Alessandra Bortolazzi

Rovigo General Hospital, Rovigo, Veneto, Italy

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Publications (28)81.87 Total impact

  • P Palatini · L Mos · C Fania · E Benetti · G Garavelli · A Mazzer · S Cozzio · A Bortolazzi · E Casiglia
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    ABSTRACT: Heart rate (HR) has been found to be associated with target organ damage in hypertension but the predictive capacity of resting HR vs ambulatory HR in longitudinal studies is not well known. We did a prospective study to investigate whether clinic HR and ambulatory HR assessed at baseline were independent predictors of albumin excretion rate (AER) and microalbuminuria (MA) in the early stage of hypertension. The study was conducted in a cohort of 621 white stage 1 hypertensive subjects from the HARVEST never treated for hypertension (mean age 33.8 ± 8.4 years, 449 men). Clinic HR was the average of 6 readings. Clinic HR, daytime HR and night-time HR were included separately in linear (for AER) and logistic (for MA) regressions and were adjusted for baseline logAER, age, gender, body mass index, blood pressure, physical activity, smoking, alcohol consumption, and follow-up time. During a median follow-up of 8.5 years AER increased from a median value of 5.7 mg/24 h to 7.2 mg/24 h (p < 0.001 for log-transformed data), and 42 subjects developed MA (AER > = 30 mg/24 h). In both linear and logistic regressions average night-time HR was an independent predictor of final AER (p = 0.014) and MA (p = 0.007), whereas clinic HR and daytime HR were not associated with these outcomes (p = NS for both). Night-time HR was 62.6 ± 8.3 bpm in the 579 subjects who did not develop MA and was 66.6 ± 7.7 bpm in the 42 subjects who developed MA (p = 0.002). Baseline BMI was another independent predictor of final AER (p = 0.007) and final MA (p = 0.001) and its inclusion into the models slightly attenuated the association of night-time HR with AER (p = 0.029) and MA (p = 0.016). HR is an independent predictor of microalbuminuria in young persons screened for stage 1 hypertension suggesting that the chronic hemodynamic stress related to tachycardia may play a role in the development of renal damage in hypertension. In agreement with previous results, HR measured during sleep seems to be more representative of the overall hemodynamic load on the arteries than HR measured during waking hours or in the doctor's office.
    Journal of Hypertension 06/2015; 33 Suppl 1 - ESH 2015 Abstract Book:e33. DOI:10.1097/01.hjh.0000467437.77375.cb · 4.22 Impact Factor
  • XX Congresso Nazionale FADOI, Torino; 05/2015
  • Journal of the American Society of Hypertension 04/2015; 9(4). DOI:10.1016/j.jash.2015.03.018 · 2.68 Impact Factor
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    ABSTRACT: BACKGROUND AND OBJECTIVES: Whether glomerular hyperfiltration is implicated in the development of microalbuminuria in hypertension is not well known. This prospective study investigated the relationship between changes in GFR and microalbuminuria in hypertension. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study assessed 534 stage 1 hypertensive participants from the Hypertension and Ambulatory Recording Venetia Study (n=386 men) without microalbuminuria at baseline, who were recruited from 1990 to 1995 and followed for a median of 8.5 years. Mean age was 33.9±8.6 years and mean BP was 146.6±10.5/94.0±5.0 mmHg. Creatinine clearance and 24-hour urinary albumin were measured at study entry and end. Participants were defined as normofilterers (normo) or hyperfilterers (hyper) according to whether GFR was <150 or ≥150 ml/min per 1.73 m(2), respectively. Participants were divided into four groups based on GFR changes from baseline to follow-up end: normo→normo (n=395), normo→hyper (n=31), hyper→hyper (n=61), and hyper→normo (n=47). RESULTS: Microalbuminuria progressively increased across the four groups and was 5.3% in normo→normo, 9.7% in normo→hyper, 16.4% in hyper→hyper, and 36.2% in hyper→normo (P<0.001). This association held true in a multivariable logistic regression in which several confounders, ambulatory BP, and other risk factors were taken into account (P<0.001). In particular, hyperfilterers whose GFR decreased to normal at study end had an adjusted odds ratio of 7.8 (95% confidence interval, 3.3-18.2) for development of microalbuminuria compared with participants with normal GFR throughout the study. CONCLUSIONS: These data support the hypothesis for a parabolic association between GFR and urinary albumin in the early stage of hypertension.
