Giuseppe Tarantini

University-Hospital of Padova, Padua, Veneto, Italy

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Publications (195)811.51 Total impact

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    ABSTRACT: Among the various complications of heart transplantation (HTx), the vasculopathy of the allograft (CAV), a phenomenon of chronic rejection, is still a serious problem. Recently, the literature has shown that low testosterone levels in men are associated with cardiovascular disease. In this study, we evaluated the influence of testosterone plasma levels on CAV development. We studied, with a prospective observational study, all consecutive male HTx patients evaluated from May 2010 to June 2011 at our center. All subjects underwent accurate medical history collection, physical examination, biochemical blood tests, hormone levels, transthoracic Doppler echocardiography, coronary flow velocity reserve assessment, and coronary angiogram. HTx subjects with CAV had significant lower total testosterone plasma levels (12.9±3.9 vs. 15.8±5.8 nmol/L), free testosterone (0.26±0.07 vs. 0.31±0.08 nmol/L), and coronary flow velocity reserve (2.35±0.60 vs. 2.81±0.78 s) with respect to No-CAV patients. Considering the patients as a whole group, a significant negative relation was found between free and total testosterone plasma levels and some cardiovascular risk factors (cholesterol and fasting blood glucose). A significant linear inverse relation was found between total and free testosterone plasma levels and CAV grading. Only free testosterone plasma levels were independent predictors for CAV. We showed for the first time the influence of testosterone plasma levels on CAV development: indirectly increasing traditional risk factors and directly with a probable influence on alloimmune response.
    Transplantation 07/2013; · 3.78 Impact Factor
  • International journal of cardiology 07/2013; · 6.18 Impact Factor
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    ABSTRACT: Despite encouraging short-term and mid-term results, transcatheter aortic valve implantation (TAVI) interventions are still burdened from high rates of adverse events, stressing the need for accurate predictive risk instruments. We compared available surgical risk scores to describe unfavorable outcomes after TAVI. The Age, Creatinine, and Ejection fraction (ACEF) score, the logistic Euroscore, and the Society of Thoracic Surgeons Mortality score (STS) were appraised for their independent power of prediction and for their accuracy (C-index) to predict 30-day and medium-term mortality, according to the Valve Academic Research Consortium. Nine hundred and sixty-two patients were included. All the scores demonstrated a moderate positive correlation. The closest correlation was observed between the STS score and Euroscore. After logistic regression analysis, STS score and Logistic Euroscore provided independent prediction for short-term all-cause mortality [P = 0.02, odds ratio (OR) 1.1; 95% confidence interval (CI) 1.06-1.31 and P = 0.027, OR 1.03; 95% CI 1.01-1.405]. For in-hospital complications, only STS score performed significantly (P = 0.005, OR 1.05; 95% CI 1.01-1.06). ACEF, Euroscore, and STS score showed low accuracy for 30-day all-cause mortality (area under the curve 0.6, 0.44-0.75; vs. 0.53, 0.42-0.61; vs. 0.62, 0.52-0.71, respectively), whereas STS score performed better for in-hospital complications (0.59, 0.55-0.64). Moreover, after Cox-multivariate adjustments, only ACEF score was near to significance to predict all-cause mortality at mid-term (OR 1.7; 0.8-2.9; P = 0.058), showing the highest accuracy (0.63, 0.55-0.71). In TAVI patients, ACEF score, STS score and Logistic Euroscore provided only a moderate correlation and a low accuracy both for 30-day and medium-term outcomes. Dedicated scores are needed to properly tailor time and kind of approach.
