Francesco Fedele

Sapienza University of Rome, Roma, Latium, Italy

Are you Francesco Fedele?

Claim your profile

Publications (197)892.65 Total impact

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of our work is to describe the Mem-net program's use and potential and to show the data of Italian Chronic Cerebrospinal Venous Insufficiency (CCSVI)-National Epidemiological Observatory (NEO) activity in the first three years (http://www.osservatori-occsvi.org). From 2011 to 2014, all echo-color-Doppler (ECD) assessments were stored by Mem-net program into CCSVI-NEO web site (http://www.mem-net.it). Mem-net is a tool for multicenter data collection based on the International Society for Neurovascular Disease consensus and position statement, where we can insert patients (pts) history, neurological visits, ECD assessments, different examinations, therapies and surgical procedures. The website provides an epidemiological and statistical program for data analysis in real time. At present, 7 medical centers, affiliated to CCSVI-NEO, input their symptomatic and asymptomatic subjects with CCSVI. Data were storage using the Mem-net program. We analyzed data of only four centers on seven (Rome, Bari, Cagliari and Benevento). Total pts number with multiple sclerosis (MS) was 1109, mean age 46.0±13.,4 [male 422 (38.05%); female 687 (61.95%)]. CCSVI positive pts were 937 (84.49%), CCSVI negative pts were 172 (15.51%). The CCSVI type 1 subjects were 530 (56.56%), CCSVI type 2 subjects were 20 (2.13%), CCSVI type 3 subjects were 387 (41.30%). We found 800 (85.38%) pts with criterion 1; 725 (77.37%) with criterion 2; 519 (55.39%) with criterion 3; 483 (51.55%) with criterion 4; 88 (9.39%) with criterion 5. The venous hemodynamic insufficiency severity score mean score was 3.8; the CCSVI mean score was 2.8; the MEM mean score was 34.7; the expanded disability status scale mean score was 4.5; the disease mean duration was 12.5±5.7 years. MS clinical types were divided as follows: relapsing-remitting pts were 449 (47.92%), Secondary progressive pts were 144 (15.37%), primary progressive pts were 72 (7.68%). The CCSVI-NEO database and Mem-net software may be useful medical and researching tools for recording, storing, analyzing and studying ECD and vascular data. Preliminary data of NEO show an elevated prevalence of CCSVI in MS.
    12/2015; 3(3). DOI:10.4081/vl.2014.4707
  • Source
    International journal of cardiology 09/2015; 194. DOI:10.1016/j.ijcard.2015.05.085 · 6.18 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: End of life is an unfortunate but inevitable phase of the heart failure patients' journey. It is often preceded by a stage in the progression of heart failure defined as advanced heart failure, and characterised by poor quality of life and frequent hospitalisations. In clinical practice, the efficacy of treatments for advanced heart failure is often assessed by parameters such as clinical status, haemodynamics, neurohormonal status, and echo/MRI indices. From the patients' perspective, however, quality-of-life-related parameters, such as functional capacity, exercise performance, psychological status, and frequency of re-hospitalisations, are more significant. The effects of therapies and interventions on these parameters are, however, underrepresented in clinical trials targeted to assess advanced heart failure treatment efficacy, and data are overall scarce. This is possibly due to a non-universal definition of the quality-of-life-related endpoints, and to the difficult standardisation of the data collection. These uncertainties also lead to difficulties in handling trade-off decisions between quality of life and survival by patients, families and healthcare providers. A panel of 34 experts in the field of cardiology and intensive cardiac care from 21 countries around the world convened for reviewing the existing data on quality-of-life in patients with advanced heart failure, discussing and reaching a consensus on the validity and significance of quality-of-life assessment methods. Gaps in routine care and research, which should be addressed, were identified. Finally, published data on the effects of current i.v. vasoactive therapies such as inotropes, inodilators, and vasodilators on quality-of-life in advanced heart failure patients were analysed. Copyright © 2015. Published by Elsevier Ireland Ltd.
