Gaetano Lanza

Publications (6)13.39 Total impact

• Chapter: Alternative Mechanisms for Myocardial Ischemia in Syndrome X - New Diagnostic Markers

  Filippo Crea, Antonio Buffon, Achille Gaspardone, Gaetano Lanza
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  ABSTRACT: Exertional chest pain, positive exercise test responses and the presence of transient ST segment depression during Holier monitoring strongly suggest the occurrence of myocardial ischemia in syndrome X. However, carefully conducted studies have failed to show: (i) myocardial lactate production during pacing [1,2]; (ii) increases in pulmonary pressure during spontaneous episodes of transient ST segment depression [3]; (iii) abnormalities of left ventricular wall motion as assessed by two-dimensional echocardiography during dipyridamole testing [4]; (iv) decreases in coronary sinus blood oxygen saturation [5] or of pH [6] during atrial pacing; (v) regional perfusion abnormalities during positron emission tomography [7]. Yet, a sizable proportion of patients with syndrome X exhibit an alteration of coronary circulation as suggested by: (i) an abnormally small increase in coronary flow in response to dipyridamole or pacing [8,9], particularly after ergonovine administration [10]; (ii) heterogeneous myocardial perfusion both at rest and during dipyridamole infusion as assessed by positron emission tomography [11,12] and (iii) a regional reduction of thallium uptake during exercise or dipyridamole infusion [13-15].
  07/2011: pages 123-133;
• Article: Rationale and design of the Randomized comparison of XiEnce V and Multilink VisioN coronary stents in the sAme muLtivessel patient with chronic kiDnEy disease (RENAL-DES) study.

  Fabrizio Tomai, Alessandro Petrolini, Leonardo De Luca, Francesco Nudi, Gaetano Lanza, Corrado Vassanelli, Flavio Ribichini
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  ABSTRACT: Percutaneous coronary intervention with bare metal stents (BMS) in patients with chronic kidney disease (CKD) has shown suboptimal results. Drug-eluting stents (DESs) might reduce the incidence of restenosis and therefore of target lesion revascularization in these patients. Of note, in patients with CKD, multiple concomitant individual variables may be responsible for neointimal hyperplasia after coronary stenting, thus making the comparison of BMS and DES in different patient groups difficult. The RENAL-DES is a prospective, randomized, multicenter, not-sponsored study to directly compare the efficacy in the prevention of clinical restenosis, of everolimus-eluting stent (Xience V) and BMS with identical design (Multilink Vision), both implanted in the same patient with multivessel coronary artery disease and CKD in order to obviate the multiple and unpredictable baseline differences. The primary endpoint of the study is 9-month ischemia-driven target vessel revascularization. The expected primary endpoint rates are 20% for BMS and 10% for DES. According to these estimates, with a significant level of 0.05, a sample size of 194 patients provides an 80% statistical power. Assuming a 10% dropout rate, the goal is to enroll 213 patients (426 treated vessels) from five Italian centers. As 20% of the patients will likely require stent implantation in three vessels, approximately 500 treated vessels will be analyzed. This intraindividual, randomized study will provide, for the first time, data on the efficacy, in the prevention of clinical restenosis, of DES compared to BMS in patients with multivessel coronary artery disease and CKD (ClinicalTrials.gov Identifier: NCT 00818792).
  Journal of Cardiovascular Medicine 11/2009; 11(4):310-7. · 1.51 Impact Factor
• Article: Predictors of exercise-induced platelet reactivity in patients with chronic stable angina.

  Giancarla Scalone, Gaetano A Lanza, Gregory A Sgueglia, Alfonso Sestito, Fabio Infusino, Lucy Barone, Antonio Di Monaco, Cristina Aurigemma, Ilaria Coviello, Roberto Mollo, Chiara Pisanello, Felicita Andreotti, Filippo Crea
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  ABSTRACT: Previous studies have shown that exercise increases platelet reactivity in patients with coronary artery disease (CAD). However, the response of platelet reactivity to exercise is considerably variable and its predictors are poorly known. We studied 214 consecutive patients (age 61.9 +/- 9 years, 167 men) with stable angina and obstructive coronary artery disease. All patients underwent a symptom-limited treadmill exercise stress test. Venous blood samples were collected before and at peak exercise. Platelet reactivity was assessed by the platelet function analyzer system as the time for flowing whole blood to occlude a collagen-adenosine diphosphate ring (closure time: shorter times = higher reactivity). Both closure time at peak exercise and the exercise-induced change in closure time from rest were assessed as an expression of exercise-related platelet reactivity. Closure time decreased significantly with exercise in the whole population (from 95.9 +/- 22 to 81.2 +/- 18 s, P < 0.001). The only variable significantly associated with closure time at peak exercise was hematocrit (P = 0.003). Basal systolic blood pressure (P = 0.023) and lack of nitrate use (P = 0.03), on the contrary, were the only variables significantly associated with increased exercise-induced closure time change. Peak hematocrit maintained an independent association with peak closure time in multivariable analysis, although the correlation was mild. No variable, on the contrary, was associated with exercise-induced platelet reactivity after correction for basal closure time values at multivariable analyses. Among stable coronary artery disease patients, platelet reactivity after exercise cannot be reliably predicted by several common clinical and laboratory variables.
  Journal of Cardiovascular Medicine 09/2009; 10(12):891-7. · 1.51 Impact Factor
• Article: Effect of pioglitazone on systemic inflammation is independent of metabolic control and cardiac autonomic function in patients with type 2 diabetes.

