS) can eventually result mainly in coronary atherosclerosis. These two conditions are connected by a complex biomarkers network. An extensive overview of these pathways could be helpful to better understand the causes of cardiovascular impairment in patients with OSAS.
Bollettino Della Societa Italiana Di Cardiologia, Feb 1, 1975
Circulation, Oct 28, 2008
Circulation, Nov 22, 2011
Bollettino della Società italiana di cardiologia
Giornale italiano di cardiologia
European Heart Journal, 2012
Patients at risk of sudden cardiac death (SCD) after myocardial infarction (MI) can be offered th... more Patients at risk of sudden cardiac death (SCD) after myocardial infarction (MI) can be offered therapy with implantable cardioverter defibrillators (ICDs). Whether plasma biomarkers can help risk stratify for SCD and ventricular arrhythmias (VT/VF) is unclear. Methods and results The primary objective of the CAMI-GUIDE study is to assess the predictive role of C-reactive protein for SCD or VT/ VF in ischaemic patients with the ejection fraction ,30% and ICDs. Secondary endpoints included all-cause mortality, hospitalizations, and death from heart failure. Additional analyses incorporated cystatin-C and NT-ProBNP in multimarker approach for the prediction of adverse outcomes. A total of 300 patients were enrolled. All-cause mortality at 2 years was 22.6%, mortality from heart failure was 8.3%. Primary endpoint occurred in 17.3%. At a competing risk multivariable analysis adjusted for baseline variables, no significant difference in primary endpoint was found between patients with C-reactive protein ≤3 vs. .3 mg/L [heart rate (HR) 0.91 (0.50-1.64) P ¼ 0.76], while C-reactive protein .3 mg/L was strongly associated with mortality due to heart failure [HR: 3.17 (1.54-6.54) P ¼ 0.002]. NT-proBNP above median was significantly associated with the primary endpoint [adjusted HR: 1.46 (1.020-2.129) P ¼ 0.042]. A risk function, including the three biomarkers, NYHA class and resting HR, allowed stratification of patient mortality risk from 5 to 50%. Conclusion C-reactive protein .3 mg/L is not associated with SCD or fast VT/VF, however, is a strong predictor of HF mortality. Biomarkers combined with clinical markers allow an excellent risk stratification of mortality at 2 years.
Journal of the American College of Cardiology, 2010
Background: implantable cardioverter-defibrillators (ICD) significantly reduce the risk of sudden... more Background: implantable cardioverter-defibrillators (ICD) significantly reduce the risk of sudden death (SD). However, predictors of SD other than ejection fraction (EF) are still lacking. The purpose of the C-reactive Protein Assessment after Myocardial Infarction to Guide Implantation of Defibrillator (CAMI GUIDE) study was to evaluate the role of CRP in predicting SCD in post MI patients scheduled for ICD implantation for primary prevention. Methods: CAMI GUIDE was a multicenter prospective observational study of patients receiving an ICD for primary prevention after MI according to MADIT II criteria. All types of ICD were considered. The primary endpoint was the combined rate of SD or fast ventricular tachycardia/ventricular fibrillation (VF) requiring ICD intervention. Secondary endpoints were total mortality, death and hospitalization for heart failure (HF). Outcomes were evaluated according to baseline CRP, using a 3mg/l cutoff , after two years of follow-up. Results: 294 Pts of which 263 male and 123 NYHA class >II, were enrolled and followed for a median of 23.6 months. 104 patients were implanted with a CRT. Mean age was 68±10yrs; LVEF 26±4%; systolic blood pressure 121±18 mmHg, resting heart rate 71±14 bpm, QRS duration 129±36 ms, median time from MI was 69 months. Total mortality at two years was 20.6%, HF mortality was 7.7% and incidence of primary endpoint was 17.0%. No significant difference in primary endpoint was found between patients with CRP≤3 vs >3 (HR:0.92 [0.52-1.62] p=0.773). In adjusted analysis including age, gender, CRT and NYHA class, presence of biventricular pacing was significantly associated with lower risk of SCD or arrhythmias (HR: 0.48 [0.23-1.98] p=0.045). CRP> 3 mg/l was associated with total mortality (HR: 2.61 [1.47-4.64] p=0.001) and mortality for HF (HR: 6.09 [1.79-20.69] p=0.004). In CRT patients, CRP>3 vs <=3 showed a significant discrimination in primary endpoint (15% vs 1.56%; p=0.0314). Conclusion: In this ICD population, CRP>3 mg/l is not associated with occurrence of SCD or fast VT/VF. However CRP is a predictor of total and HF mortality. Interestingly, CRT reduced the risk of SD and, in this subgroup, CRP was a strong predictor of primary end-point.