    International Journal of Cardiology 05/2015; 191:256-264. DOI:10.1016/j.ijcard.2015.04.235 · 6.18 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to determine the prevalence of right intraventricular dyssynchrony, its determinants and prognostic impact in idiopathic, heritable, and anorexigen-induced pulmonary arterial hypertension. Right ventricular dyssynchrony has been described in pulmonary arterial hypertension, but no evidence is available on its prognostic impact and evolution after therapy. In 83 consecutive therapy-naïve patients, right ventricular dyssynchrony was evaluated by 2-dimensional speckle-tracking echocardiography calculating the standard deviation of the times to peak-systolic strain for the 4 mid-basal right ventricular segments (RV-SD4). After baseline (World Health Organization [WHO] class, pulmonary hemodynamics, 6-min walk test [6MWT]), a second assessment was performed after 12 months or when clinical worsening occurred. Patients with right ventricular dyssynchrony (RV-SD4 >18 ms) had advanced WHO class, worse 6MWT, right ventricular remodeling, and hemodynamic profile compared with patients ≤18 ms. Determinants of dyssynchrony included pulmonary vascular resistance, QRS duration, and right ventricular end-diastolic area (r(2) = 0.38; p < 0.000001). At 12 months, 32.5% of patients presented clinical worsening (actuarial rates: 19% at 6 months, 31% at 1 year). Multivariable models for clinical worsening prediction showed that the addition of RV-SD4 to clinical and hemodynamic variables (WHO IV, 6MWT, and cardiac index) significantly increased the prognostic power of the model (0.74 vs. 0.81; p = 0.005, 95% confidence interval [CI]: 0.02 to 0.11). Receiver operating characteristic analysis identified RV-SD4 ≥ 23 ms as the best cutoff value for clinical worsening prediction (95% negative predictive value). At 12 months, normalization of dyssynchrony was achieved in patients with a large reduction of pulmonary vascular resistance (-42 ± 4%). Right ventricular dyssynchrony is frequent in pulmonary arterial hypertension, is an independent predictor of clinical worsening, and might regress during effective treatments. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    JACC. Cardiovascular imaging 05/2015; 8(6). DOI:10.1016/j.jcmg.2015.02.009 · 6.99 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Telemedicine is the provision of health care services, through the use of information and communication technology, in situations where the health care professional and the patient, or 2 health care professionals, are not in the same location. It involves the secure transmission of medical data and information, through text, sound, images, or other forms needed for the prevention, diagnosis, treatment, and follow-up of a patient. First data on implementation of telemedicine for the diagnosis and treatment of acute myocardial infarction date from more than 10years ago. Telemedicine has a potential broad application to the cardiovascular disease continuum and in many branches of cardiology, at least including heart failure, ischemic heart disease and arrhythmias. Telemedicine might have an important role as part of a strategy for the delivery of effective health care for patients with cardiovascular disease. In this document the Working Group on Telecardiology and Informatics of the Italian Society of Cardiology intends to remark some key-points regarding potential benefit achievable with the implementation of telemedicine support in the continuum of cardiovascular disease. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 04/2015; 184. DOI:10.1016/j.ijcard.2015.02.023 · 6.18 Impact Factor
  • Journal of the American College of Cardiology 03/2015; 65(10):A1668. DOI:10.1016/S0735-1097(15)61668-0 · 15.34 Impact Factor
  • Journal of the American College of Cardiology 03/2015; 65(10):A43. DOI:10.1016/S0735-1097(15)60043-2 · 15.34 Impact Factor
