Cecilia Fantoni | Università degli Studi dell'Insubria (original) (raw)
Papers by Cecilia Fantoni
Giornale italiano di cardiologia (2006), 2011
Recent observational studies show an increase of more complex and critically ill patients referre... more Recent observational studies show an increase of more complex and critically ill patients referred to Italian cardiac rehabilitation (CR) departments; the exact mechanisms underlying this phenomenon, however, have not been clearly identified. The aim of our study was to evaluate the epidemiological and clinical changes that occurred over the last decade in patients hospitalized in CR departments with high admittance rates. We have retrospectively evaluated all patients admitted between 2002 and 2009 to our division of CR (n = 3340, 1155 female, mean age 66.4 ± 11 years) after recent cardiac surgery. The study population was divided into two homogeneous groups: the four-year period 2002-2005, group A (n = 1614, 540 female, mean age 66.1 ± 10 years) and the four-year period 2006-2009, group B (n = 1726, 615 female, mean age 67.4 ± 11 years). Data were compared using specific indicators of clinical complexity. Patients aged >75 years were more in group B compared to A (26.3 vs 19.8%...
EuroIntervention, 2010
Percutaneous coronary intervention (PCI) is increasingly being used for unprotected left main (UL... more Percutaneous coronary intervention (PCI) is increasingly being used for unprotected left main (ULM) disease. Limited data are available on sex-related differences in this setting. We investigated gender-associated differences in patients undergoing stent-based PCI for ULM. We analysed baseline, procedural and long-term data of patients with ULM undergoing stent-based PCI at participating centres. The primary end-point was the long-term rate of major cardiovascular events rate (MACE, i.e., the composite of death, myocardial infarction, or target lesion revascularisation). The study population included 1,452 cases, with 27.8% females and 72.2% males. Women were older, more frequently diabetic, hypertensive or presenting with an acute coronary syndrome, and thus with a higher EuroSCORE, but were less commonly treated with drug-eluting stents (DES), in comparison to men (all p<0.01). After a median follow-up of 18 months, women showed an unadjusted higher risk of death (p=0.040), cardiac death (p=0.033), and the death/myocardial infarction (p=0.012). However, after multivariable adjustment, gender was no longer an independent predictor of death (hazard ratio=1.119 [0.804-1.558]), cardiac death (hazard ratio=1.045 [0.697-1.567]), or death/myocardial infarction (hazard ratio=0.531 [0.192-1.465]), given the predominant role of age, diabetes and EuroSCORE as independent predictors and confounders of the gender-based comparison. Women undergoing PCI for ULM present more often with an acute coronary syndrome, are treated less frequently with DES, and have more adverse events, but these gender biases are not confirmed after adjusting for confounders. Thus, stent-based PCI for ULM offers similarly favourable clinical results in women as well as in men.
Pacing and Clinical Electrophysiology, 2010
Although it has been recently demonstrated that there was no significant difference in total surv... more Although it has been recently demonstrated that there was no significant difference in total survival and clinical outcomes between patients who underwent coronary artery bypass grafting (CABG) with or without surgical ventricular reconstruction (SVR), the question of whether or not SVR decreases the arrhythmic risk profile in this population has not been clarified yet.
Pacing and Clinical Electrophysiology, 2008
Background: Altitude-induced sympathetic hyperactivity can elicit rhythm disturbances in healthy ... more Background: Altitude-induced sympathetic hyperactivity can elicit rhythm disturbances in healthy subjects, in particular during exercise.
Journal of the American College of Cardiology, 2006
The goal of this study was to investigate the effects of cardiac resynchronization therapy (CRT) ... more The goal of this study was to investigate the effects of cardiac resynchronization therapy (CRT) in heart failure patients with permanent atrial fibrillation (AF) and the role of atrioventricular junction (AVJ) ablation. BACKGROUND Cardiac resynchronization therapy has been proven effective in heart failure patients with sinus rhythm (SR). However, little is known about the effects of CRT in heart failure patients with permanent AF.
