Antonio Cittadini | Università degli Studi di Napoli "Federico II" (original) (raw)
Papers by Antonio Cittadini
International journal of cardiology, Jan 19, 2015
Riociguat is a soluble guanylate cyclase stimulator approved for pulmonary arterial hypertension ... more Riociguat is a soluble guanylate cyclase stimulator approved for pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). The objective of this study was to evaluate the change of right heart size and function assessed by echocardiography during long-term treatment with riociguat. We assessed patients who started riociguat treatment (1.0-2.5mg tid) within the trials PATENT, PATENTplus, EAS and CHEST and continued for 3-12months. Echocardiography, 6-minute walking distance (6MWD) and further clinical parameters were analyzed at baseline, after 3, 6 and 12months. Right heart catheterization was performed at baseline and after 3months. For missing data we performed the last and baseline observation carried forward (LOCF, BOCF) method as sensitivity analyses. Thirty-nine patients (21 PAH, 18 CTEPH, mean pulmonary arterial pressure 43±2mmHg, PVR 600±43dyn∗s∗cm(-5), 56.4% treatment-naïve) were included. Mean right ventricular (RV) area significantly...
Endocrine Abstracts, 2015
Frontiers of hormone research, 2014
Chronic heart failure represents a leading cause of mortality and health care expenditure in deve... more Chronic heart failure represents a leading cause of mortality and health care expenditure in developed countries. In the last 20 years, medical therapy of heart failure has dramatically changed thanks to the introduction of agents able to significantly reduce the neurohormonal hyperactivation that underpins the syndrome, and to the growing opportunities of electrical therapies. Although major advances in terms of improved survival and quality of life have been achieved, the reduction in the burden of heart failure is still the primary goal of cardiovascular societies. In the last decades, other research lines have also grown to complement the neurohormonal paradigm. It is increasingly evident that several hormonal systems are down-regulated or impaired in patients with heart failure, including growth and thyroid hormones, androgens and insulin. These abnormalities could be considered interrelated and linked, in turn, to the neurohormonal and cytokine hyperactivation. Since most of t...
![Research paper thumbnail of [The portopulmonary hypertension: an overview from diagnosis to treatment]](https://attachments.academia-assets.com/45655813/thumbnails/1.jpg)
](Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo, 2013
Portopulmonary hypertension (POPH) refers to the condition of pulmonary arterial hypertension (PA... more Portopulmonary hypertension (POPH) refers to the condition of pulmonary arterial hypertension (PAH) in association with portal hypertension. Among patients with portal hypertension, reported incidence rates of POPH range from 2 to 10% and long-term prognosis in cases of POPH is poor. Fundamental issues of management of POPH include identification of patients likely to benefit from liver transplantation (LTx) and treatment with specific pulmonary vasodilators before and after LTx. This review presents as an overview of the current knowledge on the epidemiology, diagnosis, treatment and prognosis of patients with portopulmonary hypertension.
Italian heart journal : official journal of the Italian Federation of Cardiology, 2005
Aldosterone was discovered in 1953, and until the beginning of the 1960s, when spironolactone was... more Aldosterone was discovered in 1953, and until the beginning of the 1960s, when spironolactone was developed, it was the focus of considerable interest among the scientific community. The following 30 years represented a sort of Dark Age, interrupted by the Weber's classic studies. He first demonstrated the pivotal role of aldosterone in the promotion of cardiac hypertrophy and fibrosis and such an observation represented a solid background for the implementation of large survival trials, the RALES and the EPHESUS. These landmark studies showed that aldosterone receptor blockade prolongs survival in advanced and postinfarction heart failure, respectively. After a myocardial infarction, there is a significant upregulation of the local steroidogenic system in the area remote from the scar, that leads to a remarkable fibroblast activation, collagen deposition, and reactive fibrosis. Fibrosis in turn further impairs systolic and diastolic function, and induces electrical heterogeneit...
![Research paper thumbnail of [Anabolic/catabolic imbalance in chronic heart failure]](https://attachments.academia-assets.com/45655807/thumbnails/1.jpg)
](Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo, 2010
A metabolic imbalance between anabolic drive and catabolic forces is commonly observed in chronic... more A metabolic imbalance between anabolic drive and catabolic forces is commonly observed in chronic heart failure (CHF) patients, with the latter prevailing over anabolic hormones. Moreover, anabolic deficiencies are independent markers of poor prognosis. This finding represents a solid background for the implementation of therapeutic trials based on replacement therapy. The somatotropic axis (GH/IGF-1) is the most powerful anabolic axis of the body and its decline is related with a poor outcome and a worse clinical status. Growth hormone (GH) administration may enter the therapeutic arena as adjunctive treatment in patients affected by CHF and GH/IGF-1 deficiency. The T.O.S.CA. project aims at investigating the relationship between CHF and hormonal deficiency.
