Angelo Branzi

Policlinico S.Orsola-Malpighi, Bolonia, Emilia-Romagna, Italy

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Publications (481)2084.8 Total impact

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    ABSTRACT: Aims: The use of high-sensitivity cardiac Troponin T (hs-cTnT) assay might lead to overdiagnosis and overtreatment of Acute Coronary Syndromes (ACS). This study assessed the epidemiological, clinical and prognostic impact of introducing hs-cTnT in the everyday clinical practice of an Emergency Department. Methods and results: We compared all consecutive patients presenting with suspected ACS at the Emergency Department, for whom troponin levels were measured. In particular, we considered 597 patients presenting during March 2010, when standard cardiac Troponin T (cTnT) assay was used, and 629 patients presenting during March 2011, when hs-cTnT test was used. Patients with suspected ACS and troponin levels above the 99th percentile (Upper Reference Limit, URL) significantly increased when using an hs-cTnT assay (17.2% vs. 37.4%, p< 0.001). Accordingly, also the mean GRACE risk score increased (124.2 ± 37.2 vs. 136.7 ± 32.2; p< 0.001). However, the final diagnosis of Acute Myocardial Infarction (AMI) did not change significantly (8.7% vs. 6.8%, p=0.263) by using a rising and/or falling pattern of hs-cTnT (change ≥ 50% or ≥ 20% depending on baseline values). In addition, no significant differences were found between the two study groups with respect to in-hospital (2.7% vs. 1.9%, p=0.366) and 1-year mortality (9.8% vs. 7.6%, p=0.216). Conclusions: We did not observe overdiagnosis and overtreatment issues in presenters with suspected ACS managed by appropriate changes in hs-cTnT levels, despite the increase in the number of patients presenting with abnormal troponin levels. This occurred without a rise in short-term and mid-term mortality.
    European Heart Journal: Acute Cardiovascular Care 08/2014; 4(2). DOI:10.1177/2048872614547687
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    ABSTRACT: To evaluate the relationship between ECG patterns and infarct related artery (IRA) in an all-comer population with ST-segment elevation myocardial infarction (STEMI) and validate current criteria for identifying IRA (right coronary artery (RCA) versus left circumflex artery (LCA)) in inferior STEMI and for diagnosing left main (LM) or left anterior descendent artery occlusion (LAD) in anterior STEMI. We retrospectively analysed ECGs at presentation and coronary angiogram in 885 consecutive patients undergoing primary percutaneous coronary intervention. Six ECG patterns were identified: anterior-STEMI (n=433; 49.0%), inferior-STEMI (i=365; 43.0%), lateral-STEMI (n=43; 5.0%), left bundle branch block (n=26; 3.0%), posterior-STEMI (n=7; 1.0%) and de Winter sign (n=7; 1.0%). The last two ECG patterns were univocally associated with LCA and proximal LAD occlusion respectively. In patients with inferior STEMI, predefined ECG algorithms showed high sensitivity(>90%) for RCA occlusion and high specificity(>90%) for LCA. The diagnostic performance was mainly determined by RCA dominance. In anterior STEMI the vectorial analysis of ST deviation in both frontal and horizontal planes could identify patients with LM/proximal LAD occlusion (adjusted-odds ratio for in-hospital mortality =2.45, 95% confidence interval: 1.31-4.56, p = 0.005) with low sensitivity (maximum 60%; using ST-depression in lead II, III, aVF + ΣSTE aVR + V1-ST depression V6≥0) and high specificity (maximum 95%; using ST-depression in inferior leads + ST-depression in V6). In STEMI undergoing primary percutaneous coronary intervention, six ECG patterns can be identified with a non-univocal relationship to the IRA. In inferior STEMI, vectorial analysis of ST deviation identifies IRA with a high appropriateness only when RCA is the dominant artery. In anterior STEMI, criteria derived from both frontal and horizontal planes identify LM/proximal LAD occlusion with high specificity but low sensitivity.