Journal of Endovascular Therapy, 2008
Purpose: To analyze the outcomes of endovascular treatment of thoracic aortic pathologies perform... more Purpose: To analyze the outcomes of endovascular treatment of thoracic aortic pathologies performed at a single center with the EndoFit thoracic stent-graft system. patients (33 men; mean age 69.369.7 years, range 48-84) were treated for thoracic aortic disease with the EndoFit stent-graft system. Patient data were retrieved from a retrospective review of hospital records. Indications for treatment were progression of aneurysm size in atherosclerotic aneurysms (n524, mean aneurysm diameter 7.1961.48 cm), acute contained aortic rupture (n55), aortic dissection (n56), penetrating atherosclerotic ulcers (n54), post-traumatic pseudoaneurysm (n51), and post coarctation repair aneurysm (n51).
The International Journal of Cardiovascular Imaging, 2008
Background Patients with previous myocardial revascularization, even if symptom-free, remain at r... more Background Patients with previous myocardial revascularization, even if symptom-free, remain at risk of subsequent cardiac events, so that a non-invasive tool able to stratify this population is wishful. Objectives To assess the prognostic value of dipyridamole stress echocardiography (DipSE) in a population of asymptomatic patients following complete myocardial revascularization, either by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Methods We retrospectively evaluated 104 consecutive symptomfree patients (mean age 67 ± 9.3 years, 75 males) with recent (\12 months) complete myocardial revascularization (48% PCI, 52% CABG) undergoing DipSE. Ischemia was defined as the onset of a new or worsening wall motion abnormality during DipSE. The composite end point of the study was cardiac death and non-fatal acute coronary syndrome.
International Journal of Cardiology, 2008
Background: Prior studies demonstrated that kinetics of oxygen uptake (KVO 2 ) at the onset of ex... more Background: Prior studies demonstrated that kinetics of oxygen uptake (KVO 2 ) at the onset of exercise is delayed in patients with ischemic left ventricular dysfunction (LVD), since it reflects a slower cardiac output increase. Given the myocardial contractile reserve elicited by endogenous catecholamines during exercise, it may be speculated that patients with a significant amount of myocardial viability (MV) could show a faster KVO 2 at the onset of exercise attributable to a faster increase in stroke volume compared to patients without MV. Objectives: To demonstrate a relationship between contractile reserve detected by low-dose dobutamine Echocardiography (LDDE) and KVO 2 obtained during cardiopulmonary testing in patients with ischemic LVD. Methods: Forty-one consecutive patients (62.5 ± 10.1 years) with ischemic LVD underwent LDDE and constant work rate exercise with KVO 2 determination. The time constant for VO 2 (tau) was determined by a curve fitting breath-by-breath data. Ten healthy subjects served as control group (59.5 ± 13.4 years). Results: LDDE identified contractile reserve in 20 (48%) subjects. Patients without MV detected by LDDE showed a significantly longer tau compared to patients with MV and to healthy subjects ( p = 0.03 and p = 0.01, respectively). Sensitivity, specificity, positive and negative predictive value of tau in detecting MV were 90%, 95%, 95% and 91%, respectively. Moreover, the percentage reduction of LV wall motion score index detected at LDDE was significantly related to KVO 2 (r = 0.71, pb 0.01) Conclusions: Our data suggest that KVO 2 represents a reasonable initial approach to estimate presence of MV in patients with ischemic LVD.
International Journal of Cardiology, 2009
Guillain-Barrè syndrome (GBS) is an acute, inflammatory, demyelinating polyneuropathy that nowada... more Guillain-Barrè syndrome (GBS) is an acute, inflammatory, demyelinating polyneuropathy that nowadays represents the most common cause of flaccid paralysis.
International Journal of Cardiology, 2008
Background: Given the frequent involvement of infra-popliteal arteries, an ipsilateral antegrade ... more Background: Given the frequent involvement of infra-popliteal arteries, an ipsilateral antegrade common femoral artery puncture (ACFAP) is usually preferred to a contralateral retrograde femoral access for percutaneous transluminal angioplasty (PTA) in patients with critical limb ischemia (CLI). Because of the frequent difficulty to get a sufficient manual pressure on the puncture site, ACFAP is burdened by a high number of bleeding local complications, including retroperitoneal haematoma. We report a series of patients who consecutively received a clip-based arterial closure device after ACFAP and ipsilateral PTA for CLI. Methods: Thirty patients (73 ± 6 years; 18 men; 100% diabetes) admitted to our hospital because of CLI consecutively underwent peripheral PTA after an ACFAP and received a clip-based arterial closure device. Time to haemostasis was defined as the interval elapsed between clip deployment and first observed haemostasis. All patients were mobilized after 6 h. Follow-up was 30 days. Results: All patients were on double anti-platelet therapy. At the end of the procedure, Activation Clotting Time was 226 ± 37 s. Procedural success in delivering the clip was 100%. Time to haemostasis was 21 ± 19 s. No major local vascular complications and in particular no retroperitoneal bleeding were documented. All patients could be discharged within the following 3 days. No major complications were noted during a 30 days follow-up. Conclusions: The use of a clip-based arterial closure device after ACFAP for peripheral PTA in CLI seems to be safe and effective.
