Marco Sassara

Ospedale Oncologico "Giovanni Paolo II" di Bari, Bari, Apulia, Italy

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Publications (23)64.09 Total impact


  • No preview · Article · Aug 2014 · International Journal of Cardiology
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    ABSTRACT: Cardiovascular diseases (CVD) are an important public health problem, affecting especially people over 65 years. The significant change in the structure of the population, with the progressive increase of the elderly, determined a major incidence of chronic diseases. Chronic diseases require a regular monitoring of clinical parameters in order to control the natural evolution of the pathology and to make appropriate therapeutic measures. For this reason, it's important that the patient has an adequate knowledge and involvement in the management of the disease, in order to improve clinical outcomes and reduce hospitalizations. Some studies in scientific literature demonstrated the efficacy and utility of a multi-specialized team that follow the patient in the natural history of chronic disease. These studies noted the improvement of clinical parameters and better adherence to medical therapy in patients joined by the care manager. The care manager is a sort of bridge between patients, general practitioners and other specialist. He assists the patient individually, helping him to adopt behaviors and lifestyles suitable to his health condition, and encouraging greater self-sufficiency in the monitoring of clinical parameters. The aim of present work is to provide a review of the scientific literature regarding the effectiveness of the introduction of care managers in the setting of clinical practice.
    Full-text · Article · Jul 2014

  • No preview · Article · Apr 2014 · International journal of cardiology
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    ABSTRACT: Background Our study investigates whether rheumatic autoimmune conditions are associated with an increased Carotid Intima-Media Thickness (C-IMT) when compared with healthy control subjects and evaluates possible discrepancies existing among the different rheumatic diseases types. Methods A total of 108 patients, 15 males and 93 females, aged between 18 and 82 years (mean age 51±14 years), fulfilling the ACR criteria for SLE, APS, SSc, PM/DM, MCTD, SS attending the Rheumatology Unit at Univeristy of Bari – Policlinico, were recruited between November 2010 and March 2011. Patients were subdivided into the following two groups: 1) Group SSc (Sclerodermic patients): 60 patients, 7 males and 53 females, mean age 52±14 years; 2) Group NoSSc (Non-Sclerodermic patients): 48 patients, 8 males and 40 females, mean age 50±15 years. We also enrolled 108 healthy controls, matched by sex and age with patients. All patients underwent to structured interview, physical examination, laboratory evaluation and two-dimensional echo-color Doppler of the carotid arteries. Results There were no significant differences between SSc and NoSSc regarding any of the demographics and traditional cardiovascular risk factors, except from total cholesterol that was significantly higher in SSc group, compared with the NoSSc group. The mean duration of disease since diagnosis was 8 (range 3 to 13) years, comparable in the two groups (a little longer in NoSSc). Total cholesterol was significantly higher in SSc patients (mean value 224, range 196-252 mg/dL) than in NoSSc patients (mean value 203, range 194-212 mg/dL). HDL cholesterol value was slightly raised, if compared with a cut-off value of 45 (mean value 47, range 37-57 mg/dL), and was substantially similar in the two groups. Idem for LDL and triglycerids values that were a little raised in comparison with the cut-off values. The distribution of cardiovascular risk factors was similar in the two groups. We found a mean C-IMT value of 0.86 mm (range 0.73 to 0.99 mm) that resulted from the following values: 0.91±0.1 mm in SSc group, 0.80±0.14 in NoSSc group. The difference between groups was significant (p-value <0.05). We also evaluated C-IMT in control subjects, obtaining the following result: 0.83±0.13 mm. The percentage of carotid plaques in each group was 12% for SSc and 17% for NoSSc, with a mean value of 14%. Conclusions We found no signs of increased atherosclerosis, as assessed by C-IMT measurement, among patients with rheumatic autoimmune diseases and healthy controls, and a strong evidence of higher risk in patients with SSc respect to patients with SLE, PM/DM, APS, MCTD and SS. Considering the current state of knowledge, the necessity of optimising prevention and treatment of CVD in patients with systemic rheumatic disease, in particular way those affected by SSc, must be emphasised. A comprehensive identification of cardiovascular risk profile in those diseases is an opportunity to improve prognosis of these patients, since most of the identified risk factors are susceptible of modification. Certainly, further researches are favourable in order to improve life duration and cardiovascular outcomes of these patients. Disclosure of Interest None Declared
    No preview · Article · Jan 2014 · Annals of the Rheumatic Diseases
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    ABSTRACT: Obstructive sleep apnea syndrome (OSAS) in children can induce endothelial dysfunction, a well-known early marker of atherosclerosis. The study aimed to evaluate a link among endothelial function (measured by flow-mediated vasodilation (FMD)), obesity (evaluated by body mass index (BMI)), and sleep disordered breathing (SDB), assessed with apnoea/hypopnoea index (AHI), in a paediatric population. We demonstrated that our little OSAS patients showed an impaired endothelial function as compared to controls. In particular, the higher the AHI, the worst the FMD values and thus the endothelial function. Although the population sample is small, this study demonstrated that OSAS could impair endothelial function and worsen cardiovascular risk profile since childhood.