    04/2014; 3(4). DOI:10.1177/2048872614530665
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    ABSTRACT: The objective was to report recent trends in the incidence, adoption of evidence-based treatment, and clinical outcomes for first-time hospitalization for acute myocardial infarction. This is a large retrospective population-based cohort study using medical administrative data (International Classification of Diseases, Ninth Revision, Clinical Modification, codes) performed in the Emilia-Romagna Region of Italy (approximately 4.5 million inhabitants). We identified 60,673 patients with a first hospitalization for acute myocardial infarction from 2002 through 2009. The standardized incidence rate per 100,000 person-years of acute myocardial infarction increased from 173 cases in 2002 to a peak of 197 cases in 2004 and then decreased each year thereafter to 167 cases in 2009. The proportion of patients who underwent coronary angiography and angioplasty in the acute phase increased over time, respectively, from 45.4% and 27.1% to 72.3% and 57.2% (P < .001). Medication use within 12 months of discharge increased for aspirin, β-blockers, and statins. A reduction in crude and adjusted in-hospital all-cause (16.1% in 2002 vs 12.8% in 2009, P < .001) and cardiovascular mortality (13.6% in 2002 vs 9.5% in 2009, P < .001) was observed over time. At 1 year after hospital discharge, no significant variations occurred in adjusted risk for all-cause mortality or cardiovascular mortality. Notably, crude and adjusted risk for in-hospital and postdischarge bleeding showed a significant increment. The utilization of evidence-based treatments in patients with myocardial infarction increased between 2002 and 2009. These changes in practice over time favored a reduction in early case fatality at the cost of a significant increase in bleeding.
    American heart journal 11/2013; 166(5):846-54. DOI:10.1016/j.ahj.2013.08.026 · 4.46 Impact Factor
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    European Heart Journal 10/2013; 34(40):3117-3127. DOI:10.1093/eurheartj/eht342 · 15.20 Impact Factor
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    ABSTRACT: Purpose: We sought to investigate whether coagulant active Tissue Factor (TF) can be retrieved in thrombi of patients with ST-Segment Elevation acute Myocardial Infarction (STEMI) undergoing primary Percutaneous Coronary Intervention (PCI). Methods: Nineteen patients with STEMI referred for primary PCI were enrolled in this study. Coronary thrombi aspirated from coronary arteries using manual thrombectomy devices were routinely processed for paraffin embedding and histological evaluation (4 patients) or immediately snap frozen for evaluation of TF activity using a modified aPTT test (15 patients). Immunoprecipitation followed by immunoblotting was also performed in 12 patients. Results: Thrombi aspirated from coronary arteries showed large and irregular areas of TF staining within platelet aggregates, and in close contact with inflammatory cells. Some platelet aggregates stained positive for TF, whereas others did not. Monocytes consistently stained strongly for TF, neutrophils had weak and irregular TF staining, and red blood cells did not demonstrate staining for TF. Median clotting time of plasma samples containing homogenized thrombi incubated with a monoclonal antibody that specifically inhibits TF-mediated coagulation activity (mAb 5G9) were significantly longer than their respective controls (88.9 seconds versus 76.5 seconds, respectively; p<0.001). TF was also identified by immunoprecipitation in 10 patients, with significant variability among band intensities. Conclusions: Active TF is present in coronary artery thrombi of patients with STEMI, suggesting that TF may contribute to thrombus growth and propagation during the acute phase of STEMI.