European Journal of Heart Failure, 2007
Background: Estimates of the prevalence of atrial fibrillation (AF ) in heart failure (HF ) origi... more Background: Estimates of the prevalence of atrial fibrillation (AF ) in heart failure (HF ) originate from patients enrolled in clinical trials. Aims: To assess the prevalence and clinical correlates of AF among HF patients in everyday clinical practice from HF patients screened for the T-wave ALternans in Patients with Heart fAilure (ALPHA) study; to investigate the correlation between AF and functional status. Methods and results: Consecutive patients (N = 3513) seen at nine Heart Failure Clinics were studied; 21.4% were in AF. AF prevalence was greater with increasing age (OR 1.04/year, p b 0.001) in non-ischaemic cardiomyopathy (OR 2.34, p b 0.001) and with increasing NYHA class ( p b 0.0001). Multiple logistic regression predictors of AF were age N70 years (OR 2.35), NYHA class II III or IV vs class I (OR 1.8, 4.4 and 3.1) and non-ischaemic cardiomyopathy (OR 3.2).
European Journal of Heart Failure, 2008
Background: Diabetes mellitus is an independent risk factor for increased morbidity and mortality... more Background: Diabetes mellitus is an independent risk factor for increased morbidity and mortality in heart failure (HF) patients. Aims: To compare functional and structural improvement, as well as long-term outcome, between diabetic and non-diabetic HF patients treated with cardiac resynchronization therapy (CRT). Methods: We compared response to CRT in 141 diabetic and 214 non-diabetic consecutive patients. Major events were; death from any cause, urgent heart transplantation and implantation of a left ventricular (LV) assist device. Frequencies of hospitalisation and defibrillator (CRT-D) discharges were also analyzed. Results: CRT was able to significantly improve functional capacity, ventricular geometry and neurohumoral imbalance in both diabetic and nondiabetic patients over a median follow-up time of 34 months. Overall event-free survival was similar in diabetic and non-diabetic patients (HR 1.23, p = 0.363), as was survival free from CRT-D interventions (HR 1.72; p = 0.115) and hospitalisations (HR 1.12; p = 0.500). On multivariable analysis, NYHA class IV (p = 0.002), low LV ejection fraction (p = 0.002), absence of beta-blocker therapy (p b 0.001), impaired renal function (p = 0.003), presence of an epicardial lead (p = 0.025), but not diabetes (p = 0.821) were associated with a poor outcome after CRT. Conclusions: Diabetic HF patients treated with CRT had a very favourable functional and survival outcome, which was comparable to nondiabetic patients.
European Heart Journal, 2008
To investigate the effects of cardiac resynchronization therapy (CRT) on survival in heart failur... more To investigate the effects of cardiac resynchronization therapy (CRT) on survival in heart failure (HF) patients with permanent atrial fibrillation (AF) and the role of atrio-ventricular junction (AVJ) ablation in these patients.
Blood Coagulation & Fibrinolysis, 2009
Left ventricular thrombus is a common complication after acute myocardial infarction. Although an... more Left ventricular thrombus is a common complication after acute myocardial infarction. Although anticoagulant treatment has an established role in reducing the rate of thrombus formation and embolic phenomena during acute myocardial infarction, prior studies showed that left ventricular thrombus and systemic embolization may develop irrespective of adequate anticoagulant therapy. We present a descriptive case of a patient with left ventricular thrombus who experienced dramatic peripheral embolic events soon after the onset of anterior myocardial infarction despite full anticoagulation, and we discuss possible pathogenesis.
