Michele Schiariti

• Doctor
• Researchear at Sapienza University of Rome

Congestive heart failure is a chronic medical condition that affects about 2 % of the adult population. Even though it cannot be cured, it can be relieved by a proper, long-term, complex and personalized disease management. In this paper we present the HeartMan Decision Support System (DSS), aimed at supporting individual patients in their uptake o...

This study tested the effectiveness of HeartMan—a mobile personal health system offering decisional support for management of congestive heart failure (CHF)—on health-related quality of life (HRQoL), self-management, exercise capacity, illness perception, mental and sexual health. A randomized controlled proof-of-concept trial (1:2 ratio of control...

Background Congestive heart failure (CHF) is a disease that requires complex management involving multiple medications, exercise, and lifestyle changes. It mainly affects older patients with depression and anxiety, who commonly find management difficult. Existing mobile apps supporting the self-management of CHF have limited features and are inadeq...

BACKGROUND Congestive heart failure (CHF) is a disease that requires complex management involving multiple medications, exercise, and lifestyle changes. It mainly affects older patients with depression and anxiety, who commonly find management difficult. Existing mobile apps supporting the self-management of CHF have limited features and are inadeq...

We tested the hypothesis that adjunctive thrombolysis at time of primary percutaneous coronary intervention (PCI) may affect favourably the long-term outcome of patients with ST elevation myocardial infarction (STEMI). To this end, we undertook a substudy of the DISSOLUTION (Delivery of thrombolytIcs before thrombectomy in patientS with ST-segment...

Patient-reported outcomes (PROs) have been previously considered “soft” end-points because of the lack of association of the reported outcome to measurable biological parameters. The present study aimed to assess whether electrocardiographic measures are associated to PROs changes. We evaluated the association between heart rate (HR), QRS and QT/QT...

Calcified coronary plaque represents a challenging scenario for interventional cardiology. It is often associated with stent under-expansion during percutaneous coronary intervention. We report two cases of unexpected coronary stent under-expansion due to heavily calcified plaque, successfully treated with shockwave coronary lithoplasty.

New findings: What is the central question of this study? The aim was to determine impaired deformational indicators for G+LVH- in Hypertrophic Cardiomyopathy using non-invasive 3D echocardiography. What are the main findings and its importance? Our results indicate that, using 3DSTE and modern shape analysis, peculiar deformational impairments ca...

In a previous contribution a new Riemannian shape space, named TPS space, was introduced to perform statistics on shape data. This space was endowed with a Riemannian metric and a flat connection, with torsion, compatible with the given metric. This connection allows the definition of a Parallel Transport of the deformation compatible with the thre...

Background: Heart failure (HF) is a highly prevalent chronic disease, for which there is no cure available. Therefore, improving disease management is crucial, with mobile health (mHealth) being a promising technology. The aim of the HeartMan study is to evaluate the effect of a personal mHealth system on top of standard care on disease management...

Left ventricle and left atrium are and have been practically always analyzed separately in common clinically and non-clinically oriented cardiovascular investigations. Both classic and speckle tracking echocardiographic data contributed to the knowledge about deformational impairments occurring in systo-diastolic differences. Recently new trajector...

Age is an important prognostic factor in the outcome of acute coronary syndromes (ACS). A substantial percentage of patients who experience ACS is more than 75 years old, and they represent the fastest-growing segment of the population treated in this setting. These patients present different patterns of responses to pharmacotherapy, namely, a high...

Anticoagulant therapy has been used with great effect for decades for the prevention of stroke among patients with atrial fibrillation. In recent years, the therapeutic armamentarium has been strengthened considerably, with the addition of anticoagulants acting through novel pathways. The currently available novel agents are apixaban, rivaroxaban a...

Refractory angina pectoris (RAP) is a clinical problem, frequently encountered in the elderly, associated with high health-care costs. Until recently, the goal of RAP treatment aimed at improving the quality of life (QoL) because it was thought that mortality rates were not different between stable angina pectoris and RAP. Our purpose was at determ...