    Clinical Journal of the American Society of Nephrology 09/2012; 8(1). DOI:10.2215/CJN.03470412 · 5.25 Impact Factor
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    P Palatini · F Saladini · L Mos · E Benetti · A Bortolazzi · S Cozzio · E Casiglia
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    ABSTRACT: OBJECTIVE:To examine the impact of overweight and obesity on development of target organ damage in the early stage of hypertension.SUBJECTS:Participants were 727 young-to-middle-age subjects screened for stage 1 hypertension and followed for 8 years.MEASUREMENTS:Ambulatory blood pressure (BP), albumin excretion rate and echocardiographic data were obtained at entry, every 5 years and/or before starting antihypertensive treatment.RESULTS:During the follow-up, hypertension needing treatment was developed by 54.7% of the subjects with normal weight, 66.6% of those with overweight and 73.0% of those with obesity (P<0.001). Kaplan-Meier curves showed that patients with obesity or overweight progressed to sustained hypertension earlier than those with normal weight (P<0.001). At study end, rate of organ damage was 10.7% in the normal weight, 16.4% in the overweight and 30.1% in the obese subjects (P<0.001). In a multivariable logistic regression analysis, overweight (P=0.008) and obesity (P<0.001) were significant predictors of final organ damage. Inclusion of changes in 24-h BP and body mass index, and of baseline organ damage did not virtually modify these associations (P=0.002 and <0.001, respectively). Obesity was a significant predictor of both left ventricular hypertrophy (P<0.001) and microalbuminuria (P=0.015) with an odds ratio (95% confidence interval) of 8.5 (2.7-26.8) and 3.5 (1.3-9.6), respectively.CONCLUSION:These data indicate that in hypertensive subjects obesity has deleterious effects on the cardiovascular system already at an early age. Preventive strategies addressed to achieve weight reduction should be implemented at a very early stage in young people with excess adiposity and high BP.International Journal of Obesity advance online publication, 6 March 2012; doi:10.1038/ijo.2012.32.
    International journal of obesity (2005) 03/2012; 37(2). DOI:10.1038/ijo.2012.32 · 5.39 Impact Factor
  • Artery Research 12/2011; 5(4):152. DOI:10.1016/j.artres.2011.10.019
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    ABSTRACT: The impact of high blood pressure (BP) on target organs (TO) in premenopausal women is not well known. The purpose of this study was to describe gender differences in TO involvement in a cohort of young-to-middle-aged subjects screened for stage 1 hypertension and followed for 8.2 years. Participants were 175 women and 451 men with similar age (range 18-45 years). Ambulatory BP at entry was 127.5±12.5/83.7±7.2 mm Hg in women and 131.9±10.3/81.0±7.9 mm Hg in men. Ambulatory BP, albumin excretion rate (AER), and echocardiographic data (n=489) were obtained at entry, every 5 years, and before starting antihypertensive treatment. Female gender was an independent predictor of final AER (p=0.01) and left ventricular mass index (LVMI) (p<0.001). At follow-up end, both microalbuminuria (13.7% vs. 6.2%, p=0.002) and left ventricular hypertrophy (LVH) (26.4% vs. 8.8%, p<0.0001) were more common among women than men. In a multivariable Cox analysis, after adjusting for age, lifestyle factors, body mass, ambulatory BP, heart rate, and parental hypertension, female gender was a significant predictor of time to development of microalbuminuria (p=0.002), with a hazard ratio (HR) of 3.06, (95% confidence interval [CI] 1.48-6.34) and of LVH (p=0.004), with an HR of 2.50 (1.33-4.70). Inclusion of systolic and diastolic BP changes over time in the models only marginally affected these associations, with HRs of 3.13 (1.50-6.55) and 3.43 (1.75-6.70), respectively. These data indicate that premenopausal women have an increased risk of hypertensive TO damage (TOD) and raise the question about whether early antihypertensive treatment should be considered in these patients.