  • Journal of the American College of Cardiology 03/2015; 65(10):A907. DOI:10.1016/S0735-1097(15)60907-X · 15.34 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aims of this study were: i) analysis of clinical severity evolution in multiple sclerosis patients; ii) identification of temporal indicators for clinical worsening. We investigated by echo-color-Doppler (ECD) 789 patients (490 female plus 299 male), aged 45.4 years, with chronic cerebro-spinal venous insufficiency (CCSVI) and multiple sclerosis (MS). All patients tested positive for CCSVI by ECD assessment were divided into three groups, namely: type 1 CCSVI (371) presenting an endo-vascular obstacle to the venous drainage; type 2 CCSVI (40) presenting an extra-vascular obstacle to the venous drainage, for external compression of the vessel; type 3 CCSVI (315) presenting both venous endo-vascular and extra-vascular obstructed drains. We analyzed the morphological and hemodynamic data recorded on computerized map (MEM-net). All data were collected by respecting the Italian Privacy Laws and they are available on the National Epidemiological Observatory on CCSVI website (www.osservatorioccsvi.org). We focused in the three main parameters in all studied patients. First parameter was expanded disability status scale (EDSS) score; second parameter was illness duration; third parameter was CCSVI type. The MS duration values stratified by EDSS grouped values in CCSVI-type-1 and CCSVI-type-3 patients shows that the differences were statistical significant by Kruskal-Wallis test: H=44.2829; degree of free-dom=1 for CCSVI-type-1 (P<0.001); and H=37.3036; degree of freedom=1 for CCSVI-type-3 (P<0.001). The present study confirmed and completed scientific literature about relation between CCSVI and MS. On the same time, we found a strong correlation between MS illness duration and severity of EDSS score. In fact there is a clinical severity worsening after 11 years of illness in MS patients with CCSVI type-1 or type-3 (P<0.001). These data may suggest the influence of chronic vas-cular disease on MS. Further searches need in order to learn more about this new aspect in MS etiology.
    01/2015; 4(4). DOI:10.4081/vl.2015.4570
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: There is an established tradition of cardiovascular simulation tools, but the application of this kind of technology in the e-Learning arena is a novel approach. This paper presents an e-Learning environment aimed at teaching the interaction of cardiovascular and lung systems to health-care professionals. Heart-lung interaction must be analyzed while assisting patients with severe respiratory problems or with heart failure in intensive care unit. Such patients can be assisted by mechanical ventilatory assistance or by thoracic artificial lung."In silico" cardiovascular simulator was experimented during a training course given to graduate students of the School of Specialization in Cardiology at 'Sapienza' University in Rome.The training course employed CARDIOSIM(C): a numerical simulator of the cardiovascular system. Such simulator is able to reproduce pathophysiological conditions of patients affected by cardiovascular and/or lung disease. In order to study the interactions among the cardiovascular system, the natural lung and the thoracic artificial lung (TAL), the numerical model of this device has been implemented. After having reproduced a patient's pathological condition, TAL model was applied in parallel and hybrid model during the training course.Results obtained during the training course show that TAL parallel assistance reduces right ventricular end systolic (diastolic) volume, but increases left ventricular end systolic (diastolic) volume. The percentage changes induced by hybrid TAL assistance on haemodynamic variables are lower than those produced by parallel assistance. Only in the case of the mean pulmonary arterial pressure, there is a percentage reduction which, in case of hybrid assistance, is greater (about 40%) than in case of parallel assistance (20-30%). At the end of the course, a short questionnaire was submitted to students in order to assess the quality of the course. The feedback obtained was positive, showing good results with respect to the degree of students' learning and the ease of use of the software simulator.