The American Journal of Cardiology, 2007
This multicenter longitudinal observational trial was designed to analyze the long-term outcome o... more This multicenter longitudinal observational trial was designed to analyze the long-term outcome of patients with heart failure (HF) treated with cardiac resynchronization therapy (CRT) alone or with implantable cardioverter-defibrillator (ICD) backup in a daily practice scenario. It is unknown whether the magnitude of survival benefits conferred by CRT in a daily practice scenario is comparable to what has been observed in randomized controlled trials and whether this benefit is sustained over the long term. The outcome of 1,303 consecutive patients with ischemic or nonischemic cardiomyopathy on optimal pharmacologic therapy treated from August 1, 1995 to August 1, 2004 at 4 European centers with CRT alone (44%) or with ICD backup for symptomatic HF and prolonged QRS duration was assessed. Cumulative event-free survival was evaluated for a combined end point, defined as death from any cause, urgent transplantation, or implantation of a left ventricular assist device. The cumulative incidence of competing events, HF, sudden cardiac death, and noncardiac death, was also assessed. Event-free survival was similar across the different centers. At 1 and 5 years, cumulative event-free survivals were 92% (95% confidence interval [CI] 91 to 94) and 56% (95% CI 48 to 64), respectively. The cumulative incidence of HF deaths was 25.1% (95% CI 19 to 31.7), whereas that of sudden death was 9.5% (95% CI 5.1 to 15.7). Using multivariate analysis, CRT with an ICD backup was associated with a nonsignificant decrease in mortality by 20% (hazard ratio 0.83, 95% CI 0.58 to 1.17, p = 0.284), with a highly significant protective effect against sudden cardiac death (hazard ratio 0.04, 95% CI 0.04 to 0.28, p <0.002). In conclusion, patients with advanced HF and a wide QRS complex routinely treated with CRT have a favorable long-term outcome that was reproducible at different centers. The leading cause of death in these patients remained HF, and this mode of death was competing with other causes in determining outcome. Total mortality was 20% lower with ICD backup (95% CI 42% lower to 17% higher) due to a protective effect against sudden cardiac death.
The American Journal of Cardiology, 2011
There are no parameters predicting the individual probability of "full response" to cardiac resyn... more There are no parameters predicting the individual probability of "full response" to cardiac resynchronization therapy (CRT). The aim of this work was to find prognostic factors of full clinical and echocardiographic responses (i.e., >50% left ventricular ejection fraction [LVEF] and New York Heart Association class I) after 1 year of CRT. This was a prospective follow-up study that involved 2 hospitals. Patients (n ؍ 75) with advanced heart failure (64 ؎ 9 years of age, 87% men, LVEF 24 ؎ 7%) who received CRT were followed for 17 ؎ 9 months. Univariate and multivariate regression analyses were used to identify predictors of full CRT response. A nomogram predicting the individual probability of full CRT response during follow-up was calculated. There were 13 patients with restoration of normal LVEF versus 62 without (mean LVEF 56% ؎ 5% vs 31% ؎ 8%, respectively, p <0.001). Predictors of full response included cause of heart disease, baseline QRS width, and degree of QRS shortening in response to CRT. Patients with nonischemic heart disease, baseline QRS width <150 ms, and QRS shortening >40 ms in response to CRT had a >75% probability of restoration of normal LVEF. In conclusion, our nomogram using a combination of cause, baseline QRS width, and degree of QRS shortening in response to CRT allows assessment of individual probability of full response. This observation awaits further confirmation from larger series.
CardioVascular and Interventional Radiology, 2008
We report the case of a patient with subtotal occlusion of the origin of the left common carotid ... more We report the case of a patient with subtotal occlusion of the origin of the left common carotid artery (CCA) following thoracic graft placement. Retrograde endovascular placement of a stent-graft by minimal cervical access was undertaken to repair the occlusive lesion of the left CCA and prevent future complications of endoluminal thoracic reconstruction. The retrograde endovascular repair of CCA lesions, as other authors have already suggested, may be the treatment of choice in &amp;amp;amp;amp;amp;amp;amp;quot;high-surgical-risk&amp;amp;amp;amp;amp;amp;amp;quot; patients. In these cases where the ostium of supra-aortic trunks is compromised following thoracic aorta stent-graft migration, endoluminal placement of a stent-graft in the CCA can guarantee both maintenance of carotid flow and thoracic stent-graft fixation.