    Journal of Women's Health 06/2011; 20(8):1175-81. DOI:10.1089/jwh.2011.2771 · 1.90 Impact Factor
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    ABSTRACT: We did a prospective study to investigate whether clinic heart rate (HR) and 24-h ambulatory HR were independent predictors of subsequent increase in body weight (BW) in young subjects screened for stage 1 hypertension. The study was conducted in 1,008 subjects from the Hypertension and Ambulatory Recording Venetia Study (HARVEST) followed for an average of 7 years. Ambulatory HR was obtained in 701 subjects. Data were adjusted for lifestyle factors and several confounders. During the follow-up BW increased by 2.1 ± 7.2 kg in the whole cohort. Both baseline clinic HR (P = 0.007) and 24-h HR (P = 0.013) were independent predictors of BMI at study end. In addition, changes in HR during the follow-up either measured in the clinic (P = 0.036) or with 24-h recording (P = 0.009) were independent associates of final BMI. In a multivariable Cox regression, baseline BMI (P < 0.001), male gender (P < 0.001), systolic blood pressure (BP) (P = 0.01), baseline clinic HR (P = 0.02), and follow-up changes in clinic HR (P < 0.001) were independent predictors of overweight (Ov) or obesity (Ob) at the end of the follow-up. Follow-up changes in ambulatory HR (P = 0.01) were also independent predictors of Ov or Ob. However, when both clinic and ambulatory HRs were included in the same Cox model, only baseline clinic HR and its change during the follow-up were independent predictors of outcome. In conclusion, baseline clinic HR and HR changes during the follow-up are independent predictors of BW gain in young persons screened for stage 1 hypertension suggesting that sympathetic nervous system activity may play a role in the development of Ob in hypertension.
    Obesity 03/2011; 19(3):618-23. DOI:10.1038/oby.2010.191 · 4.39 Impact Factor
  • Journal of Hypertension 06/2010; 28. DOI:10.1097/01.hjh.0000379892.56468.3c · 4.22 Impact Factor
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    ABSTRACT: The evolution of hypertension (HT) subtypes in young-to-middle-age subjects is unclear. We did a prospective study in 1,141 participants aged 18-45 years from the HARVEST study screened for stage 1 HT, and 101 nonhypertensive subjects of control during a median follow-up of 72.9 months. At baseline, 13.8% of the subjects were classified as having isolated systolic HT (ISH), 24.8% as having isolated diastolic HT (IDH), and 61.4% as having systolic-diastolic HT (SDH). All hypertensive groups developed sustained HT (clinic blood pressure > or =140/90 mm Hg from two consecutive visits occurring at least after > or =6 months of observation) more frequently than nonhypertensive subjects (P < 0.001 for all) with adjusted odds ratio of 5.2 (95%CI 2.9-9.2) among the SDH subjects, 2.6 (95%CI 1.5-4.5) among the IDH subjects, and 2.2 (95%CI 1.2-4.5) among the ISH subjects. When the definition of HT was based on ambulatory blood pressure (mean daytime blood pressure > or =135/85 mm Hg, n = 798), odds ratios were 5.1 (95%CI 3.1-8.2), 5.6 (95%CI 3.2-9.8), and 3.3 (95%CI 1.7-6.3), respectively. In the fully adjusted logistic model, the risk of ambulatory HT was smaller for the ISH than the IDH (P = 0.049) or SDH (P = 0.053) individuals. The present results indicate that young-to-middle-age subjects with ISH have a smaller risk of developing ambulatory HT than either subjects with SDH or IDH. Whether antihypertensive treatment can be postponed for long periods of time in young subjects with mild elevations of clinic systolic BP and low global cardiovascular risk should be examined in further studies.