Canadian Journal of Cardiology, 2015
Pulmonary hypertension (PH) is a pathophysiological condition defined as an increase in mean pulm... more Pulmonary hypertension (PH) is a pathophysiological condition defined as an increase in mean pulmonary artery pressure of ! 25 mm Hg at rest. Although right heart catheterization remains an essential step in the diagnostic algorithmdparticularly for pulmonary arterial hypertensiondnoninvasive multimodality imaging plays an important role in defining the cause, assessing outcome, monitoring the efficacy of specific therapeutic interventions, and detecting the preclinical stage of disease. We review the role of multimodality imaging in the evaluation of PHdincluding echocardiography, chest computed 5 groups based on specific pathogenesis and clinical characteristics . PH results in impedance to right ventricular (RV) ejection associated with varying degrees of functional or pathologic changes in small pulmonary arterioles (100-300 m), pulmonary capillaries, or pulmonary venous vasculature. Incremental afterload may cause RV dysfunction that, regardless of the cause or pathogenesis, can ultimately lead to progressive right ventricular failure, disability, and death. The early clinical symptoms of PH are often subtle or nonspecific and include unexplained fatigue, exertional Canadian Journal of Cardiology 31
European heart journal cardiovascular Imaging, 2014
Takotsubo cardiomyopathy (TTC) is a distinct clinical entity characterized by the presence of tra... more Takotsubo cardiomyopathy (TTC) is a distinct clinical entity characterized by the presence of transient left ventricular wall dysfunction without significant culprit obstructive coronary artery disease. Invasive coronary angiography and ventriculography are the 'gold standard' for definitive diagnosis, with an integrated multi-modality imaging approach offering advantages in various clinical scenarios. Echocardiography is a widely available, first-line, non-invasive imaging technique appropriate both in emergency setting to confirm diagnosis, assess for various potential acute complications, and in serial follow-up to track myocardial recovery. Cardiac magnetic resonance (CMR) may be helpful to discriminate TTC from other acute cardiac syndromes with troponin elevation and ventricular dysfunction. Echocardiography, CMR, and nuclear imaging may also provide new insights into possible underlying pathophysiological mechanisms, and myocardial (123)I-metaiodobenzyl-guanidine imag...
American Journal of Physiology - Heart and Circulatory Physiology, 2001
... Apstein CS,; Deckelbaum L,; Mueller M,; Hagopian L,; Hood W. (1977) Graded global ischemia an... more ... Apstein CS,; Deckelbaum L,; Mueller M,; Hagopian L,; Hood W. (1977) Graded global ischemia and reperfusion: cardiac function and lactate metabolism. Circulation 55:864–872. ↵: Beg AA,; Baltimore D. (1996) An essential role for NF-kappaB in preventing TNF-alpha-induced cell ...
Endocrine Reviews, 1994
To investigate cardiac effects of excess and deficiency of growth hormone (GH) 20 acromegalic sub... more To investigate cardiac effects of excess and deficiency of growth hormone (GH) 20 acromegalic subjects and 11 adult patients with GH deficiency were studied by means of a non invasive method, the Doppler echocardiography. The results obtained in the group of patients were compared with those of 2 groups of 20 and 12 normal subjects, respectively, age and sex matched. The age of the acromegalic patients ranged from 20 to 62 years. Nineteen patients were considered to have active acromegaly at the time of the study. Mean duration of disease since treatment was 12 +/- 5 years (range 5 to 24 years). The age of GH deficient adults ranged from 21 to 33 years. All these patients have been treated with extractive GH over 9 years and the therapy withdrawal was performed at least 3 years before entering the study. In the acromegalic patient group, a subgroup including 9 patients with mild to moderate hypertension was considered. All subjects gave informed consent and the study protocol was approved by the Ethical Committee of the Medical School of Naples. Right ventricular free wall thickness resulted significantly increased in acromegalic patients (8 +/- 2 versus 4 +/- 1 mm; p < 0.001). Left ventricular mass index was augmented both in the whole group and in the subgroup of normotensive acromegalics as compared with normals (134 +/- 33 and 115 +/- 20 versus 80 +/- 18 g.m-2; p < 0.01). Ejection phase indices were normal in patient group, while impaired left and right ventricular diastolic filling was found.(ABSTRACT TRUNCATED AT 250 WORDS)
International journal of cardiology, Jan 19, 2015
Riociguat is a soluble guanylate cyclase stimulator approved for pulmonary arterial hypertension ... more Riociguat is a soluble guanylate cyclase stimulator approved for pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). The objective of this study was to evaluate the change of right heart size and function assessed by echocardiography during long-term treatment with riociguat. We assessed patients who started riociguat treatment (1.0-2.5mg tid) within the trials PATENT, PATENTplus, EAS and CHEST and continued for 3-12months. Echocardiography, 6-minute walking distance (6MWD) and further clinical parameters were analyzed at baseline, after 3, 6 and 12months. Right heart catheterization was performed at baseline and after 3months. For missing data we performed the last and baseline observation carried forward (LOCF, BOCF) method as sensitivity analyses. Thirty-nine patients (21 PAH, 18 CTEPH, mean pulmonary arterial pressure 43±2mmHg, PVR 600±43dyn∗s∗cm(-5), 56.4% treatment-naïve) were included. Mean right ventricular (RV) area significantly...