The role played by glycoprotein (GP) IIb/IIIa inhibitors (GPI) has continuously evolved until the most recent Guidelines whereby they were stepped down from class I to class II recommendation for treating acute coronary syndromes (ACS). GPI compete with a wider use of ADP inhibitors and novel anticoagulant drugs although GPI use has greatly narrowe...

Background: There are no ready explanations for differences in ischemic heart disease incidence between women and men under an epidemiological perspective. However, when myocardial infarction occurs, there are more likely individuals who happen to die. Methods: This review from a more recent literature was performed for a two-fold purpose, to de...

Remote Health Monitoring (RHM) applications encounter limitations from technological front viz. bandwidth, storage and transmission time and the medical science front i.e. usage of 2-3 lead systems instead of the standard 12-lead (S12) system. Technological limitations constraint the number of leads to 2-3 while cardiologists accustomed with 12-Lea...

Background: Vectorcardiogram (VCG) has been repeatedly found useful for clinical investigations. It may not substitute but complement Standard 12-Lead (S12) ECG. There was tremendous research between 1950s to mid-1980s on VCG in general and Frank's System in particular, however, in last three decades it has been dropped as a routine cardiac test,...

Spironolactone was first developed over 50 years ago as a potent mineralocorticoid receptor antagonist with undesirable side effects; it was followed a decade ago by eplerenone, which is less potent but much more mineralocorticoid receptor-specific. From a marginal role as a potassium-sparing diuretic, spironolactone has been shown to be an extraor...

The assessment of left ventricular shape changes during cardiac revolution may be a new step in clinical cardiology to ease early diagnosis and treatment. To quantify these changes, only point registration was adopted and neither Generalized Procrustes Analysis nor Principal Component Analysis were applied as we did previously to study a group of h...

Steroid hormones appear to be a key factor in the gender differences in the rates and severity of cardiovascular diseases. Aldosterone and testosterone have typical steroid ring structure but despite this, they demonstrate very different properties. During acute myocardial ischemia-reperfusion, the deleterious impact of aldosterone is now well esta...

Objectives: To evaluate the potential benefit of systematic preoperative coronary-artery angiography followed by selective coronary-artery revascularization on the incidence of myocardial infarction (MI) in patients undergoing carotid endarterectomy (CEA) without a previous history of coronary artery disease (CAD). Methods: We randomised 426 pat...

In this article, we have proposed a robust and accurate method for the reconstruction of standard 12-lead (S12) system from Frank vectorcardiographic (FV) system using personalised transformation (PT) matrices targeting personalised remote health monitoring applications. FV system is used in the 3D visualisation of heart and diagnosis and prognosis...

Cardiovascular diseases (CVD) are the prime causes of human mortality and morbidity worldwide. However, CVD can be prevented or cured, if detected early or on-time, where technology can be of significant help. Tackling the issue of comfort of patient by reducing the number of electrode, by allowing the remote home monitoring, and by allaying the ne...

3-dimensional (3D) speckle tracking-based motion-detecting echocardiography (STE) was used in order to evaluate left ventriculum (LV) rotation, twist and torsion in 16 segments (base, medium, apex and global) in 32 healthy subjects. All parameters were indexed by body surface area. Then, gender-related differences were removed by gender-centering t...

Advanced wireless technology, high speed internet facility and availability of other communication systems can be used to provide the accessibility of state-of-the-art healthcare facilities to the patients in remote and rural areas for monitoring and diagnosis of cardiovascular diseases, one of the prime causes of human mortality today. Telemonitor...

There are few critical questions to answer in relation to remote healthcare systems and the pertinent technologies implied in transferring surveillance and care next to the patients: (1) will they help reducing and/or at least rationalizing care and lower hospitalizations and connected high costs?; (2) will this be really at hand in the near future...

Remote areas, generally, encounter scarcity of cardiologists and state-of-the-art facilities for the treatment of cardiovascular diseases (CVD). However, aforementioned constraints can be addressed using recent advancements in wireless technology and its omnipresence. Clinical CVD diagnosis is, generally, carried out using either of Standard 12-Lea...