Journal of the American College of Cardiology, 2010
Background: implantable cardioverter-defibrillators (ICD) significantly reduce the risk of sudden... more Background: implantable cardioverter-defibrillators (ICD) significantly reduce the risk of sudden death (SD). However, predictors of SD other than ejection fraction (EF) are still lacking. The purpose of the C-reactive Protein Assessment after Myocardial Infarction to Guide Implantation of Defibrillator (CAMI GUIDE) study was to evaluate the role of CRP in predicting SCD in post MI patients scheduled for ICD implantation for primary prevention.
Journal of the American College of Cardiology, Feb 24, 2009
We evaluated the diagnostic contribution and the therapeutic and prognostic implications of 3-dim... more We evaluated the diagnostic contribution and the therapeutic and prognostic implications of 3-dimensional electroanatomic mapping (EAM)-guided endomyocardial biopsy (EMB) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).
Bollettino Della Societa Italiana Di Cardiologia, Feb 1, 1975
Journal of Interventional Cardiac Electrophysiology, Feb 15, 2008
A 65-year-old man was referred for atrial fibrillation ablation to our center. Routine pre-proced... more A 65-year-old man was referred for atrial fibrillation ablation to our center. Routine pre-procedure transthoracic and transoesophageal echocardiography and cardiac computed tomography examinations showed a normal interatrial septum and fossa ovalis anatomy. Access to left atrium was initially planned using a conventional transseptal needle puncture. During the procedure, several consecutive attempts in conjunction with intracardiac echocardiography support, failed to cross the septum. The procedure was then successfully carried out using a specifically designed radiofrequency transseptal catheter.
The American Journal of Cardiology, 2004
The term "heart rate turbulence" (HRT) indicates the physiologic changes in the sinus cycle that ... more The term "heart rate turbulence" (HRT) indicates the physiologic changes in the sinus cycle that follow a ventricular premature complex; impaired HRT denotes abnormalities in cardiac autonomic function. To investigate whether HRT is impaired in patients with stable coronary artery disease (CAD), we studied 29 patients with documented CAD and frequent (>30/hour) ventricular premature complexes on Holter monitoring and 31 patients with frequent ventricular arrhythmias but normal hearts (NH-VA). HRT and heart rate variability analyses were analyzed on 24-hour Holter recordings. HRT variables differed significantly between the 2 groups (turbulence onset ؊0.20 ؎ 1.7% vs ؊0.67 ؎ 2.2%, p ؍ 0.00001; turbulence slope 2.83 ؎ 1.9 vs 10.83 ؎ 7.4 ms/RR, p ؍ 0.0001 in patients with CAD and NH-VA, respectively). The difference was independent of a history of previous myocardial infarction, left ventricular function, and age. Top quartile turbulence onset values (>؊0.26%) and bottom quartile turbulence slope values (<2.12 ms/RR) had similar predictive power in discriminating between patients with CAD and NH-VA (positive predictive value 86.7%, negative predictive value 64.4% for both). Among heart rate variables, bottom quartile SD of all RR intervals values (<96.3 ms) only had the same power of HRT variables in discriminating between patients with CAD and NH-VA. Thus, our data show that HRT variables are impaired in patients with CAD patients versus those with NH-VA, indicating abnormalities in the control of short-term cardiac autonomic mechanisms resulting in decreased vagal activity with likely predominant sympathetic activity. ᮊ2004 by Excerpta Medica, Inc.
Jama the Journal of the American Medical Association, 2009
... Isabelle C. Van Gelder, MD, PhD icvan.gelder{at}thorax ... Letters Section Editor: Robert M. ... more ... Isabelle C. Van Gelder, MD, PhD icvan.gelder{at}thorax ... Letters Section Editor: Robert M. Golub, MD, Senior Editor. References. ... Related letters. Letters Treatment With Amiodarone to Prevent Atrial Fibrillation: Pasquale Santangeli,; Antonio Dello Russo,; Fulvio Bellocci. JAMA . ...
Frontiers in Bioscience, 2013
Obstructive sleep apnea syndrome (OSAS) is a highly prevalent disorder. Important risk factors fo... more Obstructive sleep apnea syndrome (OSAS) is a highly prevalent disorder. Important risk factors for this disease are represented by obesity, male gender, smoking, some endocrinological disturbances, alcohol intake, use of benzodiazepines, and craniofacial alterations. It is well known that OSAS is a frequent comorbidity as well as a relevant risk factor for cardiovascular diseases (CVD), especially in patients with hypertension, coronary artery disease (CAD), arrhythmias, and heart failure. Furthermore, therapy with continuous positive airway pressure devices (CPAP) has been shown to significantly reduce the incidence of serious cardiovascular consequences. Interactions between OSAS and the cardiovascular system (CVS) can eventually result mainly in coronary atherosclerosis. These two conditions are connected by a complex biomarkers network. An extensive overview of these pathways could be helpful to better understand the causes of cardiovascular impairment in patients with OSAS.
Bollettino Della Societa Italiana Di Cardiologia, Feb 1, 1975
Circulation, Oct 28, 2008
Circulation, Nov 22, 2011
Bollettino della Società italiana di cardiologia
Giornale italiano di cardiologia