  Roberto Nerla, Dario Pitocco, Francesco Zaccardi, Giancarla Scalone, Ilaria Coviello, Roberto Mollo, Giovanni Ghirlanda, Gaetano A Lanza, Filippo Crea
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  ABSTRACT: The aim of this article is to investigate the relation of the anti-inflammatory effect of pioglitazone with cardiac autonomic function and metabolic control in diabetic patients. In this prospective open label trial, 36 type 2 diabetic patients (age 60 ± 10, 20 M) without overt cardiovascular disease were randomized to add pioglitazone (30 mg) to their therapy or to continue standard therapy. C-reactive protein (CRP) serum levels, metabolic parameters and cardiac autonomic function (assessed by heart rate variability [HRV] on 24-h ECG Holter monitoring) were measured at baseline and after 3 months. Clinical and laboratory variables were similar in the two groups. No significant changes were observed after 3 months for metabolic and anthropometric parameters, except for a mild increase in HDL levels in the pioglitazone group only (P = 0.04 vs. controls). CRP levels decreased significantly at follow-up in the pioglitazone group (3.2 ± 1.97 vs. 2.37 ± 1.56 mg/l) but not in the control group (3.0 ± 1.92 vs. 3.93 ± 2.14 mg/l; P = 0.003). No differences were found in basal and follow-up HRV variables between the two groups. In type 2 diabetic patients pioglitazone exerts favourable effects on inflammation even after short-term therapy. This effect precedes those on metabolic and anthropometric parameters and is not associated with changes in cardiac autonomic function.
  Acta Diabetologica 09/2009; 47(Suppl 1):117-22. · 2.78 Impact Factor
• Article: Functional and structural correlates of persistent ST elevation after acute myocardial infarction successfully treated by percutaneous coronary intervention.

  Leonarda Galiuto, Sabrina Barchetta, Serena Paladini, Gaetano Lanza, Antonio G Rebuzzi, Mario Marzilli, Filippo Crea
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  ABSTRACT: In the thrombolytic era, persistence of ST-segment elevation was considered a marker of left ventricular (LV) aneurysm. ST-segment elevation may still be found persistently raised after successful primary percutaneous coronary intervention (PCI). Echocardiographic correlates of this finding, however, are still poorly known. 82 consecutive patients with first ST-segment elevation myocardial infarction and successful PCI were divided into patients with persistent ST-segment elevation at discharge (sum of ST >4 mm) (n = 33) and those without persistent ST-segment elevation (n = 49). Conventional and myocardial contrast echocardiography were performed at discharge and at 6 months. At discharge, LV aneurysm was more common in patients with persistent ST elevation (27% vs 8%, p<0.005). Similarly, the wall motion score index was higher (2.5 vs 2.0, p<0.005) and microvascular damage larger (2.3 vs 1.8, p<0.005) in patients with persistent ST-segment elevation. At 6 months' follow-up, LV volumes were similar in the two groups. After primary PCI, persistent ST-segment elevation is associated with LV aneurysm formation in 30% of cases, it is not associated with significantly larger LV dilatation but with larger microvascular damage and dysfunctioning risk area.
  Heart (British Cardiac Society) 11/2007; 93(11):1376-80. · 4.22 Impact Factor
• Article: Noninvasive evaluation of flow reserve in the left anterior descending coronary artery in patients with cardiac syndrome X.

  Leonarda Galiuto, Alfonso Sestito, Sabrina Barchetta, Gregory A Sgueglia, Fabio Infusino, Claudio La Rosa, Gaetano Lanza, Filippo Crea
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  ABSTRACT: Data on coronary flow reserve (CFR) in patients with syndrome X are still controversial. Further, noninvasive evaluation of epicardial and microvascular flow reserves in these patients has never been performed. In 17 patients with syndrome X and in 17 age- and gender-matched control subjects, CFR in the mid left anterior descending coronary artery (LAD) was evaluated by transthoracic color and pulse-wave Doppler using a 7-mHz probe (Sequoia, Siemens). Peak diastolic LAD flow was calculated at rest and at peak adenosine (140 microg/kg/min intravenously in 90 seconds). Myocardial contrast echocardiography (MCE) was performed at rest and during adenosine use by real-time cadence pulse sequencing and intravenous SonoVue (Bracco; 5 ml at 1 ml/min) and microvascular blood volume (A), velocity (beta), and flow (Axbeta) by replenishing curves (y = A[1 - e(betat)]). CFR was measured by Doppler echocardiography as an adenosine/rest velocity ratio and by MCE as a microvascular volume, velocity, and flow adenosine/rest ratio. Compared with controls, patients with syndrome X demonstrated lower LAD CFR and velocity and flow microvascular flow reserves (p <0.01, <0.005, and <0.005, respectively). In patients with syndrome X, those with angina and ST-segment depression during adenosine testing had even lower LAD CFR and velocity and flow microvascular flow reserves compared with those with no symptoms (p <0.0001, <0.0001, and <0.005, respectively). LAD CFR demonstrated a significant linear correlation with velocity microvascular flow reserve (r = 0.92, p <0.0001) and flow microvascular flow reserve (r = 0.77, p <0.0001). In conclusion, CFR in the LAD, successfully evaluated by transthoracic Doppler echocardiography and MCE, is significantly decreased in patients with syndrome X and even more in those with angina pectoris and ST-segment depression during adenosine testing. Thus, noninvasive evaluation of CFR by echocardiography is feasible and provides information on the severity of microvascular impairment.
  The American Journal of Cardiology 05/2007; 99(10):1378-83. · 3.37 Impact Factor