    Full-text · Article · Dec 2013 · The Scientific World Journal

  • No preview · Article · Nov 2013

  • No preview · Article · Nov 2013
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    ABSTRACT: Aims: Dolichocarotids(DCs) represent a rare(2-6%) carotid imaging finding in the general population that may be free of clinical significance or be associated with cerebrovascular events. Their detection is traditionally assigned to carotid echo-color Doppler(ECD) and selective angiography(the standard method). The primary aim of this study was to estimate the sensitivity, specificity and accuracy of ECD in detecting DCs. Moreover, we monitored the DC curvature angle and the incidence of TIA, ischemic stroke, myocardial infarction and cardiovascular death over a five-year followup period. Methods: A total of 112 consecutive patients with DCs(80 men, mean age: 61±7 years) were recruited for carotid ECD and carotid angiography due to the persistence of neurological symptoms not well explained on ultrasound evaluations, according to the current guidelines. Results: ECD proved to have 100% sensitivity in detecting tortuosity and coiling and 96% sensitivity in detecting kinking, with an overall accuracy ranging from 92% to 100%. The specificity was 75% for tortuosity, 91% for kinking and 100% for coiling. During the five-year follow-up period, there was a statistically significant increase in tortuosity(61±11° at baseline versus 81±11° after five years, p<0.001) and the kinking curvature angle(97±3° at baseline versus 100±3° at five years, p<0.001), whilst no differences were observed with respect to coiling(136±10° at baseline versus 138±11° at five years, p=ns). Moreover, kinking was found to be more frequently statistically associated with cardiovascular death than tortuosity(p=0.005). Conclusions: DCs predispose patients to potentially disabling and fatal events. ECD plays a primary role in the detection of DCs and therefore should be considered to be a secure and reproducible technique.
    No preview · Article · Sep 2013 · Journal of atherosclerosis and thrombosis
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    ABSTRACT: Stress-induced cardiomyopathy or Takotsubo cardiomyopathy (TCM) is a unique syndrome, characterized by transient left ventricular (LV) apical ballooning without significant coronary arteries stenosis, affecting mainly menopausal women. We present the case of a 70 year old woman with subacute stent thrombosis (ST) at the level of the right coronary artery and transient apical ballooning with normal flow of left and circumflex coronary arteries. TCM is frequently associated with emotional stress, but to date no case of ST triggering TCM have been reported.