    PLoS ONE 09/2013; 8(12):e81501. DOI:10.1371/journal.pone.0081501 · 3.23 Impact Factor
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    ABSTRACT: First generation drug-eluting stents (DES) which impart the controlled release of sirolimus or paclitaxel from durable polymers to the vessel wall have been consistently shown to reduce the risk of restenosis and target vessel revascularization compared to bare metal stents (BMS). However, stent thrombosis (ST) emerged as a major safety concern with first generation DES early after their adoption in clinical practice, requiring prolonged dual anti-platelet therapy. Pathological studies have shown that first generation DES are associated with delayed arterial healing and polymer hypersensitivity reactions resulting in chronic inflammation, predisposing to late and very late ST. Second generation DES have been developed to overcome these issues with improved stent designs and construction and the use of biocompatible and bioabsorbable polymers. Meta-analyses have shown that the thin-strut, fluoropolymer coated cobalt-chromium everolimus-eluting stent (CoCr-EES) may be associated with lower rates of definite ST than other DES, and unexpectedly, even lower than BMS. The thin-strut structure of the stent platform, the thromboresistant properties of the fluoropolymer, and the reduced polymer and drug load may contribute to the low rate of ST with CoCr-EES. The notion of a DES being safer than a BMS represents a paradigm shift in the evolution of percutaneous coronary intervention. The relative safety and efficacy of fluoropolymer coated CoCr-EES, DES with bioabsorbable polymers and fully bioresorbable scaffolds is the subject of numerous ongoing large-scale trials.
    Journal of the American College of Cardiology 09/2013; 62(21). DOI:10.1016/j.jacc.2013.08.725 · 16.50 Impact Factor
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    ABSTRACT: IMPORTANCE Type 2 diabetes mellitus and associated chronic kidney disease (CKD) have become major public health problems. Little is known about the influence of diet on the incidence or progression of CKD among individuals with type 2 diabetes. OBJECTIVE To examine the association between (healthy) diet, alcohol, protein, and sodium intake, and incidence or progression of CKD among individuals with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS All 6213 individuals with type 2 diabetes without macroalbuminuria from the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET) were included in this observational study. Recruitment spanned from January 2002 to July 2003, with prospective follow-up through January 2008. MAIN OUTCOMES AND MEASURES Chronic kidney disease was defined as new microalbuminuria or macroalbuminuria or glomerular filtration rate decline of more than 5% per year at 5.5 years of follow-up. We assessed diet using the modified Alternate Healthy Eating Index (mAHEI). The analyses were adjusted for known risk factors, and competing risk of death was considered. RESULTS After 5.5 years of follow-up, 31.7% of participants had developed CKD and 8.3% had died. Compared with participants in the least healthy tertile of mAHEI score, participants in the healthiest tertile had a lower risk of CKD (adjusted odds ratio [OR], 0.74; 95% CI, 0.64-0.84) and lower risk of mortality (OR, 0.61; 95% CI, 0.48-0.78). Participants consuming more than 3 servings of fruits per week had a lower risk of CKD compared with participants consuming these food items less frequently. Participants in the lowest tertile of total and animal protein intake had an increased risk of CKD compared with participants in the highest tertile (total protein OR, 1.16; 95% CI, 1.05-1.30). Sodium intake was not associated with CKD. Moderate alcohol intake reduced the risk of CKD (OR, 0.75; 95% CI, 0.65-0.87) and mortality (OR, 0.69; 95% CI, 0.53-0.89). CONCLUSIONS AND RELEVANCE A healthy diet and moderate intake of alcohol may decrease the incidence or progression of CKD among individuals with type 2 diabetes. Sodium intake, within a wide range, and normal protein intake are not associated with CKD. TRIAL REGISTRATION Identifier: NCT00153101.
    JAMA Internal Medicine 08/2013; 173(18). DOI:10.1001/jamainternmed.2013.9051 · 13.12 Impact Factor
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    ABSTRACT: HLA antibodies (HLA ab) in transplant candidates have been associated with poor outcome. However, clinical relevance of noncytotoxic antibodies after heart transplant (HT) is controversial. By using a Luminex-based HLA screening, we retested pretransplant sera from HT recipients testing negative for cytotoxic HLA ab and for prospective crossmatch. Out of the 173 consecutive patients assayed (52 ± 13y; 16% females; 47% ischemic etiology), 32 (18%) showed pretransplant HLA ab, and 12 (7%) tested positive against both class I and class II HLA. Recipients with any HLA ab had poorer survival than those without (65 ± 9 versus 82 ± 3%; P = 0.02), accounting for a doubled independent mortality risk (P = 0.04). In addition, HLA-ab detection was associated with increased prevalence of early graft failure (35 versus 15%; P = 0.05) and late cellular rejection (29 versus 11%; P = 0.03). Of the subgroup of 37 patients suspected for antibody mediated rejection (AMR), the 9 with pretransplant HLA ab were more likely to display pathological AMR grade 2 (P = 0.04). By an inexpensive, luminex-based, HLA-screening assay, we were able to detect non-cytotoxic HLA ab predicting fatal and nonfatal adverse outcomes after heart transplant. Allocation strategies and desensitization protocols need to be developed and prospectively tested in these patients.
