Franco Noventa | Università degli Studi di Padova (original) (raw)
Papers by Franco Noventa
Circulation. Arrhythmia and electrophysiology, 2014
One of the reasons for patient nonresponse to cardiac resynchronization therapy is a suboptimal l... more One of the reasons for patient nonresponse to cardiac resynchronization therapy is a suboptimal left ventricular (LV) pacing site. LV electric delay (Q-LV interval) has been indicated as a prognostic parameter of cardiac resynchronization therapy response. This study evaluates the LV delay for the optimization of the LV pacing site. Thirty-two consecutive patients (23 men; mean age, 71±11 years; LV ejection fraction, 30±6%; 18 with ischemic cardiomyopathy; QRS, 181±25 ms; all mean±SD) underwent cardiac resynchronization therapy device implantation. All available tributary veins of the coronary sinus were tested, and the Q-LV interval was measured at each pacing site. The hemodynamic effects of pacing at different sites were evaluated by invasive measurement of LV dP/dtmax at baseline and during pacing. Overall, 2.9±0.8 different veins and 6.4±2.3 pacing sites were tested. In 31 of 32 (96.8%) patients, the highest LV dP/dtmax coincided with the maximum Q-LV interval. Q-LV interval co...
Haematologica, 2007
While it has long been recognized that patients with acute unprovoked deep vein thrombosis (DVT) ... more While it has long been recognized that patients with acute unprovoked deep vein thrombosis (DVT) or pulmonary embolism (PE) have a higher risk of recurrent venous thromboembolism (VTE) than that of patients with secondary thrombosis, whether other clinical parameters can help predict the development of recurrent events is controversial. The aim of this investigation was to assess the rate of recurrent VTE after withdrawal of vitamin K antagonists, and to identify clinical parameters associated with a higher likelihood of recurrence.
Thrombosis and …, 2009
1. Thromb Haemost. 2009 Apr;101(4):789-91. Anti-beta(2)-glycoprotein I ELISA assay: the influence... more 1. Thromb Haemost. 2009 Apr;101(4):789-91. Anti-beta(2)-glycoprotein I ELISA assay: the influence of different antigen preparations. Cavazzana A, Pengo V, Tonello M, Noventa F, Grossi C, Borghi MO, de Moerloose P, Reber G, Ruffatti A. ...
Journal of Hepatology, 2010
Preliminary data suggest that non-invasive methods could be useful to assess presence of oesophag... more Preliminary data suggest that non-invasive methods could be useful to assess presence of oesophageal varices (OV) in cirrhotic patients. We aimed to further investigate simple serum non-invasive markers for diagnosing and grading OV. A retrospective set of 510 cirrhotics and a prospective set of 110 cirrhotics were enrolled consecutively in five centers. Platelets, AST-to-ALT ratio, AST-to-platelet-ratio index, Forns' index, Lok index, Fib-4, and Fibroindex were measured within 2 months from upper endoscopy, taken as a gold standard. Performance was expressed as sensitivity, specificity, positive, and negative predictive values (PPV, NPV), accuracy, and area under the curve (AUC). A combination of Lok index (cutoff=1.5) and Forns' index (cutoff=8.8) had 0.80 AUC (0.76-0.84, 95% CI), and high NPV (>90%) to exclude clinically relevant OV, defined as large OV or small OV with red signs or in Child-Pugh C cirrhosis. By applying this combination, upper endoscopy would have been avoided in 1/3 of our cirrhotics. Large OV could be excluded with 96% NPV by Lok index (cutoff=1.5). A combination of Lok index (cutoff=0.9) and Forns' index (cutoff=8.5) predicted presence of any grade OV with good performance: 0.82 AUC (0.76-0.88, 95% CI), 88% PPV. Serum non-invasive markers may be useful as a first line tool to identify cirrhotic patients in which the risk of clinically relevant OV is trivial, and to reduce the number of upper endoscopies. However, we are still far from the possibility of replacing upper endoscopy by simple serum non-invasive markers in the vast majority of patients.