    No preview · Article · Aug 2013 · American Journal of Cardiovascular Disease
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    ABSTRACT: Background: Aim of our study was to investigate whether rheumatic autoimmune diseases are associated with an increased Carotid Intima-Media Thickness (C-IMT) and to evaluate possible discrepancies existing among the single pathological identities. Methods: This study involved a total of 216 subjects, 108 patients with systemic rheumatic diseases and 108 healthy controls. Our patients (15 males, age 51±14 yrs), all fulfilling the ACR criteria for rheumatic autoimmune diseases were subdivided into two groups: 1) Group SSc (Sclerodermic pts): 62 patients (7 males, age 52±14 yrs); 2) Group NoSSc (Non-Sclerodermic pts): 46 patients (8 males, age 51±14 yrs). All patients underwent to structured interview, physical examination, laboratory evaluation and echo-color Doppler of the carotid arteries. Results: We found that total cholesterol (TC) was higher in patients than controls (207±36 vs. 174±31 mg/dL, p<0.05), as well as LDL-C (131±30 vs. 104±29 mg/dL, p<0.05) and triglycerides (148±65 vs. 99±40 mg/dL, p<0.05). HDL-C was significantly lower, indeed, in patients than controls (47±10 vs. 50±10 mg/dL, p<0.05). Blood fasting glucose was similar in both patients and controls (105±18 mg/dL vs. 105±16 mg/dL, p=ns). Mean Body mass index was identical in the two groups, (mean value: 25±4 kg/m2). Comparing SSc group and NoSSc group, we observed that TC (209±36 vs. 204±37 mg/dL), LDL-C (137±31 vs. 124±27mg/dL) and triglycerides (139±61Vs 160±70 mg/dL) were significantly higher in SSc, whereas HDL-C, blood fasting glucose and BMI were not significantly different. In autoimmune pts C-IMT was 0.86 mm (range 0.73 to 0.99 mm), statistically different from C-IMT in control subjects, that was 0.65±0.17 mm (p<0.05), and resulted from the following values: 0.92±0.1 mm in SSc group and 0.78±0.13 in NoSSc group. The difference between group was significant (p<0.05). Conclusions: Patients with rheumatic autoimmune diseases had clear signs of subclinical atherosclerosis (assessed by means of C-IMT) than healthy controls, thus have an overall increased cardiovascular risk profile. Further researches are needed in order to improve life duration and cardiovascular outcomes of these patients.
    Full-text · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: P250 SPESSORE INTIMA-MEDIA CAROTIDEO E CORONARICO: VI È UNA CORRELAZIONE NELL’ATEROSCLEROSI LIEVE? Francesca Cortese1, David Rutigliano2, Filippo Masi1, Donato Quagliara1, Marco Sassara2, Michele Mongelli1, Mariangela Carbone1, Lucrezia De Michele2, Pasquale Caldarola2, Marco Matteo Ciccone1 1Sezione di Malattie dell’Apparato Cardiovascolare, Dipartimento dell’Emergenza e dei Trapianti d’Organo DETO, Università degli Studi, Policlinico, Bari, 2Cardiologia-UTIC, Ospedale San Paolo, Bari Scopo. Valutare la correlazione esistente tra lo spessore intime-media (C-IMT) misurato con ultrasonografia intracorornarica (IVUS) e lo spessore intimamedia carotideo (CCA-IMT). Metodi. Abbiamo valutato retrospettivamente 41 soggetti senza coronaropatia o con coronaropatia lieve all’esame angiografico: 18 senza alcuna anomalia coronarica e 23 con coronaropatia (stenosi con quantificazione coronarica, QCA, <30%). Questi due gruppi sono stati confrontati tra loro. Ogni paziente è stato sottoposto a esami sierologici, eco- Doppler carotideo, FMD (dilatazione flusso-mediata) misurato a livello dell’arteria brachiale ed angiografia coronarica con misurazione IVUS misurata a livello di arteria discendente anteriore prossimale (25±5 mm), intermedia (50±5 mm) e distale (75±5 mm), e considerando il valore medio in tutte le misurazioni (valore DI “plaque burden” con IVUS). Risultati. Nessuna differenza statisticamente significativa tra i due gruppi è stata trovata a seconda che si valutasse l’età, sesso, FMD, indicazione alla coronarografia, frazione di eiezione, fattori di rischio cardiovascolare e funzione renale. Il sottogruppo con stenosi coronariche inferiori al 30% mostrava valori più alti di CCA-IMT (p<0.001) se confrontati con quelli senza patologia. Lo stesso gruppo presentava una correlazione statisticamente significativa tra il valore medio di plaque burden ed i valori di CCA-IMT (p=0.01) e tra il valore medio di IVUS c-IMT e quelli di PCR (p=0.035). Conclusioni. I nostri risultati sottolineano la forte correlazione tra plaque burden coronarico misurato mediante IVUS e il CCA IMT in soggetti con aterosclerosi coronarica lieve, confermando il CCA-IMT nel suo ruolo di “finestra privilegiata” sullo stato coronarico del paziente.