    Journal of Transplantation 07/2013; 2013(8):519680. DOI:10.1155/2013/519680
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    ABSTRACT: Background: Although some trials have reported that on-pump coronary artery bypass graft (CABG) surgery may be associated with higher rates of stroke than percutaneous coronary intervention (PCI), whether stroke is more common after off-pump CABG compared with PCI is unknown. We therefore sought to determine whether off-pump CABG is associated with an increased risk of stroke compared with PCI by means of network meta-analysis. Methods: Randomized controlled trials (RCTs) comparing CABG vs PCI were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings. Results: Eighty-three RCTs with 22,729 patients randomized to on-pump CABG (n = 10,957), off-pump CABG (n = 7,119), or PCI (n = 4,653) were analyzed. Thirty-day rates of stroke were significantly lower in patients treated with PCI compared with either off-pump CABG (odds ratio [OR]; 0.39, 95% CI, 0.19-0.83) or on-pump CABG (OR, 0.26; 95% CI, 0.12-0.47). Compared with on-pump CABG, off-pump CABG was associated with significantly lower 30-day risk of stroke (OR, 0.67; 95% CI, 0.41-0.95). However, in sensitivity analyses restricted to high-quality studies, studies with more than either 100 or 1,000 patients, or studies with protocol definition or adjudication of stroke by a clinical events committee, the precision of the point estimate for the 30-day risk of stroke between off-pump vs on-pump CABG was markedly reduced. Conclusions: Percutaneous coronary intervention is associated with lower 30-day rates of stroke than both off-pump and on-pump CABG. Further studies are required to determine whether the risk of stroke is reduced with off-pump CABG compared with on-pump CABG.
    American heart journal 06/2013; 165(6):910-917.e14. DOI:10.1016/j.ahj.2013.03.011 · 4.46 Impact Factor
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    ABSTRACT: Randomized trials showed that mTOR inhibitors prevent early development of cardiac allograft vasculopathy (CAV). However, the action of these drugs on CAV late after transplant is controversial, and their effectiveness for CAV prevention in clinical practice is poorly explored. In this observational study we included 143 consecutive heart transplant recipients who underwent serial intravascular ultrasound (IVUS), receiving either everolimus or mycophenolate as adjunctive therapy to cyclosporine. Ninety-one recipients comprised the early cohort, receiving IVUS at weeks 3-6 and year 1 after transplant, and 52 the late cohort, receiving IVUS at years 1 and 5 after transplant. Everolimus independently reduced the odds for early CAV (0.14 [0.01-0.77]; p = 0.02) but it did not appear to influence late CAV progression. High-dose statins were found to be associated with reduced CAV progression both early and late after transplant (p ≤ 0.05). Metabolic abnormalities, such as high triglycerides, were associated with late, but not with early CAV progression. By highlighting a differential effect of everolimus and metabolic abnormalities on early and late changes of graft coronary morphology, this observational study supports the hypothesis that everolimus may be effective for CAV prevention but not for CAV treatment, and that risk factors intervene in a time-dependent sequence during CAV development.
