Maria Grazia MODENA - personale UniMoRe

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Maria Grazia MODENA

Professore Ordinario
Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa

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Pubblicazioni

2023 - 50 SHADES OF LOCKDOWN:SEX WORKERS? HIDDEN WORLD DURING COVID PANDEMIC [Articolo su rivista]
Lodi, Elisa; Donati, Federica; Rodighiero, Eleonora; Gasparini, PAOLO ALBERTO; Modena, Maria Grazia
abstract

2023 - Echocardiographic screening in pediatric asymptomatic or paucisymptomatic coronavirus disease 2019 outpatients: is it a useful test or an excess of zeal? [Articolo su rivista]
Gasparini, PAOLO ALBERTO; Lodi, Elisa; Rodighiero, Eleonora; Rosero Morales, Jonathan Jose; Fantini, Giuseppe; Modena, Maria Grazia
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2023 - Echocardiography in the preparticipation screening: an old topic revisited [Articolo su rivista]
Donati, F.; Guicciardi, C.; Lodi, E.; Fernando, F.; Palermi, S.; Modena, M. G.; Biffi, A.
abstract

BackgroundPreparticipation screenings have been conceived for the potential to prevent sudden cardiac death in young athletes by early identification of hidden cardiac diseases. Commonly used protocols include family history collection, physical examination, and resting electrocardiogram. Transthoracic echocardiography has been hypothesized to have a primary role in the preparticipation screening.AimsThe present study aimed to evaluate the additional role of echocardiogram in identifying cardiovascular abnormalities that might be undetected by commonly used preparticipation screening.MethodsWe retrospectively reviewed Ferrari Formula Benessere, a corporate wellness program database, and analyzed data recorded from 2017 to 2022 to compare two medical models: a 'standard' preparticipation screening including medical history, physical examination, electrocardiogram and exercise stress testing versus an 'advanced' preparticipation screening comprising history, physical examination, electrocardiogram, exercise stress testing and echocardiography.ResultsFrom an initial sample size of 7500 patients, we included 500 patients (420 male, 33.69 ± 7.9 mean age) enrolled for the first time in the corporate wellness program between 2017 and 2022. Three hundred and thirty-nine (67.8%) patients had no abnormal findings at 'standard' preparticipation screening and, even if they would have not required further evaluation, we performed echocardiography anyway ('advanced' preparticipation screening): 31 (9.1%) showed some abnormal cardiovascular findings at echocardiography, such as patent foramen ovalis, bicuspid aortic valve, aortic root ectasia or mitral valve prolapse.ConclusionsScreening echocardiogram showed an additional value (about 10% more) in detecting patients with cardiovascular abnormalities, otherwise undiagnosed with the 'standard' preparticipation screening protocol.

2023 - Information and Training on the Use of Telemedicine in Pediatric Population: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP), and of the Syndicate of Family Pediatrician Doctors (SIMPeF) [Articolo su rivista]
Esposito, S.; Rosafio, C.; Antodaro, F.; Argentiero, A.; Bassi, M.; Becherucci, P.; Bonsanto, F.; Cagliero, A.; Cannata, G.; Capello, F.; Cardinale, F.; Chiriaco, T.; Consolaro, A.; Dessi, A.; Di Mauro, G.; Fainardi, V.; Fanos, V.; Guarino, A.; Li Calzi, G.; Lodi, E.; Maghnie, M.; Manfredini, L.; Malorgio, E.; Minuto, N.; Modena, M. G.; Montori, R.; Moscatelli, A.; Patrone, E.; Pescio, E.; Poeta, M.; Ravelli, A.; Spelta, M.; Suppiej, A.; Vai, S.; Villa, L.; Zanini, R.; Botti, R.; Gaddi, A. V.
abstract

Telemedicine has entered the daily lives of doctors, although the digital skills of healthcare professionals still remain a goal to be achieved. For the purpose of a large-scale development of telemedicine, it is necessary to create trust in the services it can offer and to favor their acceptance by healthcare professionals and patients. In this context, information for the patient regarding the use of telemedicine, the benefits that can be derived from it, and the training of healthcare professionals and patients for the use of new technologies are fundamental aspects. This consensus document is a commentary that has the aim of defining the information on and training aspects of telemedicine for pediatric patients and their caregivers, as well as pediatricians and other health professionals who deal with minors. For the present and the future of digital healthcare, there is a need for a growth in the skills of professionals and a lifelong learning approach throughout the professional life. Therefore, information and training actions are important to guarantee the necessary professionalism and knowledge of the tools, as well as a good understanding of the interactive context in which they are used. Furthermore, medical skills can also be integrated with the skills of various professionals (engineers, physicists, statisticians, and mathematicians) to birth a new category of health professionals responsible for building new semiotics, identifying criteria for predictive models to be integrated into clinical practice, standardizing clinical and research databases, and defining the boundaries of social networks and new communication technologies within health services.

2023 - Un’aritmia sommersa… e una nuotatrice riemersa. Un caso di tachicardia sopraventricolare da rientro nodale in una giovane nuotatrice in riemersione dall’apnea dinamica [A submerged arrhythmia... and a surfaced swimmer. A case of nodal reentrant supraventricular tachycardia in a young swimmer resurfacing from dynamic apnea] [Articolo su rivista]
Lodi, E; Donati, F; Lodi, G; Contrafatto, I; Modena, Mg
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The irrefutable benefits of physical activity as a tool for the prevention and treatment of several clinical conditions, including cardiovascular diseases, are nowadays widely recognized. However, physical exercise may trigger adverse events in subjects with underlying heart disease, often undiagnosed and asymptom-atic. It is fundamental to consider that various sports disciplines have peculiar and specific physiological and metabolic adaptations, and it is essential to consider the individual profile of the subject, including gender. We report the case of an agonistic female swimmer with a history of tachycardia heartbeat when resurfacing from dynamic apnea, in whom a diagnosis of atrioventricular nodal reentrant tachycardia was made. This case report provides practical evidence of the importance of a personalized approach, in both individual sex-and sport-specific terms, to optimize the diagnostic and therapeutic pathways.

2023 - Use of Telemedicine Healthcare Systems in Children and Adolescents with Chronic Disease or in Transition Stages of Life: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF) [Articolo su rivista]
Esposito, S.; Rosafio, C.; Antodaro, F.; Argentiero, A.; Bassi, M.; Becherucci, P.; Bonsanto, F.; Cagliero, A.; Cannata, G.; Capello, F.; Cardinale, F.; Chiriaco, T.; Consolaro, A.; Dessi, A.; Di Mauro, G.; Fainardi, V.; Fanos, V.; Guarino, A.; Li Calzi, G.; Lodi, E.; Maghnie, M.; Manfredini, L.; Malorgio, E.; Minuto, N.; Modena, M. G.; Montori, R.; Moscatelli, A.; Patrone, E.; Pescio, E.; Poeta, M.; Ravelli, A.; Spelta, M.; Suppiej, A.; Vai, S.; Villa, L.; Zanini, R.; Botti, R.; Gaddi, A. V.
abstract

Telemedicine is considered an excellent tool to support the daily and traditional practice of the health profession, especially when referring to the care and management of chronic patients. In a panorama in which chronic pathologies with childhood onset are constantly increasing and the improvement of treatments has allowed survival for them into adulthood, telemedicine and remote assistance are today considered effective and convenient solutions both for the chronic patient, who thus receives personalized and timely assistance, and for the doctors, who reduce the need for direct intervention, hospitalizations and consequent management costs. This Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, has the objectives to propose an organizational model based on the relationships between the actors who participate in the provision of a telemedicine service aimed at minors with chronic pathologies, identifying specific project links between the areas of telemedicine in the developmental age from the first 1000 days of life to the age adult. The future scenario will have to be able to integrate digital innovation in order to offer the best care to patients and citizens. It will have to be able to provide the involvement of patients from the very beginning of the design of any care pathway, increasing where possible the proximity of the health service to citizens.

2023 - Use of Telemedicine Healthcare Systems in Pediatric Assistance at Territorial Level: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF) [Articolo su rivista]
Esposito, Susanna; Rosafio, Cristiano; Antodaro, Francesco; Argentiero, Alberto; Bassi, Marta; Becherucci, Paolo; Bonsanto, Fabio; Cagliero, Andrea; Cannata, Giulia; Capello, Fabio; Cardinale, Fabio; Chiriaco, Tiziana; Consolaro, Alessandro; Dessì, Angelica; Mauro, Giuseppe Di; Fainardi, Valentina; Fanos, Vassilios; Guarino, Alfredo; Calzi, Giada Li; Lodi, Elisa; Maghnie, Mohamad; Manfredini, Luca; Malorgio, Emanuela; Minuto, Nicola; Modena, Maria Grazia; Montori, Rossano; Moscatelli, Andrea; Patrone, Elisa; Pescio, Elena; Poeta, Marco; Ravelli, Angelo; Spelta, Maddalena; Suppiej, Agnese; Vai, Sergio; Villa, Luca; Zanini, Rinaldo; Botti, Renato; Gaddi, Antonio Vittorino
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2022 - Attilio Maseri, Italian cardiologist of universal value [Articolo su rivista]
Distante, Alessandro; Modena, Maria Grazia; Uriarte, Jorge Antonio Salerno
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Attilio Maseri, Italian cardiologist of universal value

2022 - Correction to: Updated Recommendations on Cardiovascular Prevention in 2022: An Executive Document of the Italian Society of Cardiovascular Prevention (High Blood Pressure & Cardiovascular Prevention, (2022), 29, 2, (91-102), 10.1007/s40292-021-00503-4) [Articolo su rivista]
Volpe, M.; Gallo, G.; Modena, M. G.; Ferri, C.; Desideri, G.; Tocci, G.
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2022 - Gender gap in risk factor control of coronary patients: Impossible to close? [Articolo su rivista]
Lodi, E.; Reggianini, L.; Modena, M. G.
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This editorial refers to 'Gender gap in risk factor control of coronary patients far from closing: results from the European Society of Cardiology EUROASPIRE V Registry' by P. Vynckier et al.

2022 - Hypertrophic-phenotype cardiopathy… the great simulator [Articolo su rivista]
Lodi, Elisa; D'Antonio, Lucio; Fiocchi, Federica; Letizia, Reggianini; Modena, Maria Grazia
abstract

We describe the case of an incidental finding of left ventricular hypertrophy and high blood pressure values in a patient with irrelevant medical history, who was hospitalized for a vehicle accident. After discharge, he was sent to our center, where the etiological diagnosis was pursued. After achieving blood pressure control, left ventricle reverse remodeling is observed at a 6-month follow-up.

2022 - LA QUESTIONE GENERE IN MEDICINA E CARDIOLOGIA [Articolo su rivista]
Lodi, E; Donati, F; Modena, Mg
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2022 - Mannose as a biomarker of coronary artery disease: Angiographic evidence and clinical significance [Articolo su rivista]
Modena, Maria Grazia; Ferrannini, Ele; Marx, Nikolaus; Andreini, Daniele; Campi, Beatrice; Saba, Alessandro; Gorini, Marco; Ferranni, Giulia; Milzi, Andrea; Magnoni, Marco; Maseri, Attilio; Maggioni, Aldo P.; Burgmaier on behalf of the CAPIRE investigators, Mathias
abstract

Background High mannose has previously associated with insulin resistance and cardiovascular disease (CVD). Our objective is to establish whether mannose is associated with anatomical evidence of coronary artery disease (CAD). Methods Plasma mannose concentrations were measured by liquid chromatography/tandem mass spectrometry in a discovery cohort (n = 513) and a validation cohort (n = 221) of carefully phenotyped individuals. In both cohorts CAD was quantitated using state-of-the-art imaging techniques (coronary computed coronary tomography angiography (CCTA), invasive coronary angiography and optical coherence tomography). Information on subsequent CVD events/death was collected. Associations of mannose with angiographic variables and biomarkers were tested using univariate and multivariate regression models. Survival analysis was performed using the Kaplan-Meier estimator. Results Mannose was related to indices of CAD and features of plaque vulnerability. In the discovery cohort, mannose was a marker of quantity and quality of CCTA-proven CAD and subjects with a mannose level in the top quartile had a significantly higher risk of CVD events/death (p = 3.6e-5). In the validation cohort, mannose was significantly associated with fibrous cap thickness < 65 μm (odds ratio = 1.32 per each 10 μmol/L mannose change [95% confidence interval, 1.05–1.65]) and was an independent predictor of death (hazard ratio for mannose≥vs < 84.6 μmol/L: 4.0(95%CI, 1.4–11.3), p = 0.006).

2022 - PANDEMIA. IL VIRUS CHE NON VORREI [Articolo su rivista]
Gaddi, Av; Lodi, E; Modena, Mg
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2022 - Predictive value of HDL function in patients with coronary artery disease: relationship with coronary plaque characteristics and clinical events [Articolo su rivista]
Magnoni, Marco; Andreini, Daniele; Pirillo, Angela; Uboldi, Patrizia; Latini, Roberto; Catapano, Alberico L.; Maggioni, Aldo P.; Norata, ; Giuseppe, D.; Modena, Maria Grazia
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2022 - Sex and physical exercise: one only size does not fit all. Differences between men and women in regulation and adaptations in response to exercise [Articolo su rivista]
Lodi, E.; Rodighiero, E.; Donati, F.; Pergreffi, M.; D’Antonio, L.; Guicciardi, C.; Morales, J. R.; Lodi, G.; Modena, M. G.
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2022 - TELECARDIOLOGIA TERRITORIALE PER LA FRAGILITA' [Articolo su rivista]
Gaddi, Av; Modena, Mg; Lodi, E
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2022 - Telemonitoraggio e telecontrollo per i cittadini con malattie cardiologiche, respiratorie e diabete [Articolo su rivista]
Vittorino Gaddi, Antonio; Cascini, Fidelia; Chiarolla, Emilio; Delfrate, Beatrice; Forti, Stefano; Marchetti, Marco; Paone, Simona; Modena, Maria Grazia; Pirro, Matteo; Sanna, Antonio; Stopazzolo, Giampaolo
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2022 - The occurrence of drug-induced side effects in women and men with arterial hypertension and comorbidities [Articolo su rivista]
Modena, M. G.; Lodi, E.
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2022 - Updated Recommendations on Cardiovascular Prevention in 2022: An Executive Document of the Italian Society of Cardiovascular Prevention [Capitolo/Saggio]
Volpe, M.; Gallo, G.; Modena, M. G.; Ferri, C.; Desideri, G.; Tocci, G.; Bellone, S.; Bertolotti, M.; Biffi, A.; Consoli, A.; Corsini, A.; Nati, G.; Pirro, M.; Rubattu, S.; Trimarco, B.; de Kreutzenberg, S. V.; Volpe, R.
abstract

This executive document reflects and updates the key points of a Consensus document on Cardiovascular (CV) Prevention realized through the contribution of a number of Italian Scientific Societies and coordinated by the Italian Society of Cardiovascular Prevention (SIPREC). The aim of this executive document is to analyze and discuss the new recommendations introduced by international guidelines for the management of major CV risk factors, such as hypertension, dyslipidemias and type 2 diabetes, consisting in the identification of lower therapeutic targets, in the promotion of combination fixed drug therapies and in the introduction in routine clinical practice of new effective pharmacological classes. Moreover, the document highlights the importance of effective CV prevention strategies during the the coronavirus disease 2019 (COVID-19) outbreak which has dramatically changed the priorities and the use of available resources by the national healthcare systems and have caused a reduction of programmed follow-up visits and procedures and even of hospital admissions for severe acute pathologies. In addition, the pandemic and the consequent lockdown measures imposed have caused a widespread diffusion of unhealthy behaviors with detrimental effects on the CV system. In such a context, reinforcement of CV prevention activities may play a key role in reducing the future impact of these deleterious conditions.

2021 - Association of high-risk coronary atherosclerosis at CCTA with clinical and circulating biomarkers: Insight from CAPIRE study [Articolo su rivista]
Conte, E.; Andreini, D.; Magnoni, M.; Masson, S.; Mushtaq, S.; Berti, S.; Canestrari, M.; Casolo, G.; Gabrielli, D.; Latini, R.; Marraccini, P.; Moccetti, T.; Modena, M. G.; Pontone, G.; Gorini, M.; Maggioni, A. P.; Maseri, A.; Maseri, A.; Andreini, D.; Berti, S.; Canestrari, M.; Casolo, G.; Gabrielli, D.; Latini, R.; Magnoni, M.; Marraccini, P.; Masson, S.; Moccetti, T.; Modena, M. G.; Pontone, G.; Gaspari, F.; Ferrari, S.; Cannata, A.; Stucchi, N.; Fois, M.; Bernasconi, R.; Balconi, G.; Vago, T.; Letizia, T.; Bottazzi, B.; Leone, R.; Suliman, I.; Sommaruga, M.; Gremigni, P.; Olivieri, R.; Pennacchietti, L.; Magnacca, M.; Rossi, M. G.; Pasotti, E.; Clemente, A.; Mushtaq, S.; Mauro, E.; Rossi, R.; Pigazzani, F.; Faggioni, L.; Ciardetti, M.; Puppato, M.
abstract

Background: High-risk coronary atherosclerosis features evaluated coronary CT angiography (CCTA) were suggested to have a prognostic role. The present study aimed to evaluate the association of circulating biomarkers with high-risk plaque features assessed by CCTA. Methods: A consecutive cohort of subjects who underwent CCTA because of suspected CAD was screened for inclusion in the CAPIRE study. Based on risk factors (RF) burden patients were defined as having a low clinical risk (0–1 RF with the exclusion of patients with diabetes mellitus as single RF) or an high clinical risk (≥3 RFs). In all patients, measurement of inflammatory biomarkers and CCTA analysis focused on high-risk plaque features were performed. Univariate and multivariate logistic regression analysis were used to evaluate the relationship between clinical and biological variables with CCTA advanced plaque features. Results: 528 patients were enrolled in CAPIRE study. Older age and male sex appeared to be predictors of qualitative high-risk plaque features and associated with the presence of elevated total, non-calcified and low-attenuation plaque volume. Among circulating biomarkers only hs-CRP was found to be associated with qualitative high-risk plaque features (OR 2.02, p = 0.004 and 2.02, p = 0.012 for LAP and RI > 1.1, respectively) with borderline association with LAP-Vol (OR 1.52, p = 0.076); HbA1c and PTX-3 resulted to be significantly associated with quantitative high-risk plaque features (OR 1.71, p = 0.003 and 1.04, p = 0.002 for LAP-Vol, respectively). Conclusions: Our results support the association between inflammatory biomarkers (hs-CRP, PTX- 3), HbA1c and high-risk atherosclerotic features detected by CCTA. Male sex and older age are significant predictors of high-risk atherosclerosis.

2021 - Attività sportiva e COVID-19: cosa c'è di nuovo? [Articolo su rivista]
Lodi, Elisa; Lodi, Giovanni; Reggianini, Letizia; Savino, Gustavo; Modena, Maria Grazia
abstract

Growing evidence about COVID-19 and its possible cardiopulmonary complications have raised concerns about a potential subclinical heart damage even in asymptomatic patients. Many countries worldwide provided recommendations for a safe return to play and sports activity for athletes with previous COVID-19 disease. Italy was among the first nations to deal with the problem of protecting athletes’ health. In this regard, after an initial version released on April 2020, on December 11, 2020 the Italian Sports Medicine Federation (FMSI) updated the recommendations for the return play of non-professional athletes. The purpose of this article is to analyze and deepen the contents of the new FMSI recommendations, integrating and comparing them with the previous ones. Further updates may occur if new scientific and epidemiological evidence will rise regarding COVID-19.

2021 - COVID-19 E DIFFERENZE DI GENERE IN CLINICA [Capitolo/Saggio]
Modena, Maria Grazia; Lodi, Elisa; Reggianini, Letizia
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2021 - Can sport and face masks get along? [Articolo su rivista]
Lodi, E.; Scavone, A.; Rodrigues, G. D.; D'Antonio, L.; Pergreffi, M.; Modena, M. G.
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The sports world has certainly been one of the most affected by the SARS-CoV-2 pandemic. In addition to the closure of clubs and gyms, the introduction of personal protective equipment and face masks has raised many doubts about the safety of their use during physical activity. This is due to the possible onset of symptoms related to the physical barrier standing in front of the airways, resulting in greater resistance to airways flow and a bigger respiratory work. The aim of this article was to analyze the data available so far in the literature to try to answer the question: Can sport and masks get along?

2021 - DIFFERENZE DI GENERE NELLA CARDIOPATIA ISCHEMICA [Articolo su rivista]
Lodi, Elisa; Modena, Maria Grazia
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2021 - Metabolic Correlates of Coronary Atherosclerosis, cardiovascular Risk, Both or Neither. Results of the 2x2 Phenotypic CAPIRE Study [Articolo su rivista]
Modena, Maria Grazia
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Background Traditional cardiovascular risk factors (RFs) and coronary artery disease (CAD) do not always run parallel. We investigated functional-metabolic correlations of CAD, RFs, or neither in the CAPIRE (Coronary Atherosclerosis in Outlier Subjects: Protective and Novel Individual Risk Factors Evaluation) 2 × 2 phenotypic observational study. Methods Two hundred and fortyone subjects were included based on RF burden, presence/absence of CAD (assessed by computed tomography angiography), age and sex. Participants displayed one of four phenotypes: CAD with ≥3 RFs, no-CAD with ≥3 RFs, CAD with ≤1 RF and no-CAD with ≤1 RF. Metabolites were identified by gas chromatography–mass spectrometry and pathways by metabolite set enrichment analysis. Results Characteristic patterns and specific pathways emerged for each phenotypic group: amino sugars for CAD/high-RF; urea cycle for no-CAD/high-RF; glutathione for CAD/low-RF; glycine and serine for no-CAD/low-RF. Presence of CAD correlated with ammonia recycling; absence of CAD with the transfer of acetyl groups into mitochondria; high-risk profile with alanine metabolism (all p < 0.05). The comparative case-control analyses showed a statistically significant difference for the two pathways of phenylalanine, tyrosine and tryptophan biosynthesis and phenylalanine metabolism in the CAD/Low-RF vs NoCAD/Low-RF comparison. Conclusions The present 2 × 2 observational study identified specific metabolic pathways for each of the four phenotypes, providing novel functional insights, particularly on CAD with low RF profiles and on the absence of CAD despite high-risk factor profiles.

2021 - Prevention Italy 2021 - An update of the 2018 Consensus document and recommendations for the prevention of cardiovascular disease in Italy [Capitolo/Saggio]
Battistoni, A.; Gallo, G.; Aragona, C. O.; Barchiesi, F.; Basolo, A.; Bellone, S.; Bellotti, P.; Bertolotti, M.; Bianco, A.; Biffi, A.; Borghi, C.; Cicero, A. F. G.; Consoli, A.; Corsini, A.; Desideri, G.; Di Giacinto, B.; Fernando, F.; Ferri, C.; Galiuto, L.; Grassi, D.; Grassi, G.; Icardi, G.; Indolfi, C.; Lodi, E.; Modena, M. G.; Muiesan, M. L.; Nati, G.; Orsi, A.; Palermi, S.; Parati, G.; Passantino, A.; Patelli, A.; Pelliccia, A.; Pengo, M.; Filardi, P. P.; Perseghin, G.; Pirro, M.; Pontremoli, R.; Rengo, G.; Ricotti, R.; Rizzoni, D.; Rocca, B.; Rotella, C.; Rubattu, S.; Salvetti, G.; Sciacqua, A.; Serdoz, A.; Sirico, F.; Squeo, M. R.; Tocci, G.; Trimarco, B.; Vigili de Kreutzenberg, S.; Volpe, R.; Volpe, M.
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2021 - Telemedicine [Articolo su rivista]
Lodi, E.; Modena, M. G.
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2021 - The point of view on cardiovascular prevention in women [Articolo su rivista]
Modena, M. G.; Lodi, E.
abstract

2020 - Association between loop diuretic dose changes and outcomes in chronic heart failure: observations from the ESC-EORP Heart Failure Long-Term Registry [Articolo su rivista]
Kapelios, C. J.; Laroche, C.; Crespo-Leiro, M. G.; Anker, S. D.; Coats, A. J. S.; Diaz-Molina, B.; Filippatos, G.; Lainscak, M.; Maggioni, A. P.; Mcdonagh, T.; Mebazaa, A.; Metra, M.; Moura, B.; Mullens, W.; Piepoli, M. F.; Rosano, G. M. C.; Ruschitzka, F.; Seferovic, P. M.; Lund, L. H.; Gale, C. P.; Beleslin, B.; Budaj, A.; Chioncel, O.; Dagres, N.; Danchin, N.; Erlinge, D.; Emberson, J.; Glikson, M.; Gray, A.; Kayikcioglu, M.; Maggioni, A.; Nagy, K. V.; Nedoshivin, A.; Petronio, A. -S.; Roos-Hesselink, J.; Wallentin, L.; Zeymer, U.; Crespo-Leiro, M.; Anker, S.; Mebazaa, A.; Coats, A.; Filippatos, G.; Ferrari, R.; Maggioni, A. P.; Piepoli, M. F.; Goda, A.; Diez, M.; Fernandez, A.; Fruhwald, F.; Gatzov, P.; Kurlianskaya, A.; Hullin, R.; Christodoulides, T.; Hradec, J.; Nielsen, O. W.; Nedjar, R.; Uuetoa, T.; Jimenez, J. F. D.; Harjola, V. -P.; Logeart, D.; Tousoulis, D.; Milicic, D.; Merkely, B.; Amir, O.; Shotan, A.; Shafie, D.; Metra, M.; Mirrakhimov, E.; Kavoliuniene, A.; Erglis, A.; Otljanska, M.; Kostovska, E. S.; Demarco, D. C.; Drozdz, J.; Fonseca, C.; Chioncel, O.; Dekleva, M.; Dahlstrom, U.; Lainscak, M.; Goncalvesova, E.; Estrago, V.; Bajraktari, G.; Auer, J.; Ablasser, K.; Fruhwald, F.; Dolze, T.; Brandner, K.; Gstrein, S.; Poelzl, G.; Moertl, D.; Reiter, S.; Muslibegovic, A.; Vasilj, M.; Fazlibegovic, E.; Cesko, M.; Zelenika, D.; Palic, B.; Pravdic, D.; Cuk, D.; Vitlianova, K.; Katova, T.; Kurteva, T.; Gatzov, P.; Kamenova, D.; Antova, M.; Krejci, J.; Spinar, J.; Krupicka, J.; Malek, F.; Hegarova, M.; Lazarova, M.; Monhart, Z.; Hassanein, M.; El Messiry, F.; El Shazly, A. H.; Elrakshy, Y.; Youssef, A.; Moneim, A. A.; Noamany, M.; Dayem, T. K. A.; Farag, N.; Halawa, S. I.; Hamid, M. A.; Saleh, A.; Ebeid, H.; Hanna, R.; Louis, O.; Enen, M. A.; Ibrahim, B. S.; Nasr, G.; Elbahry, A.; Sobhy, H.; Ashmawy, M.; Gouda, M.; Aboleineen, W.; Bernard, Y.; Meneveau, N.; Pillot, M.; Morel, M.; Seronde, M. -F.; Schiele, F.; Briand, F.; Delahaye, F.; Damy, T.; Eicher, J. -C.; de Groote, P.; Fertin, M.; Lamblin, N.; Isnard, R.; Thevenin, S.; Hagege, A.; Logeart, D.; Le Marcis, V.; Ly, J. -F.; Coisne, D.; Lequeux, B.; Le Moal, V.; Mascle, S.; Lotton, P.; Behar, N.; Donal, E.; Ridard, C.; Reynaud, A.; Basquin, A.; Bauer, F.; Codjia, R.; Galinier, M.; Tourikis, P.; Stavroula, M.; Stefanadis, C.; Chrysohoou, C.; Kotrogiannis, I.; Matzaraki, V.; Karavidas, A.; Tsitsinakis, G.; Kapelios, C.; Nanas, J.; Kampouri, H.; Nana, E.; Kaldara, E.; Eugenidou, A.; Vardas, P.; Saloustros, I.; Tsaknakis, T.; Evangelou, S.; Tziourganou, H.; Tsaroucha, A.; Papadopoulou, A.; Douras, A.; Polgar, L.; Kosztin, A.; Nyolczas, N.; Nagy, A. C.; Halmosi, R.; Elber, J.; Shotan, A.; Fuhrmann, A. V.; Amir, O.; Romano, S.; Marcon, S.; Penco, M.; Di Mauro, M.; Lemme, E.; Carubelli, V.; Rovetta, R.; Metra, M.; Bulgari, M.; Quinzani, F.; Bosi, S.; Schiavina, G.; Squeri, A.; Di Tano, G.; Pirelli, S.; Ferrari, R.; Fucili, A.; Passero, T.; Musio, S.; Di Biase, M.; Correale, M.; Salvemini, G.; Brognoli, S.; Zanelli, E.; Giordano, A.; Agostoni, P.; Salvioni, E.; Copelli, S.; Modena, M. G.; Valenti, C.; Olaru, A.; Bandino, S.; Deidda, M.; Mercuro, G.; Marino, P. N.; Di Ruocco, M. V.; Piccinino, C.; Parrinello, G.; Licata, G.; Torres, D.; Giambanco, S.; Busalacchi, S.; Arrotti, S.; Novo, S.; Inciardi, R. M.; Pieri, P.; Galifi, M. A.; Teresi, G.; Buccheri, D.; Minacapelli, A.; Veniani, M.; Frisinghelli, A.; Priori, S. G.; Cattaneo, S.; Opasich, C.; Gualco, A.; Pagliaro, M.; Mancone, M.; Fedele, F.; Cinque, A.; Vellini, M.; Scarfo, I.; Romeo, F.; Ferraiuolo, F.; Sergi, D.; Anselmi, M.; Melandri, F.; Leci, E.; Iori, E.; Bovolo, V.; Frea, S.; Bergerone, S.; Botta, M.; Canavosio, F. G.; Gaita, F.; Merlo, M.; Cinquetti, M.; Sinagra, G.; Ramani, F.; Fabris, E.; Artico, J.; Miani, D.; Fresco, C.; Daneluzzi, C.; Proclemer, A.; Cicoira, M.; Zanolla, L.; Marchese, G.; Torelli, F.; Vassanelli, C.; Voronina, N.; Tamakauskas, V.; Smalinskas, V.; Karaliute, R.; Petraskiene, I.; Rumbinaite,
abstract

Aims: Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes. Methods and results: We included 8130 HF patients from the ESC-EORP Heart Failure Long-Term Registry. Among patients who had dose decreased, successful decrease was defined as the decrease not followed by death, HF hospitalization, New York Heart Association class deterioration, or subsequent increase in LD dose. Mean age was 66 ± 13 years, 71% men, 62% HF with reduced ejection fraction, 19% HF with mid-range ejection fraction, 19% HF with preserved ejection fraction. Median [interquartile range (IQR)] LD dose was 40 (25–80) mg. LD dose was increased in 16%, decreased in 8.3% and unchanged in 76%. Median (IQR) follow-up was 372 (363–419) days. Diuretic dose increase (vs. no change) was associated with HF death [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.12–2.08; P = 0.008] and nominally with cardiovascular death (HR 1.25, 95% CI 0.96–1.63; P = 0.103). Decrease of diuretic dose (vs. no change) was associated with nominally lower HF (HR 0.59, 95% CI 0.33–1.07; P = 0.083) and cardiovascular mortality (HR 0.62,. 95% CI 0.38–1.00; P = 0.052). Among patients who had LD dose decreased, systolic blood pressure [odds ratio (OR) 1.11 per 10 mmHg increase, 95% CI 1.01–1.22; P = 0.032], and absence of (i) sleep apnoea (OR 0.24, 95% CI 0.09–0.69; P = 0.008), (ii) peripheral congestion (OR 0.48, 95% CI 0.29–0.80; P = 0.005), and (iii) moderate/severe mitral regurgitation (OR 0.57, 95% CI 0.37–0.87; P = 0.008) were independently associated with successful decrease. Conclusion: Diuretic dose was unchanged in 76% and decreased in 8.3% of outpatients with chronic HF. LD dose increase was associated with worse outcomes, while the LD dose decrease group showed a trend for better outcomes compared with the no-change group. Higher systolic blood pressure, and absence of (i) sleep apnoea, (ii) peripheral congestion, and (iii) moderate/severe mitral regurgitation were independently associated with successful dose decrease.

2020 - COVID-19: A gendered disease? Possible interpretations and knowledge limitations [Articolo su rivista]
Lodi, E.; Scavone, A.; Reggianini, L.; Modena, M. G.
abstract

Several important gender differences in susceptibility, clinical manifestation and response to treatments for a number of diseases are known since a long time, although they continue to be underestimated by a multiplicity of operators, especially men. The recent COVID-19 pandemic has provided a further evidence of the importance of gender medicine. The epidemiological analysis of COVID-19 data has highlighted the presence of multiple and important gender differences, with more unfavourable scenarios for the male gender. The mechanisms underlying these gender differences are varied (including socio-behavioral, immune and viral factors) and not yet fully clarified. A gender-based approach to clinical practice also in the context of this pandemic seems to be mandatory, as it could significantly contribute to health promotion by improving the effectiveness of diagnostic and/or therapeutic approaches and, therefore, leading to important benefits primarily for the patients but also for the sustainability of the National Health System.

