-
Gianluigi Savarese,
Francesca Musella,
Carmen D'Amore,
Teresa Losco, Caterina Marciano,
Paola Gargiulo,
Giuseppe Rengo,
Santo Dellegrottaglie,
Eduardo Bossone,
Dario Leosco,
Pasquale Perrone-Filardi
[show abstract]
[hide abstract]
ABSTRACT: Purpose of this study was to clarify whether changes in cardiopulmonary hemodynamics induced by pharmacologic therapy correlate with exercise capacity and clinical events in patients with pulmonary arterial hypertension.Sixteen randomized trials including 2,353 patients, followed up for 16.4±10.6 weeks, measuring cardiopulmonary hemodynamics by right heart catheterization and reporting clinical events were included. Meta-analysis and meta-regression analysis were performed to assess the effects of treatments on clinical events and the relationship between hemodynamic (pulmonary artery pressure, pulmonary vascular resistance, cardiac index and right atrial pressure) changes and clinical events.Treatments significantly reduced all-cause death (odds ratio [OR]:0.5; 95% confidence interval [IC]:0.3 to 0.7; p<0.01), hospitalization for pulmonary arterial hypertension (OR:0.4; IC:0.2 to 0.7; p<0.01), initiation of rescue therapy (OR:0.3; IC:0.2 to 0.6; p<0.01) and the composite outcome (OR:0.3; IC:0.3 to 0.5; p<0.01). No relationship was found between changes of hemodynamic parameters and clinical events, whereas changes of cardiac index and pulmonary vascular resistance significantly correlated with changes of 6 minute walking distance (r=0.64, p=0.03; r= -0.55; p=0.04 respectively).In patients with pulmonary arterial hypertension, improvements of cardiopulmonary hemodynamics, observed in randomized clinical trials, correlate with exercise capacity changes but do not predict clinical events in a short-term follow up.
European Respiratory Journal 10/2012; · 5.89 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The objectives of this study were to verify whether improvement in 6-min walk distance (6MWD) is associated with clinical outcome in pulmonary arterial hypertension (PAH).
6MWD is used as an endpoint to assess the benefit of therapies in PAH. However, whether changes in 6MWD correlate with clinical outcome is unknown.
Randomized trials assessing 6MWD in patients with PAH and reporting clinical endpoints were included in a meta-analysis. The meta-analysis was performed to assess the influence of treatment on outcomes. Meta-regression analysis was performed to test the relationship between 6MWD changes and outcomes.
Twenty-two trials enrolling 3,112 participants were included. Active treatments led to significant reduction of all-cause death (odds ratio [OR]: 0.429; 95% confidence interval [CI]: 0.277 to 0.664; p < 0.01), hospitalization for PAH, and/or lung or heart-lung transplantation (OR: 0.442; 95% CI: 0.309 to 0.632; p < 0.01), initiation of PAH rescue therapy (OR: 0.555; 95% CI: 0.347 to 0.889; p = 0.01), and composite outcome (OR: 0.400; 95% CI: 0.313 to 0.510; p < 0.01). No relationship between 6MWD changes and outcomes was detected.
In patients with PAH, improvement in 6MWD does not reflect benefit in clinical outcomes.
Journal of the American College of Cardiology 09/2012; 60(13):1192-201. · 14.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Coronary artery disease (CAD) is the major cause of morbidity and mortality worldwide. More than 50% of CAD deaths occur in previously asymptomatic individuals at intermediate cardiovascular risk, highlighting the need of more accurate individual risk assessment to decrease cardiovascular events. Cardiac computed tomography (CCT) has emerged as a valuable technique for risk stratification in asymptomatic subjects and in symptomatic patients without known CAD. The absence of coronary artery calcium (CAC) identifies asymptomatic subjects at very low cardiac risk and is reasonable in intermediate risk individuals, in whom CAC measurement reclassifies a substantial number of subjects to different risk categories. In symptomatic patients with suspected CAD, detection of non-obstructive or obstructive CAD by CCT angiography is associated with increased all-cause mortality, and provides incremental risk stratification to CAC. Further studies are needed to assess the impact of CCT on clinical outcomes and its cost-effectiveness in different clinical settings.