    American Journal of Transplantation 05/2013; 13(5):1217-26. DOI:10.1111/ajt.12208 · 5.68 Impact Factor
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    ABSTRACT: Aims: The introduction of transcatheter aortic valve implantation (TAVI) has generated a renewed interest in the treatment of high-risk patients with severe aortic stenosis. This study describes the indications and long-term outcome of balloon aortic valvuloplasty (BAV) in recent years. Methods and results: Between 2000 and 2010, 415 consecutive patients at our institution underwent BAV. The number of BAV per year increased sharply after the introduction of TAVI. Patients were 77.5±10.9 years old and showed important comorbidities (average logistic EuroSCORE=23.9±15.3%). We identified four cohorts according to the indications: 1) bridge for TAVI (B-TAVI; n=162); 2) bridge for aortic valve replacement (B-AVR, n=97); 3) cardiogenic shock (n=23); 4) palliation (n=133). Baseline characteristics were significantly different among groups. In-hospital mortality was 5.1%, and occurred predominantly in patients who underwent BAV in the setting of cardiogenic shock (56.5% vs. around 2% in the other subgroups). Other major events were stroke (0.5%), major vascular complications (2.2%), and life-threatening bleedings (1.5%). The cumulative one-year and two-year mortality rates were 33.2% and 57.4%, respectively, with the highest incidence in the shock group (70.7% and 80.4%) and the lowest in the B-AVR group (21.7% and 38.4%). Rehospitalisation for heart failure was 26.3% at one-year and 47.2% at two-year follow-up. Conclusions: The number of BAV is increasing, mainly due to increased referral of high-risk patients and to the emerging indication of bridge for TAVI. In this complex population, BAV is relatively safe but two-year survival remains poor, and more effective and definitive treatments should be pursued in a timely fashion.
    EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 04/2013; 8(12):1388-97. DOI:10.4244/EIJV8I12A212 · 3.77 Impact Factor
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    ABSTRACT: Non-functional recovery of the graft (primary graft failure, PGF) is still the major cause of early adverse outcome after heart transplantation (HT). While several donor- and recipient-related factors have been taken into account to explain PGF onset, few data are available analyzing how donor-recipient match may be optimized to reduce PGF occurrence. In this study, we explored PGF risk factors, aiming to identify specific donor-recipient matches associated with PGF onset.Methods and MaterialsWe reviewed data from all adult patients transplanted between 1999 and 2011 at our center, including those with pre-HT laboratory and hemodynamic data availability. Study endpoint was occurrence of PGF defined as need of mechanical circulatory support with ECMO/intra-aortic balloon pump, or cardiac index <2.5 l/min/m2 for three consecutive hours despite adequate filling pressure, during the first 24 post-HT hours.ResultsOut of 370 patients included, 63(17%) presented PGF. Among all clinical and laboratory variables analyzed, recipient female sex (P<0,01), transpulmonar gradient ≥12 mmHg (GTP) (P=0.02), and increasing calculated pulmonary arterial resistances (RVP) were associated with the risk of PGF (P=0.04). To analyze the interplay of donor features with recipient-related risk factors for PGF, we performed subgroup analyses revealing that recipient cerebral hemorrhage increased by 3.45 the odds for PGF only in recipients with high RVP, and that BMI mismatch increased by 2.91 the odds for PGF only in female recipients (all P<0.02). These donor-recipient matches accounted for 48% of all the PGF cases.Conclusions Female gender and high GTP independently predicted PGF onset. Allocation of donors died of cerebral hemorrhage to recipients with high RVP, or of undersized donors to female recipients, markedly increased PGF risk. Underscoring the importance of strategies directed at controlling reactive pulmonary hypertension before HT, this study suggests that development of customized allocation algorythms may signifcantly improve post-HT outcomes.