    Journal of Cardiovascular Medicine 07/2013; · 2.66 Impact Factor
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    ABSTRACT: Vascular erectile dysfunction (ED) is the expression of a systemic vascular disease and in particular of endothelial dysfunction. Dysfunctional endothelium plays also a significant role in the onset and progression of coronary artery vasculopathy (CAV). This pilot study was designed to evaluate the prevalence and pathogenesis of ED and its correlation with CAV in heart transplanted male. A total of 77 male heart transplanted patients (HTx) evaluated in our center (mean age 61.6 + 10.6 years) were enrolled in the study. All subjects underwent accurate medical history collection, including lifestyle (cigarette smoking, dietary and sedentary habits, drug intake, and erectile function before cardiac transplantation), physical examination (body mass index and arterial pressure), biochemical blood tests (fasting glucose, total cholesterol, high-density lipoprotein cholesterol, and triglycerides), and hormones (prolactin, luteinizing hormone and total testosterone). Furthermore, they were studied with penile, carotid, femoral echo-color Doppler ultrasonography and coronary angiogram. Incidence of ED was 24% before HTx and increased up to 65% after. Postischemic cardiomiopathy was an indication to HTx in ED group more frequently than in patients without ED (No-ED group) (45.1% vs. 20%). ED patients showed a lower peak systolic velocity, a higher cavernosal intima-media thickness (IMT), a higher prevalence of cavernosal plaques (26.7% vs. 5.2%, P < 0.05), peripheral vascular disease (60.87% vs. 26.1%, P < 0.05) and CAV (45.8% vs. 25.8%, P < 0.05) with respect to No-ED patients. Coronary flow reserve was significantly reduced in ED vs. No-ED patients (2.43 + 0.7 vs. 2.9 + 0.8, P < 0.04). Finally, cavernous plaque and testosterone plasma levels were statistically associated with CAV. We showed that ED is a frequent disease in HTx patients, more common when the original pathology is postischemic cardiomiopathy and associated with higher prevalence of cavernous plaques and CAV. Its evaluation should be integral to an HTx rehab program. Caretta N, Feltrin G, Tarantini G, D'Agostino C, Tona F, Schipilliti M, Selice R, Minicuci N, Gerosa G, and Foresta C. Erectile dysfunction, penile atherosclerosis, and coronary artery vasculopathy in heart transplant recipients. J Sex Med **;**:**-**.
    Journal of Sexual Medicine 06/2013; · 3.51 Impact Factor
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    ABSTRACT: BACKGROUND: Aortic root rupture is a major concern with balloon expandable transcatheter aortic valve replacement (TAVR). We sought to identify predictors of aortic root rupture during balloon-expandable TAVR using multidetector computed tomography (MDCT). METHODS AND RESULTS: Thirty one consecutive patients who experienced left ventricular outflow tract (LVOT)/annular/aortic contained/non-contained rupture during TAVR were collected from 16 centers. A caliper-matched sample of 31 consecutive patients without annular rupture, who underwent pre-TAVR MDCT served as a control group. MDCT assessment included short and long axis diameters and cross sectional area of the sinotubular junction, annulus and LVOT, as well as the presence, location, and extent of calcification of the LVOT. There were no significant differences between the two groups in any preoperative clinical and echocardiographic variables. Aortic root rupture was identified in 20 patients and periaortic hematoma in 11. Patients with root rupture had a higher degree of subannular/LVOT calcification quantified by Agatston score (181.2±211.0 vs. 22.5±37.6, p<0.001), and a higher frequency of ≥20% annular area oversizing (79.4% vs. 29.0%, p<0.001) and balloon post-dilatation (22.6% vs. 0.0%, p=0.005). In conditional logistic regression analysis for the matched data, moderate/severe LVOT/subannular calcifications (Odds Ratio [OR]: 10.92, 95%Confidence Interval [CI]: 3.23 to 36.91, p<0.001) and prosthesis oversizing ≥20% (OR:8.38,95%CI: 2.67 to 26.33, p<0.001) were associated with aortic root contained/non-contained rupture. CONCLUSIONS: This study demonstrates that LVOT calcification and aggressive annular area oversizing are associated with an increased risk of aortic root rupture during TAVR with balloon-expandable prostheses. Larger studies are warranted to confirm these findings.