    Full-text · Conference Paper · Jun 2013
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    ABSTRACT: Purpose: According to the literature, estradiol has a direct vasodilator action by means of endothelium-derived relaxing factor synthesis. The present study aims to evaluate the acute hemodynamic effects of intranasal 17-β-estradiol on cerebral and lower limb arterial circulation in postmenopausal women. Methods: Sixteen healthy women in natural menopause (mean age: 54 ± 3 years) were investigated for at least 6 months, each receiving 300 µg of intranasal 17-β-estradiol. We evaluated the heart rate, systolic/diastolic blood pressure, peak systolic velocity, end-diastolic velocity, and velocity-time integral (VTI) at the level of internal carotid and posterior tibial arteries, before and after 30, 60, and 180 minutes of drug administration. Results: After intranasal 17-β-estradiol administration, the internal carotid artery VTI showed statistically significant (P < .05) variations at all the time intervals after administration of the drug (30, 60, and 180 minutes) when compared with "time zero" (T0, ie, the speed recorded at baseline before drug administration). No significant variation was found at the posterior tibial artery. The systolic/diastolic blood pressure and heart rate did not significantly differ before and after drug administration. Conclusions: The administration of a single intranasal dose of 17-β-estradiol in healthy postmenopausal women increased cerebral perfusions, whereas the effect on peripheral circulation was much more limited.
    Full-text · Article · Apr 2013 · Journal of Cardiovascular Pharmacology and Therapeutics
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    ABSTRACT: Background: Endothelial dysfunction has been already reported in inflammatory bowel diseases (IBD). However, case series so far examined were rather heterogeneous as for disease severity and subsets investigated. Objective: We evaluated endothelial dysfunction by brachial artery flow-mediated vasodilatation (FMD), and subclinical atherosclerosis by assessment of common carotid intima-media thickness (CCA-IMT) in a cohort of patients with Crohn's disease (CD) or Ulcerative colitis (UC) in active phase compared to healthy control subjects. Methods: Forty-nine patients (mean age 41 ± 16 years), 25 with CD and 23 with UC, and forty controls (mean age 45 ± 15 years) were enrolled. Diagnosis was based on the standard clinical, endoscopic and histological criteria. Disease activity was assessed by Crohn's Disease Activity Index or Disease Activity Index. All patients, were under medical treatment as appropriate. Results: FMD values were lower in IBD patients than controls (6.1 ± 3.0 vs 8.2 ± 3.4. p = 0.003); no difference was seen between UC/CD groups (5.9 ± 3.5 vs 6.3 ± 2.6, p = 0.67). No changes in statistical differences occurred after adjustment for age, gender, body mass index and family history of cardiovascular disease. Finally, no differences in IMT values were seen between IBD patients and controls. Disease duration and medical treatment did not affect endothelial function. Conclusions: Our study showed a lower FMD in IBD patients. Inflammation and immune response could explain endothelial dysfunction, which is the earliest stage of atherosclerotic process. IBD patients in active phase might therefore be at higher risk for atherosclerosis progression.
    Full-text · Article · Mar 2013 · Journal of Crohn s and Colitis
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    ABSTRACT: Previous studies support the fact that extracorporeal shockwave (SW) induces angiogenesis and improves symptoms in patients affected by limb ischemia. The aim of this study was to evaluate the effects of SW therapy in patients with peripheral artery disease (PAD). Twenty-two patients were enrolled in this study and were randomly assigned into two groups: SW treatment (12 patients, 67 ± 9 years) and control (10 patients, 68 ± 12 years). The inclusion criteria were the following: age over 40 years, PAD diagnosis, optimal medical therapy, and ankle-brachial index less than 0.9. SW therapy was administered using the Minilith® SL1 litotriptor with an ultrasound guide able to detect the target area using a B-mode technique and a 7.5 MHz convex probe emitting 2,000 impulses with an energy flux density of 0.03 mJ/mm(2). The variation in the degree of stenosis before and after treatment was statistically significant between the groups (-9% ± -10% vs. 0% ± 0%; P = 0.001). In addition, a significantly higher number of treated patients than controls showed a reduction in the Fontaine stage (12 [63%] vs. 0 [0%]; P < 0.001). This result was confirmed by analyzing the difference in patients' pain-free walking distance before and after SW therapy (76 ± 46 m vs. 0 ± 0 m for treated patients vs. controls; P < 0.001) and the difference in pain severity (measured on a pain scale; -1.4 ± 0.5 in the treated patients vs. -0.2 ± 0.4 in the controls; P < 0.001). On the basis of these results the authors hypothesized a direct effect of SW on the ultrastructural composition of the vessel walls, inducing a reduction in artery stenosis. These data support the application of SW therapy as a new medical tool to improve the natural clinical course of PAD.