European heart journal cardiovascular Imaging. 04/2012; 13(6):453-8.
-
Caterina Marciano,
Maurizio Galderisi,
Paola Gargiulo,
Wanda Acampa,
Carmen D'Amore,
Roberta Esposito,
Enza Capasso,
Gianluigi Savarese,
Laura Casaretti,
Francesco Lo Iudice,
Giovanni Esposito,
Giuseppe Rengo,
Dario Leosco,
Alberto Cuocolo,
Pasquale Perrone-Filardi
[show abstract]
[hide abstract]
ABSTRACT: We assessed the impact of type 2 diabetes, in the presence of other major cardiovascular risk factors, on coronary microvascular function and myocardial perfusion in patients without obstructive coronary artery disease (CAD).
In this prospective study, 23 patients with type 2 diabetes and 26 nondiabetic patients matched for age, sex and other cardiovascular risk factors underwent a cold pressure test (CPT) and dipyridamole transthoracic echocardiography to determine their coronary flow (CF) ratio. Within 2 weeks, all diabetic patients also underwent dipyridamole-rest myocardial perfusion single-photon emission (MPS) CT. None of the patients with or without diabetes had significant CAD on invasive coronary angiography.
The CPT-CF ratio was significantly lower in diabetic patients than in nondiabetic patients (1.46 ± 0.26 vs. 1.71 ± 0.32, p = 0.006) and was correlated significantly with fasting glycaemia (r = -0.35, p = 0.01), but not with glycated haemoglobin. The dipyridamole-CF ratio was also lower in diabetic patients than in nondiabetic patients (2.38 ± 0.74 vs. 2.75 ± 0.49, p = 0.04). On MPS imaging, 5 diabetic patients (22%) had stress-induced ischaemia and the remaining 18 (78%) had normal myocardial perfusion. The dipyridamole-CF ratio was not different in patients with and without reversible defects (2.3 ± 1.1 vs. 2.4 ± 0.6, p = 0.97).
Coronary microvascular function is impaired in type 2 diabetic patients without significant CAD, compared to nondiabetic patients with similar other cardiovascular risk factors. In the majority of diabetic patients, microvascular dysfunction is associated with normal myocardial perfusion.
European Journal of Nuclear Medicine 04/2012; 39(7):1199-206. · 4.53 Impact Factor
-
Pasquale Perrone-Filardi,
Stefania Paolillo,
Santo Dellegrottaglie,
Paola Gargiulo,
Gianluigi Savarese, Caterina Marciano,
Laura Casaretti,
Milena Cecere,
Francesca Musella,
Elisabetta Pirozzi,
Antonio Parente,
Alberto Cuocolo
[show abstract]
[hide abstract]
ABSTRACT: Cardiac sympathetic activity can be assessed by (123)I-labelled meta-iodobenzylguanidine (MIBG) scintigraphy. Abnormalities of sympathetic cardiac activity have been shown in patients with heart failure, resulting in reduced MIBG uptake. Abnormal MIBG uptake predicts cardiac death, arrhythmias and all-cause mortality in patients with heart failure with a prognostic power incremental to that of conventional risk markers, and may identify patients at low risk of arrhythmias despite current guideline indications for implantable cardioverter defibrillator or patients at high risk for arrhythmias not fulfilling implantable cardioverter defibrillator indications. Prospective outcome studies are needed to assess whether MIBG imaging will have an impact on the mortality and morbidity of patients with heart failure.