2020 - COVID-19: UN’INFEZIONE GENDER RELATED? [Abstract in Atti di Convegno]
Lodi, Elisa; Reggianini, Letizia; Scavone, Alberto; Modena, Maria Grazia
abstract

2020 - Coronary Plaque Features on CTA Can Identify Patients at Increased Risk of Cardiovascular Events [Articolo su rivista]
Andreini, D.; Magnoni, M.; Conte, E.; Masson, S.; Mushtaq, S.; Berti, S.; Canestrari, M.; Casolo, G.; Gabrielli, D.; Latini, R.; Marraccini, P.; Moccetti, T.; Modena, M. G.; Pontone, G.; Gorini, M.; Maggioni, A. P.; Maseri, A.
abstract

Objectives: This study sought to assess whether coronary atherosclerosis analysis by coronary computed tomography angiography (CTA) may improve prognostic stratification among patients with diffuse coronary artery disease (CAD) Background: Coronary CTA has recently emerged as a promising noninvasive tool for advanced analysis of coronary atherosclerosis. Methods: The multicenter CAPIRE (Coronary Atherosclerosis in outlier subjects: Protective and novel Individual Risk factors Evaluation) study is part of the GISSI Outlier Project. A prospective cohort of subjects who underwent coronary CTA for suspected CAD was enrolled. Based on risk factor (RF) burden, patients were defined as having a low clinical risk (0 to 1 RF with the exclusion of patients with diabetes mellitus as single RF) or at high clinical risk (3 or more RFs). Patients with 2 RFs were not enrolled in the study. Coronary CTA advanced plaque assessment was performed. Outcome measures were 3 combined endpoints: acute coronary syndrome (ACS), cardiac death + ACS, and cardiac death + ACS + late revascularization. Results: Among the 544 patients enrolled in the CAPIRE study, in 522 patients, a mean follow-up of 37 ± 10 months was obtained (16 patients were excluded due to 1 < segment involvement score <5 at core lab coronary CTA analysis and 6 patients were lost at follow-up). Higher atherosclerotic burden was found in patients with higher clinical risk, but prevalence of elevated noncalcified plaque volume did not significantly differ between low- versus high-risk patients. Quantitative plaque parameters by coronary CTA were associated with composite endpoints at multivariable analysis when corrected for univariate predictors. Elevated noncalcified plaque volume, expressed as dichotomic variable, was associated with all combined endpoints. Even if the low absolute number of events represents a limitation to the present study, patients with low noncalcified plaque volume had similar risk of cardiac events independently from the presence of multivessel disease, while patients with high noncalcified plaque volume had higher rates of cardiac events. Conclusions: The CAPIRE study confirmed the prognostic value of atherosclerosis assessment by coronary CTA, demonstrating high noncalcified plaque volume as the most ACS-predictive parameter in patients with extensive CAD. (GISSE Outliers CAPIRE [CAPIRE]; NCT02157662)

2020 - Gender differences in cardiovascular risk factors [Articolo su rivista]
Lodi, E.; Stefani, O.; Reggianini, L.; Carollo, A.; Martinotti, V.; Modena, M. G.
abstract

Cardiovascular disease (CVD) has been traditionally considered a purely male disease, and for many years it has been under-estimated and under-recognized in women. Nevertheless, CVD represents the leading cause of female mortality and disability in developing countries. The increased interest in this field allowed for the description of the differences in terms of clinical presentation, prevention, treatment, and prognosis. The recognition of the gender differences in CVD plays an essential role in CVD prevention. Just as a child cannot be considered a small adult, similarly a woman should not be considered a small man, although, at this time, CVD therapy has been studied mainly on male models, and only subsequently administered to women. We should not underestimate the biological and hormonal differences between the sexes, which can affect the various clinical pictures and drug responses. Since CVD is mostly preventable, this review aims to provide an overview on the cardiovascular risk factors in women, focusing on traditional risks, affecting both sexes, though with different relative risk and prevalence, and on the novel and unique risks in women, as this knowledge would help optimize prevention, treatment and prognosis.

2020 - Kate and leopold: The odd couple [Articolo su rivista]
Lodi, E.; Reggianini, L.; Modena, M. G.
abstract

Cardiovascular disease (CVD) was traditionally considered a purely male disease, and for many years it was underestimated and under-recognized in women. Neverthe-less, the burden of CVD in women is increasing, so much so that CVD presently represents the leading cause of female mortality and disability in developing countries. The increased interest in this field highlighted the presence of gender-spe-cific differences in terms of clinical presentation, prevention, treatment, and prognosis. Biological and hormonal differences between sexes should not be underestimated, as they can affect clinical presentation and drug responses. This report is an example of the current gender-related prac-tice in the evaluation and treatment of high-risk cardiovascular patients. A 70-year-old lady with a history of coronary disease, diabetes, hypertension, Parkinson’s, rheumatoid arthritis, and hypothyroidism attended our outpatient clin-ic for continuous chest pain, exertional dyspnea, malleolar edema. A diagnosis of heart failure with preserved ejection fraction was reached after discussing several confounding factors.

2020 - LA CARDIOLOGIA E LO SPORT: UN BINOMIO CHE FUNZIONA [Abstract in Atti di Convegno]
Lodi, Elisa; Tardini, Lucia; Savino, Gustavo; Cappelli, Stefano; Modena, Maria Grazia; Patrizi, Giampiero
abstract

2020 - LA MEDICINA SPECIALISTICA IN UN'OTTICA DI GENERE: IL CARDIOVASCOLARE [Capitolo/Saggio]
Modena, Maria Grazia; Lodi, Elisa; Reggianini, Letizia
abstract

2020 - LA PRESCRIZIONE DELL’ESERCIZIO FISICO ADATTATO COME STRUMENTO DI PREVENZIONE E TERAPIA [Abstract in Atti di Convegno]
Lodi, Elisa; Savino, Gustavo; Reggianini, Letizia; Toni, Giulio; Bernaroli, Laura; Modena, Maria Grazia
abstract

2020 - LA TELEMEDICINA PER IL CUORE: UN NUOVO STRUMENTO PER I PAZIENTI CON SCOMPENSO CARDIACO? [Abstract in Atti di Convegno]
Lodi, Elisa; Reggianini, Letizia; Scavone, Alberto; Carollo, Alberto; Modena, Maria Grazia
abstract

2020 - LE ARITMIE VENTRICOLARI NEGLI ATLETI: UN CAMPANELLO D’ALLARME? [Abstract in Atti di Convegno]
Lodi, Elisa; Tardini, Lucia; Savino, Gustavo; Cappelli, Stefano; Modena, Maria Grazia; Patrizi, Giampiero
abstract

2020 - Recommendations for Cardiovascular Prevention During the Sars-Cov-2 Pandemic: An Executive Document by the Board of the Italian Society of Cardiovascular Prevention [Articolo su rivista]
Volpe, M.; Battistoni, A.; Bellotti, P.; Bellone, S.; Bertolotti, M.; Biffi, A.; Consoli, A.; Corsini, A.; Desideri, G.; Ferri, C.; Modena, M. G.; Nati, G.; Pirro, M.; Rubattu, S.; Tocci, G.; Trimarco, B.; Volpe, R.; de Kreutzenberg, S. V.
abstract

In 2020, the Sars-Cov-2 pandemic is causing a huge and dramatic impact on healthcare systems worldwide. During this emergency, fragile patients suffering from other comorbidities, especially patients susceptible to or affected by cardiovascular disease, are the ones most exposed to the poorer outcomes. Therefore, it is still mandatory to continue to strictly adhere to the rules of cardiovascular prevention. This document aims to provide all doctors with simple and clear recommendations in order to spread useful messages to the widest number of subjects in order to continue the battle against cardiovascular diseases even in times of pandemic.

2020 - Return to sport after the COVID-19 pandemic. How to behave? [Articolo su rivista]
Lodi, E.; Scavone, A.; Carollo, A.; Guicciardi, C.; Reggianini, L.; Savino, G.; Modena, M. G.
abstract

Italy, and all the world, has recently faced the arduous battle against the spread of a new coronavirus: SARS-CoV-2. This unexpected pandemic dramatically upended all areas of life, leading to a profound change in priorities, both in the medical as well as the social-economic field; and sports is no exception. Not surprisingly, the COVID-19 pandemic also walloped the world of sports. Every aspect of sports has been affected, leading professional and amateur leagues to stop their activities, in order to limit the spread of the virus, a painful but mandatory choice. Even the most popular sports in the world had to deal with the massive global threat of SARS-CoV-2. The Italian Sports Medical Federation (FMSI) has recently drawn up a protocol to be implemented when teams will receive from the authorities the permission to return to competitive activities. The purpose of this paper is to deepen the FMSI indications and allow wider dissemination and understanding.

2020 - Risk communication at the time of Coronavirus: are we washing our hand of COVID-19? [Articolo su rivista]
Capello, Fabio; Baraldini, Laura; Bertolotti, Marco; Bonomini, Mauro; Bovo, Daniele; Britti, Domenico; Caruso, Lorenzo; Castiglione, Gaetano; Casu, Gavino; Cevenini, Matteo; Cipolla, Maurizio; Cipriani, Gabriele; Dentali, Francesco; Dimilta, Michela; Fagioli, Clara; Maria, Soledad; Linarello, Simona; Guido, Alessandro; Marini, Marina; Mistretta, Laura; Modena, Maria Grazia; E Naimoli, Andrea; Noera, Giorgio; Para, Ombretta; Pili, Giuseppe; Rinaldi, Giovanni; Sabatini, Antonio; Santini, Marco; Teresa Savo, Maria; Tangianu, Flavio; Ussia, Giovanni; Visioli, Francesco; Tommaso, Diego; Volpe, Roberto; Vittorino Gaddi, Antonio
abstract

2020 - Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry [Articolo su rivista]
Lainscak, M.; Milinkovic, I.; Polovina, M.; Crespo-Leiro, M. G.; Lund, L. H.; Anker, S. D.; Laroche, C.; Ferrari, R.; Coats, A. J. S.; McDonagh, T.; Filippatos, G.; Maggioni, A. P.; Piepoli, M. F.; Rosano, G. M. C.; Ruschitzka, F.; Simic, D.; Asanin, M.; Eicher, J. -C.; Yilmaz, M. B.; Seferovic, P. M.; Gale, C. P.; Chair, G. B.; Branko Beleslin, R. S.; Andrzej Budaj, P. L.; Chioncel, R. O.; Nikolaos Dagres, D. E.; Nicolas Danchin, F. R.; David Erlinge, S. E.; Jonathan Emberson, G. B.; Michael Glikson, I. L.; Alastair Gray, G. B.; Meral Kayikcioglu, T. R.; Aldo Maggioni, I. T.; Klaudia Vivien Nagy, H. U.; Aleksandr Nedoshivin, R. U.; Anna-Sonia Petronio, I. T.; Jolien Roos-Hesselink, N. L.; Lars Wallentin, S. E.; Uwe Zeymer, D. E.; Crespo-Leiro, M.; Mebazaa, A.; Coats, A.; A. Goda A., L.; M. Diez A., R.; A. Fernandez A., R.; F. Fruhwald A., T.; Fazlibegovic, E.; P. Gatzov B., G.; A. Kurlianskaya B., Y.; R. Hullin C., H.; T. Christodoulides C., Y.; J. Hradec C., Z.; O. Wendelboe Nielsen D., K.; R. Nedjar D., Z.; T. Uuetoa E., E.; M. Hassanein E., G.; J. F. Delgado Jimenez E., S.; V-, P. Harjola F. I.; D. Logeart F., R.; V. Chumburidze G., E.; D. Tousoulis G., R.; D. Milicic H., R.; B. Merkely H., U.; O'Donoghue IE, E.; O. Amir I., L.; A. Shotan I., L.; D. Shafie I., R.; M. Metra I., T.; A. Matsumori J., P.; E. Mirrakhimov K., G.; A. Kavoliuniene L., T.; A. Erglis L., V.; Vataman, E.; M. Otljanska M., K.; E. Srbinovska Kostovska M., K.; D. Cassar DeMarco M., T.; J. Drozdz P., L.; Fonseca, C.; M. Dekleva R., S.; E. Shkolnik R., U.; U. Dahlstrom S., E.; M. Lainscak S., I.; E. Goncalvesova S., K.; A. Temizhan T., R.; V. Estrago U., Y.; G. Bajraktari X., K.; Auer, J.; Ablasser, K.; Fruhwald, F.; Dolze, T.; Brandner, K.; Gstrein, S.; Poelzl, G.; Moertl, D.; Reiter, S.; Podczeck-Schweighofer, A.; Muslibegovic, A.; Vasilj, M.; Cesko, M.; Zelenika, D.; Palic, B.; Pravdic, D.; Cuk, D.; Vitlianova, K.; Katova, T.; Velikov, T.; Kurteva, T.; Gatzov, P.; Kamenova, D.; Antova, M.; Sirakova, V.; Krejci, J.; Mikolaskova, M.; Spinar, J.; Krupicka, J.; Malek, F.; Hegarova, M.; Lazarova, M.; Monhart, Z.; Hassanein, M.; Sobhy, M.; El Messiry, F.; El Shazly, A. H.; Elrakshy, Y.; Youssef, A.; Moneim, A. A.; Noamany, M.; Reda, A.; Dayem, T. K. A.; Farag, N.; Halawa, S. I.; Hamid, M. A.; Said, K.; Saleh, A.; Ebeid, H.; Hanna, R.; Aziz, R.; Louis, O.; Enen, M. A.; Ibrahim, B. S.; Nasr, G.; Elbahry, A.; Sobhy, H.; Ashmawy, M.; Gouda, M.; Aboleineen, W.; Bernard, Y.; Luporsi, P.; Meneveau, N.; Pillot, M.; Morel, M.; Seronde, M. -F.; Schiele, F.; Briand, F.; Delahaye, F.; Damy, T.; de Groote, P.; Fertin, M.; Lamblin, N.; Isnard, R.; Lefol, C.; Thevenin, S.; Hagege, A.; Jondeau, G.; Logeart, D.; Le Marcis, V.; Ly, J. -F.; Coisne, D.; Lequeux, B.; Le Moal, V.; Mascle, S.; Lotton, P.; Behar, N.; Donal, E.; Thebault, C.; Ridard, C.; Reynaud, A.; Basquin, A.; Bauer, F.; Codjia, R.; Galinier, M.; Tourikis, P.; Stavroula, M.; Tousoulis, D.; Stefanadis, C.; Chrysohoou, C.; Kotrogiannis, I.; Matzaraki, V.; Dimitroula, T.; Karavidas, A.; Tsitsinakis, G.; Kapelios, C.; Nanas, J.; Kampouri, H.; Nana, E.; Kaldara, E.; Eugenidou, A.; Vardas, P.; Saloustros, I.; Patrianakos, A.; Tsaknakis, T.; Evangelou, S.; Nikoloulis, N.; Tziourganou, H.; Tsaroucha, A.; Papadopoulou, A.; Douras, A.; Polgar, L.; Merkely, B.; Kosztin, A.; Nyolczas, N.; Nagy, A. C.; Halmosi, R.; Elber, J.; Alony, I.; Shotan, A.; Fuhrmann, A. V.; Amir, O.; Romano, S.; Marcon, S.; Penco, M.; Di Mauro, M.; Lemme, E.; Carubelli, V.; Rovetta, R.; Metra, M.; Bulgari, M.; Quinzani, F.; Lombardi, C.; Bosi, S.; Schiavina, G.; Squeri, A.; Barbieri, A.; Di Tano, G.; Pirelli, S.; Fucili, A.; Passero, T.; Musio, S.; Di Biase, M.; Correale, M.; Salvemini, G.; Brognoli, S.; Zanelli, E.; Giordano, A.; Agostoni, P.; Italiano, G.; Salvioni, E.; Copelli, S.; Modena, M. G.; Reggianini, L.; Valenti, C.; Olaru, A.; Bandino, S.; Deidda, M.; Mercuro, G.; Dessalvi, C. C.; Marino, P. N.; Di Ruocco, M. V.; Sartori, C.; Piccinino, C.
abstract

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P ≤ 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P = 0.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P < 0.001) and there were no differences in causes of death. All-cause mortality and all-cause hospitalization increased with greater age in both sexes. Sex was not an independent predictor of 1-year all-cause mortality (restricted to patients with LVEF ≤45%). Mortality risk was significantly lower in patients of younger age, compared to patients aged >75 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF ≤45%.

2020 - The strategic alliance between clinical and molecular science in the war against sars-cov-2, with the rapid-diagnostics test as an indispensable weapon for front line doctors [Articolo su rivista]
Gaddi, A. V.; Capello, F.; Aluigi, L.; Antignani, P. L.; Callegaro, A.; Casu, G.; Cipolla, E.; Cipolla, M.; Cosco, L.; Culzoni, F.; Dentali, F.; Elexpuru-Zabaleta, M.; Forbes-Hernandez, T. Y.; Fragiacomo, C.; Giampieri, F.; Gnasso, A.; Mancini, R.; Modena, M. G.; Nichelatti, M.; Paradiso, A. V.; Ortasi, P.; Savo, M. T.; Tangianu, F.; Tempesta, S.; Voci, T. D.; Battino, M.
abstract

Our work concerns the actual problem of spread of SARS-CoV-2 outbreak which requires fast and correct as possible answer. In current scenario, the need of rapid answer put away the imperative of proper methodology. We focus on the serogical immunoassay for diagnosis of Covid-19 as an important weapon not only for diagnostic purpose, but also for epidemiologic one. The right equilibrium between high speed, low cost and accuracy is obtained with easy-to-use decentralized point-of-care test as the colloidal gold-based immunochromatographic strip assay which detects IgM and IgG antibodies directed against SARS-CoV-2. As our aim is to evaluate the efficacy of Covid-19 rapid tests and of serological assays in real-life settings, we designed a research protocol aimed to establish how to use correctly these diagnostics, taking into account the different possible clinical and epidemiological scenarios.

2020 - Unravelling the interplay between hyperkalaemia, renin–angiotensin–aldosterone inhibitor use and clinical outcomes. Data from 9222 chronic heart failure patients of the ESC-HFA-EORP Heart Failure Long-Term Registry [Articolo su rivista]
Rossignol, P.; Lainscak, M.; Crespo-Leiro, M. G.; Laroche, C.; Piepoli, M. F.; Filippatos, G.; Rosano, G. M. C.; Savarese, G.; Anker, S. D.; Seferovic, P. M.; Ruschitzka, F.; Coats, A. J. S.; Mebazaa, A.; McDonagh, T.; Sahuquillo, A.; Penco, M.; Maggioni, A. P.; Lund, L. H.; Christopher Peter Gale, G. B.; Branko Beleslin, R. S.; Andrzej Budaj, P. L.; Ovidiu Chioncel, R. O.; Nikolaos Dagres, D. E.; Nicolas Danchin, F. R.; David Erlinge, S. E.; Jonathan Emberson, G. B.; Michael Glikson, I. L.; Alastair Gray, G. B.; Meral Kayikcioglu, T. R.; Aldo Maggioni, I. T.; Klaudia Vivien Nagy, H. U.; Aleksandr Nedoshivin, R. U.; Anna-Sonia Petronio, I. T.; Jolien Roos-Hesselink, N. L.; Lars Wallentin, S. E.; Uwe Zeymer, D. E.; Crespo-Leiro, M.; Anker, S.; Mebazaa, A.; Coats, A.; Filippatos, G.; Ferrari, R.; Maggioni, A. P.; Piepoli, M. F.; Goda, A.; Diez, M.; Fernandez, A.; Fruhwald, F.; Fazlibegovic, E.; Gatzov, P.; Kurlianskaya, A.; Hullin, R.; Christodoulides, T.; Hradec, J.; Nielsen, O. W.; Nedjar, R.; Uuetoa, T.; Hassanein, M.; Jimenez, J. F. D.; Harjola, V. P.; Logeart, D.; Chumburidze, V.; Tousoulis, D.; Milicic, D.; Merkely, B.; O'Donoghue, E.; Amir, O.; Shotan, A.; Shafie, D.; Metra, M.; Matsumori, A.; Mirrakhimov, E.; Kavoliuniene, A.; Erglis, A.; Vataman, E.; Otljanska, M.; Kostovska, E. S.; DeMarco, D. C.; Drozdz, J.; Fonseca, C.; Chioncel, O.; Dekleva, M.; Shkolnik, E.; Dahlstrom, U.; Lainscak, M.; Goncalvesova, E.; Temizhan, A.; Estrago, V.; Bajraktari, G.; Auer, J.; Ablasser, K.; Fruhwald, F.; Dolze, T.; Brandner, K.; Gstrein, S.; Poelzl, G.; Moertl, D.; Reiter, S.; Podczeck-Schweighofer, A.; Muslibegovic, A.; Vasilj, M.; Fazlibegovic, E.; Cesko, M.; Zelenika, D.; Palic, B.; Pravdic, D.; Cuk, D.; Vitlianova, K.; Katova, T.; Velikov, T.; Kurteva, T.; Gatzov, P.; Kamenova, D.; Antova, M.; Sirakova, V.; Krejci, J.; Mikolaskova, M.; Spinar, J.; Krupicka, J.; Malek, F.; Hegarova, M.; Lazarova, M.; Monhart, Z.; Hassanein, M.; Sobhy, M.; El Messiry, F.; El Shazly, A. H.; Elrakshy, Y.; Youssef, A.; Moneim, A. A.; Noamany, M.; Reda, A.; Dayem, T. K. A.; Farag, N.; Halawa, S. I.; Hamid, M. A.; Said, K.; Saleh, A.; Ebeid, H.; Hanna, R.; Aziz, R.; Louis, O.; Enen, M. A.; Ibrahim, B. S.; Nasr, G.; Elbahry, A.; Sobhy, H.; Ashmawy, M.; Gouda, M.; Aboleineen, W.; Bernard, Y.; Luporsi, P.; Meneveau, N.; Pillot, M.; Morel, M.; Seronde, M. -F.; Schiele, F.; Briand, F.; Delahaye, F.; Damy, T.; Eicher, J. -C.; de Groote, P.; Fertin, M.; Lamblin, N.; Isnard, R.; Lefol, C.; Thevenin, S.; Hagege, A.; Jondeau, G.; Logeart, D.; Le Marcis, V.; Ly, J. -F.; Coisne, D.; Lequeux, B.; Le Moal, V.; Mascle, S.; Lotton, P.; Behar, N.; Donal, E.; Thebault, C.; Ridard, C.; Reynaud, A.; Basquin, A.; Bauer, F.; Codjia, R.; Galinier, M.; Tourikis, P.; Stavroula, M.; Tousoulis, D.; Stefanadis, C.; Chrysohoou, C.; Kotrogiannis, I.; Matzaraki, V.; Dimitroula, T.; Karavidas, A.; Tsitsinakis, G.; Kapelios, C.; Nanas, J.; Kampouri, H.; Nana, E.; Kaldara, E.; Eugenidou, A.; Vardas, P.; Saloustros, I.; Patrianakos, A.; Tsaknakis, T.; Evangelou, S.; Nikoloulis, N.; Tziourganou, H.; Tsaroucha, A.; Papadopoulou, A.; Douras, A.; Polgar, L.; Merkely, B.; Kosztin, A.; Nyolczas, N.; Nagy, A. C.; Halmosi, R.; Elber, J.; Alony, I.; Shotan, A.; Fuhrmann, A. V.; Amir, O.; Romano, S.; Marcon, S.; Penco, M.; Di Mauro, M.; Lemme, E.; Carubelli, V.; Rovetta, R.; Metra, M.; Bulgari, M.; Quinzani, F.; Lombardi, C.; Bosi, S.; Schiavina, G.; Squeri, A.; Barbieri, A.; Di Tano, G.; Pirelli, S.; Ferrari, R.; Fucili, A.; Passero, T.; Musio, S.; Di Biase, M.; Correale, M.; Salvemini, G.; Brognoli, S.; Zanelli, E.; Giordano, A.; Agostoni, P.; Italiano, G.; Salvioni, E.; Copelli, S.; Modena, M. G.; Reggianini, L.; Valenti, C.; Olaru, A.; Bandino, S.; Deidda, M.; Mercuro, G.; Dessalvi, C. C.; Marino, P. N.; Di Ruocco, M. V.; Sartori, C.; Piccinino, C.; Parrinello, G.; Licata, G.; Torres, D.; Giambanco, S.; Busalacchi, S.; Arrotti, S.; Novo, S.; Inciardi, R. M.; Pieri, P.; Chirco, P. R.; Galifi, M.
abstract

Aims: We assessed the interplay between hyperkalaemia (HK) and renin–angiotensin–aldosterone system inhibitor (RAASi) use, dose and discontinuation, and their association with all-cause or cardiovascular death in patients with chronic heart failure (HF). We hypothesized that HK-associated increased death may be related to RAASi withdrawal. Methods and results: The ESC-HFA-EORP Heart Failure Long-Term Registry was used. Among 9222 outpatients (HF with reduced ejection fraction: 60.6%, HF with mid-range ejection fraction: 22.9%, HF with preserved ejection fraction: 16.5%) from 31 countries, 16.6% had HK (≥5.0 mmol/L) at baseline. Angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) was used in 88.3%, a mineralocorticoid receptor antagonist (MRA) in 58.7%, or a combination in 53.2%; of these, at ≥50% of target dose in ACEi: 61.8%; ARB: 64.7%; and MRA: 90.3%. At a median follow-up of 12.2 months, there were 789 deaths (8.6%). Both hypokalaemia and HK were independently. associated with higher mortality, and ACEi/ARB prescription at baseline with lower mortality. MRA prescription was not retained in the model. In multivariable analyses, HK at baseline was independently associated with MRA non-prescription at baseline and subsequent discontinuation. When considering subsequent discontinuation of RAASi (instead of baseline use), HK was no longer found associated with all-cause deaths. Importantly, all RAASi (ACEi, ARB, or MRA) discontinuations were strongly associated with mortality. Conclusions: In HF, hyper- and hypokalaemia were associated with mortality. However, when adjusting for RAASi discontinuation, HK was no longer associated with mortality, suggesting that HK may be a risk marker for RAASi discontinuation rather than a risk factor for worse outcomes.

2019 - Acute heart failure congestion and perfusion status – impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA Heart Failure Long-Term Registry [Articolo su rivista]
Chioncel, O.; Mebazaa, A.; Maggioni, A. P.; Harjola, V. -P.; Rosano, G.; Laroche, C.; Piepoli, M. F.; Crespo-Leiro, M. G.; Lainscak, M.; Ponikowski, P.; Filippatos, G.; Ruschitzka, F.; Seferovic, P.; Coats, A. J. S.; Lund, L. H.; Auer, J.; Ablasser, K.; Fruhwald, F.; Dolze, T.; Brandner, K.; Gstrein, S.; Poelzl, G.; Moertl, D.; Reiter, S.; Podczeck-Schweighofer, A.; Muslibegovic, A.; Vasilj, M.; Fazlibegovic, E.; Cesko, M.; Zelenika, D.; Palic, B.; Pravdic, D.; Cuk, D.; Vitlianova, K.; Katova, T.; Velikov, T.; Kurteva, T.; Gatzov, P.; Kamenova, D.; Antova, M.; Sirakova, V.; Krejci, J.; Mikolaskova, M.; Spinar, J.; Krupicka, J.; Malek, F.; Hegarova, M.; Lazarova, M.; Monhart, Z.; Hassanein, M.; Sobhy, M.; El Messiry, F.; El Shazly, A. H.; Elrakshy, Y.; Youssef, A.; Moneim, A. A.; Noamany, M.; Reda, A.; Dayem, T. K. A.; Farag, N.; Halawa, S. I.; Hamid, M. A.; Said, K.; Saleh, A.; Ebeid, H.; Hanna, R.; Aziz, R.; Louis, O.; Enen, M. A.; Ibrahim, B. S.; Nasr, G.; Elbahry, A.; Sobhy, H.; Ashmawy, M.; Gouda, M.; Aboleineen, W.; Bernard, Y.; Luporsi, P.; Meneveau, N.; Pillot, M.; Morel, M.; Seronde, M. -F.; Schiele, F.; Briand, F.; Delahaye, F.; Damy, T.; Eicher, J. -C.; de Groote, P.; Fertin, M.; Lamblin, N.; Isnard, R.; Lefol, C.; Thevenin, S.; Hagege, A.; Jondeau, G.; Logeart, D.; Le Marcis, V.; Ly, J. -F.; Coisne, D.; Lequeux, B.; Le Moal, V.; Mascle, S.; Lotton, P.; Behar, N.; Donal, E.; Thebault, C.; Ridard, C.; Reynaud, A.; Basquin, A.; Bauer, F.; Codjia, R.; Galinier, M.; Tourikis, P.; Stavroula, M.; Tousoulis, D.; Stefanadis, C.; Chrysohoou, C.; Kotrogiannis, I.; Matzaraki, V.; Dimitroula, T.; Karavidas, A.; Tsitsinakis, G.; Kapelios, C.; Nanas, J.; Kampouri, H.; Nana, E.; Kaldara, E.; Eugenidou, A.; Vardas, P.; Saloustros, I.; Patrianakos, A.; Tsaknakis, T.; Evangelou, S.; Nikoloulis, N.; Tziourganou, H.; Tsaroucha, A.; Papadopoulou, A.; Douras, A.; Polgar, L.; Merkely, B.; Kosztin, A.; Nyolczas, N.; Nagy, A. C.; Halmosi, R.; Elber, J.; Alony, I.; Shotan, A.; Fuhrmann, A. V.; Amir, O.; Romano, S.; Marcon, S.; Penco, M.; Di Mauro, M.; Lemme, E.; Carubelli, V.; Rovetta, R.; Metra, M.; Bulgari, M.; Quinzani, F.; Lombardi, C.; Bosi, S.; Schiavina, G.; Squeri, A.; Barbieri, A.; Di Tano, G.; Pirelli, S.; Ferrari, R.; Fucili, A.; Passero, T.; Musio, S.; Di Biase, M.; Correale, M.; Salvemini, G.; Brognoli, S.; Zanelli, E.; Giordano, A.; Agostoni, P.; Italiano, G.; Salvioni, E.; Copelli, S.; Modena, M. G.; Reggianini, L.; Valenti, C.; Olaru, A.; Bandino, S.; Deidda, M.; Mercuro, G.; Dessalvi, C. C.; Marino, P. N.; Di Ruocco, M. V.; Sartori, C.; Piccinino, C.; Parrinello, G.; Licata, G.; Torres, D.; Giambanco, S.; Busalacchi, S.; Arrotti, S.; Novo, S.; Inciardi, R. M.; Pieri, P.; Chirco, P. R.; Galifi, M. A.; Teresi, G.; Buccheri, D.; Minacapelli, A.; Veniani, M.; Frisinghelli, A.; Priori, S. G.; Cattaneo, S.; Opasich, C.; Gualco, A.; Pagliaro, M.; Mancone, M.; Fedele, F.; Cinque, A.; Vellini, M.; Scarfo, I.; Romeo, F.; Ferraiuolo, F.; Sergi, D.; Anselmi, M.; Melandri, F.; Leci, E.; Iori, E.; Bovolo, V.; Pidello, S.; Frea, S.; Bergerone, S.; Botta, M.; Canavosio, F. G.; Gaita, F.; Merlo, M.; Cinquetti, M.; Sinagra, G.; Ramani, F.; Fabris, E.; Stolfo, D.; Artico, J.; Miani, D.; Fresco, C.; Daneluzzi, C.; Proclemer, A.; Cicoira, M.; Zanolla, L.; Marchese, G.; Torelli, F.; Vassanelli, C.; Voronina, N.; Erglis, A.; Tamakauskas, V.; Smalinskas, V.; Karaliute, R.; Petraskiene, I.; Kazakauskaite, E.; Rumbinaite, E.; Kavoliuniene, A.; Vysniauskas, V.; Brazyte-Ramanauskiene, R.; Petraskiene, D.; Stankala, S.; Switala, P.; Juszczyk, Z.; Sinkiewicz, W.; Gilewski, W.; Pietrzak, J.; Orzel, T.; Kasztelowicz, P.; Kardaszewicz, P.; Lazorko-Piega, M.; Gabryel, J.; Mosakowska, K.; Bellwon, J.; Rynkiewicz, A.; Raczak, G.; Lewicka, E.; Dabrowska-Kugacka, A.; Bartkowiak, R.; Sosnowska-Pasiarska, B.; Wozakowska-Kaplon, B.; Krzeminski, A.; Zabojszcz, M.; Mirek-Bryniarska, E.; Grzegorzko, A.; Bury, K.; Nessler, J.; Zalewski, J.; Furman, A.; Broncel, M.; Poli
abstract

Aims: Classification of acute heart failure (AHF) patients into four clinical profiles defined by evidence of congestion and perfusion is advocated by the 2016 European Society of Cardiology (ESC)guidelines. Based on the ESC-EORP-HFA Heart Failure Long-Term Registry, we compared differences in baseline characteristics, in-hospital management and outcomes among congestion/perfusion profiles using this classification. Methods and results: We included 7865 AHF patients classified at admission as: ‘dry-warm’ (9.9%), ‘wet-warm’ (69.9%), ‘wet-cold’ (19.8%) and ‘dry-cold’ (0.4%). These groups differed significantly in terms of baseline characteristics, in-hospital management and outcomes. In-hospital mortality was 2.0% in ‘dry-warm’, 3.8% in ‘wet-warm’, 9.1% in ‘dry-cold’ and 12.1% in ‘wet-cold’ patients. Based on clinical classification at admission, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: ‘wet-warm’ vs. ‘dry-warm’ 1.78 (1.43–2.21) and ‘wet-cold’ vs. ‘wet-warm’ 1.33 (1.19–1.48). For profiles resulting from discharge classification, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: ‘wet-warm’ vs. ‘dry-warm’ 1.46 (1.31–1.63) and ‘wet-cold’ vs. ‘wet-warm’ 2.20 (1.89–2.56). Among patients discharged alive, 30.9% had residual congestion, and these patients had higher 1-year mortality compared to patients discharged without congestion (28.0 vs. 18.5%). Tricuspid regurgitation, diabetes, anaemia and high New York Heart Association class were independently associated with higher risk of congestion at discharge, while beta-blockers at admission, de novo heart failure, or any cardiovascular procedure during hospitalization were associated with lower risk of residual congestion. Conclusion: Classification based on congestion/perfusion status provides clinically relevant information at hospital admission and discharge. A better understanding of the clinical course of the two entities could play an important role towards the implementation of targeted strategies that may improve outcomes.