Acute pulmonary embolism (PE) is a common complication in hospitalized patients, spanning multiple patient populations and crossing various therapeutic disciplines. Current treatment paradigm in patients with massive PE mandates prompt risk stratification with aggressive therapeutic strategies. With the advent of endovascular technologies, various...

The aim of this study is to investigate human left ventricular heart morphological changes in time among 17 healthy subjects. Preliminarily, 2 patients with volumetric overload due to aortic insufficiency were added to our analyses. We propose a special strategy to compare the shape, orientation and size of cardiac cycle's morphological trajectorie...

Cardiovascular diseases (CVD) are the prime causes of human mortality and morbidity worldwide. However, CVD can be prevented or cured, if detected early or on-time, where technology can be of significant help. Tackling the issue of comfort of patient by reducing the number of electrode, by allowing the remote home monitoring, and by allaying the ne...

Fragmented QRS (f-QRS) has been proven to be an efficient biomarker for several diseases, including remote and acute myocardial infarction, cardiac sarcoidosis, non-ischaemic cardiomyopathy, etc. It has also been shown to have higher sensitivity and/or specificity values than the conventional markers (e.g. Q-wave, ST-elevation, etc.) which may even...

Fragmented QRS (f-QRS) has been found to have higher sensitivity and/or specificity values for several diseases including remote and acute myocardial infarction, cardiac sarcoidosis etc, compared to other conventional bio-markers viz. Q-wave, ST-elevation etc. Several of these diseases do not have a reliable bio-marker and hence, patients suffering...

Abstract In recent years, the therapeutic use of non-drug substances such as herbal and medicinal foods is increasing progressively. Of these substances, Punica granatum L., which is an ancient and highly distinctive fruit, has been proposed for treatment of several different illnesses. Ellagic acid (EA) is one of those biological molecules found i...

Background: The association between endothelial progenitor cells (EPCs) at the time of percutaneous coronary intervention (PCI) and the subsequent long-term clinical outcome remains undefined. To address this issue, a pre-specified analysis of the PROgenitor Cells role in Restenosis and progression of coronary ATherosclerosis after percutaneous co...

An ischemia/reperfusion-simulating model in rabbit tissue should be right oriented and clinically relevant to provide a non expensive approach for manipulations of currents involved in the repolarization process. Standard right ventricular guinea-pig (N=18) and newly investigated rabbit (N=12) myocardial strips were placed in a special perfusion ch...

The prevalence of isolated right ventricular infarction is 0.4-2.4% in autopsy series and may occur by at least three different mechanisms, of which occlusion of a nondominant right coronary artery is reviewed here. Although rare, as oxygen demand/supply of the right is lower than that of the left ventricle, due to the smaller muscular mass, and it...

Noninvasive coronary angiography with multislice computed tomography (CT) scanners is feasible with high sensitivity and negative predictive value. The radiation exposure associated with this technique, however, is high and concerns in the widespread use of CT have arisen. We evaluated the diagnostic accuracy of coronary angiography using 320-row C...

Remote monitoring of congestive heart failure and acute coronary disease (CHF/ACD) using automated monitoring devices and bespoke care pathways/protocols to give early warning of deterioration and facilitate pre-emptive action may be an important solution to the dual problem of increasing healthcare need but static (or reducing) healthcare resource...

Antiplatelet treatment in patients with an acute coronary syndrome (ACS), without or with ST segment elevation myocardial infarction (STEMI), forces to keep the balance between potential threats and optimal clinical advantages. Apart from clopidogrel, glycoprotein (GP) IIb/IIIa inhibitors (abciximab and 2 small molecules, tirofiban and eptifibatide...

There is no head-to-head comparison between tirofiban versus eptifibatide in patients undergoing percutaneous coronary intervention (PCI) when added to standard antiaggregating drugs (AAD) to prevent ischemic events within 1 year. We compared real-world patients undergoing PCI who were on oral single AAD and were block randomized to receive, immedi...