Heart (British Cardiac Society) 09/2011; 97(22):1828-33. · 4.22 Impact Factor
-
Paola Gargiulo, Caterina Marciano,
Gianluigi Savarese,
Carmen D'Amore,
Stefania Paolillo,
Giovanni Esposito,
Maurizio Santomauro,
Fabio Marsico,
Donatella Ruggiero,
Oriana Scala,
Antonio Marzano,
Milena Cecere,
Laura Casaretti,
Pasquale Perrone Filardi
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: To assess endothelial function (EF) in type 2 diabetic patients with angiographically normal coronaries compared to diabetic patients with obstructive coronary artery disease (CAD) and to non-diabetic patients, with and without CAD. METHODS: One hundred eighty-three patients undergoing coronary angiography were divided in: group 1 with diabetes mellitus (DM) and CAD (n=58); group 2 with DM without CAD (n=58); group 3 with CAD without DM (n=31) and group 4 without CAD and DM (n=36). EF was assessed by reactive hyperemia index (RHI) using a fingertip peripheral arterial tonometry and compared to values obtained in 20 healthy volunteers. RESULTS: RHI was significantly lower in patients with DM compared to patients without DM (1.69±0.38 vs 1.84±0.44; p=0.019). RHI was comparable among groups 1, 2 and 3, each value being significantly lower compared to group 4 (2±0.44; p<0.001 vs group 1; p<0.005 vs group 2; p<0.002 vs group 3). At multivariate analysis DM and CAD were significant predictors of endothelial dysfunction (ED) (OR=2.29; p=0.012; OR=2.76; p=0.001, respectively), whereas diabetic patients (n=116) CAD and glycated haemoglobin (HbA1c) were independent significant predictors of ED (OR=3.05; p=0.009; OR=1.96; p=0.004, respectively). Diabetic patients with ED (n=67) had higher levels of HbA1c than diabetic patients with normal endothelial function (7.35±0.97 vs 6.87±0.90; p=0.008) and RHI inversely correlated to HbA1c (p=0.02; r=-0.210). CONCLUSIONS: Diabetic patients with and without CAD show significantly impaired peripheral vascular function compared to non-diabetic patients without CAD. ED in diabetic patients without CAD is comparable to that of patients with CAD but without DM. HbA1c is a weak independent predictor of ED.
International journal of cardiology 08/2011; · 7.08 Impact Factor
-
Paola Gargiulo,
Mario Petretta,
Dario Bruzzese,
Alberto Cuocolo,
Maria Prastaro,
Carmen D'Amore,
Enrico Vassallo,
Gianluigi Savarese, Caterina Marciano,
Stefania Paolillo,
Pasquale Perrone Filardi
[show abstract]
[hide abstract]
ABSTRACT: This meta-analysis summarized the accuracy of stress myocardial perfusion scintigraphy (MPS) and stress echocardiography for the diagnosis of coronary artery disease (CAD) in patients with arterial hypertension.
We searched for studies in which stress MPS or stress echocardiography were performed to detect CAD in hypertensive patients, with coronary angiography used as the reference test, published from January 1980 to December 2010. Studies performed in patients with known CAD, acute coronary syndrome and previous revascularization procedures were excluded.
Of 1,263 studies, 13 met the inclusion criteria. Pooled summary estimates showed that stress MPS had a sensitivity of 0.90 [95% confidence interval (CI) 0.82-0.95] and a specificity of 0.63 (95% CI 0.53-0.72). For stress MPS, the area under the curve (AUC) at the summary receiver-operating characteristic (SROC) graph was 0.83 (95% CI 0.80-0.86). At meta-regression analysis, the presence of positive stress electrocardiography as inclusion criterion was the only significant effect modifier (p < 0.01). Pooled summary estimates showed that stress echocardiography had a sensitivity of 0.77 (95% CI 0.69-0.83) and a specificity of 0.89 (95% CI 0.83-0.93). For stress echocardiography, the AUC at SROC was 0.91 (95% CI 0.88-0.93). At the meta-regression analysis no significant effect modifier was detected.