2019 - Cardiovascular health management: preventive assessment [Articolo su rivista]
Modena, Maria Grazia; Lodi, Elisa; Scavone, Alberto; Carollo, Alberto
abstract

2019 - Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation [Articolo su rivista]
Grigioni, F.; Benfari, G.; Vanoverschelde, J. -L.; Tribouilloy, C.; Avierinos, J. -F.; Bursi, F.; Suri, R. M.; Guerra, F.; Pasquet, A.; Rusinaru, D.; Marcelli, E.; Theron, A.; Barbieri, A.; Michelena, H.; Lazam, S.; Szymanski, C.; Nkomo, V. T.; Capucci, A.; Thapa, P.; Enriquez-Sarano, M.; for the MIDA Investigators Clavel, M. A.; Maalouf, J.; Trojette, F.; Szymanski, C.; Touati, G.; Remadi, J. P.; Russo, A.; Biagini, E.; Pasquale, F.; Ferlito, M.; Rapezzi, C.; Savini, C.; Marinelli, G.; Pacini, D.; Gargiulo, G. D.; Di Bartolomeo, R.; Boulif, J.; de Meester, C.; El Khoury, G.; Gerber, B.; Noirhomme, P.; Vancraeynest, D.; Collard, F.; Habib, G.; Mantovani, F.; Lugli, R.; Modena, M. G.; Boriani, G.; Bacchi-Reggiani, L.
abstract

Background: Scientific guidelines consider atrial fibrillation (AF) complicating degenerative mitral regurgitation (DMR) a debated indication for surgery. Objectives: This study analyzed the prognostic/therapeutic implications of AF at DMR diagnosis and long-term. Methods: Patients were enrolled in the MIDA (Mitral Regurgitation International Database) registry, which reported the consecutive, multicenter, international experience with DMR due to flail leaflets echocardiographically diagnosed. Results: Among 2,425 patients (age 67 ± 13 years; 71% male, 67% asymptomatic, ejection fraction 64 ± 10%), 1,646 presented at diagnosis with sinus rhythm (SR), 317 with paroxysmal AD, and 462 with persistent AF. Underlying clinical/instrumental characteristics progressively worsened from SR to paroxysmal to persistent AF. During follow-up, paroxysmal and persistent AF were associated with excess mortality (10-year survival in SR and in paroxysmal and persistent AF was 74 ± 1%, 59 ± 3%, and 46 ± 2%, respectively; p < 0.0001), that persisted 20 years post-diagnosis and independently of all baseline characteristics (p values <0.0001). Surgery (n = 1,889, repair 88%) was associated with better survival versus medical management, regardless of all baseline characteristics and rhythm (adjusted hazard ratio: 0.26; 95% confidence interval: 0.23 to 0.30; p < 0.0001) but post-surgical outcome remained affected by AF (10-year post-surgical survival in SR and in paroxysmal and persistent AF was 82 ± 1%, 70 ± 4%, and 57 ± 3%, respectively; p < 0.0001). Conclusions: AF is a frequent occurrence at DMR diagnosis. Although AF is associated with older age and more severe presentation of DMR, it is independently associated with excess mortality long-term after diagnosis. Surgery is followed by improved survival in each cardiac rhythm subset, but persistence of excess risk is observed for each type of AF. Our study indicates that detection of AF, even paroxysmal, should trigger prompt consideration for surgery.

2019 - Sacubitril/valsartan eligibility and outcomes in the ESC-EORP-HFA Heart Failure Long-Term Registry: bridging between European Medicines Agency/Food and Drug Administration label, the PARADIGM-HF trial, ESC guidelines, and real world [Articolo su rivista]
Kapelios, C. J.; Lainscak, M.; Savarese, G.; Laroche, C.; Seferovic, P.; Ruschitzka, F.; Coats, A.; Anker, S. D.; Crespo-Leiro, M. G.; Filippatos, G.; Piepoli, M. F.; Rosano, G.; Zanolla, L.; Aguiar, C.; Murin, J.; Leszek, P.; McDonagh, T.; Maggioni, A. P.; Lund, L. H.; Auer, J.; Ablasser, K.; Fruhwald, F.; Dolze, T.; Brandner, K.; Gstrein, S.; Poelzl, G.; Moertl, D.; Reiter, S.; Podczeck-Schweighofer, A.; Muslibegovic, A.; Vasilj, M.; Fazlibegovic, E.; Cesko, M.; Zelenika, D.; Palic, B.; Pravdic, D.; Cuk, D.; Vitlianova, K.; Katova, T.; Velikov, T.; Kurteva, T.; Gatzov, P.; Kamenova, D.; Antova, M.; Sirakova, V.; Krejci, J.; Mikolaskova, M.; Spinar, J.; Krupicka, J.; Malek, F.; Hegarova, M.; Lazarova, M.; Monhart, Z.; Hassanein, M.; Sobhy, M.; El Messiry, F.; El Shazly, A. H.; Elrakshy, Y.; Youssef, A.; Moneim, A. A.; Noamany, M.; Reda, A.; Abdel Dayem, T. K.; Farag, N.; Ibrahim Halawa, S.; Abdel Hamid, M.; Said, K.; Saleh, A.; Ebeid, H.; Hanna, R.; Aziz, R.; Louis, O.; Enen, M. A.; Ibrahim, B. S.; Nasr, G.; Elbahry, A.; Sobhy, H.; Ashmawy, M.; Gouda, M.; Aboleineen, W.; Bernard, Y.; Luporsi, P.; Meneveau, N.; Pillot, M.; Morel, M.; Seronde, M. -F.; Schiele, F.; Briand, F.; Delahaye, F.; Damy, T.; Eicher, J. -C.; de Groote, P.; Fertin, M.; Lamblin, N.; Isnard, R.; Lefol, C.; Thevenin, S.; Hagege, A.; Jondeau, G.; Logeart, D.; Le Marcis, V.; Ly, J. -F.; Coisne, D.; Lequeux, B.; Le Moal, V.; Mascle, S.; Lotton, P.; Behar, N.; Donal, E.; Thebault, C.; Ridard, C.; Reynaud, A.; Basquin, A.; Bauer, F.; Codjia, R.; Galinier, M.; Tourikis, P.; Stavroula, M.; Tousoulis, D.; Stefanadis, C.; Chrysohoou, C.; Kotrogiannis, I.; Matzaraki, V.; Dimitroula, T.; Karavidas, A.; Tsitsinakis, G.; Kapelios, C.; Nanas, J.; Kampouri, H.; Nana, E.; Kaldara, E.; Eugenidou, A.; Vardas, P.; Saloustros, I.; Patrianakos, A.; Tsaknakis, T.; Evangelou, S.; Nikoloulis, N.; Tziourganou, H.; Tsaroucha, A.; Papadopoulou, A.; Douras, A.; Polgar, L.; Merkely, B.; Kosztin, A.; Nyolczas, N.; Csaba Nagy, A.; Halmosi, R.; Elber, J.; Alony, I.; Shotan, A.; Vazan Fuhrmann, A.; Amir, O.; Romano, S.; Marcon, S.; Penco, M.; Di Mauro, M.; Lemme, E.; Carubelli, V.; Rovetta, R.; Metra, M.; Bulgari, M.; Quinzani, F.; Lombardi, C.; Bosi, S.; Schiavina, G.; Squeri, A.; Barbieri, A.; Di Tano, G.; Pirelli, S.; Ferrari, R.; Fucili, A.; Passero, T.; Musio, S.; Di Biase, M.; Correale, M.; Salvemini, G.; Brognoli, S.; Zanelli, E.; Giordano, A.; Agostoni, P.; Italiano, G.; Salvioni, E.; Copelli, S.; Modena, M. G.; Reggianini, L.; Valenti, C.; Olaru, A.; Bandino, S.; Deidda, M.; Mercuro, G.; Cadeddu Dessalvi, C.; Marino, P. N.; Di Ruocco, M. V.; Sartori, C.; Piccinino, C.; Parrinello, G.; Licata, G.; Torres, D.; Giambanco, S.; Busalacchi, S.; Arrotti, S.; Novo, S.; Inciardi, R. M.; Pieri, P.; Chirco, P. R.; Ausilia Galifi, M.; Teresi, G.; Buccheri, D.; Minacapelli, A.; Veniani, M.; Frisinghelli, A.; Priori, S. G.; Cattaneo, S.; Opasich, C.; Gualco, A.; Pagliaro, M.; Mancone, M.; Fedele, F.; Cinque, A.; Vellini, M.; Scarfo, I.; Romeo, F.; Ferraiuolo, F.; Sergi, D.; Anselmi, M.; Melandri, F.; Leci, E.; Iori, E.; Bovolo, V.; Pidello, S.; Frea, S.; Bergerone, S.; Botta, M.; Canavosio, F. G.; Gaita, F.; Merlo, M.; Cinquetti, M.; Sinagra, G.; Ramani, F.; Fabris, E.; Stolfo, D.; Artico, J.; Miani, D.; Fresco, C.; Daneluzzi, C.; Proclemer, A.; Cicoira, M.; Zanolla, L.; Marchese, G.; Torelli, F.; Vassanelli, C.; Voronina, N.; Erglis, A.; Tamakauskas, V.; Smalinskas, V.; Karaliute, R.; Petraskiene, I.; Kazakauskaite, E.; Rumbinaite, E.; Kavoliuniene, A.; Vysniauskas, V.; Brazyte-Ramanauskiene, R.; Petraskiene, D.; Stankala, S.; Switala, P.; Juszczyk, Z.; Sinkiewicz, W.; Gilewski, W.; Pietrzak, J.; Orzel, T.; Kasztelowicz, P.; Kardaszewicz, P.; Lazorko-Piega, M.; Gabryel, J.; Mosakowska, K.; Bellwon, J.; Rynkiewicz, A.; Raczak, G.; Lewicka, E.; Dabrowska-Kugacka, A.; Bartkowiak, R.; Sosnowska-Pasiarska, B.; Wozakowska-Kaplon, B.; Krzeminski, A.; Zabojszcz, M.; Mirek-Bryniarska, E.; Grzegorzko, A.
abstract

Aims: To assess the proportion of patients with heart failure and reduced ejection fraction (HFrEF) who are eligible for sacubitril/valsartan (LCZ696) based on the European Medicines Agency/Food and Drug Administration (EMA/FDA) label, the PARADIGM-HF trial and the 2016 ESC guidelines, and the association between eligibility and outcomes. Methods and results: Outpatients with HFrEF in the ESC-EORP-HFA Long-Term Heart Failure (HF-LT) Registry between March 2011 and November 2013 were considered. Criteria for LCZ696 based on EMA/FDA label, PARADIGM-HF and ESC guidelines were applied. Of 5443 patients, 2197 and 2373 had complete information for trial and guideline eligibility assessment, and 84%, 12% and 12% met EMA/FDA label, PARADIGM-HF and guideline criteria, respectively. Absent PARADIGM-HF criteria were low natriuretic peptides (21%), hyperkalemia (4%), hypotension (7%) and sub-optimal pharmacotherapy (74%); absent Guidelines criteria were LVEF>35% (23%), insufficient NP levels (30%). and sub-optimal pharmacotherapy (82%); absent label criteria were absence of symptoms (New York Heart Association class I). When a daily requirement of ACEi/ARB ≥ 10 mg enalapril (instead of ≥ 20 mg) was used, eligibility rose from 12% to 28% based on both PARADIGM-HF and guidelines. One-year heart failure hospitalization was higher (12% and 17% vs. 12%) and all-cause mortality lower (5.3% and 6.5% vs. 7.7%) in registry eligible patients compared to the enalapril arm of PARADIGM-HF. Conclusions: Among outpatients with HFrEF in the ESC-EORP-HFA HF-LT Registry, 84% met label criteria, while only 12% and 28% met PARADIGM-HF and guideline criteria for LCZ696 if requiring ≥ 20 mg and ≥ 10 mg enalapril, respectively. Registry patients eligible for LCZ696 had greater heart failure hospitalization but lower mortality rates than the PARADIGM-HF enalapril group.

2018 - Executive Summary of the 2018 Joint Consensus Document on Cardiovascular Disease Prevention in Italy [Articolo su rivista]
Volpe, Massimo; Battistoni, Allegra; Gallo, Giovanna; Rubattu, Speranza; Tocci, Giuliano; Accettura, Domenico; Bellone, Simonetta; Bellotti, Paolo; Bertolotti, Marco; Borghi, Claudio; Casasco, Maurizio; Consoli, Agostino; Coppini, Rafaele; Corsini, Alberto; Costanzo, Gianfranco; Desideri, Giovambattista; Ferri, Claudio; Galanti, Giorgio; Giada, Franco; Icardi, Giancarlo; Lombardi, Niccolò; Modena, Maria Grazia; Modesti, Pietro Amedeo; Monti, Giorgio; Mugelli, Alessandro; Orsi, Andrea; Parati, Gianfranco; Pedretti, Roberto F. E.; Perseghin, Gianluca; Pirro, Matteo; Ricotti, Roberta; Rizzoni, Damiano; Rotella, Carlo; Salvetti, Guido; Sarto, Patrizio; Tassinari, Federico; Trimarco, Bruno; de Kreutzenberg, Saula Vigili; Volpe, Roberto
abstract

Cardiovascular diseases (CVDs) are the leading cause of death, disability and hospitalization in Italy. Primary prevention strategies are able to prevent clinically evident CVDs, mostly by early identifying asymptomatic, otherwise healthy individuals at risk of developing CVDs. A more modern approach recommended for effective CVD prevention is based on “4P”, that is: Predictive, Preventive, Personalized and Participative. This executive document reflects the key points of a consensus paper on CV prevention in Italy, realized though the contribution of different Italian Scientific Societies and the National Research Council, and coordinated by the Italian Society of Cardiovascular Prevention (SIPREC), published in 2018. The need for such document relies on the difficulty to apply “sic et simpliciter” European guidelines, to which this document is largely inspired, to national, regional and local realities, in this Mediterranean country, namely Italy. Indeed, our Country has specific features in terms of demography, socio-cultural habits, distribution and prevalence of risk factors, organization, policy and access to National Health Service compared to other European countries.

2018 - Glomerular filtration rate: A prognostic marker in atrial fibrillation—A subanalysis of the AntiThrombotic Agents Atrial Fibrillation [Articolo su rivista]
Proietti, R.; Gonzini, L.; Pizzimenti, G.; Ledda, A.; Sanna, P.; AlTurki, A.; Russo, V.; Lencioni, M.; Siciliano, R.; Boffa, M.; Bazzanini, F.; Di Nucci, G.; Fonti, S.; De Franceschi, T.; Davio, P.; Alagna, G.; Cipollini, F.; Arma, P.; Gunnellini, M. G.; Dottori, M.; Paulillo, D.; Giudice, M.; Sicuro, M.; Lenti, S.; Iannelli, G.; Notarstefano, P.; Galiotto, M.; Apolloni, E.; Molini, G.; Massarelli, L.; Di Iorio, P.; Scandurra, F.; Candelmo, F.; Iodice, P.; Laureano, R.; Perlangeli, S.; Pratico, A.; Lucchesi, Q.; Conese, V.; Scalera, G.; Palma, F.; De Antoni, M. E.; Beltramello, G.; Carbonella, M.; Capone, A.; Bianchi, V.; Zerella, F.; Masina, M.; Boggian, G.; Pancaldi, L. G.; Brucato, A. L.; Scialfa, S.; Ferrari, P.; Gavazzi, A.; Santoro, E.; Bertinieri, G.; Caragnano, V.; Zaccaroni, S.; Marchetti, G.; Urbinati, S.; Belmonte, G.; Giannoni, C.; Panuccio, D.; Pedone, V.; Colletta, M.; Di Pasquale, G.; Cemin, R.; Paffoni, P. R. C.; Pezzotti, C.; Capretti, M.; Lamari, A. L.; Maugeri, S.; Moretti, R.; Ganga, R.; Mascia, P.; Caddori, A.; Cusumano, S.; Alletto, M.; De Vincenzo, C.; Musacchio, E.; Stendardo, A.; Cantarella, S. A.; Ferrari, V.; Bassano, F.; Perrone, C.; Piccinni, G. C.; Catanzaro, M.; Vinciguerra, A.; Lusiani, L.; De Caro, G.; Scarcia, M.; Scarcia, A.; Losi, E.; Gaddi, O.; Lo Sciuto, A.; Cascio Ingurgio, N.; Vignai, E.; Romano, M.; Borzi, V.; Bellanuova, I. A.; Felis, S.; Gulizia, M. M.; Francese, G. M.; Artale, S.; Mazzuca, S.; Perticone, F.; Tirotta, D.; Talini, E.; Ventrella, F.; Iosa, G.; Cuccurullo, O.; Bertello, P. D.; Benemio, G.; Garognoli, O.; Arcelli, G.; Prosciutti, L.; De Matthaeis, G.; Quattrini, C.; Calcagno, S.; Canestrini, S.; Franco, A.; Pastorelli, R.; Acquati, F.; Botto, G. L.; Sitta, N.; Migliacci, R.; Cosmi, F.; Tarquini, B.; Chiappetta, P.; Sprovieri, M. F.; Macri, G.; Bertolazzi, S.; Spotti, A.; Pirelli, S.; Marasco, M. F.; Elia, M.; Gambino, G. M.; Fenoglio, L.; Gelmini, G. P.; Ziacchi, V.; Rigon, N.; Petix, N. R.; Zipoli, A.; Caiolo, A.; Marino, E.; Scattolin, G.; Gerini, S.; Parisi, G.; Tavernese, G.; Conti, A.; Ferrante, F.; Morettini, A.; Alterini, B.; Rocchi, F.; Nozzoli, C.; Goedecke, L.; Seravalle, C.; Cuomo, A.; Panettieri, I.; Pellegrino, P.; Di Biase, M.; Savarese, G.; Patriarchi, F.; Bondi, G.; Rossini, E.; Nello, S.; Ranieri, A. T.; Gelonesi, F. N.; Costantini, M.; Dugnani, M.; Ria, L.; Mussardo, V.; Zanini, G.; Morgante, O.; Fazio, G.; Lo, G.; Castello, C.; Moroni, L. A.; Costa, S.; Domenicucci, S.; Venzano, C.; Loiacono, L.; Ortuso, R.; Esposito, L.; Cuzzucrea, D. G.; Fiammengo, F.; Selva, E.; Gestra, R.; Alessandri, M.; Nuzzi, G.; Porrino, L.; Parise, P.; Capponi, E. A.; Mandorla, S.; Politi, C.; Olivieri, C.; Gurioli, L.; Agostinelli, P.; Striuli, R.; Petrarca, M.; Corsini, F.; Orlandini, F.; Badolati, S.; Colarusso, D.; Vertullo, V.; Pelaggi, P.; Campagna, G.; Haupt, E.; Parente, F.; Milanese, G.; Magliari, F.; Morando, G.; Guarise, P.; Mazzone, A.; Palumbo, G.; Lambelet, P.; Camaiti, A.; Pasquinelli, P.; Frediani, L.; Vituliano, A.; Brunelleschi, G.; Lisi, C.; La Torre, P. P. A.; Villella, A.; Rimoldi, A.; Russo, V.; Di Summa, F.; Reggiani, A.; Raimondo, F. C.; Disalvo, D.; Borrello, V. M.; Magnante, A.; Stellitano, E.; Procopio, L.; Franculli, F.; Serafini, F.; Tondo, C.; Fiorentini, C.; Manfredini, R.; Robbiolo, L.; Pizzimenti, G.; Vasquez, L.; Piangiamore, A.; Tosi, P.; Dona, G.; Bacchiega, E.; Malavasi, V.; Modena, M. G.; Divella, C.; Marengo, C.; Montanari, P.; Manicardi, V.; Abate, L.; Cuccuini, A.; Magni, S.; Vincenti, A.; Spinelli, M.; Mortara, A.; Specchia, G.; Silvestri, N.; Silvestri, O.; Piscopo, G.; Muschera, R.; Gallucci, F.; Cannavale, A.; Bresciani, A.; Perrone Filardi, P.; Fontanella, A.; Iannuzzo, D.; Luca, S.; Zuccoli, A.; Rinaldi, P.; Ferri, G.; Barbieri, E.; Grasselli, S.; Rossi, A.; Agosti, S.; Sanna, P.; Casu, G.; Orecchioni, G.; Da Silva Carvalho, P. C.; Pozzi, R.; Salvati, F.; Bendini, M. G.; Giordano, G.; Pellegrini, F.; Pighini, G.; Tremolada, F.; Zan
abstract

Objective: An increased cardiovascular mortality and morbidity has been widely reported in patients with atrial fibrillation (AF). In this study, a subanalysis of the AntiThrombotic Agents Atrial Fibrillation (ATA-AF) is performed with the aim to evaluate estimated glomerular filtration rate (eGFR) as an independent prognostic marker of cardiovascular mortality and morbidity in patients with AF. Methods and Results: The ATA-AF study enrolled 7148 patients with AF, in 360 Italian centers. The eGFR was calculated from data reported in patient notes or hospital database. This post-hoc analysis included 1097 AF patients with eGFR data available and 1-year clinical follow-up. The endpoint was assessed as cardiovascular mortality and/or hospital admission for cardiovascular causes at follow-up. Patients were also divided in two groups according to the eGFR (<60 and ≥60 mL/min/1.73 m 2 ). The Kaplan-Meyer curve for the mentioned endpoint showed a higher endpoint incidence in the group of patient with eGFR below 60 mL/min/1.73 m 2 (P < 0.001). Using multivariate analysis (Cox regression), a trend toward a higher rate of occurrence of the primary endpoint was observed for eGFR below 60 mL/min/1.73 m 2 without reaching the conventional level of statistical significance (hazard ratio [HR] 1.40; 95% confidence interval [CI] 0.99-1.99; P = 0.0572). When eGFR was included in the analysis as continuous variable a significant correlation was observed with the combined endpoint at the Cox regression (HR 0.99, 95% CI 0.98-0.99, P = 0.04). Conclusion: The result of this post-hoc analysis indicates that an impaired eGFR is independently associated with worse prognosis among patients with AF.

2018 - Hypertension and Pharmacological Therapy in Women [Articolo su rivista]
Elisa, Lodi; Carollo, Alberto; Valentina, Martinotti; Modena, Maria Grazia
abstract

Cardiovascular (CV) disease is the leading cause of morbidity and mortality for women all over the world. The role and weight of risk factors in relation to gender are not completely clarified as well as their treatment. Pathophysiology of hypertension in woman presents different aspects in relation to phase of life, with an impact on treatment. The only certainties that we have nowadays regarding hypertension therapy in women are really few and may be summarized in: how to treat or, better, what not to use in hypertension in pregnancy and how to treat acute severe hypertension in pregnancy. We have some certainties also on treatment of hypertension associated to some women’s comorbidities. Considering guidelines and analyzing what happens in the real world, we report in this review that women have similar major CV risk factors of men, although a minor CV global risk. However, there are some data that suggest that hypertension and diabetes are more important risk factors in women than in men. Blood pressure reduction and benefit by treatment appear similar in women and men, suggesting that we should aim for similar target of blood pressure, although the lower global risk profile should imply different target. Theoretically, recommended drugs are similar in women and men, but in women we must take in account CV risk profile, comorbidity, side effects, and reproductive health. Finally, registries and observational studies show that fewer women reach the target values of blood pressure and that women receive more frequently prescription of ‘‘other’’ classes of drugs than those recommended by guidelines, even after normalization by age and comorbidities

2018 - Is it Still True that Women Live Longer than Men, But with a Worse Quality of Life? [Articolo su rivista]
Modena, Maria Grazia
abstract

In 1998 the WHO published a "gender challenge" for national and international organizations, an invitation to better assess risk factors involving women's health, to develop preventive strategies to reduce the impact of more afflicting diseases for women, and a major effort in understanding why men die before women [1]. Among such afflicting diseases, cardiovascular, depression and comorbidities are the most important.

2018 - Performance of Prognostic Risk Scores in Chronic Heart Failure Patients Enrolled in the European Society of Cardiology Heart Failure Long-Term Registry [Articolo su rivista]
Canepa, M.; Fonseca, C.; Chioncel, O.; Laroche, C.; Crespo-Leiro, M. G.; Coats, A. J. S.; Mebazaa, A.; Piepoli, M. F.; Tavazzi, L.; Maggioni, A. P.; Anker, S.; Filippatos, G.; Ferrari, R.; Amir, O.; Dahlstrom, U.; Delgado Jimenez, J. F.; Drozdz, J.; Erglis, A.; Fazlibegovic, E.; Fruhwald, F.; Gatzov, P.; Goncalvesova, E.; Hassanein, M.; Hradec, J.; Kavoliuniene, A.; Lainscak, M.; Logeart, D.; Merkely, B.; Metra, M.; Otljanska, M.; Seferovic, P. M.; Srbinovska Kostovska, E.; Temizhan, A.; Tousoulis, D.; Ferreira, T.; Andarala, M.; Fiorucci, E.; Folkesson Lefrancq, E.; Glemot, M.; Gracia, G.; Konte, M.; Mcneill, P. A.; Missiamenou, V.; Taylor, C.; Auer, J.; Ablasser, K.; Dolze, T.; Brandner, K.; Gstrein, S.; Poelzl, G.; Moertl, D.; Reiter, S.; Podczeck-Schweighofer, A.; Muslibegovic, A.; Vasilj, M.; Cesko, M.; Zelenika, D.; Palic, B.; Pravdic, D.; Cuk, D.; Vitlianova, K.; Katova, T.; Velikov, T.; Kurteva, T.; Kamenova, D.; Antova, M.; Sirakova, V.; Krejci, J.; Mikolaskova, M.; Spinar, J.; Krupicka, J.; Malek, F.; Hegarova, M.; Lazarova, M.; Monhart, Z.; Sobhy, M.; El Messiry, F.; El Shazly, A. H.; Elrakshy, Y.; Youssef, A.; Moneim, A. A.; Noamany, M.; Reda, A.; Abdel Dayem, T. K.; Farag, N.; Ibrahim Halawa, S.; Abdel Hamid, M.; Said, K.; Saleh, A.; Ebeid, H.; Hanna, R.; Aziz, R.; Louis, O.; Enen, M. A.; Ibrahim, B. S.; Nasr, G.; Elbahry, A.; Sobhy, H.; Ashmawy, M.; Gouda, M.; Aboleineen, W.; Bernard, Y.; Luporsi, P.; Meneveau, N.; Pillot, M.; Morel, M.; Seronde, M. -F.; Schiele, F.; Briand, F.; Delahaye, F.; Damy, T.; Eicher, J. -C.; de Groote, P.; Fertin, M.; Lamblin, N.; Isnard, R.; Lefol, C.; Thevenin, S.; Hagege, A.; Jondeau, G.; Le Marcis, V.; Ly, J. -F.; Coisne, D.; Lequeux, B.; Le Moal, V.; Mascle, S.; Lotton, P.; Behar, N.; Donal, E.; Thebault, C.; Ridard, C.; Reynaud, A.; Basquin, A.; Bauer, F.; Codjia, R.; Galinier, M.; Tourikis, P.; Stavroula, M.; Stefanadis, C.; Chrysohoou, C.; Kotrogiannis, I.; Matzaraki, V.; Dimitroula, T.; Karavidas, A.; Tsitsinakis, G.; Kapelios, C.; Nanas, J.; Kampouri, H.; Nana, E.; Kaldara, E.; Eugenidou, A.; Vardas, P.; Saloustros, I.; Patrianakos, A.; Tsaknakis, T.; Evangelou, S.; Nikoloulis, N.; Tziourganou, H.; Tsaroucha, A.; Papadopoulou, A.; Douras, A.; Polgar, L.; Kosztin, A.; Nyolczas, N.; Csaba Nagy, A.; Halmosi, R.; Elber, J.; Alony, I.; Shotan, A.; Vazan Fuhrmann, A.; Romano, S.; Marcon, S.; Penco, M.; Di Mauro, M.; Lemme, E.; Carubelli, V.; Rovetta, R.; Bulgari, M.; Quinzani, F.; Lombardi, C.; Bosi, S.; Schiavina, G.; Squeri, A.; Barbieri, A.; Di Tano, G.; Pirelli, S.; Fucili, A.; Passero, T.; Musio, S.; Di Biase, M.; Correale, M.; Salvemini, G.; Brognoli, S.; Zanelli, E.; Giordano, A.; Agostoni, P.; Italiano, G.; Salvioni, E.; Copelli, S.; Modena, M. G.; Reggianini, L.; Valenti, C.; Olaru, A.; Bandino, S.; Deidda, M.; Mercuro, G.; Cadeddu Dessalvi, C.; Marino, P. N.; Di Ruocco, M. V.; Sartori, C.; Piccinino, C.; Parrinello, G.; Licata, G.; Torres, D.; Giambanco, S.; Busalacchi, S.; Arrotti, S.; Novo, S.; Inciardi, R. M.; Pieri, P.; Chirco, P. R.; Ausilia Galifi, M.; Teresi, G.; Buccheri, D.; Minacapelli, A.; Veniani, M.; Frisinghelli, A.; Priori, S. G.; Cattaneo, S.; Opasich, C.; Gualco, A.; Pagliaro, M.; Mancone, M.; Fedele, F.; Cinque, A.; Vellini, M.; Scarfo, I.; Romeo, F.; Ferraiuolo, F.; Sergi, D.; Anselmi, M.; Melandri, F.; Leci, E.; Iori, E.; Bovolo, V.; Pidello, S.; Frea, S.; Bergerone, S.; Botta, M.; Canavosio, F. G.; Gaita, F.; Merlo, M.; Cinquetti, M.; Sinagra, G.; Ramani, F.; Fabris, E.; Stolfo, D.; Artico, J.; Miani, D.; Fresco, C.; Daneluzzi, C.; Proclemer, A.; Cicoira, M.; Zanolla, L.; Marchese, G.; Torelli, F.; Vassanelli, C.; Voronina, N.; Tamakauskas, V.; Smalinskas, V.; Karaliute, R.; Petraskiene, I.; Kazakauskaite, E.; Rumbinaite, E.; Vysniauskas, V.; Brazyte-Ramanauskiene, R.; Petraskiene, D.; Stankala, S.; Switala, P.; Juszczyk, Z.; Sinkiewicz, W.; Gilewski, W.; Pietrzak, J.; Orzel, T.; Kasztelowicz, P.; Kardaszewicz, P.; Lazorko-Piega, M.; Gabryel, J.; Mosak
abstract

Objectives: This study compared the performance of major heart failure (HF) risk models in predicting mortality and examined their utilization using data from a contemporary multinational registry. Background: Several prognostic risk scores have been developed for ambulatory HF patients, but their precision is still inadequate and their use limited. Methods: This registry enrolled patients with HF seen in participating European centers between May 2011 and April 2013. The following scores designed to estimate 1- to 2-year all-cause mortality were calculated in each participant: CHARM (Candesartan in Heart Failure-Assessment of Reduction in Mortality), GISSI-HF (Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico-Heart Failure), MAGGIC (Meta-analysis Global Group in Chronic Heart Failure), and SHFM (Seattle Heart Failure Model). Patients with hospitalized HF (n = 6,920) and ambulatory HF patients missing any variable needed to estimate each score (n = 3,267) were excluded, leaving a final sample of 6,161 patients. Results: At 1-year follow-up, 5,653 of 6,161 patients (91.8%) were alive. The observed-to-predicted survival ratios (CHARM: 1.10, GISSI-HF: 1.08, MAGGIC: 1.03, and SHFM: 0.98) suggested some overestimation of mortality by all scores except the SHFM. Overprediction occurred steadily across levels of risk using both the CHARM and the GISSI-HF, whereas the SHFM underpredicted mortality in all risk groups except the highest. The MAGGIC showed the best overall accuracy (area under the curve [AUC] = 0.743), similar to the GISSI-HF (AUC = 0.739; p = 0.419) but better than the CHARM (AUC = 0.729; p = 0.068) and particularly better than the SHFM (AUC = 0.714; p = 0.018). Less than 1% of patients received a prognostic estimate from their enrolling physician. Conclusions: Performance of prognostic risk scores is still limited and physicians are reluctant to use them in daily practice. The need for contemporary, more precise prognostic tools should be considered.

2018 - Women [Donne] [Articolo su rivista]
Modena, M. G.
abstract

2018 - [Consensus document and recommendations for the prevention of cardiovascular disease in Italy - 2018] [Articolo su rivista]
Volpe, Massimo; Tocci, Giuliano; Accettura, Domenico; Battistoni, Allegra; Bellone, Simonetta; Bellotti, Paolo; Bertolotti, Marco; Borghi, Claudio; Casasco, Maurizio; Consoli, Agostino; Coppini, Raffaele; Corsini, Alberto; Costanzo, Gianfranco; Desideri, Giovambattista; Ferri, Claudio; Galanti, Giorgio; Giada, Franco; Icardi, Giancarlo; Lombardi, Niccolò; Modena, Maria Grazia; Modesti, Pietro Amedeo; Monti, Giorgio; Mugelli, Alessandro; Orsi, Andrea; Parati, Gianfranco; Pedretti, Roberto F. E.; Perseghin, Gianluca; Pirro, Matteo; Ricotti, Roberta; Rizzoni, Damiano; Rotella, Carlo; Rubattu, Speranza; Salvetti, Guido; Sarto, Patrizio; Tassinari, Federico; Trimarco, Bruno; de Kreutzenberg, Saula Vigili; Volpe, Roberto
abstract

Cardiovascular prevention represents a cornerstone of modern strategies to reduce the burden of cardiovascular disease. It is of key importance to prevent cardiovascular diseases and associated events, not only to reduce morbidity and mortality, but also to increase the years of wellness in the aging population and to make the growing socio-economic burden imposed by cardiovascular events more sustainable.The current approach to prevention is based on an integrated use of effective lifestyle measures and, whenever appropriate, of antihypertensive and antidiabetic drugs, lipid-lowering agents and antiplatelet drugs.Given that population characteristics, in terms of ethnicity, demography and lifestyle habits, and healthcare system organizations differ among countries, international guidelines are not always applicable to specific countries and, often, are difficult to translate into daily clinical practice.In order to afford the specific features of Italy, 10 Scientific Societies and Research Institutions, mostly involved in preventive strategies, contributed to the present Italian consensus document, which includes brief, practical recommendations to support the preventive actions within the physician community and the general practice setting.