    BioMedical Engineering OnLine 12/2014; 13(172). DOI:10.1186/1475-925X-13-172 · 1.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although increased pulmonary pressure is caused by changes in the pulmonary vasculature, prognosis in idiopathic pulmonary arterial hypertension (IPAH) is strongly associated with right ventricular (RV) function. The aim of this study was to describe the best RV adaptive remodeling pattern to increased afterload in IPAH.Methods In 60 consecutive IPAH patients RV morphological and functional features were evaluated by echocardiography and magnetic resonance. To address the question of the best RV adaptation pattern, we divided the study population into two groups by the median value of RV mass/volume (M/V) ratio (0.46), as this parameter allows the distinction between RV eccentric (≤0.46) and concentric hypertrophy (>0.46). The two groups were compared for RV remodeling and systolic function parameters, WHO class, pulmonary hemodynamics and 6-minute walk test (6MWT).ResultsDespite similar pulmonary vascular resistance (PVR), mean pulmonary pressure and compliance, patients with eccentric hypertrophy had advanced WHO class, worse 6MWT, hemodynamics, RV remodeling and systolic function parameters compared to patients with concentric hypertrophy. The latter group had higher RV to pulmonary arterial coupling (VA coupling) compared to the former (1.24±0.26 vs 0.83±0.33; p=0.0001), indicating higher RV efficiency. A significant correlation was found between PVR and VA coupling (r=-0.55, r2=0.31; p=0.0001), with those patients with RV M/V ratio >0.46 at the higher part of the scatterplot, confirming a more adequate RV function.Conclusions Concentric hypertrophy might represent a more favorable RV adaptive remodeling pattern to increased afterload in IPAH, as it is associated with a more suitable systolic function and mechanical efficiency.
    The Journal of Heart and Lung Transplantation 11/2014; 34(3). DOI:10.1016/j.healun.2014.11.002 · 5.61 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this work is the realization of an "Artificial Arm Pressure" permitting to reproduce oscillometric waveforms able to replace expensive clinical trials for validating and testing a Holter blood pressure device. To perform this new device a hybrid simulator (numerical/hydraulic) of the left cardiocirculatory network was implemented in order to reproduce in different fixed times different oscillometric blood arterial pressure waveforms. The “Artificial Arm Pressure" consists of a numerical simulator of the left cardiovascular system, in which it is possible to fix the left atrial pressure (preload) and the left arterial pressure (afterload) and of an hydraulic system consisting of a D/A converter, a servo-amplifier, a D/C motor and a “gear pump”. The numerical simulator allows to vary the heart rate, the time duration of systole/diastole and the morphology of the ventricular/aortic pressure waveform in order to reproduce different physiopathology cardiovascular diseases. The hybrid simulator can be used to program the type and amount of steps you want to perform in 24/48-h to check the correct operation/calibration of the Holter blood pressure device. A Holter programmed to acquire data every 15 min has been tested for 24-h on the "Artificial Arm Pressure". The comparison between simulated and measured data shown that for systolic (diastolic) blood pressure the percentage of variation was in average about ±2.6% (±2.9). In the case of HR, the percentage of variation was in average about ±2.0%.
    10/2014; 1(1):27-34. DOI:10.15379/2409-3394.2014.01.01.4
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Over the last two decades the development and analysis of a number of registries have enhanced the knowledge of the epidemiology, presentation, natural history, and pathophysiology of pulmonary arterial hypertension (PAH). The understanding of the effectiveness of available treatments has also been greatly improved. However, most of the registries present some methodological issues, such as differences in the classification of patients and presence of confounding factors or missing values, that can impact on the generalizability of the results. Objective: The aim of this study is to present the Italian Pulmonary Hypertension Network (iPHnet) Project, a database used to collect health records on patients with PAH that can also be used for research purposes to retrieve ad hoc information. Results: iPHnet presents various characteristics such as facilitated access, data sharing and interoperability, update, patient's anonymity and data integrity. The system also enables the creation of patients' electronic health records (EHR), the exportation and personalization of data and the possibility to design CRF and collect information usable in clinical trials. In addition, it is possible to analyze the information present in the registry, creating graphs or other immediately-available charts to evaluate the trends of a specific data and perform therapeutic or clinic adjustments. Treatment of data in the iPHnet database complies with FDA requirements, backup and disaster recovery policies and patients' privacy. Conclusions: iPHnet is a flexible tool that integrates the capabilities of an EHR for PAH patients with those of a PAH registry. The ability to retrieve relevant information - although with all the limitations of any registry-based analysis - and to create appropriate CRF will facilitate the development of prospective and retrospective trials aimed at providing new 'real-life' evidence on PAH.
