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International journal of cardiology 04/2011; 148(2):256-7. · 7.08 Impact Factor
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Francesco Grigioni,
Antonio Russo,
Luciano Potena,
Alfonso Ielasi,
Francesca Fabbri,
Letizia Bacchi-Reggiani, Samuela Carigi,
Anna C Musuraca,
Mauro Bigliardi,
Fabio Coccolo,
Gaia Magnani,
Salvatore Specchia,
Carlo Magelli,
Angelo Branzi
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ABSTRACT: Chronic heart failure (CHF) patients with intermediate cardiopulmonary capacity referred for heart transplantation are at "medium risk," and are not amenable to further stratification based solely on peak VO(2.) Accordingly, we analyzed whether time-related and/or non-time-related parameters could provide incremental prognostic information in CHF patients with intermediate cardiopulmonary capacity.
We analyzed 134 patients with a peak VO(2) of 10 to 18 ml/kg/min (age 54 +/- 9 years, 66% males) and a left ventricular ejection fraction (LVEF) of 27% +/- 8% who underwent an extensive clinical/instrumental (electrocardiogram, echocardiogram, cardiopulmonary exercise test) index evaluation; for all patients, an equivalent pre-study evaluation (performed >or=6 months before) was also available.
Among index-evaluation parameters, systolic blood pressure (p < 0.001), LVEF (p = 0.036), and presence of severe mitral regurgitation (p = 0.006) independently predicted cardiac death/need for heart transplantation. Stable clinical condition from pre-study to index-evaluation accompanied by <10% QRS widening and <10% decrease in peak VO(2) provided incremental prognostic information with respect to all index-evaluation parameters (p = 0.014).
CHF patients with intermediate peak VO(2) who display "stable" CHF present a lower incidence of adverse cardiac events, particularly in the absence of hypotension, severe mitral regurgitation, and severe reduction of LVEF. Such a stratification might be clinically useful for deciding between medical treatment alone and consideration for heart transplantation.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 01/2006; 25(1):85-9. · 3.54 Impact Factor
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Francesco Grigioni,
Anna Chiara Musuraca,
Eliana Tossani,
Luciano Potena,
Fabio Coccolo,
Monica Naldi,
Francesca Fabbri,
Antonio Russo, Samuela Carigi,
Gaia Magnani,
Romano Zannoli,
Laura Sirri,
Silvana Grandi,
Giorgio Arpesella,
Carlo Magelli,
Angelo Branzi
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ABSTRACT: Evidence of a lack of relationship between psychiatric disorders and physical status during a heart transplantation (HT) program would configure mental well-being as an independent endpoint deserving specific interventions.
We report a prospective, longitudinal study on patients (n=127) undergoing HT in order to investigate the relationship between psychiatric disorders and physical status.
At pre-HT evaluation, at least one psychiatric disorder according to the DSM-IV diagnoses was present in 27 patients (21%); the prevalence of psychiatric disorders was not related (p > or = 0.150) to physical status (assessed by clinical, electrocardiographic, echocardiographic, and hemodynamic parameters). At post-HT evaluation 1 year after HT, all clinical-instrumental parameters significantly improved (p < or = 0.016), but not the prevalence of psychiatric disorders, which were diagnosed in 34 patients (p = 0.016 vs pre-HT).
During the HT program, no significant relationship exists between physical status and prevalence of psychiatric disorders, which increases after the operation. This finding indicates the need for the mandatory provision of adequate psychological support during all of the phases of the HT experience.
Italian heart journal: official journal of the Italian Federation of Cardiology 11/2005; 6(11):900-3.
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Luciano Potena,
Francesco Grigioni,
Gaia Magnani,
Paolo Ortolani,
Fabio Coccolo,
Simonetta Sassi,
Koen Kessels,
Koen Koessels,
Cinzia Marrozzini,
Antonio Marzocchi, Samuela Carigi,
Anna C Musuraca,
Antonio Russo,
Carlo Magelli,
Angelo Branzi
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ABSTRACT: Although observational studies suggest that hyperhomocysteinemia may be a risk factor for coronary allograft vasculopathy (CAV), prospective data on homocysteine-lowering interventions and CAV development are lacking. We, therefore, randomized 44 de novo heart transplant (HT) recipients to 15 mg/day of 5-methyl-tetrahydrofolate (n=22), or standard therapy (control group, n=22) to investigate the effect of homocysteine lowering on the change in coronary intimal hyperplasia during the first 12 months after transplant, as detected by intra-vascular ultrasound (IVUS). Although 12 months after HT, homocysteinemia was lower in folate-treated patients (p<0.001), coronary intimal area increased similarly in the two groups (p>0.4). Conversely, hypercholesterolemia and cytomegalovirus infection were both associated with increased intimal hyperplasia (p<0.04), independently from folate intake. Sub-group analysis revealed that folate therapy reduced intimal hyperplasia in patients with hyperhomocysteinemia before randomization (n=19; p=0.02), but increased intimal hyperplasia in patients with normal homocysteine plasma concentrations (p=0.02). This bimodal effect of folate therapy persisted significantly after adjusting for cytomegalovirus infection and hypercholesterolemia. Despite effective in prevent hyperhomocysteinemia after heart transplantation, folate therapy does not seem to affect early CAV onset. However, sub-group analysis suggests that folate therapy may delay CAV development only in patients with baseline hyperhomocysteinemia, while may favor CAV progression in recipients with normal baseline homocysteinemia.