Annales de Chirurgie Vasculaire, 2009
ABSTRACT Les buts de l'étude étaient de déterminer les variables qui pourraient être empl... more ABSTRACT Les buts de l'étude étaient de déterminer les variables qui pourraient être employées pour prévoir la survie des patients présentant un anévrysme de l'aorte abdominale rompu (AAAR) et d'évaluer l'exactitude des scores Glasgow pour anévrysme (GAS) et APACHE-II. De janvier 1998 à juillet 2006, 103 patients ont été opérés pour AAAR. Pour chaque patient, 44 variables ont été rétrospectivement enregistrées dans une base de données. Les données ont été analysées avec des méthodes univariées et multivariées. Dans l'analyse univariée les facteurs prédictifs significatifs de mortalité étaient l'hypotension (p = 0,001), l'existence d'une atteinte vasculaire périphérique (p < 0,001), d'une insuffisance rénale (p = 0.037), d'une bronchopneumopathie chronique obstructive (p = 0.028), le taux de HCO3- (p < 0,001), la rupture intrapéritonéale (p = 0,001), la transfusion sanguine (p < 0,001), les complications cardiaques (p < 0,001), et le score APACHE-II (p = 0,001). L'analyse multivariée a confirmé la significativité statistique de l'atteinte vasculaire périphérique associée (p < 0,001), de la pression artérielle diastolique à l'admission <60 mmHg (p = 0,039), du score APACHE II >18.5 (p = 0,025), du taux de HCO3- <21 mg/dl (p < 0,001), et de la rupture intrapéritonéale (p = 0,011) comme facteurs prédictifs de mortalité. Les résultats de l'étude suggèrent que différents facteurs peuvent être utiles pour identifier les patients à risque opératoire excessif pour le traitement chirurgical d'un AAAR. APACHE-II, contrairement au GAS, est un score efficace pour prévoir la mortalité postopératoire après le traitement chirurgical pour AAAR.
Annals of Vascular Surgery, 2009
American journal of cardiovascular disease, 2013
A short paced (p) QRS duration (d) can be a marker for selecting the most appropriate RV pacing s... more A short paced (p) QRS duration (d) can be a marker for selecting the most appropriate RV pacing site. Although this could be achieved by continual 12-Lead ECG monitoring, such a technique is not applicable during pacemaker (PM) implantation. The purpose of this study was to validate a method for identifying the optimal site for RV septum pacing using simple markers derived from few real-time ECG leads and fluoroscopy (F). An overall of 304 measurements of pQRSd in different RV sites was performed in 102 patients undergoing PM implant. In accordance with F position the lead placement was classified high, medium, and low septum. Paced electrocardiographic/fluoroscopic parameters (q-wave/negative QRS in lead I, notching in limb leads, R/S wave in lead II, QRS precordial leads transition, and F septal segments pacing site) were analyzed to predict short pQRSd (≤ 160 ms). Logistic regression analysis showed that pQRSd > 160 ms was predicted by presence of pQRS notching in limb leads (...
Circulation. Arrhythmia and electrophysiology, 2014
One of the reasons for patient nonresponse to cardiac resynchronization therapy is a suboptimal l... more One of the reasons for patient nonresponse to cardiac resynchronization therapy is a suboptimal left ventricular (LV) pacing site. LV electric delay (Q-LV interval) has been indicated as a prognostic parameter of cardiac resynchronization therapy response. This study evaluates the LV delay for the optimization of the LV pacing site. Thirty-two consecutive patients (23 men; mean age, 71±11 years; LV ejection fraction, 30±6%; 18 with ischemic cardiomyopathy; QRS, 181±25 ms; all mean±SD) underwent cardiac resynchronization therapy device implantation. All available tributary veins of the coronary sinus were tested, and the Q-LV interval was measured at each pacing site. The hemodynamic effects of pacing at different sites were evaluated by invasive measurement of LV dP/dtmax at baseline and during pacing. Overall, 2.9±0.8 different veins and 6.4±2.3 pacing sites were tested. In 31 of 32 (96.8%) patients, the highest LV dP/dtmax coincided with the maximum Q-LV interval. Q-LV interval co...
Heart Rhythm, 2015
BACKGROUND Response to cardiac resynchronization therapy (CRT) remains challenging. Pacing from m... more BACKGROUND Response to cardiac resynchronization therapy (CRT) remains challenging. Pacing from multiple sites of the left ventricle (LV) has shown promising results.