    Circulation 06/2013; · 15.20 Impact Factor
  • Enrico Favaretto, Giuseppe Tarantini
    Cardiology 05/2013; 125(2):94-95. · 1.52 Impact Factor
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    ABSTRACT: OBJECTIVE: Drug-eluting stents are more effective in reducing restenosis than bare-metal stents. Paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES) are the most widely used first-generation drug-eluting stents, but long-term comparative data on these are scant. The aim of the present report is to investigate the 6-year clinical outcomes of PES versus SES in a matched cohort of single-center registry patients. MATERIALS AND METHODS: Data were obtained from the observational, monocentric registry of 632 consecutive patients who underwent percutaneous coronary intervention between September 2002 and September 2005 with PES or SES. We assessed the composite and separate occurrence of the major adverse cardiac events (MACE), including death, nonfatal myocardial infarction, and target lesion revascularization (TLR). RESULTS: After a propensity 1 : 1 matching analysis, baseline clinical, procedural, and angiographic characteristics were well balanced between the two groups. Throughout the 6 years of follow-up, there were no significant differences between PES and SES in terms of MACE (P=0.52), all-cause death (P=0.24), myocardial infarction (P=0.25), stent thrombosis (P=0.38), and TLR (P=0.68). The sensitivity analysis on the total unmatched population confirmed this result, the stent type not being predictive of MACE (PES vs. SES group, hazard ratio 0.97, 95% confidence interval 0.66-1.41, P=0.87) or TLR (PES vs. the SES group, hazard ratio 1.35, 95% confidence interval 0.69-2.64, P=0.38). CONCLUSION: In this 'real-life' registry, PES and SES showed a comparable safety and efficacy profile throughout the 6 years of follow-up. The increase in the rate of TLR was slow and comparable between the two groups, even though the 'late catch-up' phenomenon showed a different temporal pattern between PES and SES.
    Coronary artery disease 05/2013; · 1.56 Impact Factor
  • International journal of cardiology 05/2013; · 6.18 Impact Factor
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    ABSTRACT: AIMS: Coronary artery disease (CAD) negatively affects prognosis in patients undergoing surgical aortic valve replacement, being currently evaluated in the most common used risk score. Our meta-analysis aims to clarify the prognostic role of CAD on mid-term survival in patients undergoing TAVI. METHODS AND RESULTS: Studies reporting multivariate predictors of adverse outcomes in patients undergoing TAVI were systematically searched for and pooled, when appropriate, using a random-effect method. 960 citations were first screened and finally 7 studies (2472 patients) were included. Diagnosis of CAD was reported in 52%(42-65) of patients and 1169 Edwards SAPIEN and 1303 CoreValve prostheses were implanted. After a median follow up of 452days (357-585) 24% of patients (19-33) died, and 23 (14-32) for cardiovascular death. At pooled analysis of multivariate approach, diagnosis of coronary artery disease did not increase risk of death (OR 1.0, 95% CI, confidence interval, 0.67-1.50 I(2) 0%). CONCLUSION: CAD does not affect mid-term TAVI outcome: this finding should be weighted to accurately evaluate risk and strategies for patients with severe aortic stenosis.
    International journal of cardiology 04/2013; · 6.18 Impact Factor
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    ABSTRACT: BACKGROUND: Recently, randomized controlled trials (RCTs) have shown that therapy with new oral activated factor X (Xa) inhibitors in acute coronary syndrome (ACS) yielded a reduction of ischemic events. However, this therapy was associated with a dose-related increase in major bleeding complications. We aimed to perform a systematic review and meta-analysis to appraise the clinical efficacy and safety of the lowest doses of oral factor Xa inhibitors compared with placebo in patients after a recent ACS. METHODS: The primary endpoint was cardiovascular mortality. The rate of new myocardial infarction (MI) was the secondary efficacy endpoint, whereas major bleeding complications were recorded as a safety endpoint. Five RCTs were included in the meta-analysis enrolling a total of 25,643 patients. RESULTS: There was no significant difference in mortality between patients treated with new antithrombotics compared with those receiving the standard therapy: odds ratio (OR), [95% confidence interval (CI)] = 0.97 [0.72-1.31], p = 0.86. Recurrent MI rates were decreased in the anti-Xa group: OR [95%CI] = 0.86 [0.76-0.98], p = 0.02, number needed to treat (NNT) = 189. The administration of new oral anticoagulants was associated with a strongly increased risk of major bleedings compared with the standard treatment: OR [95%CI] = 3.24 [2.29-4.59], p < 0.001, number needed to harm (NNH) = 104; similarly, intracranial bleeding rates were significantly higher in the anti-Xa arm. CONCLUSIONS: The addition of the new oral anticoagulants on top of standard therapy in the setting of ACS results in an excessive risk of major bleedings without any clear evidence of outweighing clinical benefits.