American Journal of Transplantation 09/2005; 5(9):2258-64. · 6.39 Impact Factor
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Francesco Grigioni,
Alessandra Barbieri,
Gaia Magnani,
Luciano Potena,
Fabio Coccolo,
Giuseppe Boriani,
Salvatore Specchia, Samuela Carigi,
Annachiara Musuraca,
Romano Zannoli,
Carlo Magelli,
Angelo Branzi
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ABSTRACT: In heart failure (HF), it is not known whether analysis of serial changes in prognostic parameters provides incremental information with respect to comprehensive isolated clinical and instrumental assessments.
We analyzed time-related changes in a period > or =6 months in a broad panel of clinical and instrumental (electrocardiographic, echocardiographic, hemodynamic, and cardiopulmonary) parameters in 105 patients with HF (age, 53 +/- 10 years; 88% men; 55% New York Heart Association classification III-IV; EF, 24% +/- 6%).
Among the time-related parameters, QRS widening (adjusted RR per 10 ms, 1.21; 95% CI, 1.10-1.48; P =.003) and peak oxygen uptake (pVO2) decrease (adjusted RR per mL/Kg/min, 1.11; 95% CI, 1.01-1.22; P =.034) provided independent, incremental information for predicting cardiac death/need for heart transplantation (CD/HT) with respect to the entire panel of isolated readings. The overall rate of CD/HT-free survival after 12 months was 60% +/- 5%. Patients who were clinically stable with QRS widening and pVO2 decrease values of <10% had a better CD/HT event-free survival rate at 1 year (92% +/- 5% vs 50% +/- 6%; P <.001).
This study indicates that analysis of time-related changes in prognostic parameters provides relevant incremental prognostic information and may help in the risk stratification of patients with HF and the selection of candidates for HT. In particular, patients who were clinically stable and had QRS widening and a pVO2 decreases <10% in a period > or =6 months appear to be characterized by a good prognosis and may not be suitable candidates for HT.
American heart journal 08/2003; 146(2):298-303. · 4.65 Impact Factor
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Francesco Grigioni, Samuela Carigi,
Silvana Grandi,
Luciano Potena,
Fabio Coccolo,
Letizia Bacchi-Reggiani,
Gaia Magnani,
Eliana Tossani,
Anna Chiara Musuraca,
Carlo Magelli,
Angelo Branzi
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ABSTRACT: Chronic heart failure (CHF) is a socially relevant condition carrying an adverse prognosis. Systematic analysis is needed of the relationship between quality of life (QoL) - what patients are most interested in - and objective parameters of CHF severity - which largely determines physicians' care.
We prospectively investigated QoL, as ascertained by the Minnesota Living with Heart Failure Questionnaire, alongside all the currently used objective clinical/instrumental (electrocardiographic, echocardiographic, hemodynamic and functional capacity) indicators of disease severity in 106 consecutive CHF patients.
Besides persistence of sinus rhythm (p = 0.007), the only objective parameters that correlated with QoL were NYHA class (p < 0.001) and distance covered during the six minutes walking test (p < 0.001) (two indications of patients' ability to attend to their daily needs). Presence of left bundle branch block was associated with a worse QoL only in patients with CHF due to ischemic heart disease (p = 0.032). All the other clinical/instrumental parameters showed no relation with QoL (p > 0.150 in all cases).
Objective indicators of disease severity, which largely determine physicians' care, appear to have little bearing on QoL, suggesting that current treatment for CHF fails to satisfy patients' perceived needs. The possibility of cost-effective nonpharmaceutical therapeutic protocols (e.g. psychological interventions) specifically designed to improve patients' QoL deserves investigation as a much needed new approach to the management of CHF.
Psychotherapy and Psychosomatics 72(3):166-70. · 6.28 Impact Factor