    Full-text · Article · Aug 2012 · Advances in Therapy
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    ABSTRACT: Venous echo-color-Doppler (ECD) showed that chronic cerebrospinal venous insufficiency (CCSVI) syndrome is related to multiple sclerosis (MS). Study aims were to assess interobserver variability in ultrasound evaluation of MS patients and to relate echo-markers to MS clinical symptoms and the disability degree. 277 MS patients (117 men, mean age 43.05+10.04 years) admitted to the Neurology Department of Bari University General Hospital, underwent clinical, Expanded Disability Status Scale (EDSS) evaluation, and a cerebro-venous system ECD evaluation. Two operators reevaluated 32 patients to calculate interobserver variability. McNemar test confirmed the procedure reproducibility between two operators (p=ns). Septa/membranes correlated with deep cerebral veins reflux [right: 16% absence vs. 58% presence, p < 0.0001; left: 26% vs. 50%, p < 0.0001]; their absence in Primary Progressive (PP) MS form [right: 11% vs. 2%, p < 0.001; left: 12% vs. 2%, p < 0.001]. Internal jugular veins (IJVs) reflux absence was in Relapsing-remitting (RR) form [right: 60% vs. 74%, p=0.036; left: 56% vs. 85%, p < 0.0001] like hemodynamically significant stenosis [right: 57% vs. 69%, p=0.033; left: 49% vs. 73%, p < 0.001] not present in PP [right: 11% vs. 2%, p < 0.001; left: 10% vs. 3%, p=0.009]. A supine IJVs blocked flow was related to the EDSS class [right: 4.8±1.5 vs. 5.4±1.4, p=0.006; left: 4.7±1.6 vs. 5.5±1.2, p < 0.0001]; its absence was linked to RR [right: 60% vs. 76%, p=0.016; left: 58% vs. 79%, p < 0.001]. ECD has an important value in MS patients with IJV anomalies detection and a good interobserver procedure reproducibility. MS is associated with CCSVI, although further studies are needed.
    No preview · Article · Apr 2012 · Current neurovascular research
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    ABSTRACT: Obstructive Sleep Apnea Syndrome (OSAS) is a common airways disease recognized as an independent cardiovascular risk factor. It is often associated with obesity, diabetes and dyslipidemia. Its pathophysiological consequences (hypoxia, hypercapnia, micro-arousals, sympathetic hyperactivity, oxidative stress, systemic inflammation and hyper-coagulability) are implicated in the development of hypertension, endothelial dysfunction and higher intima-media thickness (IMT) values, all elements known to lead to atherosclerosis. The study aim was to demonstrate a relationship between OSAS duration and IMT values and to confirm how OSAS severity could influence IMT (a marker of atherosclerosis). We enrolled 156 patients (125 men, mean age: 60 ± 12 years) affected by OSAS of different severity: 111 (71%) were in CPAP therapy; some of the population were also affected by hypertension [102 (65%)], dyslipidemia [52 (33%)] and diabetes [38 (24%)]. Patients underwent evaluation of carotid artery IMT and answered a questionnaire investigating the time of onset (confirmed by a person aware of the patient's previous sleeping habits) and the duration of the disease. We found a statistically significant higher IMT value in patients with longer-lasting disease (OSAS duration in IMT < 0.9 mm: 120 (60-192) months versus OSAS duration in IMT ≥ 0.9 mm: 200 (120-310) months; p < 0.001). OSAS severity is positively related to IMT values. We found a positive relationship between IMT and OSAS duration [r = 0.34; p < 0.001] and between AHI and IMT [r = 0.51; p < 0.001]. Our study shows that the duration of OSAS and its severity are important factor related with higher values of IMT and hence with a higher risk of atherosclerosis.