Giornale italiano di cardiologia (2006), 2011
Recent observational studies show an increase of more complex and critically ill patients referre... more Recent observational studies show an increase of more complex and critically ill patients referred to Italian cardiac rehabilitation (CR) departments; the exact mechanisms underlying this phenomenon, however, have not been clearly identified. The aim of our study was to evaluate the epidemiological and clinical changes that occurred over the last decade in patients hospitalized in CR departments with high admittance rates. We have retrospectively evaluated all patients admitted between 2002 and 2009 to our division of CR (n = 3340, 1155 female, mean age 66.4 ± 11 years) after recent cardiac surgery. The study population was divided into two homogeneous groups: the four-year period 2002-2005, group A (n = 1614, 540 female, mean age 66.1 ± 10 years) and the four-year period 2006-2009, group B (n = 1726, 615 female, mean age 67.4 ± 11 years). Data were compared using specific indicators of clinical complexity. Patients aged >75 years were more in group B compared to A (26.3 vs 19.8%...
EuroIntervention, 2010
Percutaneous coronary intervention (PCI) is increasingly being used for unprotected left main (UL... more Percutaneous coronary intervention (PCI) is increasingly being used for unprotected left main (ULM) disease. Limited data are available on sex-related differences in this setting. We investigated gender-associated differences in patients undergoing stent-based PCI for ULM. We analysed baseline, procedural and long-term data of patients with ULM undergoing stent-based PCI at participating centres. The primary end-point was the long-term rate of major cardiovascular events rate (MACE, i.e., the composite of death, myocardial infarction, or target lesion revascularisation). The study population included 1,452 cases, with 27.8% females and 72.2% males. Women were older, more frequently diabetic, hypertensive or presenting with an acute coronary syndrome, and thus with a higher EuroSCORE, but were less commonly treated with drug-eluting stents (DES), in comparison to men (all p&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;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;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;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;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;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;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;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;amp;lt;0.01). After a median follow-up of 18 months, women showed an unadjusted higher risk of death (p=0.040), cardiac death (p=0.033), and the death/myocardial infarction (p=0.012). However, after multivariable adjustment, gender was no longer an independent predictor of death (hazard ratio=1.119 [0.804-1.558]), cardiac death (hazard ratio=1.045 [0.697-1.567]), or death/myocardial infarction (hazard ratio=0.531 [0.192-1.465]), given the predominant role of age, diabetes and EuroSCORE as independent predictors and confounders of the gender-based comparison. Women undergoing PCI for ULM present more often with an acute coronary syndrome, are treated less frequently with DES, and have more adverse events, but these gender biases are not confirmed after adjusting for confounders. Thus, stent-based PCI for ULM offers similarly favourable clinical results in women as well as in men.
Pacing and Clinical Electrophysiology, 2010
Although it has been recently demonstrated that there was no significant difference in total surv... more Although it has been recently demonstrated that there was no significant difference in total survival and clinical outcomes between patients who underwent coronary artery bypass grafting (CABG) with or without surgical ventricular reconstruction (SVR), the question of whether or not SVR decreases the arrhythmic risk profile in this population has not been clarified yet.
Pacing and Clinical Electrophysiology, 2008
Background: Altitude-induced sympathetic hyperactivity can elicit rhythm disturbances in healthy ... more Background: Altitude-induced sympathetic hyperactivity can elicit rhythm disturbances in healthy subjects, in particular during exercise.
Journal of the American College of Cardiology, 2006
The goal of this study was to investigate the effects of cardiac resynchronization therapy (CRT) ... more The goal of this study was to investigate the effects of cardiac resynchronization therapy (CRT) in heart failure patients with permanent atrial fibrillation (AF) and the role of atrioventricular junction (AVJ) ablation. BACKGROUND Cardiac resynchronization therapy has been proven effective in heart failure patients with sinus rhythm (SR). However, little is known about the effects of CRT in heart failure patients with permanent AF.