There is some controversy as to whether tirofiban or eptifibatide, two small anti-aggregating drugs (AAD), may reduce the incidence of composite ischemic events within one year in patients undergoing percutaneous coronary intervention (PCI) in the real clinical world. We compared consecutive patients on oral double AAD (with clopidogrel and aspirin...

To evaluate the usefulness of systematic coronary angiography followed, if needed, by coronary artery angioplasty (percutaneous coronary intervention (PCI)) on the incidence of cardiac ischaemic events after carotid endarterectomy (CEA) in patients without evidence of coronary artery disease (CAD). From January 2005 to December 2008, 426 patients,...

The Sant'ANna TIrofiban Safety study (SANTISS) is an open-label investigator-initiated single-centre registry launched to assess the combination of bleeding and access site in-hospital complications (primary end-point) in patients undergoing percutaneous coronary intervention (PCI) by femoral approach only. We compared patients who were on oral sin...

A 59-year old woman was admitted at emergency for palpitation and dizziness. Medication history showed trimebutine 450 mg daily, because of meteorism, increased to 450 mg TID a week earlier. At admittance, sustained monomorphic ventricular tachycardia was interrupted by 100 mg intravenous lidocaine and a largely prolonged QTc (523 ± 12 ms) was seen...

A 23-year-old male patient, with a diagnosed mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes, was referred for recurrent fainting. Long sinus pauses were documented, and an atrial pacemaker with an active-fixation lead was implanted. He was admitted again 4 months later because of chest pain and diffuse ST segment c...

Exercise-induced ST-segment elevation in patients without previous myocardial infarction is a relatively uncommon finding. When it does occur, it may be associated with significant coronary artery disease or coronary vasospasm. Here we describe a case of exercise-induced ST-segment elevation in both anterior and inferior leads in a patient with a c...

To reduce risks, discomfort, cost, and operative time for percutaneous patent foramen ovale (PFO) closure, we propose to perform this procedure under transesophageal echo-guidance using a 10 Fr. catheter introduced through nasal way (TEENW). Transesophageal or intracardiac echocardiography is commonly used to guide percutaneous PFO closure. Sedatio...

Images are presented of coronary reperfusion that occurred shortly after insertion of an intra-aortic balloon pump for counter-pulsation in 3 patients with acute myocardial infarction refractory to thrombolytic therapy and hemodynamic derangement. It is shown that prophylactic intra-aortic balloon pump use may facilitate percutaneous coronary inter...

The aim of this study was to compare the risk of death predictive performances of the OP-RISK, EuroSCORE, and Italian coronary artery bypass grafting (CABG) Outcome studies' functions when applied to a southern Italian cardiac surgery center (Sant'Anna hospital in Catanzaro [SAHCZ]), which contributed data to the Italian CABG Outcome study, and to...

Dobutamina Studio Italiano Multicentrico (Do.S.I.M.) is a prospective, randomized, multicenter interuniversity Italian study aimed at assessing the effects of dobutamine on spontaneous variability of ventricular arrhythmias in sinus rhythm NYHA class III-IV patients with congestive heart failure (CHF). Out of 74 pre-hoc estimated CHF patients, 68 (...

The hypothesis that in normotensive offspring of hypertensive parents exercise training could influence the systemic release of endothelin (ET)-1 during a provocative testing protocol was tested. The provocative handgrip test was performed in four groups of healthy young age-matched males: offspring of hypertensive parents following a regular swimm...

We aimed at investigating frequency-related changes of human atrial action potential (AP) in vitro to see whether baseline AP shape might account for different responses to increasing stimulation rates. Human right atrial trabeculae (n = 48) obtained from adult (n = 38, mean age 59 +/- 8, range 45-72 years) consecutive patients (approximately equal...

The relative effects of nicotinic acid (NA) and nitroglycerin (NT) added to cold high K+ cardioplegia were studied, to represent the two moieties of the adenosine triphosphate-sensitive potassium channel (KATP) activator nicorandil (N). In addition, we made a pooled analysis of a large series of experiments performed in our Laboratory to investigat...