Pacing and Clinical Electrophysiology, 2009
The right ventricular septum (RVS) and Hisian area (HA) are considered more "physiological" pacin... more The right ventricular septum (RVS) and Hisian area (HA) are considered more "physiological" pacing sites than right ventricular apex (RVA). Studies comparing RVS to RVA sites have produced controversial results. There are no data about variability of electromechanical activation obtained by an approach using fluoroscopy and electrophysiological markers. This study compared the variability of left ventricular (LV) electromechanical activation in patients undergoing short-term RVA and RVS with that measured during HA pacing based on fluoroscopy and electrophysiological markers.
Pacing and Clinical Electrophysiology, 2008
Background: RVA pacing causes abnormal ventricular depolarization that may lead to mechanical LV ... more Background: RVA pacing causes abnormal ventricular depolarization that may lead to mechanical LV dyssynchrony. The relationships between pacing-induced LV dyssynchrony and baseline echocardiographic and clinical variables have not been fully clarified.
Journal of Vascular Surgery, 2003
Objective: The purpose of this study was to evaluate the short-term and long-term results of simu... more Objective: The purpose of this study was to evaluate the short-term and long-term results of simultaneous surgical treatment of coexisting abdominal aortic aneurysm and bladder carcinoma. Methods: A prospective study was carried out to compare patients undergoing simultaneous surgical treatment of abdominal aneurysm and bladder carcinoma with control patients undergoing surgery for either one of the two diseases alone. From January 1995 to December 2000, 16 consecutive patients were seen with concomitant abdominal aortic aneurysm and bladder carcinoma at our institutional referral center. All patients underwent a standard operative protocol that included aneurysm graft replacement, radical cystoprostatectomy, and urinary reconstruction. Endovascular treatment of the aneurysm was considered in the last 2 years of the study. After each simultaneous treatment case, two control patients were selected according to the same type of vascular or urinary procedure, respectively, and pathologic staging. The analyzed endpoint was mortality, and confounder variables included common and disease-specific risk factors. Frequencies of vascular, urologic, and systemic complications were carefully considered with special attention to graft infection and tumor recurrence.
Journal of Vascular Surgery, 2013
Objective: The goal of this study was to evaluate the role of intraoperative aneurysm sac emboliz... more Objective: The goal of this study was to evaluate the role of intraoperative aneurysm sac embolization during endovascular aneurysm repair (EVAR) using a standard dose of coils and fibrin glue in the prevention of type II endoleak (EII). Methods: Two groups were compared: 83 patients underwent standard EVAR during the period 2008-2009 (group A) and 79 patients underwent EVAR during the period 2010-2011 (group B). Computed tomography scans were evaluated with Osirix Pro 4.0 software to obtain aneurysm sac volume. EII rates at the first computed tomography scan follow-up, as well as midterm freedom from EII and freedom from related reintervention, were compared. Preoperative number of patent aortic side branches (inferior mesenteric artery, lumbar arteries, accessory renal arteries), sac thrombus, and sac volume were evaluated for their association with EII in the two groups using multiple logistic regressions. Results: Patient characteristics, Society for Vascular Surgery comorbidity scores (0.85 ± 0.44 vs 0.82 ± 0.46; P [ .96), and operative time (185 ± 52 vs 179 ± 49; P [ .92) were similar for groups A and B. The first computed tomography scan (#3 months) revealed a significantly larger number of EIIs in group A than in group B (23% vs 10%; P [ .02). Spontaneous EII resolution occurred in 65% of patients in group A and in 79% in group B (P [ 1.0), whereas sac volume increased in 25% and 10% (P [ .63) of cases, respectively. At 18 months (range, 6 months to 4.4 years), overall mean differences in sac volume shrinkage (27 ± 12 cm 3 vs 25 ± 12 cm 3 ; P [ .19) and freedom from EII (92% vs 96%; P [ .33) were similar, whereas freedom from reintervention was significantly lower in group A (93% vs 99%; P [ .03) than in group B. Multivariate analysis showed preoperative aneurysm sac volume >125 cm 3 to be the only independent significant predictor of EII (odds ratio, 4.0; 95% confidence interval, 1.5-10.5; P [ .005). Conclusions: Although further confirmatory studies are needed, sac embolization during EVAR may be a valid approach to preventing EII and its complications during short-and midterm follow-up. More aggressive intraoperative embolization should be considered for patients with a preoperative aneurysm sac volume >125 cm 3 . (J Vasc Surg 2013;57:934-41.)