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):S255-S256. DOI:10.1016/j.healun.2013.01.662 · 6.65 Impact Factor
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    ABSTRACT: Antibody mediated rejection (AMR) is a serious emerging issue in the management of heart transplant (HT) recipients. Although consensus criteria currently define pathological diagnosis of AMR (pAMR), the clinical drawbacks of the pAMR criteria in term of graft function and prognosis, as well as pAMR relationship with donor specific antibodies, (DSA) are unexplored.Methods and MaterialsIn this study we analyze the correlation between pAMR grading, hemodynamic features, DSA detection, and subsequent prognosis in a cohort of consecutive HT recipients with suspected AMR.ResultsWe included 184 patients, with estimated 7-year graft survival of 84±4%, after biopsy. Luminex assay was available in 86 patients, of whom 24 (28%) positive for DSA. pAMR was diagnosed in 72 (39%) recipients (61, pAMR1 and 11 pAMR2). Capillary wedge pressure was higher in patients with pAMR≥1 than in those with pAMR 0 (P=0.03) but we found no difference in hemodynamic data between pAMR 1 and 2. Patients with DSA had a lower cardiac output (P=0.02). However, DSA did not correlate with pAMR grading, but were more often detected in patients with mixed rejection (cellular and AMR), than in those with pAMR alone (P=0.03). Significant angiographic vasculopathy (CAV) accounted for 30% of total deaths, regardless of any rejection grade, and was associated with 12% yearly mortality. pAMR grading per se, on the other hand, was not associated with graft survival, while mixed rejection accounted for a 3.6 times increased risk of graft-related death, in patients without CAV (P=0.04).Conclusions While showing that pathological signs of AMR were associated with a worse hemodynamic profile, with however no differences between pAMR 1 and 2 grades, this study provide suggestive evidence that DSA co-activate both cellular and antibody-mediated graft injury, and that mixed rejection, not AMR alone, drives poor outcome. These data shed new light on the clinical significance of pAMR grading, and brings attention to the adverse consequences of mixed rejection, as opposed to “pure” AMR.
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):S103. DOI:10.1016/j.healun.2013.01.1023 · 6.65 Impact Factor
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    ABSTRACT: Purpose Intravascular ultrasound (IVUS) provides unique prognostic information on allograft vasculopathy progression by detecting increase in maximal intimal thickness (MIT) during the first post-heart transplant (HT) year. Later changes in coronary morphology, their prognostic relevance, and risk factors are however unexplored. Methods and Materials We investigated whether changes in coronary morphology assessed in patients receiving serial IVUS at 1 and 5 years after HT predicted fatal and non-fatal cardiovascular (CV) events. We additionally analyzed the impact of metabolic risk factors on changes in IVUS measurements. Results 107 consecutive patients receiving HT between 1999 and 2007 entered the study. During the 11 years of follow-up, incidence of CV death was 8±3% and of CV events was 26±6%. Between year 1 and 5, MIT and intimal volume increased, lumen volume decreased (P<0.001 for all), while vessel volume was unchanged. By Cox’s model, only MIT increase was associated with subsequent CV death (RR=4.2 [1.2-12.1] per mm, P=0.03) and CV events (RR=2.6 [1.1-5.6] per mm; P=0.03). By ROC curves, we found that a MIT change cut-off of 0.35 mm best identified patients at risk for CV death and events (Figure). Among the metabolic parameters, increasing triglycerides and HDL-cholesterol ≤65mg/dl predicted MIT increase ≥ 0.35 mm (P≤0.05). Conclusions This study provides the first suggestive evidence that MIT increase represent a relevant prognostic marker also after the first year after HT. In addition, the finding that clinically relevant MIT is predicted by lipid pattern typical of insulin resistance, provide a strong rationale supporting aggressive therapeutic interventions against metabolic abnormalities mid and long-term after HT.