The hypothesis that nicorandil might enhance myocardial protection due to cold St Thomas' Hospital (STH) solution ([K+]o 16 mmol/l) through opening of cardiac KATP channels was assessed in isometrically contracting guinea-pig papillary muscles submitted to 120 min of cardioplegic hypoxia followed by 60 min of normothermic reoxygenation. Right ventr...

Drug-induced opening of the adenosine triphosphate-sensitive potassium channel (KATP) during hypoxia and/or ischemia, achieved significant myocardial protection in several in vitro and in vivo models. Pretreatment with KATP openers simulated preconditioning and thus enhanced recovery from ischemia. We have demonstrated that the risk of hypoxia-indu...

We hypothesized that pretreatment with the potassium channel opener nicorandil might enhance myocardial protection achieved by cold (20 degrees C) high-potassium (16 mmol/L) cardioplegia (5 ml/min) during long-duration (120 minutes) myocardial hypoxia (average oxygen content 5.4 ml/dl). We tested a 15-minute infusion of nicorandil (1 mmol/L) given...

Guinea-pig ventricular myocardium was partly exposed to normal Tyrode's superfusion and partly to altered conditions (using modified Tyrode's solution) set to simulate acute myocardial ischemia (Po2 80 ± 10 mmHg; no glucose; pH 7.00 ± 0.05; K+ 12 mM). Using a double-chamber tissue bath and standard microelectrode technique, the occurrence of sponta...

The study was aimed at comparing the effects of dobutamine (dob) and dopamine (dop) on isotonic contraction and rhythmicity of isolated guinea-pig papillary muscles (in oxygenated Tyrode at 37 degrees C), by taking into account: 1) the rate of stimulation (50% above the diastolic threshold) at 5 fixed periods: (RR: 1600, 1200, 1000, 800 and 400 ms)...

Nicorandil (N) increases potassium conductance in vascular smooth muscle and so induces vasodilation; N also dose-dependently reduces action potential duration (APD). However, it is unclear whether increased potassium conductance, and concomitant APD shortening, might be arrhythmogenic, particularly when myocardial ischemia (where potassium efflux...

Predictive values of ST/HR slope and ST-segment displacement during symptom-limited exercise were determined in 85 patients who underwent coronary angiography for suspected coronary artery disease, using perfusional and functional radionuclide images with 99mTc-2-methoxy-isobutil-isonitrile as an index of stress-induced myocardial ischemia. ST/HR s...

We have investigated (multivariate Cox's model) the relative risk of stable excitation-conduction block (ECB) in right ventricular myocardial strips (2 x 5 x 1 mm) from 26 female guinea-pigs, bathed in a 2-compartment chamber (3 ml) on the anterior side of which modified Tyrode's solution (K+ 12 mM, HCO3- 9 mM, pH 7 +/- 0.05, pO2 80 +/- 10 mmHg and...

The aim of this study was to analyze the dynamic changes of QT interval--heart rate relation during exercise, fitting their reciprocal variations to an exponential formula (QT = A - B.exp(-k.RR], in order to see whether diagnostic contributions might so be derived. The authors studied 139 patients who underwent a simultaneous assessment of regional...

Aim of this study was to evaluate the possible relationship among myocardial ischemia, left ventricular volume changes and QT interval changes during exercise in patients with coronary artery disease. QT interval, expressed as absolute value, corrected according to Bazett (QTc = aT/RR0.5) and Fridericia (QTf = QT/RR0.33) and calculated by adapting...

In 60 randomized dogs the effects of epoprostenol infusion (100 ng/kg/min) on ischemia-induced premature ventricular contractions (PVCs), ventricular tachycardia (VT), ventricular flutters and ventricular fibrillation were studied. The circumflex coronary artery occlusion canine model of sudden death was used. The results demonstrate different effe...

In an attempt to assess the significance of R wave amplitude changes during exercise in patients with coronary artery disease, we retrospectively analysed radionuclide as well as exercise test results of 147 patients with either suspected or already ascertained coronary artery disease, 126 men and 21 women, whose mean age was 56.0 +/- 9.3 years, 56...