MPS has high sensitivity for detecting CAD in hypertensive patients, with specificity comparable to that reported in the general population, whereas stress echocardiography shows higher specificity but substantially reduced sensitivity compared to MPS.
European Journal of Nuclear Medicine 08/2011; 38(11):2040-9. · 4.53 Impact Factor
-
Maria Prastaro,
Stefania Paolillo,
Gianluigi Savarese,
Santo Dellegrottaglie,
Oriana Scala,
Donatella Ruggiero,
Paola Gargiulo, Caterina Marciano,
Antonio Parente,
Milena Cecere,
Francesca Musella,
Donato Chianese,
Francesco Scopacasa,
Pasquale Perrone-Filardi
[show abstract]
[hide abstract]
ABSTRACT: Amino-terminal portion of pro-B-type natriuretic peptide (NT-pro-BNP) is a valuable diagnostic and prognostic marker in congestive heart failure (CHF). In CHF patients, elevation of natriuretic peptide levels correlate with decreased left ventricular (LV) ejection fraction (EF) and increased left atrial (LA) volumes, but a correlation with LA function that is a determinant of haemodynamic and clinical status in CHF with independent prognostic value has never been investigated. Aim of this study was to evaluate the relationship between cardiac neurohormonal activation and LA function in patients with CHF due to dilated cardiomyopathy.
One hundred and one patients (86% males; mean age, 64 ± 11 years) with dilated ischaemic or non-ischaemic cardiomyopathy, LV EF ≤45% (mean LV EF, 33 ± 8%), and New York Heart Association class II-IV underwent transthoracic echocardiography to evaluate LA fractional active and total emptying from M- and B-Mode images, and, on the same day, venous blood sample collection to dose NT-pro-BNP. By univariate analyses, NT-pro-BNP significantly correlated to age, LA dimensions, LA function indexes, EF, and functional class. At multivariate analysis, LV EF and M- or B-Mode indexes of LA function were the only independent predictors of NT-pro-BNP values. A NT-pro-BNP cut-off of 1480 pg/mL identified LA dysfunction with 89% specificity and 54% sensitivity.
In CHF patients with severely impaired systolic function, NT-pro-BNP levels reflect LA and LV dysfunction. These data should prompt studies to investigate the relationship between changes of LA function and NT-pro-BNP levels and their clinical value as prognostic and therapeutic targets in CHF.
European Heart Journal – Cardiovascular Imaging 06/2011; 12(7):506-13. · 2.32 Impact Factor
-
Pasquale Perrone-Filardi,
Santo Dellegrottaglie,
James H F Rudd,
Pierluigi Costanzo, Caterina Marciano,
Enrico Vassallo,
Fabio Marsico,
Donatella Ruggiero,
Maria Piera Petretta,
Massimo Chiariello,
Alberto Cuocolo
[show abstract]
[hide abstract]
ABSTRACT: Functional characterization of atherosclerosis is a promising application of molecular imaging. Radionuclide-based techniques for molecular imaging in the large arteries (e.g. aorta and carotids), along with ultrasound and magnetic resonance imaging (MRI), have been studied both experimentally and in clinical studies. Technical factors including cardiac and respiratory motion, low spatial resolution and partial volume effects mean that noninvasive molecular imaging of atherosclerosis in the coronary arteries is not ready for prime time. Positron emission tomography imaging with fluorodeoxyglucose can measure vascular inflammation in the large arteries with high reproducibility, and signal change in response to anti-inflammatory therapy has been described. MRI has proven of value for quantifying carotid artery inflammation when iron oxide nanoparticles are used as a contrast agent. Macrophage accumulation of the iron particles allows regression of inflammation to be measured with drug therapy. Similarly, contrast-enhanced ultrasound imaging is also being evaluated for functional characterization of atherosclerotic plaques. For all of these techniques, however, large-scale clinical trials are mandatory to define the prognostic importance of the imaging signals in terms of risk of future vascular events.