Journal of Vascular Surgery, 2012
However, these values are not familiar for Clinicians. The aim of this study was to introduce a p... more However, these values are not familiar for Clinicians. The aim of this study was to introduce a patient specific and clinically applicable biomechanical rupture risk assessment tool that would be easy for Vascular Surgeons to comprehend.
Europace, 2014
Right ventricular apex (RVA) pacing has adverse effects on left atrial (LA) function and may cont... more Right ventricular apex (RVA) pacing has adverse effects on left atrial (LA) function and may contribute to atrial arrhythmias. The effects of Hisian area (HA) pacing on LA function are still lacking. The objective of this study is to assess the left ventricular (LV) electromechanical activation/relaxation, systolic (S), diastolic (D) phases, and their effects on LA function during pacing from HA and RVA. Thirty-seven patients with normal cardiac function underwent permanent HA pacing. In all patients, a RVA backup lead was added. The patients first underwent 3 months of HA pacing, followed by 3 months of RVA pacing. After each 3-month period, we compared by echocardiography: S-D LV electromechanical delay (S-D EMD), S-D intra-LV dyssynchrony, LV S-D phases, and their function evaluated by myocardial performance index (MPI) and mitral annular tissue Doppler early diastolic velocity (E&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;), pulmonary arterial systolic pressure (PASP), and LA function (LA phasic volumes and their emptying fraction). Right ventricular apex compared with HA pacing increased S-D EMD (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and intra-LV dyssynchrony (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). As a consequence, a significant longer LV isovolumetric contraction time (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and LV isovolumetric relaxation time (P = 0.05) were measured during RVA compared with HA pacing, whereas LV ejection time was shorter (P = 0.033). Moreover, HA pacing resulted in significantly better MPI (P = 0.039), higher value of E&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (P = 0.049), and lower PASP (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Finally, RVA compared with HA pacing was associated to higher LA volumes pre-atrial contraction (P = 0.001) and minimal volume (P = 0.003) with reduction in passive emptying fraction (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and total emptying fraction (P = 0.005). Hisian area compared with RVA pacing resulted in a more physiological LV electromechanical activation/relaxation and consequently better LA function.
Blood, 2011
Whether long-term use of vitamin K antagonists (VKAs) might affect the incidence of cancer is a l... more Whether long-term use of vitamin K antagonists (VKAs) might affect the incidence of cancer is a longstanding hypothesis. We conducted a population-based study including all cancer-and thromboembolism-free patients of our health area; study groups were defined according to chronic anticoagulant use to VKA-exposed and control groups. Cancer incidence and cancer-related and overall mortality was assessed in both groups. 76 008 patients (3231 VKAexposed and 72 777 control subjects) were followed-up for 8.2 ( ؎ 3.2) years. After adjusting for age, sex, and time-to-event, the hazard ratio of newly diagnosed cancer in the exposed group was 0.88 (95% confidence interval [95% CI] 0.80-0.98; P < .015). VKA-exposed patients were less likely to develop prostate cancer, 0.69 (95% CI 0.50-0.97; P ؍ .008). The adjusted hazard ratio for cancer-related and overall mortality was 1.07 (95% CI 0.92-1.24) and 1.12 (95% CI 1.05-1.19), respectively. These results support the hypothesis that anticoagulation might have a protective effect on cancer development, especially prostate cancer. (Blood.
Recenti progressi in medicina
In absence of prophylaxis, the incidence of deep vein thrombosis after knee arthroscopy is report... more In absence of prophylaxis, the incidence of deep vein thrombosis after knee arthroscopy is reported to be as high as 18%. Recommendations for thromboprophylaxis after knee arthroscopy have actually been updated. The results of the largest randomized clinical trial (KANT study) in this setting are reported together with a review of the literature.