    Atherosclerosis 04/2013; · 3.71 Impact Factor
  • Giuseppe Tarantini, Marco Mojoli, Massimo Napodano
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    ABSTRACT: We describe the technical aspects and the possible advantages of a modified anchoring-based technique for the implantation of multiple Amplatzer devices, in a case of large anteroseptal mitral paravalvular leak causing massive regurgitation, that was managed by antegrade trans-septal, single stage, percutaneous approach. Real-time three-dimensional transesofageal echocardiographic guidance was crucial to ensure successful re-crossings of the target defect and the optimal anatomical closure. © 2013 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 04/2013; · 2.51 Impact Factor
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    ABSTRACT: Cardiac rehabilitation (CR) after an acute myocardial infarction (AMI) plays a beneficial role both on morbidity and mortality. Although CR is universally considered class I treatment, its use still remains rather scant in Europe and USA; moreover, most of the CR programs begin too late after the acute event. Little is known about the impact of early, in-Hospital CR post AMI on short and long term prognosis. Methods: In the period 2007-2012, 376 consecutive patients (mean age 64,0�12,3 years; male 77%) were directly transferred for a structured, in-hospital CR program, shortly after an AMI (mean 16,4�9,9 days).The population risk profile was medium-high: 87% pts had a compli- cated AMI (ST elevation 63%) and 47% incomplete revascularization. Physical activity was under strict ECG graphic, physiotherapy and MD surveillance. Functional capacity was assessed by a six-minute walking test (6MWT) on admission and at discharge and by a cardiopulmonary exercise test (CPET). The patients were divided into 2 groups according to a 40% ejection fraction (EF) cut-off. To assess major adverse cardiovascular events (MACE) and adherence to treatments and life-style changes a MD telephone follow up was conducted.Results: During the CR stay (mean length 14,5�3,1 days), no fatal events occurred and only 4 cases (1,06%) had to be re-transferred to the previous Hospital: 2 refractory angina, 1 VT and 1 AV block. Even though the <40% EF group showed a lower absolute functional capacity (peak-VO2 19,3�5,3 vs 15,6�4,1 ml/kg/min, p<0,001), all the patients had a similar increase in the distance walked at 6MWT (mean gain 70.7�55.7 m, p<0.05). During the following 5 years, general mortality was 6.7%; as expected, in the lower EF group there was a higher MACE rate than in the control (32.1 vs 13.7%, p<0.01). In the entire population, a very high adherence to therapy was registered (aspirin: 96%; betablockers: 85%; statins: 95%; ACE-I/ARB: 89%); 73% referred a regular physical activity showing a lower rate of MACE compared to sedentary subjects (10.8% vs 22.8%, p 0.02); among addicted patients 77% had definitively given up smoking. Conclusions: An early and intensive CR, based on physical activity and counseling, resulted to be safe and effective on medium-high risk patients after AMI. As a matter of fact, a significant increase on functional capacity in the short term - apart from the residual ventricular function - and a high adherence to therapy and to the proposed lifestyle modifications was achieved; despite the high risk profile, this may have produced a positive effect on mortality in the long term.