    American Journal of Hypertension 03/2009; 22(5):531-7. DOI:10.1038/ajh.2009.21 · 3.40 Impact Factor
  • Minerva cardioangiologica 01/2009; 56(6):703-4. · 0.48 Impact Factor
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    ABSTRACT: The longitudinal relationship between aerobic exercise and left ventricular (LV) mass in hypertension is not well known. We did a prospective study to investigate the long-term effect of regular physical activity on development of LV hypertrophy (LVH) in a cohort of young subjects screened for Stage 1 hypertension. We assessed 454 subjects whose physical activity status was consistent during the follow-up. Echocardiographic LV mass was measured at entry, every 5 years, and/or at the time of hypertension development before starting treatment. LVH was defined as an LV mass >/=50 g/m(2.7) in men and >/=47 g/m(2.7) in women. During a median follow-up of 8.3 years, 32 subjects developed LVH (sedentary, 10.3%; active, 1.7%, P = 0.000). In a logistic regression, physically active groups combined (n = 173) were less likely to develop LVH than sedentary group with a crude OR = 0.15 (CI, 0.05-0.52). After controlling for sex, age, family history for hypertension, hypertension duration, body mass, blood pressure, baseline LV mass, lifestyle factors, and follow-up length, the OR was 0.24 (CI, 0.07-0.85). Blood pressure declined over time in physically active subjects (-5.1 +/- 17.0/-0.5 +/- 10.2 mmHg) and slightly increased in their sedentary peers (0.0 +/- 15.3/0.9 +/- 9.7 mmHg, adjusted P vs. active = 0.04/0.06). Inclusion of changes in blood pressure over time into the logistic model slightly decreased the strength of the association between physical activity status and LVH development (OR = 0.25, CI, 0.07-0.87). Regular physical activity prevents the development of LVH in young stage 1 hypertensive subjects. This effect is independent from the reduction in blood pressure caused by exercise.
    European Heart Journal 12/2008; 30(2):225-32. DOI:10.1093/eurheartj/ehn533 · 14.72 Impact Factor
  • P. Palatini · F. Dorigatti · V. Zaetta · P. Mormino · A. Mazzer · A. Bortolazzi
    Hipertensión y Riesgo Vascular 12/2006; 23(8):270–271. DOI:10.1016/S1889-1837(06)71653-1
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    ABSTRACT: Whether heart rate predicts the development of sustained hypertension in individuals with hypertension is not well known. We carried out a prospective study to investigate whether clinic and ambulatory heart rates assessed at baseline and changes in clinic heart rate during 6 months of follow-up were independent predictors of subsequent blood pressure (BP). The study was conducted in a cohort of 1103 white, stage 1 hypertensive individuals from the HARVEST study, never treated for hypertension and followed-up for an average of 6.4 years. Data were adjusted for baseline BP, age, sex, body fatness, physical activity habits, parental hypertension, duration of hypertension, cigarette smoking, alcohol consumption, and change of body weight from baseline. Clinic heart rate and heart rate changes during the first 6 months of follow-up were independent predictors of subsequent systolic blood pressure (SBP) and diastolic blood pressure (DBP) regardless of initial BP and other confounders (all P < 0.01). A significant interaction was found between sex (male) and baseline resting heart rate on final SBP (P = 0.017) and DBP (P < 0.001). The ambulatory heart rate and the heart rate white-coat effect did not add prognostic information to that provided by the clinic heart rate. Patients whose heart rate was persistently elevated during the study had a doubled fully adjusted risk (95% confidence interval 1.4-2.9) of developing sustained hypertension in comparison with subjects with a normal heart rate. Baseline clinic heart rate and heart rate changes during the first few months of follow-up are independent predictors of the development of sustained hypertension in young persons screened for stage 1 hypertension.
    Journal of Hypertension 09/2006; 24(9):1873-80. DOI:10.1097/01.hjh.0000242413.96277.5b · 4.22 Impact Factor
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    ABSTRACT: These days no codified multidisciplinary protocol has been reported to manage all the different patent foramen ovale (PFO)-mediated syndromes. We sought to propose a multidisciplinary program of diagnosis, treatment, and follow-up of all PFO-mediated syndromes based on an in-hospital multidisciplinary task force and to review the activities during the first year. From September 2004, we organized in our hospital, a 600-bed tertiary hospital, a management program for PFO-mediated syndromes based on a task force composed of cardiologists, neurologists, and internists. Different levels of protocols were created in order to cover diagnosis, treatment, and follow-up of PFO-mediated syndromes. We reviewed the activity of our program in the first year up to September 2005. Thirty-five patients (23 female, mean age 65 +/- 24 years) were evaluated for suspected PFO-mediated syndromes: 20 for cryptogenic stroke, 2 for peripheral and coronary embolisms, 3 for platypnea-orthodeoxia, 9 for emicrania with aura, and 1 with hypoxiemia during neurosurgical intervention in the posterior cranial fossa. Diagnosis of PFO was confirmed in 25 patients. According to the multidisciplinary protocols, 15 patients failed to meet the requirements for transcatheter closure and were left in medical therapy whereas 11 patients (7 patients with PFO, 2 with multiperforated ASD, and 2 with a secundum ASD) underwent transcatheter closure. After a mean follow-up of 10.8 +/- 4.9 months, no recurrent PFO syndromes were noted in patients treated with devices. The first year of our multidisciplinary program allowed a reasonable and potentially successful approach for correctly identifying patients with PFO-mediated syndromes until randomized studies are completed.