Thrombosis and Haemostasis
Circulation. Arrhythmia and electrophysiology, 2014
One of the reasons for patient nonresponse to cardiac resynchronization therapy is a suboptimal l... more One of the reasons for patient nonresponse to cardiac resynchronization therapy is a suboptimal left ventricular (LV) pacing site. LV electric delay (Q-LV interval) has been indicated as a prognostic parameter of cardiac resynchronization therapy response. This study evaluates the LV delay for the optimization of the LV pacing site. Thirty-two consecutive patients (23 men; mean age, 71±11 years; LV ejection fraction, 30±6%; 18 with ischemic cardiomyopathy; QRS, 181±25 ms; all mean±SD) underwent cardiac resynchronization therapy device implantation. All available tributary veins of the coronary sinus were tested, and the Q-LV interval was measured at each pacing site. The hemodynamic effects of pacing at different sites were evaluated by invasive measurement of LV dP/dtmax at baseline and during pacing. Overall, 2.9±0.8 different veins and 6.4±2.3 pacing sites were tested. In 31 of 32 (96.8%) patients, the highest LV dP/dtmax coincided with the maximum Q-LV interval. Q-LV interval co...
Haematologica, 2007
While it has long been recognized that patients with acute unprovoked deep vein thrombosis (DVT) ... more While it has long been recognized that patients with acute unprovoked deep vein thrombosis (DVT) or pulmonary embolism (PE) have a higher risk of recurrent venous thromboembolism (VTE) than that of patients with secondary thrombosis, whether other clinical parameters can help predict the development of recurrent events is controversial. The aim of this investigation was to assess the rate of recurrent VTE after withdrawal of vitamin K antagonists, and to identify clinical parameters associated with a higher likelihood of recurrence.
Thrombosis and …, 2009
1. Thromb Haemost. 2009 Apr;101(4):789-91. Anti-beta(2)-glycoprotein I ELISA assay: the influence... more 1. Thromb Haemost. 2009 Apr;101(4):789-91. Anti-beta(2)-glycoprotein I ELISA assay: the influence of different antigen preparations. Cavazzana A, Pengo V, Tonello M, Noventa F, Grossi C, Borghi MO, de Moerloose P, Reber G, Ruffatti A. ...
Journal of Hepatology, 2010
Preliminary data suggest that non-invasive methods could be useful to assess presence of oesophag... more Preliminary data suggest that non-invasive methods could be useful to assess presence of oesophageal varices (OV) in cirrhotic patients. We aimed to further investigate simple serum non-invasive markers for diagnosing and grading OV. A retrospective set of 510 cirrhotics and a prospective set of 110 cirrhotics were enrolled consecutively in five centers. Platelets, AST-to-ALT ratio, AST-to-platelet-ratio index, Forns&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; index, Lok index, Fib-4, and Fibroindex were measured within 2 months from upper endoscopy, taken as a gold standard. Performance was expressed as sensitivity, specificity, positive, and negative predictive values (PPV, NPV), accuracy, and area under the curve (AUC). A combination of Lok index (cutoff=1.5) and Forns&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; index (cutoff=8.8) had 0.80 AUC (0.76-0.84, 95% CI), and high NPV (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;90%) to exclude clinically relevant OV, defined as large OV or small OV with red signs or in Child-Pugh C cirrhosis. By applying this combination, upper endoscopy would have been avoided in 1/3 of our cirrhotics. Large OV could be excluded with 96% NPV by Lok index (cutoff=1.5). A combination of Lok index (cutoff=0.9) and Forns&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; index (cutoff=8.5) predicted presence of any grade OV with good performance: 0.82 AUC (0.76-0.88, 95% CI), 88% PPV. Serum non-invasive markers may be useful as a first line tool to identify cirrhotic patients in which the risk of clinically relevant OV is trivial, and to reduce the number of upper endoscopies. However, we are still far from the possibility of replacing upper endoscopy by simple serum non-invasive markers in the vast majority of patients.