2017 - A randomized multicenter trial comparing the XIENCE everolimus eluting stent with the CYPHER sirolimus eluting stent in the treatment of female patients with de novo coronary artery lesions: The SPIRIT WOMEN study [Articolo su rivista]
Franzone, Anna; Zaugg, Serge; Piccolo, Raffaele; Modena, Maria Grazia; Mikhail, Ghada W.; Ferrã©, Josepa Mauri; Strasser, Ruth; Grinfeld, Liliana; Heg, Dik; Jã¼ni, Peter; Windecker, Stephan; Morice, Marie-claude
abstract

Background: The comparative performance of different drug-eluting stents (DES) among female patients has not been assessed in a randomized manner. Objectives: The SPIRIT Women Clinical Evaluation trial compared the durable polymer everolimus-eluting XIENCE stent (DP-EES) with the durable polymer sirolimus-eluting Cypher stent (DP-SES) in women undergoing percutaneous coronary intervention (PCI). Methods: A total of 455 female patients with stable CAD were randomly assigned to receive DP-EES (n = 304) or DP-SES (n = 151). The powered angiographic outcome of the trial was in-stent late lumen loss (LLL) at 9 months after the index procedure. Secondary angiographic end points included in-segment LLL, in-stent and in-segment binary restenosis and percent diameter stenosis. The primary clinical outcome was a composite of all-cause death, myocardial infarction (MI) or target vessel revascularization (TVR). Results: At 9-month follow-up, in-stent LLL was 0.19Â±0.38 mm and 0.11Â±0.37 mm in patients assigned to DP-EES and DP-SES, respectively. The one-sided upper 95% CI of the difference in in-stent LLL between the groups of 0.08 mm was 0.15 and therefore within the pre-specified non-inferiority margin of 0.17 mm (p for non-inferiority = 0.013). However, the test for superiority showed a borderline significant difference in terms of LLL between DP-EES and DP-SES (p for superiority = 0.044). There were no significant differences in binary restenosis (2.0% vs. 0.72%, p = 0.44) and percent diameter stenosis (14.97Â±12.17 vs. 13.36 Â±10.82, p = 0.19). The rate of definite stent thrombosis at 12 months was lower in patients treated with DP-EES (0% vs. 2.0%, p = 0.036). Conclusions: Among women undergoing PCI, DP-EES was associated with a small but probably clinically relevant increase in in-stent LLL at 9 months as compared to DP-SES and with a lower risk of definite stent thrombosis at 12 months. Trial registration: ClinicalTrials.gov NCT01182428.

2017 - Gender Differences in Post-Traumatic Stress [Articolo su rivista]
Modena, Maria Grazia; Pettorelli, Daniele; Lauria, Giulia; Mauro, Erminio; Martinotti, Valentina
abstract

Acute stress can trigger cardiovascular events and disease. The earthquake is an ‘‘ideal’’ natural experiment for acute and chronic stress, with impact mainly on the cardiovascular system. On May 20th and 29th, 2012, two earthquakes of magnitude 5.9! to 6.4! on the Richter scale, hit the province of Modena and Reggio Emilia, an area of the north-center of Italy never considered at seismic risk. The purpose of our study was to assess whether there were gender-specific differences in stress-induced incidence of cardiovascular events and age of patients who arrived at the Emergency Departments (ED) of the three main teaching hospitals of the University of Modena and Reggio Emilia. Global access of patients, divided in relation to age, gender, and diagnosis was compared with that one detected in the same departments and in the same interval of time in 2010. The data collected were relative to consecutive cases derived by retrospective chart and acute cardiovascular events were classified according to ICD-9 (International Classification of Diseases, ninth revision). A total of 1,401 accesses were recorded in the year of earthquake versus 530 in 2010 ( p £ 0.05), with no statistically significant differences in number of cases and mean age in relation to gender, despite the number of women exceeded that of men in 2012 (730 vs. 671); the opposite occurred, in 2010 (328 vs. 202). The gender analysis of 2012 showed a prevalence of acute coronary syndromes (ACSs 177 vs. 73, p £ 0.03) in men, whereas women presented more strokes and transient ischemic attacks (TIAs) (90 vs. 94, p £ 0.05), atrial fibrillation (120 vs. 49, p £ 0.05), deep venous thrombosis and pulmonary embolism (DVT/PE; 64 vs. 9, p £ 0.05), panic attacks (124 vs. 26, p £ 0.03), aspecific chest pain (122 vs. 18, p £ 0.05), TakoTsubo cardiomyopathy (10 vs. 0, p £ 0.05), and DVT/PE (61 vs. 3, p £ 0.03). The gender analysis of 2010 showed no difference in number of accesses and age, with higher incidence of ACS in men (130 vs. 34, p £ 0.05) and aspecific chest pain in women (42 vs. 5, p £ 0.05). The analysis between 2012 and the standard period (2010) showed women recurring to ED in larger number with more panic attacks (124 vs. 3, p £ 0.01), more atrial fibrillation (120 vs. 40, p £ 0.01) and, as a possible consequence, more TIAs and strokes (190 vs. 25, p £ 0.005), more TakoTsubo (10 vs. 0, p £ 0.05), DVT/PE (61 vs. 3, p £ 0.05), and aspecific chest pain (122 vs. 5, p £ 0.01). The difference between men’s accesses to ED was less striking, but in 2012 men reported more panic attacks (26 vs. none, p £ 0.05), more atrial fibrillations, TIAs, and strokes (49 vs. 13, p £ 0.05 and 94 vs. 18, p £ 0.03). In conclusion, clinical (stress induced) events recorded during and immediately after the 2012 earthquakes were quite different between women and men, although the pathophysiological mechanism was probably the same, consisting acute sympathetic nervous activation, with elevation of blood pressure and heart rate, endothelial dysfunction, platelet and hemostatic activation, increased blood viscosity, and hypercoagulation. Women, in our observation, appeared to be more sensitive and responsive to acute stress, although men also appeared to suffer from stress effects when compared with a standard period, which, nevertheless, reflects in our population the most common epidemiology of gender difference in ED accesses for cardiovascular events.

2017 - Gender Medicine in Italy: The Point of View of Maria Grazia Modena: The Story, Limits, and Plans: My Personal Story [Capitolo/Saggio]
Modena, M. G.; Martinotti, V.
abstract

Gender medicine (GM) in Italy was born with the association I have been part of since the 90s Tailored Health for Women created by Dr. Elvira Reale and eight women doctors. We started research on risk factors for illness in women’s daily lives with Ministries of Pair Opportunity and Health, summarizing important documents in the history of GM in Italy. We had little success initially since (1) both ministers were changed and the successors were not interested in GM; (2) we were considered feminists and our congresses attended by few, all women! Each of us continued research in their own field, meeting every year with growing enthusiasm. The biggest limits for GM development in Italy are the excessive fragmentation of often self-referential associations/working groups, absence of GM in the core curriculum of medical school and of a gender-based law for health care. Finally I report of my personal story, an example of “gender related storm.”.

2017 - Paclitaxel eluting balloon plus spot bare metal stenting for diffuse and very long coronary disease. (PEB-long pilot study) [Articolo su rivista]
Rezq, Ahmed; Zoccai, Giuseppe Biondi; Latib, Azeem; Romagnoli, Enrico; Aprile, Alessandro; Amato, Andrea; Modena, Maria Grazia; Colombo, Antonio; Sangiorgi, Giuseppe
abstract

Background Albeit DES might be considered as a breakthrough against neointimal hyperplasia, concerns on stent thrombosis and increase incidence of in-stent restenosis after multiple DES implantations in complex, long lesions still exist. Hereby, we tried to test efficacy and safety of using PEB in long lesions followed by focal BMS implantation in a pilot multicenter study. Methods This study enrolled 16 patients with long lesions (> 30 mm) that were treated with PEB angioplasty followed by focal stenting with BMS. IVUS was performed before, after PEB and post stenting. Clinical and angiographic follow-up was done at 6 months. The primary end-point was angiographic late lumen loss. Results Patient age was 64.6 Â± 8.1 years, 15 (93.7%) were males, and 7 (43.7%) diabetics. Target vessels were most commonly the left anterior descending (6 [31.6%]) and the right coronary artery (6 [31.6%]). PEB diameter was 2.8 Â± 0.4 mm with a 31.3 Â± 8.9 mm length. Stents per patient were 2.1 Â± 0.8. No overlapping stents were deployed. Angiographic success was achieved in 100% of patients. Peri-procedural myocardial infarction occurred in 4 patients (25%). At 6 months follow-up angiography, MLD was 1.55 Â± 0.53 mm with a late loss of 0.48 Â± 0.52 mm, a binary re-stenosis rate of 2 (12.5%). Conclusion Using PEB with focal stenting by BMS proved to be a feasible, safe, and promising strategy in long coronary lesions. However larger study are needed to confirm these data.

2016 - Coronary atherosclerosis in outlier subjects at the opposite extremes of traditional risk factors: Rationale and preliminary results of the Coronary Atherosclerosis in outlier subjects: Protective and novel Individual Risk factors Evaluation (CAPIRE) study [Articolo su rivista]
Magnoni, Marco; Andreini, Daniele; Gorini, Marco; Moccetti, Tiziano; Modena, Maria Grazia; Canestrari, Mauro; Berti, Sergio; Casolo, Giancarlo; Gabrielli, Domenico; Marraccini, Paolo; Pontone, Gianluca; Masson, Serge; Latini, Roberto; Maggioni, Aldo Pietro; Maseri, Attilio
abstract

Although it is generally accepted that cardiac ischemic events develop when coronary atherosclerosis (coronary artery disease [CAD]) has reached a critical threshold, this is true only to a first approximation. Indeed, there are patients with severe CAD who do not develop ischemic events; conversely, at the other extreme, individuals with minimal CAD may do. Similar exceptions to this paradigm include patients with diffuse CAD with a low risk factor (RF) profile and others with multiple RFs who develop only mild or no CAD. Therefore, the CAPIRE project was designed to investigate whether the specific study of these extreme outlier populations could provide clues for identification of yet unknown risk or protective factors for CAD and ischemic events. In the CAPIRE study, 481 subjects without previous symptoms or history of ischemic heart disease and normal left ventricular systolic function undergoing coronary computed tomography angiography have been selected based on coronary computed tomography angiography findings and cardiovascular RF profile. Therefore, in the whole population, 2 extreme outlier populations have been identified: (1) subjects with no CAD despite multiple RFs, and (2) at the opposite extreme, subjects with diffuse CAD despite a low-risk profile. Each subject has been characterized by clinical, anatomical imaging variables of CAD and baseline circulating biomarkers. Blood samples were collected and stored in a biological bank for further advanced investigations. The project is designed as a prospective, observational, international multicenter study with an initial cross-sectional analysis of clinical, imaging, and biomolecular variables in the selected groups and a longitudinal 5-year follow-up.

2016 - Estrogens and the heart. Do they help or hurt? How estrogen impacts the cardiovascular system [Articolo su rivista]
Modena, Maria Grazia
abstract

Extensive epidemiological observations, clinical mechanistic studies, and basic laboratory research have suggested that the incidence of Cardiovascular Disease (CVD) increases with menopause and that Hormone Replacement Therapy (HRT), or more specifically Estrogen Replacement Therapy (ERT), is associated with beneficial cardiovascular effects in postmenopausal women. Estrogen has a multitude of biological effects that may account for its apparent cardiovascular protection, including favourable effects on the lipid profile, antioxidant activity, enhanced fibrinolysis, and a series of actions on the vasculature. However, because estrogen affects so many cellular processes, it is imperative to gain a better understanding of the molecular mechanisms, both genomic and non-genomic, by which estrogen induces cellular signals and modulates vascular responses. While there is no question that HRT effectively mitigates troublesome menopause symptoms, conflicting evidence about other effects of HRT has fuelled controversy concerning its relative benefits and risks. Moreover, it could seem that CVD protection mediated by replacement therapy is maximum when the therapy was initiated in the absence of signs of atherosclerosis (typically in premenopause) while it vanishes as atherosclerosis proceeds (in the postmenopausal patient). In addition, many questions remain regarding the effectiveness of type of hormonal compounds, doses, regimens, route and, mainly, on time of administration. There are data from recent literature that early menopause and not menopause per se, is a risk factor for CVD and that early ERT may have a role on delaying the atherosclerosis process in postmenopausal women. We conclude that is not time yet to close the chapter of the role of estrogens in the postmenopausal research, in fact, in this area has begun again.

2016 - Usefulness of High-Sensitivity Cardiac Troponin T for the Identification of Outlier Patients with Diffuse Coronary Atherosclerosis and Low-Risk Factors [Articolo su rivista]
Magnoni, Marco; Masson, Serge; Andreini, Daniele; Moccetti, Tiziano; Modena, Maria Grazia; Canestrari, Mauro; Berti, Sergio; Casolo, Giancarlo; Gabrielli, Domenico; Marraccini, Paolo; Pontone, Gianluca; Latini, Roberto; Maggioni, Aldo Pietro; Maseri, Attilio
abstract

Novel high-sensitivity assay can detect very low levels of circulating cardiac troponin (hs-cTnT) in apparently healthy subjects. Within normal range, higher levels are associated with coronary artery disease (CAD) and cardiac abnormalities commonly associated to traditional risk factors (RFs) for CAD. Therefore, we investigated the relation between circulating hs-cTnT and CAD in patients with a spectrum of RF burden aiming to assess the added value of hs-cTnT to identify "outlier" patients with CAD despite a low RF burden. Hs-cTnT was measured in 525 stable patients without previous diagnosis of ischemic heart disease with 0 to 1 RF, excluded diabetes, (low-RF group, n = 263) or â¥2 RFs (multiple-RF group, n = 262) and without CAD (segment involvement score = 0) or diffuse CAD (segment involvement score >5) at coronary computed tomography angiography. Outlier patients with diffuse CAD despite low-RF burden had similar extent, severity, and plaque composition than patients with multiple RFs. Overall, hs-cTnT was measurable in 81% of patients with median value of 6.0 ng/L. In both groups, hs-cTnT concentration was higher in patients with CAD than in patients with normal coronary arteries (p <0.0001). Hs-cTnT was more accurate to detect patients with CAD in the low-RF group than in the multiple-RF group (p = 0.04). In multivariate analysis, higher level of hs-cTnT (>6 ng/L) was independently associated with CAD in low-RF group only. Despite very low circulating concentrations, hs-cTnT may identify with a good accuracy the outlier patients with diffuse CAD despite low-RF burden.

2015 - Ezetimibe added to statin therapy after acute coronary syndromes [Articolo su rivista]
Cannon, C. P.; Blazing, M. A.; Giugliano, R. P.; Mccagg, A.; White, J. A.; Theroux, P.; Darius, H.; Lewis, B. S.; Ophuis, T. O.; Jukema, J. W.; De Ferrari, G. M.; Ruzyllo, W.; De Lucca, P.; Im, K.; Bohula, E. A.; Reist, C.; Wiviott, S. D.; Tershakovec, A. M.; Musliner, T. A.; Braunwald, E.; Califf, R. M.; Musliner, T.; Tershakovec, A.; Gurfinkel, E.; Aylward, P.; Tonkin, A.; Maurer, G.; Van de Werf, F.; Nicolau, Jc.; Genest, J.; Armstrong, P.; Corbalan, R.; Isaza, D.; Spinar, J.; Grande, P.; Voitk, J.; Kesaniemi, A.; Bassand, Jp.; Farnier, M.; Keltai, M.; Mathur, A.; Mittal, S.; Reddy, K.; White, H.; Pedersen, T.; Britto, F.; Carrageta, M.; Duris, T.; Dalby, A.; Seung, Kb.; Lopez-Sendon, J.; Dellborg, M.; Mach, F.; Guneri, S.; Parkhomenko, A.; Brady, A.; Ballantyne, C.; de Lemos, J.; Kleiman, N.; Mcguire, Dk.; Centeno, E.; Casalins, M.; Cartasegna, L.; Beltrano, Mc.; Guerrero, R.; Fanuele, M.; Berra, F.; Egido, J.; Colombo, H.; Dellatorre, M.; Terns, P.; Blumberg, E.; Reges, P.; Azize, G.; Ramos, H.; Fernandez, R.; Carlessi, C.; Milesi, R.; Schmuck, R.; Duronto, E.; Procopio, G.; Carlevaro, O.; Maffeo, H.; Beloscar, J.; Viso, M.; Hominal, M.; Castoldi, M.; Bluguermann, J.; Mauro, D.; Macin, S.; Cocco, N.; Ruiz, N.; Ricart, J.; Lozada, A.; Nani, S.; Turri, D.; Fernandez, H.; Caruso, O.; Zarandon, R.; Bono, J.; Arias, V.; Allall, O.; Marino, J.; Cusimano, S.; Schygiel, P.; Buzetti, C.; Penaloza, N.; Berli, M.; Worthley, S.; Roach, A.; Chew, D.; Wright, T.; Leitch, J.; Hicks, E.; Rankin, J.; Venn-Edmonds, C.; Lehman, R.; Morrison, H.; Shaw, J.; Mak, V.; Hii, C.; Smith, K.; Cross, D.; Lilwall, L.; Nelson, G.; Loxton, A.; Horowitz, J.; Rose, J.; Steinwender, C.; Leisch, F.; Kammler, J.; Brussee, H.; Zweiker, R.; Niederl, E.; Weihs, W.; Giorgio, G.; Lang, I.; Drexel, H.; Zanolin, D.; Hoppe, U.; Atzenhofer-Baumgartner, K.; Pichler, M.; Hainzer, D.; Eber, B.; Pichler, F.; Foeger, B.; Wechselberger, T.; Mayr, H.; Hofer, J.; Stockenhuber, F.; Warlits, B.; Huber, K.; Egger, F.; Weidinger, F.; Ziegler, B.; Jirak, P.; Metzler, B.; Pachinger, O.; Wanitschek, M.; Auer, J.; Grabscheit, G.; Podczeck-Schweighofer, A.; Priesnitz, T.; Frank, H.; El Allaf, D.; Marechal, P.; Roosen, J.; Joly, E.; Lefebvre, P.; Arend, C.; Sinnaeve, P.; De Velder, L.; Hellemans, S.; Vanhauwaert, B.; Van Dorpe, A.; Heyse, A.; Vantomme, C.; Striekwold, H.; Van Den Broeck, D.; Lancellotti, P.; Schoors, D.; Lemoine, I.; Taeymans, Y.; De Wolf, L.; Brike, C.; Vercauteren, S.; Tahon, S.; Vervoort, G.; Mestdagh, I.; Pirenne, B.; Cardinal, F.; Lips, S.; Dujardin, K.; Debrouwer, K.; Dhooghe, G.; Holvoet, G.; van de Borne, P.; Renard, M.; De Clippel, M.; Lesseliers, H.; Van Miert, N.; Saraiva, J.; Vicente, C.; Rossi, P.; Dos Santos, Lb.; Duda, N.; Tognon, Ap.; Serrano, C.; Gomes, Fl.; Manenti, Er.; Silveira, Ds.; Maia, L.; Mouco, Om.; Paiva, M.; Antonangelo, A.; de Souza, J.; Lino, Ea.; Leaes, P.; Blacher, Mg.; Kormann, A.; Ultramari, Ft.; Dutra, O.; Mendelski, Am.; Morgado, S.; Ardito, W.; Greque, G.; Ardito, Rv.; Pimentel Filho, P.; Zucchetti, C.; Alves, A.; Seabra, Am.; Mattos, M.; Miranda, Lf.; Silva, D.; Uehara, Rm.; Marin Neto, J.; Schmidt, A.; Braga, J.; Rodrigues, A.; Abrantes, J.; Pinheiro, L.; Bodanese, L.; Magedanz, E. H.; Piegas, L.; Dos Santos, Es.; Wainstein, M.; Ribeiro, J.; Stein, R.; Marino, R.; Machado, Vm.; Moraes Junior, J.; Guimaraes, S.; da Costa, Fa.; Ferraz, Rf.; Albuquerque, D.; Rocha, Rm.; de Carvalho Moreira, R.; Dohmann, H.; Costantini, C.; Tarastchuk, Jc.; Coelho, O.; Cirillo, W.; Sousa, A.; Almeira, As.; Stefanini, E.; Silva, F.; Teixeira, M.; da Cunha, C.; Precoma, D.; Facchi, Tl.; Rupka, D.; Thiessen, S.; Warnica, J.; Smith, B.; Della Siega, A.; Klinke, P.; Nelson, S.; Dion, D.; Gilbert, N.; Hui, W.; Kvill, L.; Sussex, B.; Luther, A.; Dupuis, R.; Ouimet, F.; Pandey, A.; Clarus, S.; Senaratne, M.; Ferdinandis, H.; Mukherjee, A.; Bozek, B.; Vizel, S.; Markov, G.; Zimmermann, R.; Stephens, W.; Tremblay, B.; Wong, G.; Uchida, N.; Brossoit, R.; Peck,
abstract

BACKGROUND: Statin therapy reduces low-density lipoprotein (LDL) cholesterol levels and the risk of cardiovascular events, but whether the addition of ezetimibe, a nonstatin drug that reduces intestinal cholesterol absorption, can reduce the rate of cardiovascular events further is not known. METHODS: We conducted a double-blind, randomized trial involving 18,144 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and had LDL cholesterol levels of 50 to 100 mg per deciliter (1.3 to 2.6 mmol per liter) if they were receiving lipid-lowering therapy or 50 to 125 mg per deciliter (1.3 to 3.2 mmol per liter) if they were not receiving lipid-lowering therapy. The combination of simvastatin (40 mg) and ezetimibe (10 mg) (simvastatin-ezetimibe) was compared with simvastatin (40 mg) and placebo (simvastatin monotherapy). The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularization (≥30 days after randomization), or nonfatal stroke. The median follow-up was 6 years. RESULTS: The median time-weighted average LDL cholesterol level during the study was 53.7 mg per deciliter (1.4 mmol per liter) in the simvastatin-ezetimibe group, as compared with 69.5 mg per deciliter (1.8 mmol per liter) in the simvastatin-monotherapy group (P<0.001). The Kaplan-Meier event rate for the primary end point at 7 years was 32.7% in the simvastatin-ezetimibe group, as compared with 34.7% in the simvastatin-monotherapy group (absolute risk difference, 2.0 percentage points; hazard ratio, 0.936; 95% confidence interval, 0.89 to 0.99; P = 0.016). Rates of pre-specified muscle, gallbladder, and hepatic adverse effects and cancer were similar in the two groups. CONCLUSIONS: When added to statin therapy, ezetimibe resulted in incremental lowering of LDL cholesterol levels and improved cardiovascular outcomes. Moreover, lowering LDL cholesterol to levels below previous targets provided additional benefit.

2015 - Huge coronary perforation during percutaneous intervention sealed by injection of polyvinyl alcohol microspheres [Articolo su rivista]
Politi, Luigi; Iaccarino, Daniele; Sangiorgi, Giuseppe M.; Modena, Maria Grazia
abstract

During percutaneous coronary intervention, coronary perforation is one of the most feared life-threatening complications, as it may cause cardiac tamponade or acute myocardial infarction. The incidence of this serious complication in recent years has increased from 0.2 to 0.6%, most likely due to the increase of complex procedures. However, the management of coronary perforation has not been established yet. We report the first case of coronary perforation successfully managed with intracoronary injection of hydrogel microspheres.

2015 - Prognostic value of a negative peak supine bicycle stress echocardiography with or without concomitant ischaemic stress electrocardiographic changes: a cohort study [Articolo su rivista]
Barbieri, Andrea; Mantovani, Francesca; Bursi, Francesca; Ruggerini, Sara; Lugli, Roberta; Abdelmoneim, Sahar S.; Modena, Maria Grazia
abstract

Background: a negative peak supine bicycle exercise stress echocardiography (ESE) was shown to have a long-term favourable prognostic value. Data on the long-term prognosis of ischaemic electrocardiographic (ISECG) changes in the setting of a negative peak supine bicycle ESE are lacking. Design: we evaluated the prognostic value of negative peak supine bicycle ESE with or without concomitant ISECG changes in a referral population evaluated for chest pain after an inconclusive first-line work-up including clinical evaluation and exercise ECG stress. Methods: from 2003 to 2010, patients who underwent a peak supine bicycle ESE and were deemed to be negative were evaluated. Two groups based on concomitant stress ECG tracing were analysed-those with normal stress ECG and those with ISECG changes. The primary endpoint was cumulative incidence of cardiovascular death, hospitalizations for acute coronary syndrome and coronary revascularizations. Results: a total of 371 patients (mean age 59.1Â±12.1 years, 49.9% women) were studied. Of those, 141 (38.0%) had concomitant ISECG changes. Mean follow-up was 3.46Â±1.76 years. The primary endpoint occurred in 3.0% of patients, (2.2% in those with normal stress ECG, and in 4.3% with ISECG changes, p=0.251); with unadjusted hazard ratio for primary endpoint of 2.04 (95%CI 0.62-6.69, p=0.239) in patients with ISECG changes compared to those with normal stress ECG. Conclusions: in an outpatient population without known CAD evaluated for chest pain after inconclusive first-line work-up, a negative peak supine bicycle ESE confers an excellent prognosis regardless of the nature of concomitant stress ECG abnormalities.

2015 - Un nome nuovo nel linguaggio della prevenzione cardiovascolare: I Vaccini - Documento SIPREC 2015 [Altro]
Modena, Maria Grazia; Bonanni, Paolo; Gabutti, Giovanni; Icardi, Giancarlo; Sudano, Luigi; Andrea, Orsi
abstract

Cominciamo questa carrellata di evidenze con una premessa importante: il Servizio Sanitario Nazionale ha previsto, tra le strutture che lo compongono, i Dipartimenti di Prevenzione. Questi hanno il compito, tra gli altri, di realizzare applicandola, la P revenzione in senso lato. C osa significa “applicare la Prevenzione”? Il personale da cui è composto ogni Dipartimento di Prevenzione lavora per realizzare i progetti e i piani per la prevenzione decisi, in collaborazione con le Regioni, dal Ministero della Salute. Tra questi vi sono anche progetti che riguardano l’obesità, lo sport, la dieta e, quindi, con forti ripercussioni sulle tematiche cardiovascolari, esattamente come fa, operando al meglio, la S.I.P.R.E.C. e, al suo pari, ogni professionista che la compone. Premessa necessaria per aprire la porta al tema della prevenzione cardiovascolare dei soggetti a rischio attraverso la pratica vaccinale, sulle cui problematiche, chi non ha avuto modo di approfondire questo tema, non può avere sentore dell’importanza, soprattutto alla luce delle più recenti novità scientifico-tecnologiche. O ggi possiamo scegliere vaccini che consentono di modulare la risposta immunitaria, per renderla più performante e di più lunga durata, mediante l’utilizzo di vaccini “Coniugati” o “Adiuvati”; sistemi biologici che consentono l’attivazione dei linfociti B e T , nonché la collaborazione di questi due sistemi. Questo consente di ottenere Anticorpi Neutralizzanti e Cellule

2015 - Usefulness of negative supine bicycle exercise stress echocardiography in patients with end stage renal disease evaluated for renal transplantation [Abstract in Atti di Convegno]
Mantovani, F; Bertelli, Luca; Lugli, R; Bursi, F; Modena, Mg; Chiarini, Valentina; Abdelmoneim, Ss; Rubbiani, E; Cappelli, G; Barbieri, A.
abstract

Usefulness of negative supine bicycle exercise stress echocardiography in patients with end stage renal disease evaluated for renal transplantation

2014 - Hypertension in postmenopausal women: How to approach hypertension in menopause [Articolo su rivista]
Modena, Maria Grazia
abstract

During fertile life women are usually normo or hypotensive. Hypertension may appear during pregnancy and this represents a peculiar phenomenon increasing nowadays for delay time of pregnancy. Gestational hypertension appears partially similar to hypertension in the context of metabolic syndrome for a similar condition of increased waste circumference. Parity, for the same pathogenesis, has been reported to be associated to peri and postmenopausal hypertension, not confirmed by our study of parous women with transitional non persistent perimenopausal hypertension. Estrogen's deficiency inducing endothelial dysfunction and increased body mass index are the main cause for hypertension in this phase of life. For these reasons lifestyle modification, diet and endothelial active drugs represent the ideal treatment. Antioxidant agents may have a role in prevention and treatment of hypertension. In conclusion, hypertension in women represents a peculiar constellation of different biological and pathogenic factors, which need a specific gender related approach, independent from the male model. Â© 2014 Springer International Publishing.

2014 - Hypertension, menopause and natural antioxidants in foods and diet [Altro]
Modena, Maria Grazia
abstract

Book contents Chapter contents Worldwide, hypertension (HTN) is the most important cardiovascular risk factor for stroke, myocardial infarction and heart failure. The issue of HTN, menopause and antioxidants in foods and diet is going to open a new scenario in the treatment of the most prevalent risk factor in postmenopausal women. HTN, in fact, in this particular phase of life, is due to an increase in body mass index and a deficiency of estrogen, which induces endothelial dysfunction and an increase in oxidative stress. The term ‘antioxidant’ refers to enzymatic and non-enzymatic complexes that prevent or inhibit oxidation of biomolecules. The main non-enzymatic antioxidants are biologic compounds found mainly in vegetables and fruits. Pharmacologic therapy is very important, but it should be the second or the alternative choice after modification of lifestyle. In this context, antioxidants and diet my help in weight control as well as in the natural substitution of estrogen’s properties.

2014 - Hypertension, menopause and natural antioxidants in foods and the diet [Capitolo/Saggio]
Modena, Maria Grazia
abstract

Worldwide, hypertension (HTN) is the most important cardiovascular risk factor for stroke, myocardial infarction and heart failure. The issue of HTN, menopause and antioxidants in foods and diet is going to open a new scenario in the treatment of the most prevalent risk factor in postmenopausal women. HTN, in fact, in this particular phase of life, is due to an increase in body mass index and a deficiency of estrogen, which induces endothelial dysfunction and an increase in oxidative stress. The term ‘antioxidant’ refers to enzymatic and non-enzymatic complexes that prevent or inhibit oxidation of biomolecules. The main non-enzymatic antioxidants are biologic compounds found mainly in vegetables and fruits. Pharmacologic therapy is very important, but it should be the second or the alternative choice after modification of lifestyle. In this context, antioxidants and diet my help in weight control as well as in the natural substitution of estrogen’s properties.

2014 - Longitudinal evaluation of endothelial function in children and adolescents with type 1 diabetes mellitus: a long term follow up study. [Articolo su rivista]
Bruzzi, Patrizia; Predieri, Barbara; Patianna, VIVIANA DORA; Salvini, Annamaria; Rossi, Rosario; Modena, Maria Grazia; Iughetti, Lorenzo
abstract

BACKGROUND: Type 1 diabetes (T1DM) predisposes to cardiovascular disease increasing the risk to develop atherosclerosis. In pediatric population the cardiovascular risk may be evaluated examining endothelial function by a noninvasive ultrasound technique, namely flow-mediated dilation (FMD) of the brachial artery. The aims of this study were the longitudinal evaluation of the potential change in the endothelium-dependent vasomotor function in children and adolescents with T1DM and the identification of clinical and laboratory data correlated to modifications. METHODS: We studied 39 T1DM patients (20 girls and 19 boys; aged 11.2 ± 3.72 years). FMD and blood samples were obtained from all patients at baseline (time 0) and after a follow-up of at least 1 year (time 1). FMD was also evaluated in 45 healthy controls (22 boys, 23 girls) aged 10.2 ± 3.05 years. RESULTS: At time 0, 43.6% T1DM patients presented an impaired FMD. FMD at time 1 revealed a dramatic impairment of endothelial function: altered FMD values were shown in 61.5% of patients and it got worse in 74.3% of them. Longitudinally males had a greater impairment of FMD than females. At baseline multivariate analysis identified only gender as significant predictor of FMD (β = 0.470, p = 0.029). CONCLUSIONS: Because endothelial dysfunction appears earlier in diabetic children, they are at higher risk to develop atherosclerosis. Our results suggest the usefulness of FMD as a tool to stratify pediatric T1DM patients according to their cardiovascular risk and to follow up them longitudinally.

2014 - Prognostic Value of a Negative Peak Supine Bicycle Stress Echocardiography With or Without Concomitant Ischemic Stress Electrocardiographic Changes: a Cohort Study. [Articolo su rivista]
Barbieri, Andrea; Mantovani, Francesca; Bursi, Francesca; Ruggerini, Sara; Lugli, Roberta; Abdelmoneim, Ss; Modena, Maria Grazia
abstract

BACKGROUND: a negative peak supine bicycle exercise stress echocardiography (ESE) was shown to have a long-term favourable prognostic value. Data on the long-term prognosis of ischaemic electrocardiographic (ISECG) changes in the setting of a negative peak supine bicycle ESE are lacking. DESIGN: we evaluated the prognostic value of negative peak supine bicycle ESE with or without concomitant ISECG changes in a referral population evaluated for chest pain after an inconclusive first-line work-up including clinical evaluation and exercise ECG stress. METHODS: from 2003 to 2010, patients who underwent a peak supine bicycle ESE and were deemed to be negative were evaluated. Two groups based on concomitant stress ECG tracing were analysed - those with normal stress ECG and those with ISECG changes. The primary endpoint was cumulative incidence of cardiovascular death, hospitalizations for acute coronary syndrome and coronary revascularizations. RESULTS: a total of 371 patients (mean age 59.1 ± 12.1 years, 49.9% women) were studied. Of those, 141 (38.0%) had concomitant ISECG changes. Mean follow-up was 3.46 ± 1.76 years. The primary endpoint occurred in 3.0% of patients, (2.2% in those with normal stress ECG, and in 4.3% with ISECG changes, p = 0.251); with unadjusted hazard ratio for primary endpoint of 2.04 (95%CI 0.62-6.69, p = 0.239) in patients with ISECG changes compared to those with normal stress ECG. CONCLUSIONS: in an outpatient population without known CAD evaluated for chest pain after inconclusive first-line work-up, a negative peak supine bicycle ESE confers an excellent prognosis regardless of the nature of concomitant stress ECG abnormalities.