    Journal of Interventional Cardiology 07/2006; 19(3):264-8. DOI:10.1111/j.1540-8183.2006.00141.x · 1.32 Impact Factor
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    ABSTRACT: Cardiac resynchronization therapy (CRT) has become one of the main therapeutic alternatives for advanced congestive heart failure (CHF), but the effects on morbidity and mortality are still unclear. Aim of the Study was to analyze hospitalization rate and mortality - total mortality (TM) and cardiac mortality (CM) - in a wide patient population implanted in our institution in the last six years. Methods since 1999, 187 pts (158 male) underwent CRT for severe CHF (EF 26.3% ± 6.9). In 82 pts a backup ICD was associated. The mean age was 71.1 ± 8.8 years (range 36 to 92); 103 pts (53%) had ischemic heart disease (IHD) while 84 were non ischemic (NIHD); 36 pts were in atrial fibrillation at the time of implant; 46 were previously paced via the right ventricular apex; 16 were candidates for heart transplantation. All the pts were evaluated in our clinic and the follow-up was scheduled every three month for the first year and then twice a year. Results the implant success rate was 98.9%. The mean follow-up was 29±16 months (range 1 – 74 months). Compared to the year before CRT, a significant decrease in hospitalization rate was observed during the first year of follow-up (2.38±1.6 vs. 0.56±0.7, p<.001). TM was 10.7%, CM was 8.0 %. The ICD group shows a reduction of TM compared to the group without: 7.3% vs. 13.3%: - 46 %. TM was also evaluated at implant, 6 months and steps of 1 year as follow:
    Europace 10/2005; 7. DOI:10.1016/j.eupc.2005.08.102 · 3.05 Impact Factor
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    ABSTRACT: Background Right ventricular apical pacing alters impulse conduction producing an intraventricular desynchronization that could be detrimental for LV function. Direct His bundle pacing (DHBP) represents a novel approach to cardiac pacing in pts with normal His-Purkinje activation because it maintains or restores the physiological activation of the ventricular muscle during cardiac pacing. Methods 13 pts (mean age 76±3 years; 2 females; QRS duration 118±24 ms; LV EF% 60±11; LV end-diastolic volume 61±22 ml/m2) have been investigated. At baseline and after DHBP Tissue Doppler Imaging was performed to evaluate the intraventricular dyssynchrony [defined as the interval between the earliest LV wall motion and the latest (intra LV delay) or as standard deviation (SD, modified Yu index) of all time intervals]. Tei index, E/A ratio, dP/dT, MR (mitral regurgitation-diameter of vena contracta) were also obtained. Baseline intra-LV desynchronization (intra-LV delay above 40 ms) was observed in 2 pts with normal QRS and in all 4 pts who had intraventricular conduction delay (QRS > 120 ms). Results in table are displayed the values at baseline and after DHBP:
    Europace 10/2005; 7. DOI:10.1016/j.eupc.2005.08.064 · 3.05 Impact Factor
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    ABSTRACT: Resting heart rate has been shown to predict the development of hypertension in general population studies. The purpose of this study was to investigate the relationship between heart rate and long-term changes in heart rate with changes in blood pressure in a cohort of young subjects with mild hypertension.The study was carried out in 1095 subjects who took part in the multicenter HARVEST study. Subjects 18 to 45 years old with diastolic blood pressure (BP) from 90 to 99 mm Hg and/or systolic BP between 140 and 159 mm Hg, who never took antihypertensive therapy, were enrolled. Ambulatory 24h BP was measured at baseline. Urinary epinephrine and nor-epinephrine were measured at entry from 24h urine collections (n=713) and were 