Annales de Chirurgie Vasculaire, 2009
ABSTRACT Les buts de l'étude étaient de déterminer les variables qui pourraient être empl... more ABSTRACT Les buts de l'étude étaient de déterminer les variables qui pourraient être employées pour prévoir la survie des patients présentant un anévrysme de l'aorte abdominale rompu (AAAR) et d'évaluer l'exactitude des scores Glasgow pour anévrysme (GAS) et APACHE-II. De janvier 1998 à juillet 2006, 103 patients ont été opérés pour AAAR. Pour chaque patient, 44 variables ont été rétrospectivement enregistrées dans une base de données. Les données ont été analysées avec des méthodes univariées et multivariées. Dans l'analyse univariée les facteurs prédictifs significatifs de mortalité étaient l'hypotension (p = 0,001), l'existence d'une atteinte vasculaire périphérique (p < 0,001), d'une insuffisance rénale (p = 0.037), d'une bronchopneumopathie chronique obstructive (p = 0.028), le taux de HCO3- (p < 0,001), la rupture intrapéritonéale (p = 0,001), la transfusion sanguine (p < 0,001), les complications cardiaques (p < 0,001), et le score APACHE-II (p = 0,001). L'analyse multivariée a confirmé la significativité statistique de l'atteinte vasculaire périphérique associée (p < 0,001), de la pression artérielle diastolique à l'admission <60 mmHg (p = 0,039), du score APACHE II >18.5 (p = 0,025), du taux de HCO3- <21 mg/dl (p < 0,001), et de la rupture intrapéritonéale (p = 0,011) comme facteurs prédictifs de mortalité. Les résultats de l'étude suggèrent que différents facteurs peuvent être utiles pour identifier les patients à risque opératoire excessif pour le traitement chirurgical d'un AAAR. APACHE-II, contrairement au GAS, est un score efficace pour prévoir la mortalité postopératoire après le traitement chirurgical pour AAAR.
Annals of Vascular Surgery, 2009
American journal of cardiovascular disease, 2013
A short paced (p) QRS duration (d) can be a marker for selecting the most appropriate RV pacing s... more A short paced (p) QRS duration (d) can be a marker for selecting the most appropriate RV pacing site. Although this could be achieved by continual 12-Lead ECG monitoring, such a technique is not applicable during pacemaker (PM) implantation. The purpose of this study was to validate a method for identifying the optimal site for RV septum pacing using simple markers derived from few real-time ECG leads and fluoroscopy (F). An overall of 304 measurements of pQRSd in different RV sites was performed in 102 patients undergoing PM implant. In accordance with F position the lead placement was classified high, medium, and low septum. Paced electrocardiographic/fluoroscopic parameters (q-wave/negative QRS in lead I, notching in limb leads, R/S wave in lead II, QRS precordial leads transition, and F septal segments pacing site) were analyzed to predict short pQRSd (≤ 160 ms). Logistic regression analysis showed that pQRSd > 160 ms was predicted by presence of pQRS notching in limb leads (...
Circulation. Arrhythmia and electrophysiology, 2014
One of the reasons for patient nonresponse to cardiac resynchronization therapy is a suboptimal l... more One of the reasons for patient nonresponse to cardiac resynchronization therapy is a suboptimal left ventricular (LV) pacing site. LV electric delay (Q-LV interval) has been indicated as a prognostic parameter of cardiac resynchronization therapy response. This study evaluates the LV delay for the optimization of the LV pacing site. Thirty-two consecutive patients (23 men; mean age, 71±11 years; LV ejection fraction, 30±6%; 18 with ischemic cardiomyopathy; QRS, 181±25 ms; all mean±SD) underwent cardiac resynchronization therapy device implantation. All available tributary veins of the coronary sinus were tested, and the Q-LV interval was measured at each pacing site. The hemodynamic effects of pacing at different sites were evaluated by invasive measurement of LV dP/dtmax at baseline and during pacing. Overall, 2.9±0.8 different veins and 6.4±2.3 pacing sites were tested. In 31 of 32 (96.8%) patients, the highest LV dP/dtmax coincided with the maximum Q-LV interval. Q-LV interval co...
Heart Rhythm, 2015
BACKGROUND Response to cardiac resynchronization therapy (CRT) remains challenging. Pacing from m... more BACKGROUND Response to cardiac resynchronization therapy (CRT) remains challenging. Pacing from multiple sites of the left ventricle (LV) has shown promising results.