2014 - Response to letter regarding article, good prognosis for pericarditis with and without myocardial involvement: Results from a multicenter, prospective cohort study [Articolo su rivista]
Imazio, Massimo; Brucato, Antonio; Barbieri, Andrea; Ferroni, Francesca; Maestroni, Silvia; Ligabue, Guido; Chinaglia, Alessandra; Cumetti, Davide; DELLA CASA, Giovanni; Bonomi, Federica; Mantovani, Francesca; Di Corato, Paola; Lugli, Roberta; Faletti, Riccardo; Leuzzi, Stefano; Bonamini, Rodolfo; Modena, Maria Grazia; Belli, Riccardo
abstract

2013 - Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long-Term Registry [Articolo su rivista]
Maggioni, A. P.; Anker, S. D.; Dahlstrom, U.; Filippatos, G.; Ponikowski, P.; Zannad, F.; Amir, O.; Chioncel, O.; Leiro, M. C.; Drozdz, J.; Erglis, A.; Fazlibegovic, E.; Fonseca, C.; Fruhwald, F.; Gatzov, P.; Goncalvesova, E.; Hassanein, M.; Hradec, J.; Kavoliuniene, A.; Lainscak, M.; Logeart, D.; Merkely, B.; Metra, M.; Persson, H.; Seferovic, P.; Temizhan, A.; Tousoulis, D.; Tavazzi, L.; Andarala, M.; Fiorucci, E.; Folkesson, E.; Glemot, M.; Gracia, G.; Konte, M.; Laroche, C.; Mcneill, P.; Missiamenou, V.; Taylor, C.; Eberl, A.; Heller, S.; Dolze, T.; Platzer, V.; Ablasser, K.; Auer, J.; Poelzl, G.; Moertl, D.; Podczeck-Schweighofer, A.; Reiter, S.; Pravdic, D.; Muslibegovic, A.; Vitlianova, K.; Katova, T.; Kotirkov, K.; Petrov, I.; Velikov, T.; Kurteva, T.; Kamenova, D.; Antova, M.; Tisheva, S.; Sirakova, V.; Krejci, J.; Spinar, J.; Mikolaskova, M.; Krupicka, J.; Malek, F.; Hegarova, M.; Pudil, R.; Monhart, Z.; Lazarova, M.; Reda, A.; Khairy, T.; Farag, N.; Saleh, A.; Said, K.; Abdel Hamid, M.; Halawa, S.; Ibrahim, B.; Hanna, R.; Sobhy, M.; El Messiry, F.; El Shazly, A. H.; Elrakshy, Y.; Aboleineen, W.; Gouda, M.; Youssef, A.; Elbahry, A.; Abdel, A.; Ebeid, H.; Nasr, G.; Sobhy, H.; Ashmawy, M.; Lefol, C.; Isnard, R.; Hagege, A.; Thevenin, S.; Jondeau, G.; Codjia, R.; Galinier, M.; Bauer, F.; Delahaye, F.; Lamblin, N.; Fertin, M.; De Groote, P.; Coisne, D.; Le Marcis, V.; Lequeux, B.; Ly, J. -F.; Lotton, P.; Donal, E.; Le Moal, V.; Basquin, A.; Reynaud, A.; Ridard, C.; Thebault, C.; Behar, N.; Mascle, S.; Schiele, F.; Seronde, M. -F.; Morel, M.; Meneveau, N.; Luporsi, P.; Bernard, Y.; Pillot, M.; Briand, F.; Damy, T.; Eicher, J. -C.; Avgeropoulou, C.; Panagiotis, T.; Kotrogiannis, I.; Stefanadis, C.; Chrysohoou, C.; Tsitsinakis, G.; Dimitroula, T.; Karavidas, A.; Matzaraki, V.; Terrovitis, J.; Kapelios, C.; Sfakianaki, T.; Parissis, J. T.; Ntai, K.; Papadopoulou, A.; Tziourganou, H.; Douras, A.; Ntertsas, K.; Karotsaki, T.; Nikoloulis, N.; Tsaknakis, T.; Patrianakos, A.; Nyktari, E.; Vardas, P.; Soos, P.; Nyolczas, N.; Csaba Nagy, A.; Halmosi, R.; Nemeth, F.; Amon, G.; Dinnyes, J.; Vazan Fuhrmann, A.; Shotan, A.; Alony, I.; Elber, J.; Olaru, A.; Valenti, C.; Reggianini, L.; Modena, M. G.; Copelli, S.; Leuzzi, C.; Dei Cas, L.; Carubelli, V.; Lombardi, C.; Bulgari, M.; Tanghetti, E.; Quinzani, F.; Rovetta, R.; Brasolin, B.; Fedele, F.; Sergi, D.; Romeo, F.; Scarfo, I.; Vellini, M.; Fabris, E.; Cinquetti, M.; Stolfo, D.; Sinagra, G.; Merlo, M.; Fucili, A.; Ferrari, R.; Vassanelli, C.; Torelli, F.; Marchese, G.; Zanolla, L.; Cicoira, M.; Anselmi, M.; Piccinino, C.; Sartori, C.; Di Ruocco, M. V.; Marino, P. N.; Giordano, A.; Brognoli, S.; Zanelli, E.; Cosmi, F.; Cadeddu, C.; Bandino, S.; Mercuro, G.; Deidda, M.; Salvemini, G.; Correale, M.; Di Biase, M.; Musio, S.; Passero, T.; Italiano, G.; Agostoni, P.; Salvioni, E.; Schiavina, G.; Squeri, A.; Bosi, S.; Barbieri, A.; Lemme, E.; Penco, M.; Marcon, S.; Romano, S.; Di Mauro, M.; Frisinghelli, A.; Veniani, M.; Pieri, P.; Novo, S.; Proclemer, A.; Fresco, C.; Miani, D.; Artico, J.; Gaita, F.; Bergerone, S.; Pirelli, S.; Di Tano, G.; Cattaneo, S.; Gualco, A.; Opasich, C.; Priori, S. G.; Iori, E.; Leci, E.; Melandri, F.; Voronina, N.; Kalnins, A.; Rumbinaite, E.; Kazakauskaite, E.; Petraskiene, I.; Karaliute, R.; Smalinskas, V.; Tamakauskas, V.; Petraskiene, D.; Brazyte-Ramanauskiene, R.; Vysniauskas, V.; Nowicka, A.; Grabia, J.; Dankowski, R.; Szyszka, A.; Szymanowska, K.; Straburzynska-Migaj, E.; Kaluzna-Oleksy, M.; Grajek, S.; Kasztelowicz, P.; Orzel, T.; Bednarczyk, G.; Ruszkowski, P.; Klimkiewicz, J.; Majzner, A.; Matusiak, A.; Bylicka, E.; Kwiatkowska, E.; Kwiatkowska, K.; Ochnio, M.; Krzyzewska, T.; Tarnowska, A.; Komuda, K.; Sobieszczanska-Malek, M.; Leszek, P.; Rywik, T.; Wisniewska, J.; Kozar-Kaminska, K.; Piotrowska, M.; Zielinski, T.; Mamcarz, A.; Welnicki, M.; Folga, A.; Kaplon-Cieslicka, A.; Opolski, G.; Marchel, M.; Balsam, P.; Michalek, A.; Pawlak, A.; Byczkowska, K.; M
abstract

AimsTo evaluate how recommendations of European guidelines regarding pharmacological and non-pharmacological treatments for heart failure (HF) are adopted in clinical practice.Methods and resultsThe ESC-HF Long-Term Registry is a prospective, observational study conducted in 211 Cardiology Centres of 21 European and Mediterranean countries, members of the European Society of Cardiology (ESC). From May 2011 to April 2013, a total of 12 440 patients were enrolled, 40.5% with acute HF and 59.5% with chronic HF. Intravenous treatments for acute HF were heterogeneously administered, irrespective of guideline recommendations. In chronic HF, with reduced EF, renin-angiotensin system (RAS) blockers, beta-blockers, and mineralocorticoid antagonists (MRAs) were used in 92.2, 92.7, and 67.0% of patients, respectively. When reasons for non-adherence were considered, the real rate of undertreatment accounted for 3.2, 2.3, and 5.4% of the cases, respectively. About 30% of patients received the target dosage of these drugs, but a documented reason for not achieving the target dosage was reported in almost two-thirds of them. The more relevant reasons for non-implantation of a device, when clinically indicated, were related to doctor uncertainties on the indication, patient refusal, or logistical/cost issues.ConclusionThis pan-European registry shows that, while in patients with acute HF, a large heterogeneity of treatments exists, drug treatment of chronic HF can be considered largely adherent to recommendations of current guidelines, when the reasons for non-adherence are taken into account. Observations regarding the real possibility to adhere fully to current guidelines in daily clinical practice should be seriously considered when clinical practice guidelines have to be written. © 2013 Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013. For permissions please email: journals.permissions@oup.com.

2013 - Comparative effectiveness of novel oral anticoagulants for atrial fibrillation : evidence from pair-wise and warfarin -controlled network meta-analyses [Articolo su rivista]
BIONDI ZOCCAI, Giuseppe; D’Ascenzo, F.; Malavasi, Valentina; Mmarietta, M. Marietta; Modena, Maria Grazia
abstract

INTRODUCTION: Novel oral anticoagulants have been tested against warfarin for atrial fibrillation, yet no direct comparison is available. We thus aimed to perform pair-wise (direct) and warfarin-adjusted network (i.e. indirect) meta-analyses of novel oral anticoagulants for atrial fibrillation. METHODS: Databases were searched for randomized warfarin-controlled trials of novel anticoagulants for non-valvular atrial fibrillation. The primary end-point was long-term stroke/systemic embolism. Odds ratios (95% intervals) were computed with RevMan and WinBUGS. RESULTS: Seven trials (52701 patients) were included, focusing on apixaban, dabigatran, edoxaban and rivaroxaban. Pair-wise meta-analysis showed that after a weighted average of 23 months these novel anticoagulants lead to significant reductions in the risk of stroke/systemic embolism (odds ratio=0.81 [0.71-0.92], I2=23%) and all cause death (odds ratio=0.88 [0.82-0.95], I2=0%) in comparison to warfarin. Network meta-analysis showed that apixaban and dabigatran proved similarly superior to warfarin in preventing stroke/systemic embolism (odds ratio=0.78 [0.62-0.96] for apixaban vs warfarin; odds ratio=0.66 [0.52-0.84] for high-dose dabigatran vs warfarin; odds ratio for apixaban vs high-dose dabigatran=1.17 [0.85-1.63]), but apixaban was associated with fewer major bleedings (odds ratio=0.73 [0.57-0.93]) and drug discontinuations (odds ratio=0.64 [0.52-0.78]) than dabigatran. Rivaroxaban did not reduce stroke/systemic embolism (odds ratio=0.87 [0.71-1.07]) or major bleedings in comparison to warfarin (odds ratio=0.87 [0.71-1.07]) and was associated with more major bleedings in comparison to apixaban (odds ratio=1.52 [1.19-1.92]). Data for edoxaban were inconclusive. CONCLUSIONS: Novel oral anticoagulants appear as a very promising treatment option for atrial fibrillation.

2013 - EURObservational Research Programme: Regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot) [Articolo su rivista]
Maggioni, A. P.; Dahlstrom, U.; Filippatos, G.; Chioncel, O.; Leiro, M. C.; Drozdz, J.; Fruhwald, F.; Gullestad, L.; Logeart, D.; Fabbri, G.; Urso, R.; Metra, M.; Parissis, J.; Persson, H.; Ponikowski, P.; Rauchhaus, M.; Voors, A. A.; Nielsen, O. W.; Zannad, F.; Tavazzi, L.; Alonso, A.; Ferrari, R.; Komajda, M.; Wood, D.; Manini, M.; Taylor, C.; Laroche, C.; Fiorucci, E.; Lucci, D.; Gonzini, L.; Auer, J.; Oberrauner, A.; Schumacher, M.; Ebner, C.; Hallas, A.; Espersen, G.; Gustafsson, F.; Mattsson, N.; Egstrup, K.; Aagaard, S.; Gohr, T.; Huld, K.; Knudsen, A.; Refsgaard, J.; Charniot, J.; Juillard, A.; Pon-Gabrielsen, P.; Douna, F.; Jondeau, G.; Jourdain, P.; Michel, L.; Hamm, C.; Lehinant, S.; Rieth, A.; Goeing, O.; Schultheiss, H. P.; Von-Schlippenbach, J.; Knollmann, R.; Neubuser, C.; Katus, H. A.; Taeger, T.; Zugck, C.; Fink, H.; Schulz, J.; Held, S.; Karmann, W.; Kreuzer, J.; Nitsche, K.; Winter, K.; Fahnrich, A.; Bruederlein, K.; Turan, C. H.; Berentelg, J.; Ittel, T.; Rubens, C.; Hanke, M.; Stoerk, S.; Chrysohoou, C.; Kaldara, E.; Karavidas, A.; Margari, R.; Matzaraki, V.; Nanas, J.; Pozios, I.; Psarogiannakopoulos, P.; Pyrgakis, V.; Stefanadis, C.; Terrovitis, J.; Trikas, A.; Xydonas, S.; Patrianakos, A.; Vardas, P.; Douras, A.; Nastas, J.; Ntertsas, K.; Tsaknakis, T.; Midi, P.; Pajes, G.; Moretti, L.; Partemi, M.; Barberini, F.; Branzi, A.; Gallelli, I.; Grigioni, F.; Ionico, T.; Pasquale, F.; Cas, L.; Delmagro, F.; Tanghetti, E.; Vaccari, A.; Mercuro, G.; Arcuri, G. M.; Marinacci, L.; Severini, D.; Cosmi, F.; Bosi, S.; Di Tano, G.; Pirelli, S.; Ferrari, R.; Fucili, A.; Minneci, C.; Santoro, G. M.; Correale, M.; Di Biase, M.; Buccolieri, M.; Mandorla, S.; Martinelli, S.; Barbiero, M.; Giordano, A.; Zanelli, E.; Agostoni, P.; Fiorentini, C.; Salvioni, E.; Leuzzi, C.; Modena, M. G.; Reggianini, L.; Cobelli, F.; Opasich, C.; Baldini, P.; Romei, M.; Pulitano, G.; Ruggeri, A.; Bologna, F.; Piovaccari, G.; Brasolin, B.; Fedele, F.; Merlo, M.; Sinagra, G.; Albanese, M. C.; Miani, D.; Linssen, G.; Rodijk, E.; Pinto, Y.; Van Donk, P.; Dunselman, P.; Lok, D.; Brouwers, F.; De Jong, R. M.; Boen, R.; Hole, T.; Rasmussen, L.; Christiansen, E. M.; Gjertsen, E.; Lyng, J.; German, M.; Hogalmen, G.; Skardal, R.; Apelland, T.; Borgen, M.; Forfang, E.; Baak, T.; Dickstein, K.; Olsen, I.; Stachurski, D.; Juszczyk, Z.; Stankala, S.; Gilewski, W.; Sinkiewicz, W.; Kasztelowicz, P.; Gabryel, J.; Kardaszewicz, P.; Lazorko-Piega, M.; Bellwon, J.; Mosakowska, K.; Rynkiewicz, A.; Olczyk, S.; Pagorek, M.; Bartlinski, R.; Borej, G.; Tarchalski, J.; Bartkowiak, R.; Sosnowska-Pasiarska, B.; Wozakowska-Kaplon, B.; Krzeminski, A.; Bury, K.; Grzegorzko, A.; Mirek-Bryniarska, E.; Nessler, J.; Zabojszcz, M.; Broncel, M.; Poliwczak, A.; Retwinski, A.; Soska, K.; Grajek, S.; Straburzynska-Migaj, E.; Kuzniar, J.; Rzeszuto, T.; Bednarczyk, G.; Ruszkowski, P.; Piasecka-Krysiak, E.; Zambrzycki, J.; Nowak, T.; Szelemej, R.; Balsam, P.; Folga, A.; Kaplon-Cieslicka, A.; Kowalewski, S.; Mamcarz, A.; Marchel, M.; Opolski, G.; Welnicki, M.; Jankowska, E.; Nowak, J.; Nowalany-Kozielska, E.; Rozentryt, P.; Zembala, M.; Kleinrok, A.; Prokop-Lewicka, G.; Kudlinska, B.; Radoi, M.; Macarie, C.; Vinereanu, D.; Capalneanu, R.; Giuca, A.; Ionescu, D. D.; Nechita, E.; Datcu, M.; Istrate, C.; Vladoianu, M.; Christodorescu, R.; Salguero, R.; Blanco, V. M.; Lavilla, M. A.; Comin-Colet, J.; Cantillo, D.; Bernal, J.; del Prado, J. M.; Pita, A.; Aguero, J.; Jimenez, J. F.; Calvo, F.; Gonzalez, R.; Molina, B.; Luengos, D.; Lostal, C.; Bonet, L.; Gonzalez, P.; Soriano, F.; Campos, M. J.; Karlstrom, P.; Nyrinder, I.; Olsson, B.; Pettersson, T.; Stenberg, A.; Lindmark, K.; Asserlund, B.
abstract

AimsThe ESC-HF Pilot survey was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). The pilot phase was also specifically aimed at validating structure, performance, and quality of the data set for continuing the survey into a permanent Registry.MethodsThe ESC-HF Pilot study is a prospective, multicentre, observational survey conducted in 136 Cardiology Centres in 12 European countries selected to represent the different health systems across Europe. All outpatients with HF and patients admitted for acute HF on 1 day per week for eight consecutive months were included. From October 2009 to May 2010, 5118 patients were included: 1892 (37%) admitted for acute HF and 3226 (63%) patients with chronic HF. The all-cause mortality rate at 1 year was 17.4% in acute HF and 7.2% in chronic stable HF. One-year hospitalization rates were 43.9% and 31.9%, respectively, in hospitalized acute and chronic HF patients. Major regional differences in 1-year mortality were observed that could be explained by differences in characteristics and treatment of the patients.ConclusionThe ESC-HF Pilot survey confirmed that acute HF is still associated with a very poor medium-term prognosis, while the widespread adoption of evidence-based treatments in patients with chronic HF seems to have improved their outcome profile. Differences across countries may be due to different local medical practice as well to differences in healthcare systems. This pilot study also offered the opportunity to refine the organizational structure for a long-term extended European network. © 2013 The Author.

2013 - Early and long-term outlook of percutaneous coronary intervention for bifurcation lesions in young patients [Articolo su rivista]
Roversi, S; Biondi Zoccai, G; Romagnoli, E; Sheiban, I; De Servi, S; Tamburino, C; Colombo, A; Burzotta, F; Presbitero, P; Bolognese, L; Paloscia, L; Rubino, P; Sardella, G; Briguori, C; Niccoli, L; Franco, G; Di Girolamo, D; Piatti, L; Greco, C; Petronio, S; Loi, B; Lioy, E; Benassi, A; Patti, A; Gaspardone, A; Capodanno, D; Modena, Maria Grazia; Sangiorgi, G.
abstract

Abstract BACKGROUND: Coronary artery disease is most common in older patients, but may occur in younger subjects. The outlook of young patients after percutaneous coronary intervention (PCI) of challenging lesion subsets such as coronary bifurcations, is not established. We thus aimed to appraise the early and long-term results of PCI for bifurcations in young patients. METHODS: A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between 2002 and 2006 in 22 Italian centers. Patients were divided in 2 groups: age ≤45years, and age >45years. The primary end-point was long-term rate of major adverse cardiac events (MACE). RESULTS: 4,314 patients were included: 195 (4.5%) in the younger group, and 4119 (95.5%) in the older group. 30-day outcomes did not show significant differences in MACE rates, with 1.0% in the ≤45years group and 2.1% in the >45years group (p=0.439), with death in 0.5% and 1.2% (p=0.388). At long-term follow-up (24.4±15.1months), younger patients showed similar rates of MACE, (12.8% vs. 16.6%, p=0.161), myocardial infarction (3.1% vs. 3.7%, p=0.633), target lesion revascularization (11.3% vs. 12.5%, p=0.627), or stent thrombosis (1.5% vs. 2.8%, p=0.294), despite an increased risk of death in older patients (1.0% vs. 5.0%, p=0.012). Even at extensive multivariable analysis, younger patients still faced a similar risk of MACE (HR=0.78 [0.48-1.27], p=0.318). CONCLUSIONS: Despite their low age, young patients undergoing PCI for bifurcation face a significant risk of early and late non-fatal adverse events. Thus, they should not be denied careful medical management and follow-up.

2013 - Effect of cardiac resynchronization therapy on left atrial reverse remodeling: Role of echocardiographic AV delay optimization. [Articolo su rivista]
A., Malagoli; L., Rossi; F., Franchi; M. F., Piepoli; V., Malavasi; E., Casali; Modena, Maria Grazia; G. Q., Villani
abstract

Abstract BACKGROUND/OBJECTIVES: Cardiac resynchronization therapy (CRT) improves left ventricular (LV) function in patients with advanced heart failure (HF) and there are some evidences about beneficial effects also on left atrial (LA) dimension and function. The contribution of atrioventricular delay (AVD) optimization on LA changes has not been evaluated. The purpose of the present study was to further investigate the effect of CRT on LA reverse remodelling and to evaluate the contribution of AVD optimization. METHODS AND RESULTS: From the Cardiology Department of Piacenza Hospital and Modena University Hospital fifty one patients with refractory systolic HF and left bundle branch block were prospectively enrolled before CRT implantation. Patients were 1:1 randomized to either an optimized AVD (AV Opt group) determined by continuous wave Doppler aortic velocity-time integral (VTI) or an empiric AVD of 110ms (AV Fixed group). Optimal AVD was defined as the AVD that yielded the largest aortic VTI at one of eight tested AV intervals (between 60 and 200ms). LA volumes and emptying fractions were assessed by two-dimensional echocardiography at baseline and 6months after CRT. At 6-month follow-up, CRT induced LA reverse remodeling in the whole population (maximal LA volume: 55.8±16.4ml/m² vs 50.3±18.9ml/m², p=0.006; pre-systolic LA volume: 47.0±15.2ml/m² vs 41.4±17.4ml/m², p=0.003; post-systolic LA volume: 36.4±15.0ml/m² vs 30.3±18.0ml/m(2), p=0.001); nevertheless, no substantial difference was observed about LA structural and functional remodeling between both AV Opt group and AV Fixed group. CONCLUSION: CRT induces LA reverse remodeling that appears independent from AVD optimization.

2013 - Effects of pregnancy on endothelial function and cardiovascular disease risk in HIV-infected women [Articolo su rivista]
K., Luzi; A. R., Eckard; A., Lattanzi; ZONA, Stefano; MODENA, Maria Grazia; FACCHINETTI, Fabio; GUARALDI, Giovanni
abstract

– This study assessed flow–mediated vasodilation (FMD) and brachial artery diameter (BAD) in HIV–infected pregnant women compared to healthy pregnant controls, and determined their relationships to variables of interest, including the HIV status. No differences were observed in FMD or BAD between HIV–infected and healthy pregnant women, and neither measure changed significantly during pregnancy. HIV status did not affect endothelial function or brachial artery diameter. Pregnancy does not appear to further increase the CVD risk associated with HIV infection.

2013 - Good prognosis for pericarditis with and without myocardial involvement: Results from a multicenter, prospective cohort study [Articolo su rivista]
Massimo, Imazio; Antonio, Brucato; Andrea, Barbieri; Francesca, Ferroni; Silvia, Maestroni; Ligabue, Guido; Alessandra, Chinaglia; Federica, Bonomi; Mantovani, Francesca; Paola, Di Corato; Lugli, Roberta; Riccardo, Faletti; Stefano, Leuzzi; Rodolfo, Bonamini; Modena, Maria Grazia; Riccardo, Belli
abstract

Background—The natural history of myopericarditis/perimyocarditis is poorly known and recently published data have presented contrasting data on their outcomes. The aim of the present article is to assess their prognosis in a multicenter, prospective cohort study. Methods and Results—A total of 486 patients (median age 39 years, range 18-83, 300 men) with acute pericarditis or a myopericardial inflammatory syndrome (myopericarditis/perimyocarditis) (85% idiopathic, 11% connective tissue disease or inflammatory bowel disease, 5% infective) were prospectively evaluated from January 2007 to December 2011. The diagnosis of acute pericarditis was based on the presence of 2 of 4 clinical criteria (chest pain, pericardial rubs, widespread ST-segment elevation or PR depression, and new or worsening pericardial effusion). Myopericardial inflammatory involvement was suspected with atipycal ECG changes for pericarditis, arrhythmias, cardiac troponin elevation and/or new or worsening ventricular dysfunction on echocardiography, and confirmed by cardiac magnetic resonance. After a median follow-up of 36 months normalization of LV function was achieved in >90% of patients with myopericarditis/perimyocarditis. No deaths were recorded, as well as evolution to heart failure or symptomatic LV dysfunction. Recurrences (mainly as recurrent pericarditis) were the most common complication during follow-up and were more frequently recorded in patients with acute pericarditis (32%) than myopericarditis (11%) or perimyocarditis (12%; p<0.001). Troponin elevation was not associated with an increase of complications. Conclusions—The outcome of myopericardial inflammatory syndromes is good. Unlike acute coronary syndromes, troponin elevation is not a negative prognostic marker in this setting.

2013 - Impact of ageing on presentation and outcome of mitral regurgitation due to flail leaflet: A multicentre international study [Articolo su rivista]
Avierinos, J. -F.; Tribouilloy, C.; Grigioni, F.; Suri, R.; Barbieri, A.; Michelena, H. I.; Ionico, T.; Rusinaru, D.; Ansaldi, S.; Habib, G.; Szymanski, C.; Giorgi, R.; Mahoney, D. W.; Enriquez-Sarano, M.; Theron, A.; Riberi, A.; Collard, F.; Touati, G.; Remadi, J. P.; Caus, T.; Barbaresi, E.; Russo, A.; Biagini, E.; Piovaccari, G.; Ferlito, M.; Branzi, A.; Savini, C.; Marinelli, G.; Petridis, F.; Di Bartolomeo, R.; Bursi, F.; Grimaldi, T.; Nuzzo, A.; Modena, M. G.
abstract

Aims: Define the impact of age at diagnosis on degenerative mitral regurgitation (MR) prognosis. Methods and results: The Mitral regurgitation International DAtabase (MIDA) is a multicentre registry of MR due to flail leaflets including 862 patients (65 ± 12 years) diagnosed by echocardiography. The 498 older patients (≥ 65 years at diagnosis) were compared with the 364 younger (< 65) with regard to presentation and the outcome was compared with that expected in the general population. Older vs. younger patients had MR of similar severity and ventricular overload but presented with more MR consequences and incurred higher mortality [risk ratio (rr) 95% confidence interval (95% CI) 4.7 (2.5 - 10.0), P < 0.001] independently of co-morbidity. Compared with expected survival [relative risk (95% confidence interval)], excess mortality, non-significant in younger patients [1.1 (0.6 - 2.0), P = 0.65], was prominent in older patients [1.4 (1.2 - 1.7), P < 0.001]. Compared with expected, excess heart failure (HF) occurred in younger [9.3 (6.5 - 13.3), P < 0.0001) and in older patients [6.7 (5.6 - 8.1), P < 0.0001]. Excess atrial fibrillation (AF) was even higher in younger [6.9 (4.5 - 10.6), P < 0.0001] than in older patients [3.5 (2.6 - 4.7), P < 0.0001; P < 0.001 for comparison between age groups]. Subsequent excess mortality [rr (95% CI)] was associated with occurrence of HF and/or AF in both age groups [13.5 (7.4 - 24.6), P < 0.001]. Mitral surgery was associated with reduced long-term mortality in older patients and lower rate of HF in both the age groups (all P < 0.01). Conclusions: Both older and younger patients incurred excess risk of complications. Older patients suffered excess mortality, AF, and HF, whereas younger incurred excess morbidity linked to subsequent long-term excess mortality. The excess risks of uncorrected degenerative MR should be considered in deliberating surgical management, which significantly reduced mortality in older patients and HF in younger patients.

2013 - Incidence and predictors of coronary stent thrombosis: Evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses. [Articolo su rivista]
D'Ascenzo, F; Bollati, M; Clementi, F; Castagno, D; Lagerqvist, B; de la Torre Hernandez, Jm; Ten Berg, Jm; Brodie, Br; Urban, P; Jensen, Lo; Sardi, G; Waksman, R; Lasala, Jm; Schulz, S; Stone, Gw; Airoldi, F; Colombo, A; Lemesle, G; Applegate, Rj; Buonamici, P; Kirtane, Aj; Undas, A; Sheiban, I; Gaita, F; Sangiorgi, G; Modena, Maria Grazia; Frati, G; Biondi Zoccai, G.
abstract

Abstract BACKGROUND: Stent thrombosis remains among the most feared complications of percutaneous coronary intervention (PCI) with stenting. However, data on its incidence and predictors are sparse and conflicting. We thus aimed to perform a collaborative systematic review on incidence and predictors of stent thrombosis. METHODS: PubMed was systematically searched for eligible studies from the drug-eluting stent (DES) era (1/2002-12/2010). Studies were selected if including ≥2000 patients undergoing stenting or reporting on ≥25 thromboses. Study features, patient characteristics, and incidence of stent thrombosis were abstracted and pooled, when appropriate, with random-effect methods (point estimate [95% confidence intervals]), and consistency of predictors was formally appraised. RESULTS: A total of 30 studies were identified (221,066 patients, 4276 thromboses), with DES used in 87%. After a median of 22months, definite, probable, or possible stent thrombosis had occurred in 2.4% (2.0%; 2.9%), with acute in 0.4% (0.2%; 0.6%), subacute in 1.1% (1.0%; 1.3%), late in 0.5% (0.4%; 0.6%), and very late in 0.6% (0.4%; 0.8%). Similar figures were computed for studies reporting only on DES. From a total of 47 candidate variables, definite/probable stent thrombosis was more commonly and consistently predicted by early antiplatelet therapy discontinuation, extent of coronary disease, and stent number/length, with acute coronary syndrome at admission, diabetes, smoking status, and bifurcation/ostial disease also proving frequent predictors, but less consistently. CONCLUSIONS: Despite numerous possible risk factors, the most common and consistent predictors of stent thrombosis are early antiplatelet therapy discontinuation, extent of coronary disease, and stent number/length

2013 - Incidence, etiology and predictors of adverse outcomes in 43,315 patients presenting to the Emergency Department with syncope: An international meta-analysis. [Articolo su rivista]
D'Ascenzo, F; Biondi Zoccai, G; Reed, Mj; Gabayan, Gz; Suzuki, M; Costantino, G; Furlan, R; Del Rosso, A; Sarasin, Fp; Sun, Bc; Modena, Maria Grazia; Gaita, F.
abstract

BACKGROUND: Syncope remains challenging for Emergency Department (ED) physicians due to difficulties in assessing the risk of future adverse outcomes. The aim of this meta-analysis is to establish the incidence and etiology of adverse outcomes as well as the predictors, in patients presenting with syncope to the ED. METHODS: A systematic electronic literature review was performed looking for eligible studies published between 1990 and 2010. Studies reporting multivariate predictors of adverse outcomes in patients presenting with syncope to the ED were included and pooled, when appropriate, using a random-effect method. Adverse events were defined as 'incidence of death, or of hospitalization and interventional procedures because of arrhythmias, ischemic heart disease or valvular heart disease'. RESULTS: 11 studies were included. Pooled analysis showed 42% (CI 95%; 32-52) of patients were admitted to hospital. Risk of death was 4.4% (CI 95%; 3.1-5.1) and 1.1% (CI 95%; 0.7-1.5) had a cardiovascular etiology. One third of patients were discharged without a diagnosis, while the most frequent diagnosis was 'situational, orthostatic or vasavagal syncope' in 29% (CI 95%; 12-47). 10.4% (CI 95%; 7.8-16) was diagnosed with heart disease, the most frequent type being bradyarrhythmia, 4.8% (CI 95%; 2.2-6.4) and tachyarrhythmia 2.6% (CI 95%; 1.1-3.1). Palpitations preceding syncope, exertional syncope, a history consistent of heart failure or ischemic heart disease, and evidence of bleeding were the most powerful predictors of an adverse outcome. CONCLUSION: Syncope carries a high risk of death, mainly related to cardiovascular disease. This large study which has established the most powerful predictors of adverse outcomes, may enable care and resources to be better focused at high risk patients. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

2013 - Long term prognostic value of subclinical carotid and femoral arterial wall lesions in patients with ST-elevation-myocardial infarction having percutaneous coronary intervention [Articolo su rivista]
Monopoli, Daniel Enrique; Bertelli, Luca; Sgura, Fabio Alfredo; Politi, Luigi; Becirovic, Mirza; Iaccarino, Daniele; Lattanzi, Antonella; Rampino, Katia Clelia; Gorlato, Giulia; Menozzi, Mila; Modena, Maria Grazia; Zennaro, Romeo Giulietto; Rossi, Rosario
abstract

The presence of clinical peripheral arterial disease (PAD) is associated with an increased risk for adverse cardiovascular outcomes in patients with coronary artery disease. However, there are few data regarding the impact of the presence and degree of the subclinical PAD on outcomes in patients with coronary artery disease. The aim of this study was to assess prospectively the grade of subclinical PAD in the setting of patients who underwent primary percutaneous coronary intervention for the prediction of intermediate- and long-term clinical outcomes. A total of 971 consecutive patients without histories of clinical PAD who under went primary percutaneous coronary intervention for ST-segment elevation myocardial infarction were included in a prospective follow-up. Subclinical PAD severity was blindly assessed on the basis of an ultrasound arterial morphologic classification defined with the assessment of wall carotid and femoral artery bifurcations. This classification included 4 increasing classes of subclinical carotid and femoral arterial wall lesions, and the total group was divided accordingly. Death and major cardiovascular and cerebrovascular events were evaluated. During a median follow-up period of 40 months, a total of 109 patients (11.2%) died, 9 (2.8%) in class I, 12 (3.1%) in class II, 37 (23.7%) in class III, and 51 (49.0%) in class IV (p <0.001). On multivariate analysis, mortality in class IV was sevenfold higher (hazard ratio [HR] 7.34, 95% confidence interval [CI] 3.3 to 16.33, p <0.001) compared to class I and was also increased in class III (HR 5.38, 95% CI 2.42 to 11.92, p <0.001). Similar results were obtained for major adverse cardiovascular and cerebrovascular events in class IV (HR 7.50, 95% confidence interval 5.36 to 10.50, p <0.0001), class III (HR 6.44, 95% CI 4.45 to 9.32, p <0.001), and class II (HR 1.73, 95% CI 1.23 to 2.43, p = 0.002). In conclusion, ultrasound arterial morphologic classification may be applied in patients with ST-segment elevation myocardial infarctions who undergo primary percutaneous coronary intervention and can stratify patients for poor clinical outcomes during long-term follow-up. © 2013 Elsevier Inc. All rights reserved.