Endocrine Abstracts, 2015
Frontiers of hormone research, 2014
Chronic heart failure represents a leading cause of mortality and health care expenditure in deve... more Chronic heart failure represents a leading cause of mortality and health care expenditure in developed countries. In the last 20 years, medical therapy of heart failure has dramatically changed thanks to the introduction of agents able to significantly reduce the neurohormonal hyperactivation that underpins the syndrome, and to the growing opportunities of electrical therapies. Although major advances in terms of improved survival and quality of life have been achieved, the reduction in the burden of heart failure is still the primary goal of cardiovascular societies. In the last decades, other research lines have also grown to complement the neurohormonal paradigm. It is increasingly evident that several hormonal systems are down-regulated or impaired in patients with heart failure, including growth and thyroid hormones, androgens and insulin. These abnormalities could be considered interrelated and linked, in turn, to the neurohormonal and cytokine hyperactivation. Since most of t...
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo, 2013
Portopulmonary hypertension (POPH) refers to the condition of pulmonary arterial hypertension (PA... more Portopulmonary hypertension (POPH) refers to the condition of pulmonary arterial hypertension (PAH) in association with portal hypertension. Among patients with portal hypertension, reported incidence rates of POPH range from 2 to 10% and long-term prognosis in cases of POPH is poor. Fundamental issues of management of POPH include identification of patients likely to benefit from liver transplantation (LTx) and treatment with specific pulmonary vasodilators before and after LTx. This review presents as an overview of the current knowledge on the epidemiology, diagnosis, treatment and prognosis of patients with portopulmonary hypertension.
Italian heart journal : official journal of the Italian Federation of Cardiology, 2005
Aldosterone was discovered in 1953, and until the beginning of the 1960s, when spironolactone was... more Aldosterone was discovered in 1953, and until the beginning of the 1960s, when spironolactone was developed, it was the focus of considerable interest among the scientific community. The following 30 years represented a sort of Dark Age, interrupted by the Weber's classic studies. He first demonstrated the pivotal role of aldosterone in the promotion of cardiac hypertrophy and fibrosis and such an observation represented a solid background for the implementation of large survival trials, the RALES and the EPHESUS. These landmark studies showed that aldosterone receptor blockade prolongs survival in advanced and postinfarction heart failure, respectively. After a myocardial infarction, there is a significant upregulation of the local steroidogenic system in the area remote from the scar, that leads to a remarkable fibroblast activation, collagen deposition, and reactive fibrosis. Fibrosis in turn further impairs systolic and diastolic function, and induces electrical heterogeneit...
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo, 2010
A metabolic imbalance between anabolic drive and catabolic forces is commonly observed in chronic... more A metabolic imbalance between anabolic drive and catabolic forces is commonly observed in chronic heart failure (CHF) patients, with the latter prevailing over anabolic hormones. Moreover, anabolic deficiencies are independent markers of poor prognosis. This finding represents a solid background for the implementation of therapeutic trials based on replacement therapy. The somatotropic axis (GH/IGF-1) is the most powerful anabolic axis of the body and its decline is related with a poor outcome and a worse clinical status. Growth hormone (GH) administration may enter the therapeutic arena as adjunctive treatment in patients affected by CHF and GH/IGF-1 deficiency. The T.O.S.CA. project aims at investigating the relationship between CHF and hormonal deficiency.