    EuroPRevent 2013, Rome, April 18-20, 2013 - Abstract P780; 04/2013
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    ABSTRACT: Patients with acute coronary syndrome (ACS) and nonobstructive coronary artery disease (CAD) have a substantial risk of subsequent coronary events within 1 year. The aim of the present study was to evaluate the prevalence, long-term outcomes, and adherence to oral antiplatelet therapy in patients with ACS and nonobstructive CAD compared with patients with ACS and obstructive CAD who had undergone percutaneous coronary intervention. Nonobstructive CAD was defined as an angiographic finding of <50% diameter stenosis in any major epicardial artery. These patients were further stratified into 2 groups: those with normal coronary arteries (0% angiographic stenosis) and those with mild CAD (0% to 50% angiographic stenosis). Major adverse cardiac events, defined as death, myocardial infarction, ACS leading to hospitalization, and nonfatal stroke, were recorded and compared with a historical control group of patients with ACS and obstructive CAD who had undergone percutaneous coronary intervention. Of 2,438 consecutive patients with ACS undergoing coronary angiography, 318 (13%) had nonobstructive CAD. Of the 318 with nonobstructive CAD, 160 had normal coronary arteries and 158 had mild CAD. Patients with obstructive CAD had experienced greater rates of major adverse cardiac events at 26 ± 16 months (16.6% vs 9.1%, p = 0.001), driven by a greater rate of myocardial infarction compared with those without (5.3% vs 0%, p <0.001). However, the rate of death, ACS leading to hospitalization, and stroke was similar. After adjusting for baseline characteristics, no difference was found in the risk of major adverse cardiac events across the groups. Only 50% of patients with nonobstructive CAD were prescribed dual antiplatelet therapy. In conclusion, patients with ACS and nonobstructive CAD remain at high risk of long-term recurrent ischemic events.
    The American journal of cardiology 04/2013; · 3.58 Impact Factor
  • International journal of cardiology 04/2013; · 6.18 Impact Factor
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    ABSTRACT: Aims: Tryton side branch (SB) reverse culotte stenting has been employed for the treatment of left main (LM) stem bifurcations in patients at high risk for bypass surgery. The aim of this study was to assess acute angiographic results and six-month clinical outcome after implantation of the Tryton stent in the LM. Methods and results: We studied 52 consecutive patients with LM disease treated in nine European centres. Angiographic and clinical data analysis was performed centrally. Fifty-one of 52 patients (age 68±11 yrs, 75% male, 42% unstable angina, SYNTAX score 20±8) were successfully treated with the Tryton stent. Medina class was 1,1,1 in 33 (63%), 1,0,1 in 7 (13%), 1,1,0 in 3 (6%), 0,1,1 in 8 (4%) and 0,0,1 in 1 (2%). The Tryton stent on a stepped balloon (diameter 3.5-2.5 mm) was used in 41/51 (80%) of cases. The mean main vessel stent diameter was 3.4±0.4 mm with an everolimus-eluting stent employed in 30/51 (59%) of cases. Final kissing balloon dilatation was performed in 48/51 (94%). Acute gain was 1.52±0.86 mm in the LM and 0.92±0.47 mm in the SB. The angiographic success rate was 100%; the procedural success rate reached 94%. Periprocedural MI occurred in three patients. At six-month follow-up, the TLR rate was 12%, MI 10% and cardiac death 2%. The hierarchical MACE rate at six months was 22%. No cases of definite stent thrombosis occurred. Conclusions: The use of the Tryton stent for treatment of LM bifurcation disease in combination with a conventional drug-eluting stent is feasible and achieves an optimal angiographic result. Safety of the procedure and six-month outcome are acceptable in this high-risk lesion PCI. Further safety and efficacy studies with long-term outcome assessment of this strategy are warranted.
    EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 03/2013; 8(11):1259-69. · 3.17 Impact Factor
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    ABSTRACT: BACKGROUND: Aortic regurgitation (AR) is an important limitation of transcatheter aortic valve replacement (TAVR) with ill-defined predictors and unclear long term impact on outcomes. We sought to analyze currently published literature to establish the incidence, impact and predictors of post TAVR AR. METHODS AND RESULTS: Studies published between 2002 and 2012 with regards to TAVR were identified using an electronic search and reviewed using the random effects model of DerSimonian and Laird. From 3871 initial citations, 45 studies reporting on 12,926 patients (CoreValve 5,261 and Edward's valve 7,279) were included in the analysis of incidence and outcomes of post TAVR AR. The pooled estimate for moderate or severe AR post TAVR was 11.7% (95% CI 9.6% to 14.1%). Moderate or severe AR was more common with use of the CoreValve (16.0% vs. 9.1%, p =0.005). The presence of moderate or severe AR post TAVR increased mortality at 30 days (OR 2.95, 95% CI 1.73- 5.02) and at 1 year, (HR 2.27, 95% CI - 1.84-2.81). Mild AR was also associated with an increased hazard for mortality (HR 1.829, 95% CI 1.005-3.329) that was however overturned by sensitivity analysis. Twenty five studies reported on predictors of post TAVR AR. Implantation depth, valve under sizing and Agatston calcium score (r=0.47, p = 0.001) were identified as important predictors. CONCLUSION: Moderate or severe aortic regurgitation is common after TAVR and is an adverse prognostic indicator of short and long term survival. Incidence of moderate or severe AR is higher with use of the CoreValve. Mild AR may be associated with increased long term mortality. Every effort should therefore be made to minimize AR by a comprehensive pre procedural planning and meticulous procedural execution.
    Journal of the American College of Cardiology 03/2013; · 14.09 Impact Factor
  • Chiara Fraccaro, Massimo Napodano, Giuseppe Tarantini
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    ABSTRACT: The presence of periprocedural conduction disorders (CD) and the need for permanent pacemaker (PPM) after transcatheter aortic valve implantation (TAVI) are frequent findings in clinical practice. Notwithstanding, robust information on the prognostic and therapeutic implications of these complications are lacking. The newly occurrence of CD after TAVI seems related to the trauma of the conduction system during procedure. On the contrary, major predictors for PPM implantation after TAVI seems to be the use of CoreValve prosthesis (Medtronic, Minneapolis, MN, USA) and the presence of CD before TAVI. An accurate pre-TAVI screening, careful valve implantation as well as post-TAVI monitoring must be pursued to prevent avoidable PPM implantation. The aim of this report is to analyze the available data on this field and to propose some practical clinical tips to prevent or to manage these complications. © 2012 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 03/2013; · 2.51 Impact Factor
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    ABSTRACT: An 88-year-old man with severe aortic stenosis and normal left ventricular ejection fraction underwent transcatheter aortic valve implantation via a transapical approach, without periprocedural complications. Some 16 months later the patient was readmitted because of worsening dyspnea, when left ventricular dysfunction due to apical akinesia was identified. A gated, rest-only myocardial single-photon emission computed tomography (G-SPECT) demonstrated apical hypoperfusion that persisted after attenuation correction. Necrosis involved the apical and mid-inferior wall, the apical lateral wall, and the apical segment.
    The Journal of heart valve disease 03/2013; 22(2):259-60. · 1.07 Impact Factor
  • Giuseppe Tarantini, Filippo Cademartiri
    European heart journal cardiovascular Imaging. 02/2013;
  • Enrico Favaretto, Giuseppe Tarantini
    International journal of cardiology 02/2013; · 6.18 Impact Factor

Publication Stats

1k Citations
811.51 Total Impact Points

Institutions

  • 2004–2014
    • University-Hospital of Padova
      Padua, Veneto, Italy
  • 2000–2014
    • University of Padova
      • • Department of Cardiac, Thoracic and Vascular Sciences
      • • Department of Medicine DIMED
      Padua, Veneto, Italy
  • 2013
    • Harbor-UCLA Medical Center
      Torrance, California, United States
  • 2012
    • University of Catania
      Catania, Sicily, Italy
  • 2009–2010
    • University Hospital of Parma
      Parma, Emilia-Romagna, Italy