2013 - Parity as predictor of early hypertension during menopausal transition [Articolo su rivista]
Giubertoni, E; Bertelli, L; Bartolacelli, Y; Origliani, G; Modena, Maria Grazia
abstract

Studies regarding the effects of parity on blood pressure in later life produced conflicting results. The aim of our study is to analyse whether parity influences the prevalence of hypertension in perimenopausal and postmenopausal women. METHODS: One thousand perimenopausal and postmenopausal women (mean age 55.2 ± 5.4 years) were enrolled with a median follow-up of 63.0 months. The study sample consisted of patients who self-referred, in 1998-2009, to the BenEssere Donna Clinic, dedicated to menopause-related disorders. RESULTS: One hundred and twenty-two (12.2%) women were nulliparous and 878 (87.8%) had at least one child. Thirty-four (27.9%) women among nulliparous and 326 (37.1%) among parous were hypertensive at baseline (P = 0.046) and 812 women (81.2%) were in their postmenopausal period. Univariate analysis showed that women with one or more children were at higher risk of being hypertensive [odds ratio (OR): 1.529; 95% confidence interval (CI): 1.006-2.324; P = 0.047]. Likewise, multivariate analysis revealed that parity (OR: 2.907; 95% CI: 1.290-6.547; P = 0.010), BMI (OR: 1.097; 95% CI: 1.048-1.149; P < 0.001) and family history of hypertension (OR: 3.623; 95% CI: 2.231-5.883; P < 0.001) were independently related to hypertension at baseline. In a subanalysis of 640 initially normotensive women, 109 (17.0%) patients developed hypertension after follow-up, without a statistically significant association with parity (13.6% in nulliparous versus 17.6% in parous; P = 0.362). Consistently, parity showed no relationship with the incidence of hypertension during follow-up (OR: 1.350; 95% CI: 0.707-2.579; P = 0.363). CONCLUSION: For the first time in a population of White perimenopausal and postmenopausal women, parity was demonstrated to be independently associated with early hypertension during menopausal transition. Conversely, postmenopausal hypertension was not related with parity.

2013 - Percutaneous Left Ventricular Support With the Impella 2.5 Assist Device in Acute Cardiogenic Shock - Results of the Impella EUROSHOCK-Registry. Circulation Heart failure [Articolo su rivista]
Alexander, Lauten; Annemarie E., Engström; Christian, Jung; Klaus, Empen; Paul, Erne; Stéphane, Cook; Stephan, Windecke; Martin W., Bergmann; Roland, Klingenberg; Thomas F., Lüscher; Michael, Haude; Dierk, Rulands; Christian, Butter; Bengt, Ullmann; Laila, Hellgren; Modena, Maria Grazia; Giovanni, Pedrazzini; Jose P. S., Henriques; Hans R., Figulla; Markus, Ferrari
abstract

Background—Acute cardiogenic shock (CS) following myocardial infarction (AMI) is associated with high in-hospital mortality due to persisting low cardiac output. The Impella-EUROSHOCK-registry evaluates the safety and efficacy of the Impella-2.5 percutaneous left ventricular assist device (pLVAD) in patients with CS following AMI. Methods and Results—This multicenter registry retrospectively included 120 patients (63.6±12.2 years; 81.7% male) with CS from AMI receiving temporary circulatory support with the Impella-2.5-pLVAD. The primary endpoint evaluated mortality at 30 days. The secondary endpoint analyzed the change of plasma lactate after institution of hemodynamic support, the rate of early major adverse cardiac and cerebrovascular events (MACCE) as well as long-term survival. 30-day mortality was 64.2% in the study population. After Impella-2.5-pLVAD-implantation, lactate levels decreased from 5.8±5.0mmol/l to 4.7±5.4mmol/l (p= 0.28) and 2.5±2.6mmol/l (p=0.023) at 24 and 48 hours. Early MACCE were reported in 18(15%) patients. Major bleeding at the vascular access site, hemolysis and pericardial tamponade occurred in 34 (28.6%), 9 (7.5%) and 2 (1.7%) patients, respectively. The parameters age>65 and lactate level >3.8mmol/l at admission were identified as predictors of 30day-mortality. After 317±526days of follow-up, survival was 28.3% Conclusions—In patient with acute CS from AMI, Impella 2.5-treatment is feasible and results in a reduction of lactate levels suggesting improved organ perfusion. However, 30-day mortality remains high in these patients. This likely reflects the last-resort character of Impella-2.5-application in selected patients with a poor hemodynamic profile and a greater imminent risk of death. Carefully conducted randomized controlled trials are necessary to evaluate the efficacy of Impella-2.5-support in this high-risk patient group.

2013 - Response to letter regarding article, "percutaneous left-ventricular support with the impella-2.5-assist device in acute cardiogenic shock results of the impella-EUROSHOCKRegistry" [Articolo su rivista]
Lauten, A.; Engstrom, A. E.; Jung, C.; Empen, K.; Erne, P.; Cook, S.; Windecker, S.; Bergmann, M. W.; Klingenberg, R.; Luscher, T. F.; Haude, M.; Rulands, D.; Butter, C.; Ullman, B.; Hellgren, L.; Modena, M. G.; Pedrazzini, G.; Henriques, J. P. S.; Figulla, H. R.; Ferrari, M.
abstract

Comment on Letter by Maini regarding article, "percutaneous left-ventricular support with the impella-2.5-assist device in acute cardiogenic shock: results of the impella-EUROSHOCK-registry". [Circ Heart Fail. 2013] Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: results of the Impella-EUROSHOCK-registry. [Circ Heart Fail. 2013]

2013 - Right versus left radial artery access for coronary procedures: an international collaborative systematic review and meta-analysis including 5 randomized trials and 3210 patients [Articolo su rivista]
Biondi Zoccai, G; Sciahbasi, A; Bodí, V; Fernández Portales, J; Kanei, Y; Romagnoli, E; Agostoni, P; Sangiorgi, G; Lotrionte, M; Modena, Maria Grazia
abstract

BACKGROUND: Radial artery access is a mainstay in the diagnosis and treatment of coronary artery disease. However, there is uncertainty on the comparison of right versus left radial access for coronary procedures. We thus undertook a systematic review and meta-analysis comparing right versus left radial access for coronary diagnostic and interventional procedures. METHODS: Pertinent studies were searched in CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus, together with international conference proceedings. Randomized trials comparing right versus left radial (or ulnar) access for coronary diagnostic or interventional procedures were included. Risk ratios (RR) and weighted mean differences (WMD) were computed to generate point estimates (95% confidence intervals). RESULTS: A total of 5 trials (3210 patients) were included. No overall significant differences were found comparing right versus left radial access in terms of procedural time (WMD=0.99 [-0.53; 2.51]min, p=0.20), contrast use (WMD=1.71 [-1.32; 4.74]mL, p=0.27), fluoroscopy time (WMD=-35.79 [-3.54; 75.12]s, p=0.07) or any major complication (RR=2.00 [0.75; 5.31], p=0.49). However, right radial access was fraught with a significantly higher risk of failure leading to cross-over to femoral access (RR=1.65 [1.18; 2.30], p=0.003) in comparison to left radial access. CONCLUSIONS: Right and left radial accesses appear largely similar in their overall procedural and clinical performance during transradial diagnostic or interventional procedures. Nonetheless, left radial access can be recommended especially during the learning curve phase to reduce femoral cross-overs.

2013 - Sex-related differences in carotid plaque features and inflammation [Articolo su rivista]
Sangiorgi, Giuseppe; Roversi, Sara; Biondi Zoccai, Giuseppe; Modena, Maria Grazia; Servadei, Francesca; Ippoliti, Arnaldo; Mauriello, Alessandro
abstract

Objective: Severe carotid stenosis is a frequent cause of stroke in both men and women. Whereas several sex-related comparisons are available on coronary atherosclerosis, there are few data appraising gender-specific features of carotid plaques. We aimed to systematically compare the pathology and inflammatory features of carotid plaques in men vs women. Methods: Carotid plaque specimens were collected from patients undergoing surgical endarterectomy for asymptomatic or symptomatic carotid stenosis. Histologic analysis was performed, as well as measurements of plaque composition and inflammation. Results: A total of 457 patients were included (132 women, 325 men). Baseline analyses showed a greater prevalence of hypercholesterolemia, hypertension, and former smoking status in women, despite a higher Framingham Heart Score in men (all P <.05). Women had a lower prevalence of thrombotic plaques, smaller percentage area of necrotic core, and hemorrhage extension (all P <.05). Plaque inflammation analysis showed a lower concentration of inflammatory and, in particular, of macrophage foam cells in the plaque cap of women (both P <.05). These differences were, however, no longer significant at multivariable analysis, including several baseline features, such as symptom status and stenosis severity. Conclusions: Carotid plaques seem significantly different in women and men, but the main drivers of such pathologic differences are baseline features, including stenosis severity and symptom status. Â© 2013 Society for Vascular Surgery.

2012 - Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy [Articolo su rivista]
Fabrizio, D'Ascenzo; Enrico, Cerrato; Giuseppe Biondi, Zoccai; Claudio, Moretti; Pierluigi, Omedè; Filippo, Sciuto; Mario, Bollati; Modena, Maria Grazia; Fiorenzo, Gaita; Imad, Sheiban
abstract

Aims Highly active antiretroviral therapy (HAART) dramatically reduces human immunodeficiency virus (HIV)-associated morbidity and mortality, but adverse effects of HAART are becoming an increasing challenge, especially in the setting of acute coronary syndromes (ACS). We thus performed a comprehensive review of studies focusing on ACS in HIV patients. Methods and results MEDLINE/PubMed was systematically screened for studies reporting on ACS in HIV patients. Baseline, treatment, and outcome data were appraised and pooled with random-effect methods computing summary estimates [95% confidence intervals (CIs)]. A total of 11 studies including 2442 patients were identified, with a notably low prevalence of diabetes [10.86 (4.11, 17.60); 95% CI]. Rates of in-hospital death were 8.00% (2.8, 12.5; 95% CI), ascribable to cardiovascular events for 7.90% (2.43, 13.37; 95% CI), with 2.31% (0.60, 4.01; 95% CI) developing cardiogenic shock. At a median follow-up of 25.50 months (11.25, 42; 95% CI), no deaths were recorded, with an incidence of 9.42% of acute myocardial infarction (2.68, 16.17; 95% CI) and of 20.18% (9.84, 30.51; 95% CI) of percutaneous coronary revascularization. Moreover, pooled analysis of the studies reporting incidence of acute myocardial infarction in patients exposed to protease inhibitors showed an overall significant risk of 2.68 (odds ratio 1.89, 3.89; 95% CI). Conclusion Human immunodeficiency virus patients admitted for ACS face a substantial short-term risk of death and a significant long-term risk of coronary revascularization and myocardial infarction, especially if receiving protease inhibitors.

2012 - COMPARISON OF RENALGUARD SYSTEM, CONTINUOUS VENOVENOUS HEMOFILTRATION AND HYDRATION IN HIGH-RISK PATIENTS FOR CONTRAST-INDUCED NEPHROPATHY [Poster]
Bertelli, L; Politi, L; Roversi, S; Bartolacelli, Y; Perrone, S; Zoccai, Gb; Bursi, F; Sangiorgi, Gm; Modena, Mg
abstract

Contrast-induced nephropathy (CIN) is a relatively frequent complication of percutaneous coronary and peripheral artery interventions and is associated with significant in-hospital and long term morbidity and mortality. We aim to compare the impact on major events of RenalGuard system (RG), continuous veno-venous Hemofiltration (CVVH) and hydration (Hy) with sodium bicarbonate plus N-acetylcysteine in patients with severe renal failure.

2012 - COPD in the elderly is almost invariably associated with one or more chronic comorbidities [Relazione in Atti di Convegno]
Verduri, A; Roca, M; Bortolotti, M; Garofalo, M; Balduzzi, S; Veronesi, J; Leuzzi, C; Clini, Enrico; Modena, Maria Grazia; Fabbri, Leonardo; Beghe', Bianca
abstract

non presente

2012 - Catheters for transradial coronary procedures: Pros and cons [Capitolo/Saggio]
Marzullo, Raffaella; Aprile, Alessandro; Biondi-Zoccai, Giuseppe; Sangiorgi, Giuseppe; Modena, Maria Grazia
abstract

Transradial access for coronary diagnostic and interventional procedures is a mainstay in current and future invasive cardiology, given the superior safety of this site in comparison to femoral access. However, catheter choice, manipulation and overall performance may differ strikingly when using transradial or transfemoral access. Thus, several diagnostic and guiding catheters, including sheathless guiding catheters, have been proposed to increase the efficacy of transradial access. The ultimate goal is to enable the performance of complex coronary interventions requiring large inner lumens, as well as minimizing radial trauma by employing the smallest catheters possible (e.g. 4 French). The present review provides a concise synthesis on currently available diagnostic and guiding catheters for transradial access. In particular, we explicitly state pros and cons of Judkins (e.g. Judkins Right 4 and Judkins Left 3.5), Amplatz Left 2, Sones, Tiger and Kimny catheters, among others, building upon extensive experience and thorough knowledge of the available evidence base. Â© 2012 Nova Science Publishers, Inc.

2012 - Consultation-liaison psychiatry and the "Woman Wellness Project": a model of integrated services for female mental health [Abstract in Rivista]
Simoni, Elena; Baraldi, Sara; Tedeschini, Enrico; Bartolacelli, Ylenia; Giubertoni, Elisa; G., Origliani; Modena, Maria Grazia; Ferrari, Silvia
abstract

wellness, integrated care, females

2012 - Detrimental synergy of age and menopausal status in women undergoing percutaneous coronary stenting: evidence from the SPIRIT-Women study [Abstract in Atti di Convegno]
Modena, Mg; Roversi, S; Biondi-Zoccai, G; Politi, L; Simonetti, CONCETTINA REBECCA; Stuteville, M; Dorange, C; Windecker, S; Morice, Mc
abstract

Detrimental synergy of age and menopausal status in women undergoing percutaneous coronary stenting: evidence from the SPIRIT-Women study

2012 - Dronedarone: Una reale innovazione o solo una valida seconda scelta? Come districarsi tra linee guida, agenzie regolatorie e pratica clinica quotidiana [Articolo su rivista]
Capucci, A; Guerra, F; Antenucci, C; Antonicelli, R; Bocconcelli, P; Boriani, Giuseppe; Busacca, P; Ciampani, N; Della Casa, S; Gabrielli, D; Galvani, M; Margheri, M; Melandri, F; Modena, Maria Grazia; Perna, Gp; Pieri, P; Piovaccari, G; Pozzolini, A; Rapezzi, C; Villani, Gq
abstract

Dronedarone is the antiarrhythmic drug with the most complete and wide literature preceding its marketing. Most of these studies showed a good efficacy along with an excellent risk profile, especially in low- and medium-risk patients. Recently, updates of European, American and even Italian guidelines gave dronedarone its own spot into the antiarrhythmic armamentarium, recommending its use both for rhythm control and rate control in non-permanent atrial fibrillation. In Italy, however, dronedarone prescription is still possible only when amiodarone is not tolerated, making dronedarone a mere second choice of its older "relative". Moreover, patients taking dronedarone must undergo a strict alanine aminotransferase and bilirubin follow-up, which usefulness in predicting drug-induced liver damage (probably idiosyncratic in nature and therefore unpredictable) is far from demonstrated. The aim of this review is to sum up actual evidences on dronedarone, describe how these evidences had been differently transposed by panel of experts and drug agencies into guidelines and recommendations, and define the current difficulties encountered by the cardiologist in the correct use of this new antiarrhythmic agent in clinical practic

2012 - Erectile Dysfunction Is Not a Mirror of Endothelial Dysfunction in HIV-Infected Patients. [Articolo su rivista]
Guaraldi, Giovanni; Beggi, M; Zona, Stefano; Luzi, K; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Rochira, Vincenzo; Rossi, Rosario; Modena, Maria Grazia; Bouloux, P.
abstract

Introduction. The penis has been compared to a barometer of endothelial health, erectile dysfunction (ED) being an early sign of endothelial dysfunction. Aim. The aim of the study was to investigate the extent of the association between ED and endothelial dysfunction in patients with human immunodeficiency virus (HIV) infection on antiretroviral therapy. Methods. In this observational cross-sectional study, we evaluated the prevalence and factors associated with ED in a cohort of 133 HIV-infected men. Main Outcome Measures. The International Index of Erectile Function, ultrasound assessment of brachial artery flow mediated dilatation (FMD), and multi-slice computed tomography for coronary artery calcifications (CAC) as surrogates of endothelial dysfunction, the Adult Treatment Panel III criteria to diagnose metabolic syndrome (MS), plasma total testosterone (hypogonadism), and a visual analogue scale (VAS) of aesthetic satisfaction of the face and of the body (psychological distress associated with lipodystrophy). Results. Thirty-nine (29.32%) patients had mild ED, 14 (10.52%) patients had moderate ED, and 26 (19.55%) patients had severe ED. Prevalence of ED ranged from 45% to 65%, respectively, in patients less than 40 and more than 60 years old. MS was present in 20 (25%) patients with ED and 13 (24%) patients without ED (P value = 0.87). Prevalence of ED neither appeared to be associated with MS as a single clinical pathological entity nor with the numbers of its diagnostic components. FMD < 7% was present in 25 (32%) patients with ED and 18 (33%) patients without ED (P value = 0.83), and CAC > 100 was present in 8 (10%) patients with ED and 5 (9%) patients without ED (P value = 0.87). A stepwise multivariable logistic regression analysis was used to find predictors of ED. Independent predictors were VAS face (odds ratio [OR] = 0.85, 95% confidence interval [CI] 0.73-0.99, P = 0.049) and age per 10 years of increase (OR = 1.73, 95% CI 1.02-2.94, P = 0.04). Conclusions. Age constituted the most important risk factor for ED, which was related to aesthetic dissatisfaction of the face leading to negative body image perception. Guaraldi G, Beggi M, Zona S, Luzi K, Orlando G, Carli F, Ligabue G, Rochira V, Rossi R, Modena MG, and Bouloux P. Erectile dysfunction is not a mirror of endothelial dysfunction in HIV-infected patients.

2012 - Gender differences in cardiovascular risk and metabolic syndrome [Articolo su rivista]
Nuzzo, Anna Chiara; Modena, Maria Grazia
abstract

Gender differences in cardiovascular risk and metabolic syndrome

2012 - Gender-Specific Aspects in the Clinical Presentation of Cardiovascular Disease [Capitolo/Saggio]
Leuzzi, Chiara; Marzullo, Raffaella; TARABINI CASTELLANI, Emma; Modena, Maria Grazia
abstract

2012 - Healthy Diet to Prevent Cardiovascular Diseases and Osteoporosis [Articolo su rivista]
Volpe, Roberto; Sotis, Gianluca; Gavita, Roberto; Urbinati, Stefania; Valle, Sabrina; Modena, Maria Grazia
abstract

The ProSa (PROmozione e tutela della SAlute) Project ('Health Promotion Project') is a workplace programme geared to promote health among the Roman staff of the National Research Council of Italy. 789 employees of both genders (450 men, 339 women) have participated in the cardiovascular prevention programme (screening, computerized calculation of the risk level, dietary and pharmacological intervention) and 245 women have participated in the osteoporosis programme (calcaneal ultrasonometer test, dietary and pharmacological intervention). Menopause increases the risk of cardiovascular diseases and osteoporosis. In order to lower dietary fat content, dietary intake of calcium and vitamin D could be reduced. However, supplementation of both may not be necessary if we follow an integrated dietary approach. Therefore, for women in menopause with mixed hyperlipidaemia (hypercholesterolaemia and/or hypertriglyceridaemia) and/or overweight/obesity, dietary intervention was aimed at promoting the choice of foods low in fats and rich in calcium based on a list of recommended products distributed to all the participants. The dietary intervention was accompanied by a programme of regular physical activity with adequate exposure to sunlight. By following a balanced diet it is possible to improve the prognosis not only for hyperlipidaemic patients, but also for patients with signs of osteopaenia or osteoporosis.

2012 - Indexed left atrial volume is superior to left atrial diameter in predicting nonvalvular atrial fibrillation recurrence after successful cardioversion: a prospective study. [Articolo su rivista]
Marchese, P; Malavasi, V; Rossi, L; Nikolskaya, N; Donne, Gd; Becirovic, M; Colantoni, A; Luciani, A; Modena, Maria Grazia
abstract

BACKGROUND: Although indexed left atrial volume (iLAV) is the most accurate measure of left atrial size, it has not been evaluated prospectively as predictor of recurrence of atrial fibrillation (AFib) after successful cardioversion (CV). METHODS: We prospectively selected 76 patients (mean age 66.1 ± 13.6 years, 65.8% men) with AFib who underwent successful CV. Baseline clinical and echocardiographic characteristics were obtained before CV. LAV was measured using Simpson's method and indexed to body surface area. All patients were scheduled for follow-up visit at 1, 6, 12 months, and then annually. A 24-hour Holter ECG was performed within 6 months and each time the patients reported symptoms suggestive of arrhythmia. RESULTS: The 52 patients (68.4%) with AFib recurrence had larger iLAV (35.5 ± 8.9 mL/m(2) vs 27.0 ± 6.7 mL/m(2) , P < 0.001). Anteroposterior LA diameter was not associated with AFib relapse (OR 1.08, 95% CI: 0.96-1.21, P = 0.09). Each unit increase in iLAV was associated with a 1.15-fold increased risk of recurrence (OR 1.15, 95% CI: 1.06-1.25, P < 0.001). In a multivariable model, iLAV remained the only independent predictor of relapse (adjusted OR 1.14, 95% CI: 1.02-1.28, P = 0.02). The area under ROC curves, generated to compare LA diameter, and iLAV as predictors of AFib recurrence were 0.56 (SE 0.07) versus 0.78 (SE 0.05), respectively (P = 0.003). CONCLUSION: This is the first prospective study to show that larger iLAV, as a more accurate measure of LA remodeling than anteroposterior diameter, is strongly and independently associated with a higher risk of AFib recurrence after CV.

2012 - Influence of radiotherapy on cardiac implantable electronic devices: a single center experience [Abstract in Atti di Convegno]
Franchi, F; Malavasi, V; Parmiggiani, Marco; Bertoni, F; Boccedi, M; Nikolskaya, N; Casali, E; Modena, Mg
abstract

Influence of radiotherapy on cardiac implantable electronic devices: a single center experience

2012 - Is menopause a risk factor for ischemic heart disease? [Articolo su rivista]
C., Leuzzi; R., Marzullo; Modena, Maria Grazia
abstract

Abstract Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality in men and women worldwide. The apparent cardioprotective effects of endogenous estrogens seem to prevent CVD in premenopausal women. Following menopause and loss of hormonal effects, gender-based differences in CVD are reduced, with the CVD risk being higher in women who develop the metabolic syndrome. In postmenopausal women, many features of the metabolic syndrome emerge with estrogen deficiency. Estrogen deficiency occurring in the menopausal period is associated with 1) dyslipidemia (hypertriglyceridemia, reduced HDL, and increased small dense LDL particles); 2) insulin resistance; 3) hypertension; 4) increased central fat and reduction in lean body mass; and 5) increased hypercoagulability and pro-inflammatory state. In addition to traditional cardiovascular risk factors, also early menopause has a negative impact on females. Over the past years, different approaches were found to improve quality of life and cardiovascular health in menopausal women. Since the concept of hormone replacement therapy (HRT), large observational studies and randomized clinical trials have amassed a wealth of data about the effects of menopause and the safety and efficacy of using estrogen replacement therapies to treat menopause symptoms and menopause-related diseases. While there is no question that HRT effectively mitigates troublesome menopause symptoms, conflicting evidence about other effects of HRT has fueled controversy concerning its relative benefits and risks. Moreover, it seems that CVD protection mediated by replacement therapy is maximum when treatment is initiated in the absence of signs of atherosclerosis (typically in the premenopausal period), whereas it vanishes as atherosclerosis progresses (postmenopausal period). However, many questions remain unsolved regarding the effectiveness of hormonal compounds, doses, regimens, and route of administration. On the basis of these considerations, it is necessary in the near future to expand scientific knowledge and develop appropriate lifestyle modifications and therapeutic strategies for the treatment of either traditional cardiovascular risk factors or menopause-related metabolic changes.

2012 - Left ventricular hypertrophy reclassification and death: application of the Recommendation of the American Society of Echocardiography/European Association of Echocardiography [Articolo su rivista]
A., Barbieri; Mantovani, F. B. u. r. s. i. F.; C., Valenti; M., Quaglia; E., Berti; M., Marino; Modena, Maria Grazia
abstract

AIMS: Despite the American Society of Echocardiography (ASE)/European Association of Echocardiography (EAE) recommended the use of left ventricular (LV) mass to diagnose left ventricular hypertrophy (LVH), several laboratories continue to use only the septal thickness by M-mode because it appears easier to measure. Aim of the study was to investigate the discrepancy between the categorization of LVH severity based on measurement of septal thickness and indexed LV mass and the relative prognostic utility of these two methods. METHODS AND RESULTS: Observational cohort study. Unselected adults (>18 years) referred to the echocardiography laboratory for any indication had septal thickness and LV mass measured by the ASE/EAE formula using LV linear dimensions indexed to body surface area. LVH was categorized as absent, mild, moderate, and severe according to the ASE/EAE guideline sex-specific categorization cut-offs for septal thickness and LV mass. Follow-up for death was obtained from the national death index. A total of 2545 subjects (mean age 61.9 ± 15.8, 53% women, mean diastolic septal thickness 10.3 ± 2.2 mm, and mean indexed LV mass 107.5 ± 37.3 g/m(2)) were enrolled. Agreement between the two methods in classifying LVH degree across the four categories was 52.6% (Kappa = 0.29, 95% confidence interval (CI): 0.26-0.32, P < 0.001). Of the 2513 subjects without severely thickened septum, 472 (18.9%) had severely abnormal indexed LV mass. Vice versa, of the 2045 individuals without severely abnormal indexed LV mass, only 4 (0.1%) were classified as severe LVH by septal thickness. After a mean follow-up of 2.5 ± 1.2 years 121 (4.7%) deaths occurred. Using indexed LV mass partition values there was a graded association between LVH degree and survival. Compared with patients with normal indexed LV mass, the adjusted hazard ratio (HR) for death from all causes was 2.17 for mild (95% CI: 1.23-3.81, P = 0.007), 3.04 for moderate (95% CI: 1.76-5.24, P < 0.001), and 3.81 for severe (95% CI: 2.43-5.97, P < 0.001) LVH by indexed LV mass. The area under the receiver-operator characteristic (ROC) curve for the four degrees of LVH by indexed LV mass was superior [area under the curve (AUC) = 0.66] to that of the septal thickness partition values (AUC = 0.58, P = 0.0004). CONCLUSION: In a large cohort study of unselected adult outpatients referred to the echocardiography laboratory, the measurements of indexed LV mass applying the ASE/EAE recommended cut-offs yielded remarkable discrepancy in the diagnosis of LVH severity and offered prognostic information beyond that provided by septal thickness only criteria.

2012 - Novel insights on HIV/AIDS and cardiac disease:shedding light on the HAART of Darkness [Articolo su rivista]
Biondi Zoccai, G; D’Ascenzio, F; Modena, Maria Grazia
abstract

Comment on Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy. [Eur Heart J. 2012] Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy.D'Ascenzo F, Cerrato E, Biondi-Zoccai G, Moretti C, Omedè P, Sciuto F, Bollati M, Modena MG, Gaita F, Sheiban I. Eur Heart J. 2012 Apr; 33(7):875-80. Epub 2011 Dec 20. Contribution of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic to de novo presentations of heart disease in the Heart of Soweto Study cohort. [Eur Heart J. 2012]

2012 - PICKING THE BEST NOVEL ORAL ANTICOAGULANT FOR ATRIAL FIBRILLATION: EVIDENCE FROM A WARFARIN-CONTROLLED NETWORK META-ANALYSIS [Abstract in Atti di Convegno]
Roversi, S; Malavasi, Vincenzo; D'Ascenzo, F; Abbate, A; Castagno, D; Van Tassell, B; Casali, Edoardo; Modena, Mg
abstract

Warfarin is a mainstay atrial ibrillation (AF) treatment, yet it has a narrow therapeutic window. Novel agents have been successfully tested against warfarin, yet no direct comparison among them is available. We thus performed a pair-wise and warfarin-adjusted network metaanalyses of novel oral anticoagulants for AF.

2012 - Parallel increase of subclinical atherosclerosis and epicardial adipose tissue in patients with HIV. [Articolo su rivista]
Zona, Stefano; P., Raggi; Bagni, Pietro; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Scaglioni, Riccardo; Rossi, Rosario; Modena, Maria Grazia; Guaraldi, Giovanni
abstract

BACKGROUND: Epicardial adipose tissue (EAT) may contribute to the development of coronary atherosclerosis via paracrine secretion of inflammatory cytokines.METHODS: This is a prospective, observational study of 240 consecutive HIV-infected patients receiving antiretroviral therapy. All patients underwent 2 sequential chest computed tomographic scans to assess the change in coronary artery calcium (CAC), a marker of subclinical atherosclerosis, and EAT volume. Patients with known cardiovascular disease were excluded. Factors independently associated with EAT change were explored using multivariable linear regression analyses. The association between EAT increase and CAC progression was explored using logistic regression analyses.RESULTS: Two hundred forty patients were included. Patients' mean age was 47.5 ± 8 years, and 68% were men. The median interval between computed tomographic scans was 18.7 months (interquartile range 10-27 months). Men showed a larger increase in EAT (5 ± 14.2 cm(3)) than did women (-0.45 ± 8.8 cm(3), P = .007). Factors independently associated with change in EAT were CD4(+) recovery (β = 0.43, CI 0.05-0.82) and male gender (β = 5.65, CI, 1.05-10.26). Change in EAT was independently associated with CAC progression (odds ratio 1.04, 95% CI 1.004-1.88, P = .030) after adjusting for traditional cardiovascular risk factors.CONCLUSIONS: In this cohort of patients with HIV receiving antiretroviral therapy, male gender and CD4(+) were independent predictors of EAT increase, and there was a parallel progression of CAC and EAT. Abnormal immunoreactivity associated with T-lymphocyte recovery should be further studied as a determinant of atherosclerosis progression in HIV-infected patients.

2012 - Potential pitfalls of meta-analyses of observational studies in cardiovascular research [Articolo su rivista]
BIONDI ZOCCAI, Giuseppe; Agostoni, P; Abbate, A; D'Ascenzo, F; Modena, Maria Grazia
abstract

Comment on Culprit vessel only versus multivessel and staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction: a pairwise and network meta-analysis. [J Am Coll Cardiol. 2011]

2012 - Prasugrel during primary percutaneous coronary intervention: evidence from clinical data [Articolo su rivista]
Biondi Zoccai, G; Abbate, A; D’Ascenzo, F; Lotrionte, M; Modena, Maria Grazia
abstract

Primary percutaneous coronary intervention (PCI) encompassing stent implantation is a mainstay in the management of acute ST-elevation myocardial infarction (STEMI). Despite refinements in techniques and devices, peri- and post-procedural antithrombotic therapy remains pivotal to prevent early and late thrombotic events, without unduly increasing bleeding risk. Concomitant dual antiplatelet therapy with aspirin and clopidogrel has been considered until recently the standard of care in terms of oral antiplatelet agents. However, most recently a novel and more potent thienopyridine, prasugrel, has been tested in randomized trials including patients with STEMI, and subsequently approved for clinical practice in Europe and North America. Despite its potent antithrombotic effect, prasugrel also carries a statistically significant increase in the risk of bleeding, especially in the elderly, those with low body weight, and previous stroke or transient ischemic attack. Thus, the use of prasugrel, as well as that of clopidogrel or ticagrelor, should best be individualized to maximize clinical benefits and minimize hazards.