Journal of Endovascular Therapy, 2008
Purpose: To analyze the outcomes of endovascular treatment of thoracic aortic pathologies perform... more Purpose: To analyze the outcomes of endovascular treatment of thoracic aortic pathologies performed at a single center with the EndoFit thoracic stent-graft system. patients (33 men; mean age 69.369.7 years, range 48-84) were treated for thoracic aortic disease with the EndoFit stent-graft system. Patient data were retrieved from a retrospective review of hospital records. Indications for treatment were progression of aneurysm size in atherosclerotic aneurysms (n524, mean aneurysm diameter 7.1961.48 cm), acute contained aortic rupture (n55), aortic dissection (n56), penetrating atherosclerotic ulcers (n54), post-traumatic pseudoaneurysm (n51), and post coarctation repair aneurysm (n51).
The International Journal of Cardiovascular Imaging, 2008
Background Patients with previous myocardial revascularization, even if symptom-free, remain at r... more Background Patients with previous myocardial revascularization, even if symptom-free, remain at risk of subsequent cardiac events, so that a non-invasive tool able to stratify this population is wishful. Objectives To assess the prognostic value of dipyridamole stress echocardiography (DipSE) in a population of asymptomatic patients following complete myocardial revascularization, either by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Methods We retrospectively evaluated 104 consecutive symptomfree patients (mean age 67 ± 9.3 years, 75 males) with recent (\12 months) complete myocardial revascularization (48% PCI, 52% CABG) undergoing DipSE. Ischemia was defined as the onset of a new or worsening wall motion abnormality during DipSE. The composite end point of the study was cardiac death and non-fatal acute coronary syndrome.
International Journal of Cardiology, 2008
Background: Prior studies demonstrated that kinetics of oxygen uptake (KVO 2 ) at the onset of ex... more Background: Prior studies demonstrated that kinetics of oxygen uptake (KVO 2 ) at the onset of exercise is delayed in patients with ischemic left ventricular dysfunction (LVD), since it reflects a slower cardiac output increase. Given the myocardial contractile reserve elicited by endogenous catecholamines during exercise, it may be speculated that patients with a significant amount of myocardial viability (MV) could show a faster KVO 2 at the onset of exercise attributable to a faster increase in stroke volume compared to patients without MV. Objectives: To demonstrate a relationship between contractile reserve detected by low-dose dobutamine Echocardiography (LDDE) and KVO 2 obtained during cardiopulmonary testing in patients with ischemic LVD. Methods: Forty-one consecutive patients (62.5 ± 10.1 years) with ischemic LVD underwent LDDE and constant work rate exercise with KVO 2 determination. The time constant for VO 2 (tau) was determined by a curve fitting breath-by-breath data. Ten healthy subjects served as control group (59.5 ± 13.4 years). Results: LDDE identified contractile reserve in 20 (48%) subjects. Patients without MV detected by LDDE showed a significantly longer tau compared to patients with MV and to healthy subjects ( p = 0.03 and p = 0.01, respectively). Sensitivity, specificity, positive and negative predictive value of tau in detecting MV were 90%, 95%, 95% and 91%, respectively. Moreover, the percentage reduction of LV wall motion score index detected at LDDE was significantly related to KVO 2 (r = 0.71, pb 0.01) Conclusions: Our data suggest that KVO 2 represents a reasonable initial approach to estimate presence of MV in patients with ischemic LVD.
International Journal of Cardiology, 2009
Guillain-Barrè syndrome (GBS) is an acute, inflammatory, demyelinating polyneuropathy that nowada... more Guillain-Barrè syndrome (GBS) is an acute, inflammatory, demyelinating polyneuropathy that nowadays represents the most common cause of flaccid paralysis.
International Journal of Cardiology, 2008
Background: Given the frequent involvement of infra-popliteal arteries, an ipsilateral antegrade ... more Background: Given the frequent involvement of infra-popliteal arteries, an ipsilateral antegrade common femoral artery puncture (ACFAP) is usually preferred to a contralateral retrograde femoral access for percutaneous transluminal angioplasty (PTA) in patients with critical limb ischemia (CLI). Because of the frequent difficulty to get a sufficient manual pressure on the puncture site, ACFAP is burdened by a high number of bleeding local complications, including retroperitoneal haematoma. We report a series of patients who consecutively received a clip-based arterial closure device after ACFAP and ipsilateral PTA for CLI. Methods: Thirty patients (73 ± 6 years; 18 men; 100% diabetes) admitted to our hospital because of CLI consecutively underwent peripheral PTA after an ACFAP and received a clip-based arterial closure device. Time to haemostasis was defined as the interval elapsed between clip deployment and first observed haemostasis. All patients were mobilized after 6 h. Follow-up was 30 days. Results: All patients were on double anti-platelet therapy. At the end of the procedure, Activation Clotting Time was 226 ± 37 s. Procedural success in delivering the clip was 100%. Time to haemostasis was 21 ± 19 s. No major local vascular complications and in particular no retroperitoneal bleeding were documented. All patients could be discharged within the following 3 days. No major complications were noted during a 30 days follow-up. Conclusions: The use of a clip-based arterial closure device after ACFAP for peripheral PTA in CLI seems to be safe and effective.