Canadian Journal of Cardiology, 2015
Pulmonary hypertension (PH) is a pathophysiological condition defined as an increase in mean pulm... more Pulmonary hypertension (PH) is a pathophysiological condition defined as an increase in mean pulmonary artery pressure of ! 25 mm Hg at rest. Although right heart catheterization remains an essential step in the diagnostic algorithmdparticularly for pulmonary arterial hypertensiondnoninvasive multimodality imaging plays an important role in defining the cause, assessing outcome, monitoring the efficacy of specific therapeutic interventions, and detecting the preclinical stage of disease. We review the role of multimodality imaging in the evaluation of PHdincluding echocardiography, chest computed 5 groups based on specific pathogenesis and clinical characteristics . PH results in impedance to right ventricular (RV) ejection associated with varying degrees of functional or pathologic changes in small pulmonary arterioles (100-300 m), pulmonary capillaries, or pulmonary venous vasculature. Incremental afterload may cause RV dysfunction that, regardless of the cause or pathogenesis, can ultimately lead to progressive right ventricular failure, disability, and death. The early clinical symptoms of PH are often subtle or nonspecific and include unexplained fatigue, exertional Canadian Journal of Cardiology 31
European heart journal cardiovascular Imaging, 2014
Takotsubo cardiomyopathy (TTC) is a distinct clinical entity characterized by the presence of tra... more Takotsubo cardiomyopathy (TTC) is a distinct clinical entity characterized by the presence of transient left ventricular wall dysfunction without significant culprit obstructive coronary artery disease. Invasive coronary angiography and ventriculography are the 'gold standard' for definitive diagnosis, with an integrated multi-modality imaging approach offering advantages in various clinical scenarios. Echocardiography is a widely available, first-line, non-invasive imaging technique appropriate both in emergency setting to confirm diagnosis, assess for various potential acute complications, and in serial follow-up to track myocardial recovery. Cardiac magnetic resonance (CMR) may be helpful to discriminate TTC from other acute cardiac syndromes with troponin elevation and ventricular dysfunction. Echocardiography, CMR, and nuclear imaging may also provide new insights into possible underlying pathophysiological mechanisms, and myocardial (123)I-metaiodobenzyl-guanidine imag...
American Journal of Physiology - Heart and Circulatory Physiology, 2001
... Apstein CS,; Deckelbaum L,; Mueller M,; Hagopian L,; Hood W. (1977) Graded global ischemia an... more ... Apstein CS,; Deckelbaum L,; Mueller M,; Hagopian L,; Hood W. (1977) Graded global ischemia and reperfusion: cardiac function and lactate metabolism. Circulation 55:864–872. ↵: Beg AA,; Baltimore D. (1996) An essential role for NF-kappaB in preventing TNF-alpha-induced cell ...
Endocrine Reviews, 1994
To investigate cardiac effects of excess and deficiency of growth hormone (GH) 20 acromegalic sub... more To investigate cardiac effects of excess and deficiency of growth hormone (GH) 20 acromegalic subjects and 11 adult patients with GH deficiency were studied by means of a non invasive method, the Doppler echocardiography. The results obtained in the group of patients were compared with those of 2 groups of 20 and 12 normal subjects, respectively, age and sex matched. The age of the acromegalic patients ranged from 20 to 62 years. Nineteen patients were considered to have active acromegaly at the time of the study. Mean duration of disease since treatment was 12 +/- 5 years (range 5 to 24 years). The age of GH deficient adults ranged from 21 to 33 years. All these patients have been treated with extractive GH over 9 years and the therapy withdrawal was performed at least 3 years before entering the study. In the acromegalic patient group, a subgroup including 9 patients with mild to moderate hypertension was considered. All subjects gave informed consent and the study protocol was approved by the Ethical Committee of the Medical School of Naples. Right ventricular free wall thickness resulted significantly increased in acromegalic patients (8 +/- 2 versus 4 +/- 1 mm; p < 0.001). Left ventricular mass index was augmented both in the whole group and in the subgroup of normotensive acromegalics as compared with normals (134 +/- 33 and 115 +/- 20 versus 80 +/- 18 g.m-2; p < 0.01). Ejection phase indices were normal in patient group, while impaired left and right ventricular diastolic filling was found.(ABSTRACT TRUNCATED AT 250 WORDS)