25±38 mcg/24h and 91±80 mcg/24h, respectively. Subjects were seen every six months for clinic BP and heart rate assessment to determine which subjects reached the end-point (need for drug therapy according to current guidelines).Clinic BP at entry was 146±11/94±5 mmHg, and clinic heart rate was 75±10 bpm. During a mean follow-up of 78±32 months, BP declined by 2.3±13.9/0.6±9.3 mmHg, and heart rate decreased by 3.0±10.8 bpm. In the subjects divided into tertiles of changes in heart rate, BP decreased by 6.6±13.5/2.9±9.1 mmHg in the bottom heart rate tertile (-14.4 bpm) and increased by 2.3±13.9/1.0±9.6 mmHg in the top tertile (+8.5 bpm). In a multivariable Cox regression analysis, significant predictors of changes in systolic BP were age (p=0.000), baseline heart rate (p=0.000), changes of heart rate over time (p=0.000), clinic systolic BP (p=0.000, negative association), 24h systolic BP (p=0.000), BMI (p=0.003), and gender (p=0.04). A similar model was obtained for changes in diastolic BP. Urinary catecholamines did not predict changes in BP in any model.These findings indicate that besides the resting heart rate also the changes in heart rate over time are predictive of development of more severe hypertension in young subjects with mildly elevated BP levels.
    American Journal of Hypertension 05/2005; 18(5). DOI:10.1016/j.amjhyper.2005.03.317 · 3.40 Impact Factor
  • Heart Rhythm 05/2005; 2(5):S282. DOI:10.1016/j.hrthm.2005.02.887 · 4.92 Impact Factor
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    ABSTRACT: Cardiac resynchronization therapy (CRT) has become one of the main therapeutic alternatives for advanced congestive heart failure (CHF), but the effects on morbidity and mortality are still unclear. Aim of the Study was to analyze hospitalization rate and mortality - total mortality (TM) and cardiac mortality (CM) - in a wide patient population implanted in our institution in the last six years. Methods since 1999, 187 pts (158 male) underwent CRT for severe CHF (EF 26.3% � 6.9). In 82 pts a backup ICD was associated. The mean age was 71.1 � 8.8 years (range 36 to 92); 103 pts (53%) had ischemic heart disease (IHD) while 84 were non ischemic (NIHD); 36 pts were in atrial fibrillation at the time of implant; 46 were previously paced via the right ventricular apex; 16 were candidates for heart transplantation. All the pts were evaluated in our clinic and the follow-up was scheduled every three month for the first year and then twice a year. Results the implant success rate was 98.9%. The mean follow-up was 29�16 months (range 1 – 74 months). Compared to the year before CRT, a significant decrease in hospitalization rate was observed during the first year of follow-up (2.38�1.6 vs. 0.56�0.7, p<.001). TM was 10.7%, CM was 8.0 %. The ICD group shows a reduction of TM compared to the group without: 7.3% vs. 13.3%: - 46 %. TM was also evaluated at implant, 6 months and steps of 1 year as follow: In the group of IHD vs. NIHD, TM was 11.6% % vs. 9.5% and CM was 10.7% vs. 4.7% respectively. The main causes of death in IHD were heart failure (8 pts) and sudden death (3 pts). In NIHD 3 pts died from cancer and 1 due to acute abdomen. Conclusions 1) the benefit of CRT is similar in IHD and NIHD; 2) IHD seems to have a worse prognosis than NIHD in term of TM and CM; 3) CRT decreases the hospitalization rate and increases survival; 4) the association with a back-up ICD strongly reduces the mortality in this population.

Publication Stats

201 Citations
81.87 Total Impact Points

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Institutions

  • 2006–2015
    • Rovigo General Hospital
      Rovigo, Veneto, Italy
  • 1996–2002
    • University of Padova
      • Department of Medicine DIMED
      Padua, Veneto, Italy