European Journal of Heart Failure, 2007
Background: Estimates of the prevalence of atrial fibrillation (AF ) in heart failure (HF ) origi... more Background: Estimates of the prevalence of atrial fibrillation (AF ) in heart failure (HF ) originate from patients enrolled in clinical trials. Aims: To assess the prevalence and clinical correlates of AF among HF patients in everyday clinical practice from HF patients screened for the T-wave ALternans in Patients with Heart fAilure (ALPHA) study; to investigate the correlation between AF and functional status. Methods and results: Consecutive patients (N = 3513) seen at nine Heart Failure Clinics were studied; 21.4% were in AF. AF prevalence was greater with increasing age (OR 1.04/year, p b 0.001) in non-ischaemic cardiomyopathy (OR 2.34, p b 0.001) and with increasing NYHA class ( p b 0.0001). Multiple logistic regression predictors of AF were age N70 years (OR 2.35), NYHA class II III or IV vs class I (OR 1.8, 4.4 and 3.1) and non-ischaemic cardiomyopathy (OR 3.2).
European Journal of Heart Failure, 2008
Background: Diabetes mellitus is an independent risk factor for increased morbidity and mortality... more Background: Diabetes mellitus is an independent risk factor for increased morbidity and mortality in heart failure (HF) patients. Aims: To compare functional and structural improvement, as well as long-term outcome, between diabetic and non-diabetic HF patients treated with cardiac resynchronization therapy (CRT). Methods: We compared response to CRT in 141 diabetic and 214 non-diabetic consecutive patients. Major events were; death from any cause, urgent heart transplantation and implantation of a left ventricular (LV) assist device. Frequencies of hospitalisation and defibrillator (CRT-D) discharges were also analyzed. Results: CRT was able to significantly improve functional capacity, ventricular geometry and neurohumoral imbalance in both diabetic and nondiabetic patients over a median follow-up time of 34 months. Overall event-free survival was similar in diabetic and non-diabetic patients (HR 1.23, p = 0.363), as was survival free from CRT-D interventions (HR 1.72; p = 0.115) and hospitalisations (HR 1.12; p = 0.500). On multivariable analysis, NYHA class IV (p = 0.002), low LV ejection fraction (p = 0.002), absence of beta-blocker therapy (p b 0.001), impaired renal function (p = 0.003), presence of an epicardial lead (p = 0.025), but not diabetes (p = 0.821) were associated with a poor outcome after CRT. Conclusions: Diabetic HF patients treated with CRT had a very favourable functional and survival outcome, which was comparable to nondiabetic patients.
European Heart Journal, 2008
To investigate the effects of cardiac resynchronization therapy (CRT) on survival in heart failur... more To investigate the effects of cardiac resynchronization therapy (CRT) on survival in heart failure (HF) patients with permanent atrial fibrillation (AF) and the role of atrio-ventricular junction (AVJ) ablation in these patients.
Blood Coagulation & Fibrinolysis, 2009
Left ventricular thrombus is a common complication after acute myocardial infarction. Although an... more Left ventricular thrombus is a common complication after acute myocardial infarction. Although anticoagulant treatment has an established role in reducing the rate of thrombus formation and embolic phenomena during acute myocardial infarction, prior studies showed that left ventricular thrombus and systemic embolization may develop irrespective of adequate anticoagulant therapy. We present a descriptive case of a patient with left ventricular thrombus who experienced dramatic peripheral embolic events soon after the onset of anterior myocardial infarction despite full anticoagulation, and we discuss possible pathogenesis.