European Journal of Nuclear Medicine 12/2010; 38(5):969-75. · 4.53 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to assess the effect of calcium channel blocker (CCB) treatment, compared with other drugs or placebo/top of therapy, on all-cause mortality, cardiovascular death, major cardiovascular events, heart failure, myocardial infarction and stroke.
We performed a meta-analysis of randomized controlled trials that compared a long-acting calcium channel blocker with another drug or placebo/top of therapy and that assessed all-cause mortality and cardiovascular events.
We included 27 trials (175,634 patients). The risk of all-cause death was reduced by dihydropyridine CCBs [odds ratio (OR) 0.96; 95% confidence interval (CI) 0.93-0.99; comparison P = 0.026; heterogeneity P = 0.87)] without influence of placebo trials. The risk of heart failure was increased by CCBs compared with active treatment (OR 1.17; 95% CI 1.11-1.24; comparison P = 0.0001; heterogeneity P = 0.0001), and it was decreased when compared with placebo (OR 0.72; 95% CI 0.59-0.87; comparison P = 0.001; heterogeneity P = 0.77), also in the subgroup of coronary artery disease patients (OR 0.76; 95% CI 0.61-0.95; comparison P = 0.01; heterogeneity P = 0.29). CCBs did not increase the risk of myocardial infarction (OR 1; 95% CI 0.95-1.04; comparison P = 0.83, heterogeneity P = 0.004), cardiovascular death (OR 0.97; 95% CI 0.93-1.02; comparison P = 0.24; heterogeneity P = 0.16), major cardiovascular events (OR 0.97; 95% CI 0.90-1.06; comparison P = 0.53; heterogeneity P = 0.0001). CCBs decreased the risk of fatal or nonfatal stroke (OR 0.86; 95% CI 0.82-0.90; comparison P = 0.0001, heterogeneity P = 0.12), also, when compared with angiotensin-converting enzyme inhibitors (OR 0.87; 95% CI 0.78-0.97; comparison P = 0.016; heterogeneity P = 0.48).
Our study demonstrates that CCBs reduce the risk of all-cause mortality compared with active therapy and prevent heart failure compared with placebo. Furthermore, with the inclusion of recent trials, we confirm that they reduce the risk of stroke, also in comparison to angiotensin-converting enzyme inhibitors and do not increase the risk of cardiovascular death, myocardial infarction and major cardiovascular events.
Journal of hypertension 07/2009; 27(6):1136-51. · 4.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Objective: The aim of this study was to assess the effect of calcium channel blocker (CCB) treatment, compared with other drugs or placebo/top of therapy, on all-cause mortality, cardiovascular death, major cardiovascular events, heart failure, myocardial infarction and stroke.
Methods: We performed a meta-analysis of randomized controlled trials that compared a long-acting calcium channel blocker with another drug or placebo/top of therapy and that assessed all-cause mortality and cardiovascular events.
Results: We included 27 trials (175 634 patients). The risk of all-cause death was reduced by dihydropyridine CCBs [odds ratio (OR) 0.96; 95% confidence interval (CI) 0.93-0.99; comparison P = 0.026; heterogeneity P = 0.87)] without influence of placebo trials. The risk of heart failure was increased by CCBs compared with active treatment (OR 1.17; 95% CI 1.11-1.24; comparison P = 0.0001; heterogeneity P = 0.0001), and it was decreased when compared with placebo (OR 0.72; 95% CI 0.59-0.87; comparison P = 0.001; heterogeneity P = 0.77), also in the subgroup of coronary artery disease patients (OR 0.76; 95% CI 0.61-0.95; comparison P = 0.01; heterogeneity P = 0.29). CCBs did not increase the risk of myocardial infarction (OR 1; 95% CI 0.95-1.04; comparison P = 0.83, heterogeneity P = 0.004), cardiovascular death (OR 0.97; 95% CI 0.93-1.02; comparison P = 0.24; heterogeneity P = 0.16), major cardiovascular events (OR 0.97; 95% CI 0.90-1.06; comparison P = 0.53; heterogeneity P = 0.0001). CCBs decreased the risk of fatal or nonfatal stroke (OR 0.86; 95% CI 0.82-0.90; comparison P = 0.0001, heterogeneity P = 0.12), also, when compared with angiotensin-converting enzyme inhibitors (OR 0.87; 95% CI 0.78-0.97; comparison P = 0.016; heterogeneity P = 0.48).