Pacing and Clinical Electrophysiology, 2009
The right ventricular septum (RVS) and Hisian area (HA) are considered more "physiological" pacin... more The right ventricular septum (RVS) and Hisian area (HA) are considered more "physiological" pacing sites than right ventricular apex (RVA). Studies comparing RVS to RVA sites have produced controversial results. There are no data about variability of electromechanical activation obtained by an approach using fluoroscopy and electrophysiological markers. This study compared the variability of left ventricular (LV) electromechanical activation in patients undergoing short-term RVA and RVS with that measured during HA pacing based on fluoroscopy and electrophysiological markers.
Pacing and Clinical Electrophysiology, 2008
Background: RVA pacing causes abnormal ventricular depolarization that may lead to mechanical LV ... more Background: RVA pacing causes abnormal ventricular depolarization that may lead to mechanical LV dyssynchrony. The relationships between pacing-induced LV dyssynchrony and baseline echocardiographic and clinical variables have not been fully clarified.
Journal of Vascular Surgery, 2003
Objective: The purpose of this study was to evaluate the short-term and long-term results of simu... more Objective: The purpose of this study was to evaluate the short-term and long-term results of simultaneous surgical treatment of coexisting abdominal aortic aneurysm and bladder carcinoma. Methods: A prospective study was carried out to compare patients undergoing simultaneous surgical treatment of abdominal aneurysm and bladder carcinoma with control patients undergoing surgery for either one of the two diseases alone. From January 1995 to December 2000, 16 consecutive patients were seen with concomitant abdominal aortic aneurysm and bladder carcinoma at our institutional referral center. All patients underwent a standard operative protocol that included aneurysm graft replacement, radical cystoprostatectomy, and urinary reconstruction. Endovascular treatment of the aneurysm was considered in the last 2 years of the study. After each simultaneous treatment case, two control patients were selected according to the same type of vascular or urinary procedure, respectively, and pathologic staging. The analyzed endpoint was mortality, and confounder variables included common and disease-specific risk factors. Frequencies of vascular, urologic, and systemic complications were carefully considered with special attention to graft infection and tumor recurrence.
Journal of Vascular Surgery, 2013
Objective: The goal of this study was to evaluate the role of intraoperative aneurysm sac emboliz... more Objective: The goal of this study was to evaluate the role of intraoperative aneurysm sac embolization during endovascular aneurysm repair (EVAR) using a standard dose of coils and fibrin glue in the prevention of type II endoleak (EII). Methods: Two groups were compared: 83 patients underwent standard EVAR during the period 2008-2009 (group A) and 79 patients underwent EVAR during the period 2010-2011 (group B). Computed tomography scans were evaluated with Osirix Pro 4.0 software to obtain aneurysm sac volume. EII rates at the first computed tomography scan follow-up, as well as midterm freedom from EII and freedom from related reintervention, were compared. Preoperative number of patent aortic side branches (inferior mesenteric artery, lumbar arteries, accessory renal arteries), sac thrombus, and sac volume were evaluated for their association with EII in the two groups using multiple logistic regressions. Results: Patient characteristics, Society for Vascular Surgery comorbidity scores (0.85 ± 0.44 vs 0.82 ± 0.46; P [ .96), and operative time (185 ± 52 vs 179 ± 49; P [ .92) were similar for groups A and B. The first computed tomography scan (#3 months) revealed a significantly larger number of EIIs in group A than in group B (23% vs 10%; P [ .02). Spontaneous EII resolution occurred in 65% of patients in group A and in 79% in group B (P [ 1.0), whereas sac volume increased in 25% and 10% (P [ .63) of cases, respectively. At 18 months (range, 6 months to 4.4 years), overall mean differences in sac volume shrinkage (27 ± 12 cm 3 vs 25 ± 12 cm 3 ; P [ .19) and freedom from EII (92% vs 96%; P [ .33) were similar, whereas freedom from reintervention was significantly lower in group A (93% vs 99%; P [ .03) than in group B. Multivariate analysis showed preoperative aneurysm sac volume >125 cm 3 to be the only independent significant predictor of EII (odds ratio, 4.0; 95% confidence interval, 1.5-10.5; P [ .005). Conclusions: Although further confirmatory studies are needed, sac embolization during EVAR may be a valid approach to preventing EII and its complications during short-and midterm follow-up. More aggressive intraoperative embolization should be considered for patients with a preoperative aneurysm sac volume >125 cm 3 . (J Vasc Surg 2013;57:934-41.)