    Full-text · Article · Feb 2012 · Respiratory medicine
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    ABSTRACT: Estrogens interact with cardiovascular effects of catecholamines and other vasoactive substances, and their deficiency causes impaired circulatory adjustments in response to both exercise and heat stress. The aim of this study was to evaluate changes induced by handgrip test on key elements of cardiac afterload, before and after hormone replacement therapy in postmenopausal women. We studied two groups of healthy women volunteers: 12 postmenopausal women (group M) (mean age 57.7±4.5) and 12 menstruated women (mean age 26.3±4.9) (control group, C). All patients underwent handgrip maneuver to produce a static muscle effort and we evaluated vascular reactivity in superficial handheld artery. The test were conducted in postmenopausal women before (M) and after administration of raloxifene for 30 days at a dose of 60 mg/day (M+R). During the test were recorded ECG, sphygmic wave, Doppler velocimetry curve, pneumogramma, skin electrical conductance and cardiac periodogram, corresponding to the value of the R-R interval beat-to beat. In the 5 seconds immediately preceding the maneuver, were evaluated systolic blood pressure (SBP), diastolic blood pressure (DBP), arterial pulse pressure (APP), mean arterial pressure (MAP), maximum value of arterial flow in systole (Fmax syst), arterial flow mean value (Fmed), mean value of R-R interval throughout interval studied (R-R) and index of resistance (IR) and index of elasticity (IE) of arterial district studied. We found overlapping values of F max syst and F med in group M and group C. In M+R values of the same two parameters were very similar to those obtained in M in first part of handgrip maneuvre, and during recovery phase. In the second part of maneuver blood flow in M+R was higher than M. Therefore, values of MAP/Fmed and APP/Fmax syst were lower in M+R state than in group M. Interestingly, MAP/Fmed and APP/Fmax syst values in the M+R state were at bottom of the range of variability of the values in C. During isometric effort there was the almost complete overlap of the R-R interval variations in C, M, M+R, and trend of SBP/R-R ratio was in M higher than both C and M+R. The SBP, DBP, MAP values increased significantly at end of the handgrip maneuver in all M, M+R and C, compared to pressures recorded at rest, instead this was not for APP. At end of the handgrip maneuver SBP and DBP was significantly higher in M than in C, while in M+R it showed no significant differences compared to C. DBP and MAP at end of the effort in M+R not only showed no differences compared to C, but was also significantly lower than M. A significant increase of APP/Fmax syst ratio was found in M at end of maneuver compared at rest, and disappeared in M+R. In M and C, MAP/Fmed ratio at end of maneuver was significantly higher than at rest, and in M+R was significantly lower than values of M and C. The handgrip maneuver caused a significantly reduction of duration of R-R interval in the M, C and M+R. The SBP/R-R ratio increased significantly with exercise in M,C and M+R. The treatment with raloxifene decreases the activation of sympathetic vasoconstrictor system in arteries smooth muscle cells.