The American Journal of Cardiology, 2007
This multicenter longitudinal observational trial was designed to analyze the long-term outcome o... more This multicenter longitudinal observational trial was designed to analyze the long-term outcome of patients with heart failure (HF) treated with cardiac resynchronization therapy (CRT) alone or with implantable cardioverter-defibrillator (ICD) backup in a daily practice scenario. It is unknown whether the magnitude of survival benefits conferred by CRT in a daily practice scenario is comparable to what has been observed in randomized controlled trials and whether this benefit is sustained over the long term. The outcome of 1,303 consecutive patients with ischemic or nonischemic cardiomyopathy on optimal pharmacologic therapy treated from August 1, 1995 to August 1, 2004 at 4 European centers with CRT alone (44%) or with ICD backup for symptomatic HF and prolonged QRS duration was assessed. Cumulative event-free survival was evaluated for a combined end point, defined as death from any cause, urgent transplantation, or implantation of a left ventricular assist device. The cumulative incidence of competing events, HF, sudden cardiac death, and noncardiac death, was also assessed. Event-free survival was similar across the different centers. At 1 and 5 years, cumulative event-free survivals were 92% (95% confidence interval [CI] 91 to 94) and 56% (95% CI 48 to 64), respectively. The cumulative incidence of HF deaths was 25.1% (95% CI 19 to 31.7), whereas that of sudden death was 9.5% (95% CI 5.1 to 15.7). Using multivariate analysis, CRT with an ICD backup was associated with a nonsignificant decrease in mortality by 20% (hazard ratio 0.83, 95% CI 0.58 to 1.17, p = 0.284), with a highly significant protective effect against sudden cardiac death (hazard ratio 0.04, 95% CI 0.04 to 0.28, p &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;0.002). In conclusion, patients with advanced HF and a wide QRS complex routinely treated with CRT have a favorable long-term outcome that was reproducible at different centers. The leading cause of death in these patients remained HF, and this mode of death was competing with other causes in determining outcome. Total mortality was 20% lower with ICD backup (95% CI 42% lower to 17% higher) due to a protective effect against sudden cardiac death.
The American Journal of Cardiology, 2011
There are no parameters predicting the individual probability of "full response" to cardiac resyn... more There are no parameters predicting the individual probability of "full response" to cardiac resynchronization therapy (CRT). The aim of this work was to find prognostic factors of full clinical and echocardiographic responses (i.e., >50% left ventricular ejection fraction [LVEF] and New York Heart Association class I) after 1 year of CRT. This was a prospective follow-up study that involved 2 hospitals. Patients (n ؍ 75) with advanced heart failure (64 ؎ 9 years of age, 87% men, LVEF 24 ؎ 7%) who received CRT were followed for 17 ؎ 9 months. Univariate and multivariate regression analyses were used to identify predictors of full CRT response. A nomogram predicting the individual probability of full CRT response during follow-up was calculated. There were 13 patients with restoration of normal LVEF versus 62 without (mean LVEF 56% ؎ 5% vs 31% ؎ 8%, respectively, p <0.001). Predictors of full response included cause of heart disease, baseline QRS width, and degree of QRS shortening in response to CRT. Patients with nonischemic heart disease, baseline QRS width <150 ms, and QRS shortening >40 ms in response to CRT had a >75% probability of restoration of normal LVEF. In conclusion, our nomogram using a combination of cause, baseline QRS width, and degree of QRS shortening in response to CRT allows assessment of individual probability of full response. This observation awaits further confirmation from larger series.
CardioVascular and Interventional Radiology, 2008
We report the case of a patient with subtotal occlusion of the origin of the left common carotid ... more We report the case of a patient with subtotal occlusion of the origin of the left common carotid artery (CCA) following thoracic graft placement. Retrograde endovascular placement of a stent-graft by minimal cervical access was undertaken to repair the occlusive lesion of the left CCA and prevent future complications of endoluminal thoracic reconstruction. The retrograde endovascular repair of CCA lesions, as other authors have already suggested, may be the treatment of choice in &amp;amp;amp;amp;amp;amp;amp;quot;high-surgical-risk&amp;amp;amp;amp;amp;amp;amp;quot; patients. In these cases where the ostium of supra-aortic trunks is compromised following thoracic aorta stent-graft migration, endoluminal placement of a stent-graft in the CCA can guarantee both maintenance of carotid flow and thoracic stent-graft fixation.