Journal of Vascular Surgery, 2012
However, these values are not familiar for Clinicians. The aim of this study was to introduce a p... more However, these values are not familiar for Clinicians. The aim of this study was to introduce a patient specific and clinically applicable biomechanical rupture risk assessment tool that would be easy for Vascular Surgeons to comprehend.
Europace, 2014
Right ventricular apex (RVA) pacing has adverse effects on left atrial (LA) function and may cont... more Right ventricular apex (RVA) pacing has adverse effects on left atrial (LA) function and may contribute to atrial arrhythmias. The effects of Hisian area (HA) pacing on LA function are still lacking. The objective of this study is to assess the left ventricular (LV) electromechanical activation/relaxation, systolic (S), diastolic (D) phases, and their effects on LA function during pacing from HA and RVA. Thirty-seven patients with normal cardiac function underwent permanent HA pacing. In all patients, a RVA backup lead was added. The patients first underwent 3 months of HA pacing, followed by 3 months of RVA pacing. After each 3-month period, we compared by echocardiography: S-D LV electromechanical delay (S-D EMD), S-D intra-LV dyssynchrony, LV S-D phases, and their function evaluated by myocardial performance index (MPI) and mitral annular tissue Doppler early diastolic velocity (E&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;), pulmonary arterial systolic pressure (PASP), and LA function (LA phasic volumes and their emptying fraction). Right ventricular apex compared with HA pacing increased S-D EMD (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and intra-LV dyssynchrony (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). As a consequence, a significant longer LV isovolumetric contraction time (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and LV isovolumetric relaxation time (P = 0.05) were measured during RVA compared with HA pacing, whereas LV ejection time was shorter (P = 0.033). Moreover, HA pacing resulted in significantly better MPI (P = 0.039), higher value of E&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (P = 0.049), and lower PASP (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Finally, RVA compared with HA pacing was associated to higher LA volumes pre-atrial contraction (P = 0.001) and minimal volume (P = 0.003) with reduction in passive emptying fraction (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and total emptying fraction (P = 0.005). Hisian area compared with RVA pacing resulted in a more physiological LV electromechanical activation/relaxation and consequently better LA function.
Blood, 2011
Whether long-term use of vitamin K antagonists (VKAs) might affect the incidence of cancer is a l... more Whether long-term use of vitamin K antagonists (VKAs) might affect the incidence of cancer is a longstanding hypothesis. We conducted a population-based study including all cancer-and thromboembolism-free patients of our health area; study groups were defined according to chronic anticoagulant use to VKA-exposed and control groups. Cancer incidence and cancer-related and overall mortality was assessed in both groups. 76 008 patients (3231 VKAexposed and 72 777 control subjects) were followed-up for 8.2 ( ؎ 3.2) years. After adjusting for age, sex, and time-to-event, the hazard ratio of newly diagnosed cancer in the exposed group was 0.88 (95% confidence interval [95% CI] 0.80-0.98; P < .015). VKA-exposed patients were less likely to develop prostate cancer, 0.69 (95% CI 0.50-0.97; P ؍ .008). The adjusted hazard ratio for cancer-related and overall mortality was 1.07 (95% CI 0.92-1.24) and 1.12 (95% CI 1.05-1.19), respectively. These results support the hypothesis that anticoagulation might have a protective effect on cancer development, especially prostate cancer. (Blood.
Recenti progressi in medicina
In absence of prophylaxis, the incidence of deep vein thrombosis after knee arthroscopy is report... more In absence of prophylaxis, the incidence of deep vein thrombosis after knee arthroscopy is reported to be as high as 18%. Recommendations for thromboprophylaxis after knee arthroscopy have actually been updated. The results of the largest randomized clinical trial (KANT study) in this setting are reported together with a review of the literature.
Thrombosis and Haemostasis