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):S33–S34. DOI:10.1016/j.healun.2013.01.886 · 6.65 Impact Factor
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    ABSTRACT: AimsThis study compared the clinical, functional, and haemodynamic characteristics and current era survival of subgroups of patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD): Eisenmenger syndrome (ES); PAH-CHD associated with systemic-to-pulmonary shunts (SPs); PAH with small defects (SDs); and PAH after defect correction (CDs).Methods and resultsData from consecutive PAH-CHD patients referred to our centre from 1 January 1998 to 31 May 2011 were collected. A contemporary group of idiopathic PAH patients was utilized for comparison. Treatment was per PAH guidelines, including combination therapy, with approved PAH-specific drugs. Survival was assessed with Kaplan-Meier analysis from the first invasive haemodynamic confirmation of PAH and compared across subgroups by log-rank test. Of 192 patients (mean age 41 ± 17 years; 61% female), 90 had ES (aged 41 ± 16 years); 48 SP (aged 47 ± 18 years); 10 SD (aged 25 ± 21 years); and 44 CD (aged 36 ± 17 years). Patients with ES had the highest baseline pulmonary vascular resistance and the lowest exercise capacity. Seventy-eight per cent were treated with approved PAH-specific drugs, and 44% were treated with combination therapy. Kaplan-Meier survival estimates (95% confidence interval) at 20 years for ES, SP, and CD were 87% (77-93%), 86% (60-96%), and 36% (12-72%, P = 0.0001 vs. ES; P = 0.004 vs. SP), respectively, and at 15 years for SD was 66% (16-91%, P = 0.015 vs. ES; P = 0.016 vs. SP). The survival of the 278 patients with idiopathic PAH appeared to be worse when compared with the PAH-CHD subgroups.Conclusion Relevant clinical, functional, haemodynamic, and survival differences were observed among subgroups. In particular, patients with CD and SD had the worst survival. These findings should be considered when planning medical or interventional treatment strategies in PAH-CHD patients.
    European Heart Journal 03/2013; 35(11). DOI:10.1093/eurheartj/eht072 · 15.20 Impact Factor
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    ABSTRACT: Objectives: To investigate the prognostic significance of baseline white blood cell count (WBCc) in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and its additive predictive value beyond the Global Registry of Acute Coronary Events (GRACE) score. Methods: We included 1,315 consecutive NSTE-ACS patients. Patients were divided in quartiles according to the WBCc (cells per 1 mm(3)) i.e. Q1 <6,850, Q2 = 6,850-8,539, Q3 = 8,540-10,857 and Q4 ≥10,858. The study end point was 3-year cardiovascular death (CVD). Results: The median age of the study population was 76 years. Overall, 335 patients (25.5%) died with 211 of these (16%) suffering from CVD. Patients in Q4 showed a higher cumulative probability of CVD compared to patients in Q1-Q3. On multivariable analysis, patients in Q4 were at higher risk of CVD [hazard ratio (HR) = 1.47, 95% confidence interval (CI) 1.09-1.98, p = 0.011]. WBCc as a continuous variable was also independently associated with the study end point (HR = 1.043; 95% CI 1.02-1.07; p = 0.001). However, the incorporation of WBCc into the GRACE score did not improve either prediction of risk (C-index = 0.796 for GRACE score with or without WBCc) or classification of risk [relative integrated discrimination improvement = 0.0154, 95% CI) -0.029 to 0.0618; continuous net reclassification improvement = -0.0676, 95% CI -0.2149-0.0738). Conclusions: WBCc was an independent predictor of 3-year CVD in patients with NSTE-ACS. However, it did not add prognostic information beyond the GRACE score.
    Cardiology 02/2013; 124(2):97-104. DOI:10.1159/000346377 · 2.18 Impact Factor
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    ABSTRACT: Background: Limited data exist on renal complications of transcatheter aortic valve implantation (TAVI) within a comprehensive program using different valves with transfemoral, transapical, and trans-subclavian approach. Methods: Prospective single-center registry of 102 consecutive patients undergoing TAVI using both approved bioprostheses and different access routes. The main objective was to assess the incidence, predictors and the clinical impact of acute kidney injury (AKI). AKI was defined according to the valve academic research consortium (VARC) indications. Results: Mean age was 83.7 ± 5.3 years, logistic EuroSCORE 22.6 ± 12.4%, and STS score 8.2 ± 4.1%. Chronic kidney disease at baseline was present in 87.3%. Periprocedural AKI developed in 42 patients (41.7%): 32.4% stage 1, 4.9% stage 2 and 3.9% stage 3. The incidence of AKI was 66.7% in transapical, 30.3% in transfemoral, and 50% in trans-subclavian procedures. The only independent predictor of AKI was transapical access, with a hazard ratio (HR) between 4.57 and 5.18 based on the model used. Cumulative 1-year survival was 88.2%. At Cox regression analysis, the only independent predictor of 30-day mortality was diabetes mellitus (HR 7.05, 95% CI 1.07-46.32; p=0.042), whilst the independent predictors of 1-year death were baseline glomerular filtration rate<30 mL/min (HR 5.74, 95% CI 1.42-23.26; p=0.014) and post-procedural AKI 3 (HR 8.59, 95% CI 1.61-45.86, p=0.012). Conclusions: TAVI is associated with a high incidence of AKI. Although in the majority of the cases AKI is of mild entity and reversible, AKI 3 holds a strong negative impact on 1-year survival. The incidence of AKI is higher with transapical access.