2012 - Prevalence and non-invasive predictors of left main or three vessel coronary disease: evidence from a collaborative world-wide meta-analysis including 22,470 patients [Articolo su rivista]
D'Ascenzo, f. F.; D. G., Presutti; E., Picardi; C., Moretti; P., Omedè; F., Sciuto; M., Novara; Yan, A. T.; S., Goodman; N., Mahajan; M., Kosuge; A., Palazzuoli; Jong, G. P.; H., Isma'Eel; Budoff, M. J.; R., Rubinshtein; H., Gewirtz; Reed, M. J.; P., Theroux; G., Biondi Zoccai; Modena, Maria Grazia; I., Sheiban; F., Gaita
abstract

BACKGROUND: Left main disease (LMD) and three-vessel disease (3VD) have important prognostic value in patients with coronary artery disease. However, uncertainties still exist about their prevalence and predictors in patients with acute coronary syndrome (ACS) and also in patients with stable coronary disease. Thus the aim of this study was to perform an international collaborative systematic review and meta-analysis to appraise the prevalence and predictors of LMD and 3VD. METHODS: Medline/PubMed were systematically searched for eligible studies published up to 2010, reporting multivariate predictors of LMD or 3VD. Study features, patient characteristics, and prevalence and predictors of LMD and 3VD were abstracted and pooled with random-effect methods (95% CIs). RESULTS: 17 studies (22 740 patients) were included, 11 focusing on ACS (17 896 patients) and six on stable coronary disease (4844 patients). In the ACS subgroup, LMD or 3VD occurred in 20% (95% CI 7.2% to 33.4%), LMD in 12% (95% CI 10.5% to 13.5%), and 3VD in 25% (95% CI 23.1% to 27.0%). Heart failure at admission and extent of ST-segment elevation in lead aVR on 12-lead ECG were the most powerful predictors of LMD or 3VD. In the stable disease subgroup, LMD or 3VD was found in 36% (95% CI 18.5% to 48.8%), with the most powerful predictors being transient ischaemic dilation during the imaging stress test, extent of ST-segment elevation in aVR and V1 during the stress test, and hyperlipidaemia. CONCLUSIONS: This meta-analysis demonstrated that severe coronary disease-that is, LMD or 3VD-is more common in patients with ACS or stable coronary disease than generally perceived, and that simple and low-cost tools may help in the selection of the most appropriate therapeutic approach

2012 - Progression of coronary artery calcium in men affected by human immunodeficiency virus infection. [Articolo su rivista]
Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Fiocchi, Federica; Rossi, Rosario; Modena, Maria Grazia; P., Raggi
abstract

Cardiovascular risk is increased in HIV infected patients. We assessed progression of coronary artery calcium (CAC) in patients with HIV infection to identify factors that may help explain progression of atherosclerosis. Prospective, observational study of 132 HIV-infected men receiving chronic antiretroviral therapy (ART); we measured traditional atherosclerosis risk factors and assessed progression of CAC on sequential 64-slice CT scans at an average interval of 11 months (range 6–36). CAC score progression was defined as absolute and percentage change from baseline. During follow-up 45 patients (34%) showed absolute progression of CAC and 34 of them showed >15% yearly progression, a threshold previously associated with a high risk of myocardial infarction. Age, LDL cholesterol, visceral abdominal fat and current T-helper (CD4+) cell count were significantly associated with absolute CAC progression. Progression of subclinical atherosclerosis in HIV patients is associated with traditional coronary risk factors as well as HIV related factors such as the CD4+ cell count. Therefore, immunologic perturbations secondary to HIV infection may contribute to atherosclerosis progression.

2012 - Reduction of scatter radiation during transradial percutaneous coronary angiography: A randomized trial using a lead-free radiation shield. [Articolo su rivista]
Politi, L; Biondi Zoccai, G; Nocetti, L; Costi, T; Monopoli, D; Rossi, Rosario; Sgura, F; Modena, Maria Grazia; Sangiorgi, G. M.
abstract

BACKGROUND: Occupational radiation exposure is a growing problem due to the increasing number and complexity of interventional procedures performed. Radial artery access has reduced the number of complications at the price of longer procedure duration. Radpad® scatter protection is a sterile, disposable bismuth-barium radiation shield drape that should be able to decrease the dose of operator radiation during diagnostic and interventional procedures. Such radiation shield has never been tested in a randomized study in humans. METHODS: Sixty consecutive patients undergoing coronary angiography by radial approach were randomized 1:1 to Radpad use versus no radiation shield protection. The sterile shield was placed around the area of right radial artery sheath insertion and extended medially to the patient trunk. All diagnostic procedures were performed by the same operator to reduce variability in radiation absorption. Radiation exposure was measured blindly using thermoluminescence dosimeters positioned at the operator's chest, left eye, left wrist, and thyroid. RESULTS: Despite similar fluoroscopy time (3.52 ± 2.71 min vs. 3.46 ± 2.77 min, P = 0.898) and total examination dose (50.5 ± 30.7 vs. 45.8 ± 18.0 Gycm(2), P = 0.231), the mean total radiation exposure to the operator was significantly lower when Radpad was utilized (282.8 ± 32.55 μSv vs. 367.8 ± 105.4 μSv, P < 0.0001) corresponding to a 23% total reduction. Moreover, mean radiation exposure was lower with Radpad utilization at all body locations ranging from 13 to 34% reduction. CONCLUSIONS: This first-in-men randomized trial demonstrates that Radpad significantly reduces occupational radiation exposure during coronary angiography performed through right radial artery access.

2012 - Remote ischaemic preconditioning in coronary artery bypass surgery: a meta-analysis [Articolo su rivista]
F., D’Ascenzo; E., Cavaliero; C., Moretti; P., Omedè P; T., Sciuto; Modena, Maria Grazia; G., Biondi Zoccai; I., Sheiban
abstract

Aim Randomised trials exploring remote ischaemic preconditioning (RIPC) in patients undergoing coronary artery bypass graft (CABG) surgery have yielded conflicting data regarding potential cardiovascular and renal protection, and are individually flawed by small sample size. Methods Three investigators independently searched the MEDLINE, EMBASE and Cochrane databases to identify randomised trials testing RIPC in patients undergoing CABG. Results Nine studies with 704 patients were included. Standardised mean difference of troponin I and T release showed a significant decrease (−0.36 (95% CI −0.62 to −0.09)). This difference held true after excluding the trials with cross-clamp fibrillation, the study with off-pump CABG and studies using a flurane as anaesthetic agent (−0.41 (95% CI −0.69 to −0.12), −0.38 (95% CI −0.70 to −0.07) and −0.37 (95% CI −0.63 to −0.12), respectively). A similar trend was also obtained for patients with multivessel disease (−0.41 (95% CI −0.73 to −0.08)). The trials evaluating postoperative creatinine reported a non-significant reduction (0.02 (95% CI −0.09 to 0.13)). Moreover, the length of in-hospital stay was not influenced by the kind of treatment (weighted mean difference 0.27 (95% CI −0.24 to 0.79)). Conclusion RIPC reduced the release of troponin in patients undergoing CABG. Larger randomised trials are needed to clarify the presence of a causal relationship between RIPC-induced troponin release and clinical adverse events.

2012 - Renalguard, hemofiltration and hydration in prevention of contrast induced nephropathy in patients with severe chronic kidney disease undergoing percutaneous vascular interventions [Abstract in Atti di Convegno]
Bertelli, L; Politi, L; Roversi, S; Bartolacelli, Y; Perrone, S; Becirovic, M; Zoccai, Gb; Bursi, F; Sangiorgi, Gm; Modena, Mg
abstract

Contrast-induced nephropathy (CIN) is a frequent complication of percutaneous coronary and peripheral artery interventions and is associated with significant in-hospital and long-term morbidity and mortality. We aim to compare the impact on major events of RenalGuard system(RG), continuous veno-venous Hemofiltration (CVVH) and hydration (Hy) with sodium bicarbonate plus N-acetylcysteine in patients with severe renal failure.

2012 - Retrograde popliteal access as bail-out strategy for challenging occlusions of the superficial femoral artery: A Multicenter Registry. [Articolo su rivista]
Sangiorgi, G; Lauria, G; Airoldi, F; Godino, C; Politi, L; Colombo, A; Clerici, G; Modena, Maria Grazia; Biondi Zoccai, G.
abstract

BACKGROUND: The concomitant use of femoral and popliteal accesses has been recommended for challenging superficial femoral artery (SFA) occlusions, but no comprehensive comparison of this approach to a strategy of femoral access only is available. We thus aimed to appraise the risk-benefit balance of retrograde popliteal access as bail-out strategy for SFA occlusions. METHODS: Consecutive patients with symptomatic SFA occlusion and undergoing percutaneous revascularization were enrolled. We distinguished patients in whom retrograde popliteal access was required as bail-out strategy versus those not requiring such access. The primary end-point was procedural success. RESULTS: A total of 130 patients (152 limbs) were included, with 23 patients (25 limbs) requiring retrograde popliteal access. Occlusion length was 20.6 ± 8.8 cm in those requiring popliteal access versus 18.5 ± 8.5 cm in those without popliteal access, with TASC C/D lesions in 23 (92%) versus 106 (83%). Procedural success was achieved in 92 out of 107 patients (86.0%) treated with a standard approach and 22 out of 23 patients (95.7%) treated with retrograde popliteal access (total 114 out of 130 [87.7%]) and 112 out of 127 limbs (88.2%) and 24 out of 25 limbs (96.0%), respectively (total 136 out of 152 [89.5%]). No significant increase in early or long-term adverse events was associated with retrograde popliteal access. CONCLUSIONS: Whenever standard access sites do not enable successful recanalization of SFA occlusions, retrograde popliteal access can be safely and effectively envisioned as bail-out strategy

2012 - Right ventricular function predicts cardiovascular events in outpatients with stable cardiovascular diseases: Preliminary results [Articolo su rivista]
Giovanardi, Paolo; Tincani, Enrico; Rossi, Rosario; Agnoletto, Virginia; Bondi, Marco; Modena, Maria Grazia
abstract

Right ventricular (RV) function impacts the outcome in cardiac and pulmonary diseases such as heart failure, pulmonary hypertension, myocardial infarction, valvular, and congenital heart diseases. To our knowledge, simultaneous evaluation of left ventricular (LV) and RV systolic and diastolic echocardiographic indices in outpatients with clinically stable cardiovascular diseases has never been performed. Thus, we designed a prospective cohort study to define the prognostic power of these parameters. One hundred and sixty-three patients were submitted to transthoracic echocardiography with multiparametric and tissue Doppler evaluation of the following indices: ejection fraction, MAPSE, TAPSE, RV presystolic peak, LV and RV diastolic function, pulmonary artery systolic pressure, and functional mitral regurgitation. All these parameters and clinical variables (age, sex, and prior cardiovascular events) were entered in a multivariable Cox regression model. The primary end point was the occurrence of major cardiovascular events (MACEs) during the follow-up period. Twenty-one MACEs were observed; in the final multivariable Cox regression model only prior cardiovascular events (B 1. 305, p 0. 004, 95% CI 1. 523-8. 933), age (B 0. 067, p 0. 005, 95% CI 1. 020-1. 121), and TAPSE (B -1. 065, p 0. 026, 95% CI 0. 135-0. 883) were associated with MACEs. TAPSE, a simple and reproducible echocardiographic index, may be viewed as an early echocardiographic marker of heart involvement in atherosclerosis. We believe that TAPSE may be useful in clinical practice for risk stratification. Â© 2011 SIMI.

2012 - SPIRIT Women, evaluation of the safety and efficacy of the XIENCE V everolimus-eluting stent system in female patients: referral time for coronary intervention and 2-year clinical outcomes. [Articolo su rivista]
Morice, Mc; Mikhail, Gw; Mauri i., Ferré F; Modena, Maria Grazia; Strasser, Rh; Grinfeld, L; Sudhir, K; Stuteville, M; Papeleu, P; Li, D; Rutledge, D; Windecker, S.
abstract

AIMS: SPIRIT Women is the first interventional trial dedicated exclusively to women, focusing on symptoms at presentation, referral time to coronary intervention and the safety and performance of the XIENCE V stent. METHODS AND RESULTS: SPIRIT Women is a prospective, open-label, multicentre study in which 1,573 women were enrolled at 73 sites outside the United States. The primary endpoint is the composite of all death, Academic Research Consortium (ARC) defined myocardial infarction (MI) and target vessel revascularisation (TVR) at one year. Data collected included symptoms at presentation and referral to coronary intervention. To allow comparison by gender, the latter were compared to data from male patients from the SPIRIT V study. The one- and two-year composite of all death, MI and TVR was 12% and 15%, respectively. Target lesion revascularisation (TLR) and stent thrombosis (definite and probable) rates were 2.4% and 0.59%, respectively, at one year and 3.6% and 0.73%, at two years. The total referral time for coronary intervention in women was four days longer than for men in the SPIRIT V study. CONCLUSIONS: The XIENCE V stent is safe and effective with low TLR and stent thrombosis rates. More efforts remain to be made to increase the awareness of women and physicians of the risk for coronary artery disease (CAD).

2012 - TIMI, GRACE and alternative risk scores in Acute Coronary Syndromes: A meta-analysis of 40 derivation studies on 216,552 patients and of 42 validation studies on 31,625 patients. [Articolo su rivista]
D'Ascenzo, F; Biondi Zoccai, G; Moretti, C; Bollati, M; Omedè, P; Sciuto, F; Presutti, Dg; Modena, Maria Grazia; Gasparini, M; Reed, Mj; Sheiban, I; Gaita, F.
abstract

BACKGROUND: Acute coronary syndromes (ACS) represent a difficult challenge for physicians. Risk scores have become the cornerstone in clinical and interventional decision making. METHODS AND RESULTS: PubMed was systematically searched for ACS risk score studies. They were divided into ACS studies (evaluating Unstable Angina; UA, Non ST Segment Elevation Myocardial Infarction; NSTEMI, and ST Segment Elevation Myocardial Infarction; STEMI), UA/NSTEMI studies or STEMI studies. The c-statistics of validation studies were pooled when appropriate with random-effect methods. 7 derivation studies with 25,525 ACS patients and 15 validation studies including 257,654 people were formally appraised. Pooled analysis of GRACE scores, both at short (0.82; 0.80-0.89 I.C 95%) and long term follow up (0.84; 0.82-0.87; I.C 95%) showed the best performance, with similar results to Simple Risk Index (SRI) derivation cohorts at short term. For NSTEMI/UA, 18 derivation studies with 56,560 patients and 18 validation cohorts with 56,673 patients were included. Pooled analysis of validations studies showed c-statistics of 0.54 (95% CI = 0.52-0.57) and 0.67 (95% CI = 0.62-0.71) for short and long term TIMI validation studies, and 0.83 (95% CI = 0.79-9.87) and 0.80 (95% CI = 0.74-0.89) for short and long term GRACE studies. For STEMI, 15 studies with 134,557 patients with derivation scores, and 17 validation studies with 187,619 patients showed a pooled c-statistic of 0.77 (95% CI = 0.71-0.83) and 0.77 (95% CI = 0.72-0.85) for TIMI at short and long term, and a pooled c-statistic of 0.82 (95% CI = 0.81-0.83) and 0.81 (95% CI = 0.80-0.82) for GRACE at short and long terms respectively. CONCLUSIONS: TIMI and GRACE are the risk scores that up until now have been most extensively investigated, with GRACE performing better. There are other potentially useful ACS risk scores available however these have not undergone rigorous validation. This study suggests that these other scores may be potentially useful and should be further researched.

2012 - Use and misuse of multivariable approaches in interventional cardiology studies on drug-eluting stents: a systematic review. [Articolo su rivista]
D’Ascenzo, F; Cavaliero, E; Biondi Zoccai, G; Moretti, C; Omedè, P; Bollati, M; Castagno, D; Modena, Maria Grazia; Gaita, F; Sheiban, I.
abstract

Aims: Randomized clinical trials (RCTs) are the most reliable evidence, even if they require important resource and logistic efforts. Large, cost-free and real-world datasets may be easily accessed yielding to observational studies, but such analyses often lead to problematic results in the absence of careful methods, especially from a statistic point of view. We aimed to appraise the performance of current multivariable approaches in the estimation of causal treatment and effects in studies focusing on drug-eluting stents (DES). Methods and Results: Pertinent studies published in the literature were searched, selected, abstracted, and appraised for quality and validity features. Six studies with a logistic regression were included, all of them reporting more than 10 events for covariates and different length of follow-up, with an overall low risk of bias. Most of the 15 studies with a Cox proportional hazard analysis had a different follow-up, with less than 10 events for covariates, yielding an overall low or moderate risk of bias. Sixteen studies with propensity score were included: the most frequent method for variable selection was logistic regression, with underlying differences in follow-up and less than 10 events for covariate in most of them. Most frequently, calibration appraisal was not reported in the studies, on the contrary of discrimination appraisal, which was more frequently performed. In seventeen studies with propensity and matching, the latter was most commonly performed with a nearest neighbor-matching algorithm yet without appraisal in most of the studies of calibration or discrimination. Balance was evaluated in 46% of the studies, being obtained for all variables in 48% of them. Conclusions: Better exploitation and methodological appraisal of multivariable analysis is needed to improve the clinical and research impact and reliability of nonrandomized studies. (J Interven Cardiol 2012;**:1-11

2012 - Women with at least one child, compared to nulliparous, have almost three-fold risk of early hypertension during menopausal transition [Abstract in Atti di Convegno]
Giubertoni, E; Bertelli, L; Bartolacelli, Y; Origliani, G; Modena, Mg
abstract

Women with at least one child, compared to nulliparous, have almost three-fold risk of early hypertension during menopausal transition

2011 - Acute myocardial infarction with occlusion of all three main epicardial coronary arteries: When Mother Nature takes care more than physicians [Articolo su rivista]
Monopoli, Daniel E.; Politi, Luigi; Sgura, Fabio; Rossi, Rosario; Modena, Maria G.; Sangiorgi, Giuseppe M.
abstract

Double-arterial coronary stent thrombosis in acute myocardial infarction (AMI) is an infrequent but severe complication, especially when the third main coronary artery is chronically occluded. The conus artery (CA) can serve as a major source of collateral when the left anterior descendent coronary artery (LAD) becomes obstructed. We report a case of a 48-year-old man presenting with AMI due to a very late double-arterial stent thrombosis (ST) following drug-eluting stent implantation and a chronic occlusion of LAD collateralized by a large anomalous CA, which provided for the entire vascularization of the coronary tree. Â© 2010 Springer.

2011 - Agreement between adjusted indirect comparison and simplified network meta-analyses on prasugrel and ticagrelor (Reply to Passaro et al. - Int J Cardiol 2011) [Articolo su rivista]
Biondi-Zoccai, Giuseppe; D'Ascenzo, Fabrizio; Abbate, Antonio; Agostoni, Pierfrancesco; Modena, Maria Grazia
abstract

Comment on Anti-platelet treatments in acute coronary syndrome: simplified network meta-analysis. [Int J Cardiol. 2011]

2011 - An international collaborative meta-analysis on the incidence of coronary stent thrombosis including 30 studies, 225,536 patients, and 4,203 thromboses [Abstract in Atti di Convegno]
D'Ascenzo, F; Biondi-Zoccai, G; Clementi, F; Sheiban, I; Gaita, F; Sangiorgi, G; Modena, Mg
abstract

An international collaborative meta-analysis on the incidence of coronary stent thrombosis including 30 studies, 225,536 patients, and 4,203 thromboses

2011 - Antegrade access: Choose the right operator and the right patient [Articolo su rivista]
Biondi-Zoccai, Giuseppe; Sangiorgi, Giuseppe; Modena, Maria Grazia
abstract

We welcome the study by Wheatley et al1 comparing antegrade vs retrograde femoral access for endovascular lower limb procedures. However, we believe that their conclusion that the antegrade access is more likely to result in complications and should be used cautiously is inaccurate and biased. Indeed, despite their prospective data collection and careful analyses, they failed to recognize the importance of key operator and patient features that make antegrade access, respectively, remarkably safe and mandatory in at least selected cases.

2011 - Are propensity scores really superior to standard multivariable analysis? [Articolo su rivista]
Biondi-Zoccai, Giuseppe; Romagnoli, Enrico; Agostoni, Pierfrancesco; Capodanno, Davide; Castagno, Davide; D'Ascenzo, Fabrizio; Sangiorgi, Giuseppe; Modena, Maria Grazia
abstract

Clinicians often face difficult decisions despite the lack of evidence from randomized trials. Thus, clinical evidence is often shaped by non-randomized studies exploiting multivariable approaches to limit the extent of confounding. Since their introduction, propensity scores have been used more and more frequently to estimate relevant clinical effects adjusting for established confounders, especially in small datasets. However, debate persists on their real usefulness in comparison to standard multivariable approaches such as logistic regression and Cox proportional hazard analysis. This holds even truer in light of key quantitative developments such as bootstrap and Bayesian methods. This qualitative review aims to provide a concise and practical guide to choose between propensity scores and standard multivariable analysis, emphasizing strengths and weaknesses of both approaches. Â© 2011 Elsevier Inc.

2011 - Carotid plaque characterisation by IVUS-VH during carotid stenting: The "Eyes Wide Shut" between plaque morphology and symptoms [Articolo su rivista]
Politi, L.; Aprile, A.; Rollini, F.; Amato, A.; Biondi-Zoccai, G.; Mauriello, A.; Modena, M. G.; Sangiorgi, G. M.
abstract

Stroke is the third most common cause of death in North America and ever year approximately 700,000 new strokes are reported in the United States. Seventy-five percent of these occur in the distribution of the carotid arteries. Among strokes of a thromboembolic etiology, carotid occlusive disease is the most common cause. As many as 150,300 stroke-related fatalities are documented annually, with a total cost for the health-care system of approximately $ 18 billion per year. This review will focus on the different pathomorphologic aspects of carotid plaque, outlining the similarities and differences with the coronary plaque, with particular attention on how intravascular imaging may contribute to a better stratification of the patient treatment.

2011 - Circumflex Coronary Artery Agenesis Associated with Thoracic Great Vessels Anomalies [Articolo su rivista]
Coppi, Francesca; Roversi, Sara; Giuliani, Enrico; Sansone, R.; Sangiorgi, G. m.; Modena, Maria Grazia; Barbieri, Alberto
abstract

Coronary artery anomalies are identified in approximately 1% of patients who undergo angiography; among these, circumflex branch agenesis represents 0.003%. A 38-year-old woman was brought to our emergency department with clinical findings suggestive of acute myocardial infarction. Absence of circumflex branch was reported during angiography. Further analysis showed great vessel abnormalities: the presence of a left superior vena cava, a left arterial trunk of abnormal origin, and a small cerebral aneurysm. To our knowledge, this is the only reported case with such vascular anomalies.

2011 - Congenital complete absence of the pericardium: A multimodality imaging diagnostic approach [Articolo su rivista]
Mantovani, Francesca; Barbieri, Andrea; Modena, Maria Grazia
abstract

The complete congenital absence of the pericardium is a rare and benign condition, which often presents a diagnostic dilemma. We reported a case of essentially complete absence of the pericardium with an otherwise normal heart in a 16 year old that was imaged with both transthoracic echocardiography and MRI. Â© 2010, Wiley Periodicals, Inc.

2011 - Detection of localized chronic type A aortic dissection: a multimodality imaging approach. [Articolo su rivista]
Malagoli, A.; Barbieri, A.; Veronesi, B.; Pacini, D.; Ligabue, Guido; Modena, Maria Grazia
abstract

2011 - Devices for Infrainguinal Endovascular Therapy: Menu a la Carte or Table d'Hote? [COMMENTARY] [Articolo su rivista]
Biondi-Zoccai, Giuseppe; Sangiorgi, Giuseppe; Modena, Maria Grazia
abstract

Comment on Endovascular management as first therapy for chronic total occlusion of the lower extremity arteries: comparison of balloon angioplasty, stenting, and directional atherectomy. [J Endovasc Ther. 2011]

2011 - EAT volume is an independent risk factor of cardiovascular disease in HIV-infected patients [Abstract in Rivista]
Guaraldi, Giovanni; Zona, Stefano; Raggi, P; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Scaglioni, R; Besutti, G; Rossi, Rosario; Modena, Maria Grazia
abstract

Epicardial adipose tissue volume (EAT) is increased in HIV infected patients. EAT may contribute to coronary artery atherosclerosis via paracrine secretion of proinflammatory cytokines, plying a role in the development of cardiovascular disease (CVD). The aim of the study was to evaluate EAT associated factors and the relationship between EAT and occult CVD and predictors of EAT change over time.

2011 - Effects of antihypertensive treatment on endothelial function in postmenopausal hypertensive women. A significant role for aldosterone inhibition [Articolo su rivista]
Rossi, Rosario; Nuzzo, Annachiara; Iaccarino, Daniele; Lattanzi, Antonella; Origliani, Giorgia; Monopoli, Daniel Enrique; Modena, Maria Grazia
abstract

Introduction: Endothelial dysfunction is a well-demonstrated independent predictor of cardiovascular events in hypertensive postmenopausal women. Accordingly, it is plausible that improving endothelial function could represent an adjunctive target for antihypertensive treatment. The aim of our study was to evaluate the effect of pharmacologic treatment on endothelial function in the specific population of hypertensive postmenopausal women.Methods: A total of 320 consecutive hypertensive postmenopausal women underwent a high-resolution ultrasound study of the brachial artery at baseline and after six months, while 'optimal' control of blood pressure (maintenance of blood pressure values below 140/90 mmHg at all follow-up visits) was achieved using antihypertensive therapy. Endothelial function was measured as flow-mediated dilation, using ultrasound method.Results: After six months of treatment, flow-mediated dilatation (FMD) had significantly improved in the majority of patients (n = 257 [80.3% of the entire population]; FMD = 8.1 Â± 1.0% at baseline vs. 10.6 Â± 1.5% after follow-up; p < 0.001), but it had not changed or worsened in others (n = 63 [19.7%]; FMD = 8.2 Â± 1.2% at baseline vs. 7.6 Â± 1.0% after six months; p = ns). Improvement of endothelial function, at multivariate analysis, resulted independently associated with the use of aldosterone inhibitors (odds ratio = 2.15; 95% confidence interval: 1.55-2.75; p = 0.001).Conclusions: This study demonstrates that a significant improvement in endothelial function may be obtained after six months of an optimal antihypertensive therapy. Among all hypertensive postmenopausal women that achieved an optimal control of blood pressure during follow-up, the use of drugs that inhibit aldosterone receptors was associated with an improvement of endothelial function, beyond the 'optimal' blood pressure control. Â© SAGE Publications 2011.

2011 - Efficacy and Saftey of 38 mm Long Stent Treatment for Diffuse Coronary Disease: A Multicenter Evaluation by Angiography and OCT Analysis at One Year After Implantation [Abstract in Atti di Convegno]
Sangiorgi, G; Rollini, F; Rezq, A; Romagnoli, E; Polili, L; Zoccai, Gb; Aprile, A; Marzullo, R; Leuzzi, C; Modena, Mg; Colombo, A.
abstract

Background: Very long lesions treatment usually contemplates the use of DES but the implantation of multiple overlapping DES for diffuse disease increases the risk of restenosis and stent thrombosis. Methods: We prospectively evaluated the performance of 38mm-long DES in terms of feasibility, efficacy and safety in elective patients undergoing stent implantation for de novo diffuse (>33 mm) coronary disease. Endpoint of the study was the occurrence of MACE (cardiac death, myocardial infarction, TLR and stent thrombosis at one year FU). Secondary endpoints were OCT struts coverage, and malapposed struts at followup. Results: 68 pts with 79 lesions were enrolled, 83.8% male, mean age of 67.2 ±10 yrs. All 79 lesions were type C, 23.5% C3. Lesions were treated with Taxus Libertè®, 14 with Endeavor Resolute®, and 10 with Xience® stents all post-dilated at high atmosphere (>20 atm) with NC balloons. Mean stent size was 3.0±0.2, mean stent per lesion was 1.1, mean stent length was 42.18 mm. No adverse in-hospital events were observed. Mean follow-up of 8.2±3.7 months was done for all pts. No MACE but 2 not cardiac deaths (2.9%) occurred, no TLR detected. OCT was randomly performed in 5 patients of each group at 8 mo FU angiography. Mean neointimal thickness was 140±72 μm, 223±107 μm and 254.5±82.5 μm and percentage of neointimal hyperplasia was 15.7±9.4%, 20.7±11.9%, and 30.7±9.4% for the Resolute®, Taxus Libertè®, and Xience® groups respectively, with a significant difference between Resolute® and the other 2 groups (P= 0.0001 with Taxus®, P=0.024 with Xience®). Percentage of IIIb+IV stent struts were 15.7%, 9.89%, and 0.87% of total struts analysed. Frames with RUTTS > 30% were 23.1%, 16.2%, and 1.3% of total analyzed for Resolute®, Taxus Libertè®, and Xience® groups respectively with a significant difference between Xience® and the other 2 groups (P=0.0001 for both Resolute® and Taxus®) Conclusion: Dedicated 38mm-long DES for treatment of complex diffuse disease can be achieved with high success rate and excellent mid term safety profile. OCT analysis revealed that second generation stents may perform significantly better than first generation in terms of safety parameters.

2011 - Endothelial function affects early carotid atherosclerosis progression in hypertensive postmenopausal women [Articolo su rivista]
Rossi, Rosario; Nuzzo, Annachiara; Olaru, Alina I.; Origliani, Giorgia; Modena, Maria Grazia
abstract

OBJECTIVES: Endothelial dysfunction is known to be associated with atherosclerosis progression and cardiovascular events. Limited information exists regarding the importance of this topic in hypertensive postmenopausal women. In this particular population the influence of endothelial dysfunction on cardio-vascular end cerebro-vascular events is well demonstrated. Therefore, we investigated, in a prospective study, the influence of endothelial-dependent vasodilation on carotid intima-media thickness (IMT) progression in our population of hypertensive postmenopausal women. METHODS: In addition to common risk factors and pharmacological therapy, we measured carotid IMT and flow-mediated dilation (FMD) of the brachial artery at baseline and after 1 year of follow-up. RESULTS: Baseline and follow-up data were available for 618 hypertensive postmenopausal women with an age of 55 ± 8 years. The mean IMT at baseline was 754 ± 161 μm [interquartile range (IQR) from 600 to 838 μm]. The mean FMD at baseline was 5.8 ± 3.9% (IQR from 3.2 to 8.2%). There was a significant correlation between baseline FMD and carotid IMT (r = -0.16; P = 0.003). Mean IMT progression resulted in 103 μm (range from -250 to 567 μm; IQR from 0 to 200 μm) per year. Baseline FMD, FMD change and the amount of SBP reduction during follow-up remained the independent predictors of IMT progression in multivariable analysis. CONCLUSIONS: In this prospective study we observed a significant interaction between baseline FMD, FMD change during follow-up and IMT progression in our population of hypertensive postmenopausal women. These results are in accordance with the suggestion that endothelial dysfunction is associated with enhanced atherosclerosis development. This hypothesis could provide a pathophysiological explanation for the increase in cardio-vascular and cerebro-vascular episodes recorded in hypertensive postmenopausal women with endothelial dysfunction.

2011 - Epicardial Adipose Tissue Volume is an Independent Risk Factor of CVD in HIV-infected Patients [Abstract in Atti di Convegno]
Zona, Stefano; Raggi, P.; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Scaglioni, R.; Besutti, G.; Rossi, Rosario; Modena, Maria Grazia; Guaraldi, Giovanni
abstract

Epicardial adipose tissue (EAT) volume is increased in HIV-infected patients. EAT may contribute to coronary artery atherosclerosis via paracrine secretion of proinflammatory cytokines, playing a role in the development of cardiovascular disease (CVD). The aim of the study was to evaluate EAT-associated factors and the relationship between EAT and occult CVD and predictors of EAT change over time.

2011 - Epicardial adipose tissue is an independent marker of cardiovascular risk in HIV-infected patients. [Articolo su rivista]
Guaraldi, Giovanni; Scaglioni, R.; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Besutti, G.; Bagni, P.; Rossi, Rosario; Modena, Maria Grazia; Raggi, P.
abstract

BACKGROUND: Epicardial adipose tissue (EAT) is increased in HIV-infected patients. The aim of this study was to evaluate the association between EAT and coronary artery calcium (CAC) a marker of atherosclerosis; furthermore, we investigated the association of EAT with HIV infection, antiretroviral treatment (ART), and lipodystrophy.METHODS: This was a cross-sectional study of 876 consecutive HIV-infected ART experienced patients. Patients underwent CAC imaging with multidetector computed tomography (CT) for atherosclerosis screening and risk of cardiovascular events (CAC score >100); EAT was measured in the same CT images. Factors independently associated with EAT were explored in a multivariable backward stepwise linear regression analysis. Multivariable logistic regression was used to evaluate the association of EAT and CAC score greater than 100.RESULTS: Patients' mean age was 47.2 ± 8 years, 68% were men. EAT was associated with central fat accumulation and mixed lipodystrophy phenotypes. Factors independently associated with EAT were: age [β = 0.6, confidence interval (CI) 0.2-1.0], male sex (β = 6.6, CI 0.5-12.7), visceral adipose tissue (β = 0.12, CI 0.08-0.17), waist circumference (β = 0.7, CI 0.04-1.3), current CD4 (β = 0.6, CI 0.1-1.2, per 50 cells), total cholesterol (β = 0.1, CI 0.02-0.15), and cumulative exposure to ART (months) (β = 0.05, CI 0.00-0.11). EAT (per 10 cm) was associated with CAC greater than 100 (odds ratio = 1.10, CI 1.02-1.19) after adjustment for age, male sex, and diabetes.CONCLUSION: We showed an association between EAT and central fat accumulation and mixed form lipodystrophy phenotypes as well as traditional risk factors for atherosclerosis. EAT may be a useful marker of cardiovascular risk as shown by its association with CAC greater than 100.

2011 - Gender differences in the impact of uric acid on features of metabolic syndrome and subclinical atherosclerosis [Abstract in Atti di Convegno]
Olaru, Ionela Alina; Monopoli, D; Nuzzo, A; Lattanzi, A; Modena, Mg
abstract

Gender differences in the impact of uric acid on features of metabolic syndrome and subclinical atherosclerosis

2011 - Has gender a significant impact on carotid plaque instability and inflammation? Evidence from a 457-patient clinicopathologic study [Abstract in Atti di Convegno]
Sangiorgi, G; Modena, Mg; Biondi-Zoccai, G; Servadei, F; Liotti, D; Spagnoli, Lg; Mauriello, A.
abstract

An international collaborative meta-analysis on the incidence of coronary stent thrombosis including 30 studies, 225,536 patients, and 4,203 thromboses

2011 - Human immunodeficiency virus infection is associated with accelerated atherosclerosis. [Articolo su rivista]
Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Fiocchi, Federica; M., Menozzi; Rossi, Rosario; Modena, Maria Grazia; P., Raggi
abstract

Objectives Cardiovascular risk is increased in HIV-infected individuals compared with the general population, making HIV disease an ideal model to investigate the pathogenesis and natural history of atherosclerosis. In this pilot study, we compared the progression of coronary artery calcium (CAC) between HIV-infected and uninfected patients. Methods Atherosclerosis progression was assessed in 25 HIV-infected men and 13 HIV-negative controls by means of sequential CAC scans using CT. A CAC score progression ≥15%/year was used as a surrogate marker of increased risk of cardiovascular events. Results During a median follow-up of 11 months, a CAC score increase ≥15%/year was detected in 14 HIV-infected patients (56%) and 4 HIV-negative individuals (31%). HIV infection, age and hypercholesterolaemia were independently associated with a CAC score increase ≥15%/year in an adjusted Cox regression model. Conclusions HIV infection, age and hypercholesterolaemia were independently associated with CAC progression. HIV as well as traditional risk factors contribute to accelerate atherosclerosis in HIV-infected patients.