Conclusion: Our study demonstrates that CCBs reduce the risk of all-cause mortality compared with active therapy and prevent heart failure compared with placebo. Furthermore, with the inclusion of recent trials, we confirm that they reduce the risk of stroke, also in comparison to angiotensin-converting enzyme inhibitors and do not increase the risk of cardiovascular death, myocardial infarction and major cardiovascular events.
Journal of Hypertension 05/2009; 27(6):1136-1151. · 4.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In HIV infected patients an increased occurence of cardiac events has been demontrated from the introduction of highly active antiretroviral therapy (HAART). Antiretroviral drugs' regimens are, in fact, associated with several metabolic side effects, such as dyslipidemia, impaired glucose metabolism and abnormal body fat distribution, that increase the cardiovascular risk of HIV subjects. In addition, HIV infection itself, the chronic inflammatory status and the relevant presence in this population of some of the traditional cardiovascular risk factors contribute to an higher incidence of cardio and cerebrovascular events. In last years several studies showed the occurence of carotid vascular impairment in patients in treatment with protease inhibitors (PI). Similarly the DAD Study reported an increase of 26% of the risk of myocardial infarction in patients on HAART and that this risk is indipendently associated with longer exposure to PI, even after multivariate adjustments. A correct evaluation of the metabolic status before starting HAART and an adeguate control of the drugs-related metabolic abnormalities may reduce the incidence of cardiac events and still improve HIV patients prognosis. This review will focus on the metbolic effects of antiretroviral drugs and to the contribution of combination antiretroviral therapy on cardiovascular risk.
Cardiovascular & hematological disorders drug targets. 01/2009; 8(4):238-44.
-
Pasquale Perrone Filardi,
Alberto Cuocolo,
Andrea Petretta,
Gianluca Caiazzo,
Pierluigi Costanzo, Caterina Marciano,
Paolo Cesarano,
Antonio Marzano,
Teresa Losco,
Fabio Marsico,
Annamaria Lorio,
Paola Gargiulo,
Donatella Ruggiero,
Oriana Scala,
Massimo Chiariello
[show abstract]
[hide abstract]
ABSTRACT: Single photon emission computed tomography (SPECT) for the assessment of myocardial perfusion was introduced in the early 1970s, following pioneer studies of Gould et al. It has rapidly become one of the most used noninvasive technique for the assessment of myocardial ischemia. Thanks to the current technetium based tracers that allow electrocardiogram gated synchronization, it is possible to assess the regional ventricular systolic function and the evaluation of myocardial perfusion as well. In the last twenty years, beyond its diagnostic role, myocardial SPECT has become also a prognostic technique. Indeed, it has acquired a role for the short-term prediction of major coronary events in a large cohort with known or suspected coronary artery disease (CAD). The aim of this review is to give an update of the correct use and interpretation of myocardial SPECT in patients with known or suspected CAD and without left ventricular dysfunction.
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 01/2008; 68(4):213-8.
-
[show abstract]
[hide abstract]
ABSTRACT: The development and progression of cardiovascular disease can be regarded as a continuum (Fig. 1) [1]. Targeting different points within this continuum is therefore of major importance for reducing cardiovascular morbidity
and mortality. Inhibition of the renin-angiotensin-aldosterone system (RAAS) has become a key target in this regard, given
that angiotensin II (Ang II) has been implicated as a pathogenic factor at many steps in the development and progression of
cardiovascular disease [2, 3].
12/2006: pages 425-432;