    Current Medical Research and Opinion 09/2014; DOI:10.1185/03007995.2014.960514 · 2.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Right ventricle compromise affects survival of patients with HIV-associated pulmonary artery hypertension (PAH).
    AIDS (London, England) 08/2014; 28(17). DOI:10.1097/QAD.0000000000000426 · 6.56 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Journal of Vascular Diagnostics Dovepress submit your manuscript | www.dovepress.com Dovepress 59 S t u Dy P r o t o c o l open access to scientific and medical research open Access Full text Article http://dx.doi.org/10.2147/JVD.S60526 using the MEM-net program to report on mapping the EchocolorDoppler assessment for chronic cerebro spinal venous insufficiency Introduction: Chronic cerebrospinal venous insufficiency (CCSVI) is characterized by multiple
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The intravenous inodilator levosimendan was developed for the treatment of patients with acutely decompensated heart failure. In the last decade scientific and clinical interest has arisen for its repetitive or intermittent use in patients with advanced chronic, but not necessarily acutely decompensated, heart failure. Recent studies have suggested long-lasting favourable effects of levosimendan when administered repetitively, in terms of haemodynamic parameters, neurohormonal and inflammatory markers, and clinical outcomes. The existing data, however, requires further exploration to allow for definitive conclusions on the safety and clinical efficacy of repetitive use of levosimendan. Methods and results A panel of 30 experts from 15 countries convened to review and discuss the existing data, and agreed on the patient groups that can be considered to potentially benefit from intermittent treatment with levosimendan. The panel gave recommendations regarding patient dosing and monitoring, derived from the available evidence and from clinical experience. Conclusions The current data suggest that in selected patients and support out-of-hospital care, intermittent/repetitive levosimendan can be used in advanced heart failure to maintain patient stability. Further studies are needed to focus on morbidity and mortality outcomes, dosing intervals, and patient monitoring. Recommendations for the design of further clinical studies are made.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Limited data are available on prognostic indicators for HIV patients presenting with ACS.
    Thrombosis Research 06/2014; DOI:10.1016/j.thromres.2014.05.037 · 2.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Right ventricular (RV) dyssynchrony has been described in pulmonary arterial hypertension (PAH), but no evidence is available on its morphological determinants and its effect on systolic function. Aim of this study was to evaluate the morphological determinants of RV dyssynchrony by echocardiographic and cardiac magnetic resonance imaging and its effect on systolic function. Methods In 60 consecutive idiopathic PAH (IPAH) patients with narrow QRS, RV dyssynchrony was evaluated by 2D speckle-tracking echocardiography calculating the standard deviation of the times to peak-systolic strain for the 4 mid-basal RV segments (RV-SD4). Patients were grouped by the median value of RV-SD4 (19 ms) and compared for RV remodeling and systolic function parameters, WHO class, pulmonary hemodynamics and 6-minute walk test (6MWT). Results Despite similar pulmonary vascular resistance and mean pulmonary arterial pressure, patients with RV-SD4 >19 ms had advanced WHO class, worse 6MWT, RV hemodynamics, RV remodeling and systolic function parameters compared to patients ≤19 ms. The morphological determinants of RV dyssynchrony resulted RV end-diastolic area, LV diastolic-eccentricity index and RV mass-volume ratio (r= 0.69; r2= 0.47; p<0.0001). Finally we found a significant inverse correlation between RV mid-basal segments post-systolic shortening time and cardiac index (r=-0.64, r2=0.41, p=0.001), accounting for the significant correlation between RV-SD4 and CI (r=0.57, r2=0.32, p=0.003). Conclusions In IPAH with narrow QRS, RV dyssynchrony is associated with RV dilatation and eccentric hypertrophy pattern, suggesting a role of segmental wall stress heterogeneity as the major determinant of mechanical delay. Post-systolic shortening, as inefficient contraction, contributes to pump dysfunction.