    Full-text · Conference Paper · Dec 2011
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    ABSTRACT: There is a close link between heart failure and endothelial dysfunction. Brachial flow-mediated dilation (FMD) is a validated non-invasive measure of endothelial function. The aim of this study was to investigate the clinical correlates of FMD in patients with chronic heart failure (CHF). We evaluated 60 CHF outpatients (age 62 ± 14 years; 49 males, NYHA class 2.2 ± 0.7, left ventricular ejection fraction, LVEF, 33 ± 8%) taking conventional medical therapy (ACE-inhibitors and/or ARBs 93%, beta-blockers 95%) and in stable clinical conditions. The maximum recovery value of FMD was calculated as the ratio of the change in diameter (maximum-baseline) over the baseline value. As compared with patients with a higher FMD, those with FMD below the median value (4.3%) were more frequently affected by ischemic cardiopathy (50 vs. 23%; p = 0.032) and diabetes mellitus (20 vs. 3%; p = 0.044), had a higher NYHA class (2.5 ± 0.5 vs. 1.9 ± 0.7; p < 0.001) and NT-proBNP (2,690 ± 3,690 vs. 822 ± 1,060; p = 0.001), lower glomerular filtration rate estimated by Cockcroft-Gault (GFRCG: 63 ± 28 vs. 78 ± 25; p = 0.001) and LVEF (29 ± 8 vs. 37 ± 9; p = 0.001), as well as more frequently showing a restrictive pattern (40 vs. 7%; p = 0.002). In a multivariate regression model (R (2) = 0.48; p < 0.001), FMD remained associated only with the NYHA class (p = 0.039) and diabetes mellitus (p = 0.024). This study demonstrates that a better functional status and absence of diabetes mellitus are associated to higher FMD regardless of the etiology of the cardiac disease.
    Full-text · Article · Jun 2011 · Clinical Research in Cardiology
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    ABSTRACT: To establish, using echocardiography, color-flow Doppler and tissue doppler imaging (TDI), physiological values of systolic/diastolic indexes in healthy term/pre-term newborns, and to identify how different degrees of maturity influence morpho-functional cardiac alterations during the transitional period. 33 term newborns (M = 19, F = 14; gestational ages: 37th-41st week), and 20 pre-term infants (M = 11, F = 9; gestational ages: 31st-36th week) admitted to our department were studied. All infants underwent to clinical and Doppler ultrasound evaluations, carried out by the third to fourth day. Investigations included: M-mode echocardiography, color-flow Doppler and TDI. Term and preterm neonates differed for: interventricular septum and left systolic/diastolic ventricle diameters (p<0.01 and <0.05 respectively); left ventricle posterior wall in systole (p<0.01); shortening and ejection fraction (p<0.05). Color-flow Doppler parameters on the tricuspid (peak E, peak A, ratio E/A; p<0.05) and on the mitral (peak E and E/A ratio; p<0.01) significantly differed between the two groups. Significant differences were also present for basal left ventricular lateral wall and right ventricular lateral wall in the Ew (p<0.01 and <0.05 respectively), Sw peak (p<0.01 and <0.05 respectively), and Ew/Aw (p<0.05). The isovolumetric relax time and the E/Ew measured on the medial mitral annulus also demonstrated significant differences (p<0.01) between the two groups. TDI is feasible in preterm neonates and enables assessment of myocardial velocities. With increasing gestational age, higher myocardial velocities and lower E/E' Πratios were found. TDI addition to standard neonatal echocardiography may provide further important information about cardiac function.
    No preview · Article · May 2011 · Early human development
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    ABSTRACT: Silent ischemia is an asymptomatic form of myocardial ischemia, not associated with angina or anginal equivalent symptoms, which can be demonstrated by changes in ECG, left ventricular function, myocardial perfusion, and metabolism. The aim of this study was to evaluate the prevalence of silent myocardial ischemia in a group of patients with asymptomatic carotid stenosis. A total of 37 patients with asymptomatic carotid plaques, without chest pain or dyspnea, was investigated. These patients were studied for age, sex, hypertension, diabetes, dyslipidemia, smoking, and family history of cardiac disease, and underwent technetium-99 m sestamibi myocardial stress-rest scintigraphy and echo-color Doppler examination of carotid arteries. A statistically significant relationship (P=0.023) was shown between positive responders and negative responders to scintigraphy test when both were tested for degree of stenosis. This relationship is surprising in view of the small number of patients in our sample. Individuals who had a positive scintigraphy test had a mean stenosis degree of 35% ± 7% compared with a mean of 44% ± 13% for those with a negative test. Specificity of our detection was 81%, with positive and negative predictive values of 60% and 63%, respectively. The present study confirms that carotid atherosclerosis is associated with coronary atherosclerosis and highlights the importance of screening for ischemic heart disease in patients with asymptomatic carotid plaques, considering eventually plaque morphology (symmetry, composition, eccentricity or concentricity of the plaque, etc) for patient stratification.
    Full-text · Article · Mar 2011 · Vascular Health and Risk Management