    International journal of cardiology 11/2012; 168(2). DOI:10.1016/j.ijcard.2012.10.029 · 4.04 Impact Factor

  • Transplantation 11/2012; 94(10S):1002. DOI:10.1097/00007890-201211271-01980 · 3.83 Impact Factor
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    ABSTRACT: Background: Subcutaneous almost substituted subpectoral approach of implantable cardioverter-defibrillator (ICD) implantation as a less invasive surgical technique. However, the impact of this change in placement site on procedure-related shoulder impairment is poorly understood. Methods: Candidates for ICD implantation were prospectively evaluated at baseline, 2-weeks and 3-months after the procedure. Assessment of shoulder function included: Constant Score, Numeric Rating Scale (NRS) for pain and the Disability of the Arm, Shoulder and Hand (DASH) scoring method. The Short Form-36 (SF-36) questionnaire was adopted for quality of life. Results: Fifty consecutive patients were enrolled (21 single-chamber, 5 dual-chamber and 24 biventricular ICD). Significant changes in the short term were observed: physical component summary (regarding SF-36) decreased from 44.5 ± 9.1 to 41.8 ± 11.4 (p=0.016), patients with NRS >1 increased from 14% to 44% (p<0.001), DASH score increased from 1.29 [interquartile range 0.00-10.34] to 30.60 [interquartile range 12.93-46.34] (p<0.001). Notably, only the shoulder ipsilateral to implantation site presented a decrease in Constant Score (76.00 [interquartile range 61.37-86.87] vs. 95.75 [interquartile range 91.37-98.00]; p<0.001). After three months most of the parameters seemed to have recovered, except for range of motion. Procedure-related increase in pain (i.e. NRS increase ≥ 1 point) was the most important independent predictor of shoulder impairment, in terms of Constant Score modification (r=0.570; p<0.001). Conclusions: ICD implantation is frequently associated with ipsilateral shoulder impairment which tends to recover within 3-months. These data positively compare with the subpectoral approach and should be considered for future research regarding impact of ICD implant on physical well-being and quality of life.
    International journal of cardiology 10/2012; 168(1). DOI:10.1016/j.ijcard.2012.09.071 · 4.04 Impact Factor

Publication Stats

9k Citations
2,084.80 Total Impact Points


  • 1996-2013
    • Policlinico S.Orsola-Malpighi
      Bolonia, Emilia-Romagna, Italy
  • 1983-2013
    • University of Bologna
      • • Institute of Cardiology
      • • Department of Biomedical Science and Neuromotor Sciences DIBINEM
      Bolonia, Emilia-Romagna, Italy
  • 2009
    • Azienda Ospedaliero Universitaria Foggia
      Foggia, Apulia, Italy
  • 1995-2003
    • Università degli Studi di Siena
      Siena, Tuscany, Italy
  • 1999
    • Università degli Studi G. d'Annunzio Chieti e Pescara
      Chieta, Abruzzo, Italy
  • 1998
    • Cineca
      Casalecchio di Reno, Emilia-Romagna, Italy
  • 1988-1993
    • Università Politecnica delle Marche
      Ancona, The Marches, Italy