    The Journal of Heart and Lung Transplantation 06/2014; 34(3). DOI:10.1016/j.healun.2014.06.010 · 5.61 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Staging of heart failure represents a major issue in clinical practice. In this setting, MOGE(S) classification has been designed to be similar to TNM used in oncology. Nevertheless, MOGE(S) nosology is far away from the key elements of TNM classification, as well as simplicity and clinical applicability. In fact, MOGE(S) acronym refers to morphofunctional characteristics (M), organ involvement (O), genetic or familial inheritance pattern (G), etiological informations (E) and functional status (S). Recently, a new TNM-like classification for heart failure has been proposed. This classification, named HLM, refers to the heart damage, raising from impaired systolic or diastolic function without structural injury to bi-ventricular dysfunction (H), different stages of lung involvement (L) and malfunction of peripheral organs, like kidney, liver and brain (M). HLM classification is inspired to key elements of TNM staging: simplicity, clinical usefulness, efficacy for planning the therapeutic strategy and skill to identify patient prognosis. In conclusion, HLM classification seems to be easily applicable in the real world and to be valuable in order to balance economic resources to the clinical complexity of patients.
    Journal of the American College of Cardiology 05/2014; 63(19). DOI:10.1016/j.jacc.2014.02.552 · 15.34 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The intravenous inodilator levosimendan was developed for the treatment of patients with acutely decompensated heart failure. In the last decade scientific and clinical interest has arisen for its repetitive or intermittent use in patients with advanced chronic, but not necessarily acutely decompensated, heart failure. Recent studies have suggested long-lasting favourable effects of levosimendan when administered repetitively, in terms of haemodynamic parameters, neurohormonal and inflammatory markers, and clinical outcomes. The existing data, however, requires further exploration to allow for definitive conclusions on the safety and clinical efficacy of repetitive use of levosimendan. A panel of 30 experts from 15 countries convened to review and discuss the existing data, and agreed on the patient groups that can be considered to potentially benefit from intermittent treatment with levosimendan. The panel gave recommendations regarding patient dosing and monitoring, derived from the available evidence and from clinical experience. The current data suggest that in selected patients and support out-of-hospital care, intermittent/repetitive levosimendan can be used in advanced heart failure to maintain patient stability. Further studies are needed to focus on morbidity and mortality outcomes, dosing intervals, and patient monitoring. Recommendations for the design of further clinical studies are made.
    International journal of cardiology 04/2014; 174(2). DOI:10.1016/j.ijcard.2014.04.111 · 6.18 Impact Factor

Publication Stats

3k Citations
892.65 Total Impact Points

Institutions

  • 1987–2015
    • Sapienza University of Rome
      • • Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences
      • • Department of Biology and Biotechnology "Charles Darwin" BBCD
      • • Department of Clinical Medicine
      • • Department of Experimental Medicine
      Roma, Latium, Italy
  • 2014
    • Università degli Studi di Torino
      • Department of Medical Science
      Torino, Piedmont, Italy
  • 2013
    • Umberto I Policlinico di Roma
      Roma, Latium, Italy
  • 2012
    • The American University of Rome
      Roma, Latium, Italy
  • 2006
    • Tufts University
      • Department of Medicine
      Бостон, Georgia, United States
  • 1993
    • Catholic University of the Sacred Heart
      • Institute of Biochemistry and Clinical Biochemistry
      Milano, Lombardy, Italy
  • 1990–1993
    • University of Rome Tor Vergata
      Roma, Latium, Italy
  • 1992
    • Università degli Studi dell'Aquila
      Aquila, Abruzzo, Italy