[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.
[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.
[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%.
[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; 30(12):1-0. DOI:10.1185/03007995.2014.960514 · 2.37 Impact Factor
[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
[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.
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: Aims: Limited data are available on prognostic indicators for HIV patients presenting with ACS. Methods and results: Data on consecutive patients with HIV infection receiving standard highly active antiretroviral therapy (HAART) presenting with ACS between January 2001 and September 2012 were collected. Cardiac death and myocardial infarction (MI) were the primary end-points. 10,050 patients with ACS were screened, and among them a total of 201 patients (179 [89%] males and a median age of 53 [47-62] years) were included, 48% of them admitted for ST-elevation myocardial infarction and 14% having left ventricular systolic dysfunction (LVSD) at discharge. CD4+ counts less than 200 cells/mm(3) were reported in 18 patients (9%), and 136 patients (67%) were treated with nucleoside-reverse transcriptase inhibitors (NRTI). After a median of 24 months (10-41), 30 patients (15%) died, 12 (6%) for cardiac reasons, 20 (10%) suffered a MI, 29 (15%) a subsequent revascularization, and 7 (3%) a stent thrombosis. Other than LVSD (hazard ratio = 6.4 [95% confidence interval [CI]: 1.6-26: p = 0.009]), the only other independent predictor of cardiac death was not being treated with NRTI (hazard ratio = 9.9 [95% CI: 2.1-46: p = 0.03); a CD4 cell count <200 cells/mm(3) was the only predictor of MI (hazard ratio = 5.9 [95% CI: 1.4-25: p = 0.016]). Conclusions: HIV patients presenting with ACS are at significantly increased risk for cardiac death if not treated with NRTI, and at significantly increased risk of MI if their CD4 cell count is <200 cells/mm(3), suggesting that the stage of HIV disease (and lack of NRTI treatment) may contribute to cardiovascular instability.
Thrombosis Research 06/2014; 134(3). DOI:10.1016/j.thromres.2014.05.037 · 2.43 Impact Factor