2011 - Hypertension in postmenopausal women: Pathophysiology and treatment [Articolo su rivista]
Leuzzi, Chiara; Modena, Maria Grazia
abstract

Hypertension is the most common chronic disease in industrialized countries and represents the most common major cardiovascular risk factor after the fifth decade of life in both men and women. The prevalence of hypertension is lower in premenopausal women than men, whereas in postmenopausal women it is higher than in men. Mechanisms responsible for the increase in blood pressure are complex and multifactorial, including loss of estrogen, oxidative stress, endothelial dysfunction, modification in renin-angiotensin system spillover and sympathetic activation. In addition, postmenopausal hypertension can be considered an isolated disease, more typical of elderly women, or part of the metabolic syndrome, which is indeed more common in early postmenopausal women. In particular, metabolic syndrome may be considered a potentially unfavourable prognostic factor in hypertensive postmenopausal women, because it seems to worsen the severity of hypertension and reduce the capacity to respond to specific treatments. Â© 2011 Adis Data Information BV. All rights reserved.

2011 - Il cuore nelle Donne [Capitolo/Saggio]
Modena, Maria Grazia
abstract

Ciò che ci ha spinto a realizzare questo lavoro è stata la osservazione di una significativa carenza di riferimenti aggiornati nel settore, dal momento che lo studente e il medico devono orientarsi tra la disponibilità di trattati troppo estesi per rispondere ad un’esigenza specifica, o di opere di Medicina Interna, che, per loro natura, finiscono con il penalizzare alcuni settori fondamentali dello studio della Cardiologia

2011 - Indexed left atrial volume predicts the recurrence of non-valvular atrial fibrillation after successful cardioversion [Articolo su rivista]
Marchese, P; Bursi, F; Delle Donne, G; Malavasi, V; Casali, E; Barbieri, A; Melandri, F; Modena, Maria Grazia
abstract

AIMS: Atrial fibrillation (AFib) induces remodelling of the left atrium (LA). Indexed LA volume (iLAV) as more accurate measure of LA size has not been evaluated as predictor of recurrence of AFib after cardioversion.METHODS AND RESULTS: We identified 411 adults (mean age 64.1 ± 11.4 years, 34.5% women) who underwent successful cardioversion and with no history of other atrial arrhythmia, stroke, congenital heart disease, valvular dysfunction, surgery, thyroid dysfunction, acute or chronic inflammatory disease, and pacemaker. All echocardiographic data were retrieved from the laboratory database. iLAV was measured off-line using Simpson's method. Clinical characteristics and recurrence of clinical AFib were determined by review of medical records. Patients with scheduled follow-up of at least 6 months were included. About 250 patients (60.8%) developed AFib recurrence after a median (25th-75th percentile) follow-up of 345.0 (210.0-540.0) days. Patients with AFib recurrence had significantly greater iLAV than patients without AFib recurrence (39.7 ± 8.4 vs. 31.4 ± 4.6, P < 0.001). Each mL/m(2) increase in iLAV was associated with a 30% increased risk of AFib recurrence [odds ratio (OR) 1.30, confidence interval (CI) 1.23-1.38, P < 0.001]. In a multivariable model, each mL/m(2) increase in iLAV was independently associated with a 21% increase in the risk of AFib recurrence (OR 1.21, CI 1.11-1.30, P < 0.001). The areas under receiver operating characteristic curves, generated to compare LA diameter and iLAV as predictors of AFib recurrence, were 0.59 ± 0.3 and 0.85 ± 0.2, respectively (P < 0.001).CONCLUSION: The present study is the first to show that larger iLAV before cardioversion, as a more accurate measure of LA remodelling than LA diameter, is strongly and independently associated with higher risks of AFib recurrence.

2011 - Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets results from a large international multicenter study [Articolo su rivista]
Rusinaru, Dan; Tribouilloy, Christophe; Grigioni, Francesco; Avierinos, Jean FranÃ§ois; Suri, Rakesh M.; Barbieri, Andrea; Szymanski, Catherine; Ferlito, Marinella; Michelena, Hector; Tafanelli, Laurence; Bursi, Francesca; Mezghani, Sonia; Branzi, Angelo; Habib, Gilbert; Modena, Maria G.; Enriquez-Sarano, Maurice
abstract

Background-Left atrium (LA) enlargement is common in organic mitral regurgitation (MR) and is an emerging prognostic indicator. However, outcome implications of LA enlargement have not been analyzed in the context of routine clinical practice and in a multicenter study. Methods and Results-The Mitral Regurgitation International DAtabase (MIDA) registry enrolls patients with organic MR due to flail leaflets, diagnosed in routine clinical practice, in 5 US and European centers. We investigated the relation between LA diameter and mortality under medical treatment and after mitral surgery in 788 patients in sinus rhythm (64Â±12 years; median LA, 48 [43 to 52] mm). LA diameter was independently associated with survival after diagnosis (hazard ratio, 1.08 [1.04 to 1.12] per 1 mm increment). Compared with patients with LA<55 mm, those with LA â¥55 mm had lower 8-year overall survival (P<0.001). LA â¥55 mm independently predicted overall mortality (hazard ratio, 3.67 [1.95 to 6.88]) and cardiac mortality (hazard ratio, 3.74 [1.72 to 8.13]) under medical treatment. The association of LA â¥55 mm and mortality was consistent in subgroups. Similar excess mortality associated with LA â¥55 mm was observed in asymptomatic and symptomatic patients (P for interaction, 0.77). In patients who underwent mitral surgery, LA â¥55 mm had no impact on postoperative outcome (P<0.20). Mitral surgery was associated with greater survival benefit in patients with LA â¥55 mm compared with LA <55 mm (P for interaction, 0.008). Conclusions-In MR caused by flail leaflets, LA diameter â¥55 mm is associated with increased mortality under medical treatment, independent of the presence of symptoms or left ventricular dysfunction. Â© 2011 American Heart Association, Inc.

2011 - Menopause In Hiv Infected Patients: Women In A Midlife Polypathology Crisis [Abstract in Rivista]
Berardi, C; Rossi, Rosario; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Casalgrandi, C; Bedini, A; Cocchi, S; Modena, Maria Grazia; Guaraldi, Giovanni
abstract

Menopause can be considered a paradigm of physiological ageing. The aim of this study was to compare the physical and psychological health profile of postmenopausal women with and without HIV. Secondary objective was to assess polypathology prevalence and risk factors as surrogate of ageing phenotype.

2011 - Mid-term outcomes of iodixanol versus iomeprol contrast medium after primary angioplasty for st elevation myocardial infarction [Abstract in Atti di Convegno]
Bertelli, L; Sgura, Fa; Manicardi, M; Campioli, Alice; Spadafora, Giuseppe; Leuzzi, C; Rossi, R; Zoccai, Gb; Sangiorgi, Gm; Modena, Mg
abstract

Mid-term outcomes of iodixanol versus iomeprol contrast medium after primary angioplasty for st elevation myocardial infarction

2011 - PERIPHERAL ARTERIAL CHANGES IN SYSTEMIC SCLEROSIS PATIENTS ARE SIMILAR TO THOSE OBSERVED IN PATIENTS WITH CORONARY ARTERY DISEASE [Abstract in Rivista]
Colaci, Michele; Giuggioli, D.; Manfredi, Andreina Teresa; Nuzzo, A.; Rossi, Rosario; Modena, Maria Grazia; Ferri, Clodoveo
abstract

Patients with systemic sclerosis presented functional alterations of coronaries, similair to those of cardiopathic patients.

2011 - Persistent Chest Pain in Absence of Angiographic Significant Coronary Artery Disease is Associated with Permanent Myocardial Perfusion Defects in Magnetic Resonance Imaging in Postmenopausal Women [Articolo su rivista]
Modena, Maria Grazia; Nuzzo, Annachiara; Rossi, Rosario; Lammirato, Anna; Fiocchi, Federica; Ligabue, Guido; Torricelli, Pietro; Romagnoli, Renato
abstract

We studied a population of post-menopausal women with persistent chest pain (PChP) in order to investigate the relationship between myocardial perfusion at rest and during a stress test using magnetic resonance imaging (MRI). Our goals were to document whether transient myocardial perfusion is induced by dipyridamole infusion and if perfusion defects are also present at rest. The study population consisted of 45 consecutive women (mean age 57.6±8.7 years), who reported chest pain symptoms. PChP was defined as self-reported continuing chest pain after one year. We compared the results of the perfusion MRI studies in subgroups with and without obstructive coronary artery disease (CAD). The latest tools and technologies of Synapse™ Cardiovascular – Fujifilm's cardiovascular (CV) image and information management system – helped us to achieve clear and comprehensive outcomes. In the group of women with PChP and non-obstructive CAD, 16 of 34 (48%) showed a well-evident left ventricular perfusion defect at baseline (four in one segment; eight in two segments and four in three or more segments). The localisation of the perfusion defects – seen using Synapse Cardiovascular – were anteroapical (n=6); septal (n=10); and inferoor inferolateral (n=4). These defects were ‘permanent’ or ‘fixed’, i.e. were present at rest and were neither induced nor modified by the administration of dipyridamole. In any of the women with CAD we found these anomalies. ‘Fixed’ perfusion defects at MRI – probably due to permanent damage of the coronary microcirculation – suggest a disease state typical for post-menopausal women with PChP.

2011 - Prevalence of “borderline” values of cardiovascular risk factors in the clinical practice of general medicine in italy: results of the BORDERLINE study [Articolo su rivista]
Tocci, G; Ferrucci, A; Passerini, J; Averna, M; Bellotti, P; Bruno, G; Cosentino, F; Crepaldi, G; Giannattasio, C; Modena, Maria Grazia; Nati, G; Tiengo, A; Trimarco, B; Vanuzzo, D; Volpe, M.
abstract

Introduction: The prevalence of patients with 'borderline' levels of cardiovascular risk factors has been rarely investigated, being often reported in studies evaluating abnormal values of these parameters. The BORDERLINE study represents a pilot experience to primarily identify the prevalence of 'high-normal' conditions, such as pre-hypertension, lipid and glucose levels in the upper range of normality in the setting of general practice in Italy. Aim: The aim of this study was to evaluate the prevalence of patients with 'borderline' values of cardiovascular risk factors in Italy. Methods: Involved physicians were asked to evaluate the first 20 outpatients, consecutively seen in June 2009. Data were collected in a study-designed case-report form, in which physicians identified thresholds rather than reported absolute values of several clinical parameters. High-normal values were defined as follows: blood pressure (BP) 130-140/85-90 mmHg; total cholesterol 180-200 mg/dL; low-density lipoprotein cholesterol (LDL-C) 130-150 mg/dL; high-density lipoprotein cholesterol (HDL-C) 30-40 mg/dL in males and 40-50 mg/dL in females; triglycerides 130-150 mg/dL and fasting glucose 100-110 mg/dL. Results: Fifty-three Italian physicians provided valuable clinical data on 826 individual outpatients, among which 692 (83.7%, 377 women, mean age 60.9 ± 13.2 years, body mass index 26.6 ± 5.0 kg/m 2) were included in the present analysis. Prevalence of borderline values of systolic BP and total cholesterol levels were at least comparable with those in the normal limits of the corresponding parameters, whereas prevalence of borderline diastolic BP, LDL-C, HDL-C, triglycerides and fasting glucose levels was significantly lower than that of normal values, but higher than that of abnormal values of the corresponding parameters. Conclusions: Using this sample of healthy subjects in the setting of general practice in Italy, our results demonstrated a relatively high prevalence of borderline values of cardiovascular risk factors, which was at least comparable with that of normal, but significantly higher than that of abnormal thresholds. These preliminary findings may prompt more extensive investigations in the area of 'borderline' cardiovascular risk. This information may, in fact, potentially enable the design of more effective prevention strategies in the future to limit the burden of cardiovascular disease in the general population in Italy.

2011 - Primary prevention of diastolic dysfunction in the normal heart: The "Eyes Wide Shut" on a statin pleiotropic effect? [Articolo su rivista]
Monopoli, De; Modena, Maria Grazia; Sangiorgi, G. M.
abstract

Primary prevention of diastolic dysfunction in the normal heart: the "eyes wide shut" on a statin pleiotropic effect?

2011 - Prognostic and therapeutic implications of pulmonary hypertension complicating degenerative mitral regurgitation due to flail leaflet: A Multicenter Long-term International Study. [Articolo su rivista]
Barbieri, A; Bursi, F; Grigioni, F; Tribouilloy, C; Avierinos, Jf; Michelena, Hi; Rusinaru, D; Szymansky, C; Russo, A; Suri, R; Bacchi Reggiani, Ml; Branzi, A; Modena, Maria Grazia; Enriquez Sarano, M; On, behalf of the Mitral Regurgitati Internatial DAtabase Investigators
abstract

Aims To determine the frequency, predictors, and outcome implications of pulmonary hypertension (PH) diagnosed by Doppler echocardiography in a large cohort of patients with the homogenous diagnosis of degenerative mitral regurgitation (MR) due to flail leaflets. Methods and results The Mitral Regurgitation International DAtabase (MIDA) is a registry including patients with MR due to flail leaflets consecutively referred at tertiary centres in Europe and the USA. Between 1987 and 2004, pulmonary artery systolic pressure (PASP) was measured at baseline by Doppler echocardiography in 437 patients (age 67 ± 11 years; 66% men). Pulmonary hypertension (PASP > 50 mmHg) was observed in 102 patients (23%). Independent predictors of PH were age and left atrial size (P < 0.0001). During a mean follow-up of 4.8 ± 2.8 years, PH was a strong independent predictor of death [adjusted HR 2.03 (1.30-3.18) P = 0.002], cardiovascular death [CVD; adjusted HR 2.21 (1.30-3.76) P = 0.003], and heart failure [adjusted HR 1.70 (1.10-2.62) P = 0.018]. Mitral valve surgery at any time during follow-up (performed in 325 patients, 75%) was beneficial [adjusted HR for death 0.22 (0.14-0.36) P < 0.001], but PH was associated with the increased risk of postoperative death and CVD (P = 0.01). Conclusion Pulmonary hypertension is a frequent complication of significant MR due to flail leaflet and is associated with major outcome implications, approximately doubling the risk of death and heart failure after diagnosis. Mitral valve surgery performed during follow-up is beneficial but does not completely abolish the adverse effects of PH once it is established and is particularly beneficial in patients without PH. These data support relieving PH secondary to MR due to flail leaflet, but also careful consideration for mitral surgery before PH is established.

2011 - Prognostic impact of left ventricular mass severity according to the classification proposed by the American society of echocardiography/European association of echocardiography [Articolo su rivista]
Barbieri, Andrea; Bursi, Francesca; Mantovani, Francesca; Valenti, Chiara; Quaglia, Michele; Berti, ELENA MARIA; Marino, Massimiliano; Modena, Maria Grazia
abstract

Background: The American Society of Echocardiography (ASE) and European Association of Echocardiography (EAE) recommend the use of quantitative estimation of left ventricular (LV) mass and defined partition values for mild, moderate, and severe hypertrophy. However, the prognostic implications associated with this categorization are unknown. Methods: In this observational cohort study of unselected adults undergoing echocardiography for any indication, LV hypertrophy was assessed using the ASE/EAE-recommended formula and measurement convention from LV linear dimensions indexed to body surface area. Mortality and incident hospitalizations for cardiovascular disease were the outcomes of this study. Results: Of 2,545 subjects (mean age, 61.9 Â± 15.8 years; 56.3% women), 52.9% had normal LV mass, and 15.4% had mild, 12.1% moderate, and 19.6% severe LV hypertrophy. During a mean follow-up period of 2.5 Â± 1.2 years, 121 deaths and 292 incident hospitalizations for cardiovascular disease occurred. In multivariate models including age, gender, LV ejection fraction, wall motion score index, significant valvular disease, and atrial fibrillation, the adjusted hazard ratios for death were 1.81 (95% confidence interval [CI], 1.03-3.20; P =.041) for mild, 2.31 (95% CI, 1.33-4.01; P =.003) for moderate, and 2.30 (95% CI, 1.39-3.79, P =.001) for severe LV hypertrophy. The adjusted hazard ratios for incident cardiovascular hospitalizations were 1.24 (95% CI, 0.84-1.82; P =.277) for mild, 2.02 (95% CI, 1.42-2.88; P =.0001) for moderate, and 2.38 (95% CI, 1.75-3.22, P <.0001) for severe LV hypertrophy. After adjustment for known risk predictors, there was a 1.3-fold risk for death and cardiovascular disease events per category of LV mass (P =.001). Conclusions: In a cohort study of unselected adult outpatients, the categorization of LV mass according to the ASE/EAE recommendations offered prognostic information independently of age, gender, and other known predictors. Copyright 2011 by the American Society of Echocardiography.

2011 - Radial Versus Femoral Randomized Investigation in ST Elevation Acute Coronary Syndrome: the RIFLE STEACS Study [Abstract in Atti di Convegno]
Romagnoli, E; Sciahbasi, A; Pendenza, G; Summaria, F; Patrizi, R; Lioy, E; Biondi-Zoccai, Gg; Politi, L; Aprile, A; Modena, Mg; Sangiorgi, Gm; Biondi-Zoccai, Gg; Moretti, C; Sheiban, I; Rigattieri, S; Di Russo, C; Loschiavo, P.
abstract

OBJECTIVES: The purpose of this study was to assess whether transradial access for ST-segment elevation acute coronary syndrome undergoing early invasive treatment is associated with better outcome compared with conventional transfemoral access. BACKGROUND: In patients with acute coronary syndrome, bleeding is a significant predictor of worse outcome. Access site complications represent a significant source of bleeding for those patients undergoing revascularization, especially when femoral access is used. METHODS: The RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) was a multicenter, randomized, parallel-group study. Between January 2009 and July 2011, 1,001 acute ST-segment elevation acute coronary syndrome patients undergoing primary/rescue percutaneous coronary intervention were randomized to the radial (500) or femoral (501) approach at 4 high-volume centers. The primary endpoint was the 30-day rate of net adverse clinical events (NACEs), defined as a composite of cardiac death, stroke, myocardial infarction, target lesion revascularization, and bleeding). Individual components of NACEs and length of hospital stay were secondary endpoints. RESULTS: The primary endpoint of 30-day NACEs occurred in 68 patients (13.6%) in the radial arm and 105 patients (21.0%) in the femoral arm (p = 0.003). In particular, compared with femoral, radial access was associated with significantly lower rates of cardiac mortality (5.2% vs. 9.2%, p = 0.020), bleeding (7.8% vs. 12.2%, p = 0.026), and shorter hospital stay (5 days first to third quartile range, 4 to 7 days] vs. 6 [range, 5 to 8 days]; p = 0.03). CONCLUSIONS: Radial access in patients with ST-segment elevation acute coronary syndrome is associated with significant clinical benefits, in terms of both lower morbidity and cardiac mortality. Thus, it should become the recommended approach in these patients, provided adequate operator and center expertise is present. (Radial Versus Femoral Investigation in ST Elevation Acute Coronary Syndrome [RIFLE-STEACS]; NCT01420614).

2011 - Randomized clinical trial on short-time compression with Kaolin-filled pad: a new strategy to avoid early bleeding and subacute radial artery occlusion after percutaneous coronary intervention. [Articolo su rivista]
Politi, L; Aprile, A; Paganelli, C; Amato, A; BIONDI ZOCCAI, Giuseppe; Sgura, F; Monopoli, D; Rossi, Rosario; Modena, Maria Grazia; Sangiorgi, G. M.
abstract

BACKGROUND: Despite the increasing use of transradial techniques for cardiac percutaneous procedures, none of the strategies commonly utilized for hemostasis has been able to reduce the occurrence of radial artery occlusion (RAO). The aim of this study was to evaluate the occurrence of 24-hour RAO and the rate of bleeding of a novel hemostatic device for radial closure after percutaneous interventions, in adjunct to short-time compression.METHODS: Once the radial access was obtained, patients were randomized to 3 different strategies of radial closure: a short compression with the QuikClot® Interventional™ pad (Z-Medica Corporation, Wallingford, CT, USA) (15 minutes, group 1), a short compression (15 minutes, group 2), and a conventional prolonged compression (2 hours, group 3) both without QuikClot® utilization.RESULTS: Fifty patients in group 1, 20 in group 2, and 50 in group 3 were enrolled. The three groups were homogenous for baseline and procedural characteristics. None of patients in group 1 developed RAO, 1 (5%) occurred in group 2, and 5 (10%) in group 3 (P = 0.05). Active bleeding after compression removal occurred in 10 patients (20%) in group 1, 18 (90%) in group 2, and 1 (2%) in group 3 (P < 0.001). Among patients in group 1, at univariate analysis, the predictors of acute bleeding resulted in chronic therapy with clopidogrel (Odds Ratio 28.78, 95% Confidence Intervals 4.79-172.82, P < 0.001) and high levels of activated clotting time (ACT) at the time of sheath removal (OR 1.02, 95% CI 1.00-1.03, P = 0.009). At ROC analysis, the cutoff value of ACT for the risk of bleeding with a sensitivity of 80% and specificity of 75% was 287 seconds.CONCLUSIONS: Early sheet removal and short-time compression with QuikClot® Interventional™ can reduce the rate of RAO after diagnostic or interventional procedures especially in patients not on double antiplatelet therapy.

2011 - Repetita iuvant (repeating helps): why another paper on a new stent is important. [Articolo su rivista]
Sangiorgi, G; Biondi Zoccai, G; Modena, Maria Grazia
abstract

Comment on Cre8™ coronary stent: preclinical in vivo assessment of a new generation polymer-free DES with Amphilimus™ formulation. [EuroIntervention. 2012]

2011 - Sensitivity and specificity of visceral and epicardial adipose tissue values in the prediction of occult cardiovascular disease in HIV-infected patients. [Abstract in Rivista]
Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Bagni, Pietro; Rossi, Rosario; Modena, Maria Grazia; Falutz, J; Raggi, P.
abstract

Visceral adipose tissue and epicardial adipose tissue have been shown to be associated with the presence of occult cardiovascular disease identified with coronary artery calcium >100. The clinical relevance of VAT and EAT values are not known. The aim of this study was to identify sensitivity and specificity of different VAt and EAT values associated with occult CVD.

2011 - Sostituzione valvolare aortica percutanea: imaging pre-procedurale [Capitolo/Saggio]
Politi, Luigi Vincenzo; Modena, Maria Grazia; Sangiorgi, Giorgia
abstract

Diagnostica coronarica e cardiaca avanzata- Sostituzione valvolare aortica percutanea: imaging pre-procedurale

2011 - Subclinical cardiac dysfunction in moderate to severe COPD patients [Poster]
Verduri, Alessia; Bottazzi, B; Leuzzi, C; Boschetto, P; Modena, Mg; Mantovani, A; Fabbri, Leonardo; Beghe', Bianca
abstract

Non previsto

2011 - Subclinical cardiac dysfunction in moderatw to severe COPD patients [Articolo su rivista]
A., Verduri; B., Bottazzi; C., Leuzzi; P., Boschetto; Modena, Maria Grazia; A., Mantovani; Fabbri, Leonardo; Beghe', Bianca
abstract

BACKGROUND: The co-existence between chronic obstructive pulmonary disease (COPD) and heart failure has been previously described. However, the co-existence between COPD and subclinical left ventricular (LV) dysfunction, without the presence of heart failure symptoms, is less well understood. This study determined the relationship and clinical relevance of COPD and subclinical LV dysfunction in vascular surgery patients. METHODS: 1005 consecutive vascular surgery patients were included in which COPD was determined using spirometry and LV function using echocardiography. Mild COPD was defined as FEV(1)>or=80% of predicted+FEV(1)/FVC-ratio<0.70. Moderate/severe COPD was defined as FEV(1)<80% of predicted+FEV(1)/FVC-ratio<0.70. Systolic LV dysfunction was defined as LV ejection fraction <50% and diastolic LV dysfunction was diagnosed based on E/A-ratio, pulmonary vein flow and deceleration time. Multivariate regression analyses were used to evaluate the impact of COPD and LV dysfunction on all-cause mortality. The mean follow-up time was 2.2+/-1.8 years. RESULTS: Both, mild and moderate/severe COPD were associated with increased risk for subclinical LV dysfunction with odds ratio of 1.6 (95%-CI=1.1-2.3) and 1.7 (95%-CI=1.2-2.4), respectively. Mild- or moderate/severe COPD in combination with LV dysfunction was associated with increased risk for all-cause mortality (mild: hazard ratio 1.7; 95%-CI=1.1-3.6, moderate/severe: hazard ratio 2.5; 95%-CI=1.5-4.7). CONCLUSIONS: COPD was associated with increased risk for subclinical LV dysfunction. COPD+subclinical LV dysfunction was associated with increased risk for all-cause mortality compared to patients with COPD+normal LV function. Echocardiography may be useful to detect subclinical cardiovascular disease and risk-stratify COPD patients undergoing vascular surgery.

2011 - The SPIRIT WOMEN Single Arm Study: Two Year Follow-up Results [Abstract in Atti di Convegno]
Morice, Mc; Windecker, S; Modena, Mg; Mikhail, G; Mauri, F; Strasser, R; Grinfeld, L.
abstract

The SPIRIT WOMEN Single Arm Study: Two Year Follow-up Results

2011 - The authors' reply [Articolo su rivista]
Politi, Luigi; Sangiorgi, Giuseppe Massimo; Modena, Maria Grazia
abstract

We appreciate Dr West's comments on our paper1; he has given us the opportunity to clarify some points that seem unresolved.

2010 - 2009 SIPREC consensus document executive summary: Cardiovascular prevention in subjects with impaired fasting glucose or impaired glucose tolerance [Articolo su rivista]
Volpe, Massimo; Borghi, Claudio; Cavallo Perin, Paolo; Chiariello, Massimo; Manzato, Enzo; Miccoli, Roberto; Modena, Maria G.; Riccardi, Gabriele; Sesti, Giorgio; Tiengo, Antonio; Trimarco, Bruno; Vanuzzo, Diego; Verdecchia, Paolo; Zaninelli, Augusto; Del Prato, Stefano
abstract

Cardiovascular diseases still represent the leading cause of mortality and hospitalization, worldwide. As a consequence of the marked demographic changes observed in the general population, the improved survival rate after an acute cardiovascular event and the progressive rise of costs (mostly due to technological and pharmacological innovations), the estimated burden of cardiovascular diseases will be soon become insurmountable for national healthcare systems. In this view, an integrated approach aimed at improving strategies for cardiovascular disease prevention and, thus, limiting the negative outcomes, would probably be successful. Such an approach may not only achieve long-term benefits, but even significant advantages in the short to medium term, mostly in asymptomatic high-risk individuals. Indeed, this latter population of asymptomatic high-risk individuals would mostly benefit from extensive application and improvement of strategies for cardiovascular disease prevention with a favourable cost-benefit ratio.The Italian Society for Cardiovascular Disease Prevention Societ Italiana per la Prevenzione Cardiovascolare (SIPREC) has recognized this strategic aim, focusing a significant part of its institutional actions on the effort for providing educational supports and consensus documents, which represent an overview of the scientific knowledge and personal clinical expertise by national and international key opinion leaders. Expert committees periodically generate 'state-of-the-art' documents on specific scientific topics with relevant socioeconomic implications and large clinical impact. The present article is dedicated to healthcare professionals, is based on the available evidence, and provides information on diagnostic algorithms and therapeutic options on abnormal glucose regulation (or dysglycaemia).The relationship between abnormalities in glucose metabolism and cardiovascular complications represents an important and relatively early target for cardiovascular disease prevention. SIPREC identified, even in this clinical setting, a group of scientific experts in order to form a multidisciplinary 'task force'. This group has been asked to explain in a short, simple and effective fashion the epidemiological impact and the pathophysiological nature of the problem, its clinical features, potential diagnostic algorithms and therapeutic options, and its influence on the clinical practice of both specialist physicians and general practitioners.This work provides the background for discussing novel future strategies for cardiovascular prevention. It is also aimed at highlighting the importance of an emerging marker of cardiovascular risk, which is often not recognized and underestimated. Â© 2010 Adis Data Information BV. All rights reserved.

2010 - A multicenter randomized study to evaluate intracoronary abciximab with the ClearWay catheter to improve outcomes with Lysis (IC ClearLy): trial study design and rationale. [Articolo su rivista]
Sardella, G; Sangiorgi, Gm; Mancone, M; Colantonio, R; Donahue, M; Politi, L; Ducci, Cb; Carbone, I; Francone, M; Ligabue, Guido; Fiocchi, F; Di Roma, A; Benedetti, G; Lucisano, L; Stio, Re; Agati, L; Modena, Maria Grazia; Genuini, I; Fedele, F; Gibson, M.
abstract

BACKGROUND: Percutaneous coronary intervention (PCI) is a highly effective therapy for acute ST-elevation myocardial infarction. Adjunctive therapy with platelet glycoprotein (GP) IIb/IIIa inhibitor can result in increased vessel patency and improved outcomes in ST-elevation myocardial infarction patients undergoing PCI. The investigation of novel dosing and delivery strategies of this therapy may help to further improve outcomes.METHODS: IC-Clearly is a randomized, open-label, multicenter trial, with the purpose of evaluating the effectiveness of an intracoronary bolus dose of abciximab delivered using the ClearWay RX catheter vs. an intravenous bolus of abciximab for ST-elevation myocardial infarction with angiographically visible thrombus (thrombus grade >or=2). A total of 150 patients will be randomized 1: 1 to treatment of the culprit artery with intracoronary abciximab (75 patients) or intravenous abciximab (75 patients) in addition to a maintenance infusion regimen of abciximab administered intravenously for 12 h after PCI. The number of patients included in this study is based on the estimation of sample size needed to identify a statistically significant difference in the primary endpoints between the two groups. The primary endpoint chosen to evaluate this hypothesis is infarct size assessed by cardiac magnetic resonance. Clinical outcomes will be assessed for each patient through hospital discharge and at 30-day follow-up.CONCLUSION: The purpose of this study is to evaluate whether an intracoronary bolus of abciximab delivered with the ClearWay RX catheter prior to the 12 h post-PCI intravenous infusion regimen of abciximab will result in significant additional clot resolution in vivo and improved myocardial perfusion when compared with an intravenous bolus of abciximab on top of the 12 h post-PCI intravenous infusion regimen of abciximab as per standard practice. The primary endpoint chosen to evaluate this hypothesis is infarct size as assessed by cardiac magnetic resonance.

2010 - A randomised trial of target-vessel versus multi-vessel revascularisation in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up. [Articolo su rivista]
Politi, L; Sgura, F; Rossi, Rosario; Monopoli, D; Guerri, E; Leuzzi, C; Bursi, F; Sangiorgi, Gm; Modena, Maria Grazia
abstract

BACKGROUND: Few reports described outcomes of complete compared with infarct related artery (IRA) only revascularization in patients with ST elevation myocardial infarction (STEMI) and multivessel coronary disease (CAD). Moreover there are no studies comparing simultaneous treatment of non-IRAs with the IRA treatment followed by elective procedure for the other lesions (staged revascularization). METHODS: We studied the outcomes of 214 consecutive patients with STEMI and multivessel CAD undergoing primary angioplasty. Before the first angioplasty patients were randomized to 3 different strategies: 1) culprit vessel angioplasty only (COR group), 2) staged revascularization (SR group), and 3) simultaneous treatment of non-IRAs (CR group). RESULTS: During a mean follow-up of 2.5 years, 42 (50.0%) patients in COR group experienced at least one major adverse cardiac event (MACE), 13 (20.0%) in SR group, and 15 (23.1%) in CR group, p<0.001. In-hospital death, repeat revascularization and re-hospitalization occurred more frequently in COR group (all p<0.05), while there was no significant difference in re-infarction among the 3 groups. Survival free of MACE was significantly reduced in COR group but it was similar in CR and SR groups. CONCLUSIONS: Culprit vessel only angioplasty was associated with the highest rate of long-term MACE as compared to multivessel treatment. Patients scheduled for staged revascularization experienced a similar rate of MACE as patients undergoing complete simultaneous treatment of non-IRAs.

2010 - ANTIALDOSTERONE THERAPY IN LIVER CIRRHOSIS: A ROLE FOR PREVENTION OF CIRROTHIC CARDIOMIOPATHY? [Abstract in Rivista]
Ventura, Paolo; Ferrari, Mariachiara; Nuzzo, Anna Chiara; Nascimbeni, Fabio; Romagnoli, Elisa; Rossi, Rosario; Moriondo, V; Vegetti, Alberto; Modena, Maria Grazia; Pietrangelo, Antonello
abstract

2010 - Acute ST elevation myocardial infarction in early puerperium due to left main coronary thrombosis in a woman with thrombophilic state: a case report.: a case report. [Articolo su rivista]
Iaccarino, D; Monopoli, D; Rampino, Kc; Sangiorgi, Gm; Modena, Maria Grazia
abstract

We report a case of a middle-aged woman presenting with ST elevation myocardial infarction in early puerperium after Caesarean intervention secondary to left main coronary artery thrombosis, likely to be associated with thrombophilic state and concomitant use of oxytocin.

2010 - Acute myocardial infarction - From territory to definitive treatment in an Italian province [Articolo su rivista]
Giuliani, E.; Lazzerotti, S.; Fantini, G.; Guerri, E.; Serantoni, C.; Modena, Maria Grazia; Barbieri, Alberto
abstract

Rationale, aims and objectives Early reperfusion is the key to therapeutic success in acutemyocardial infarction (AMI). The duration of the process is influenced by various factorswhich in most of the cases are not easily modifiable. The aim of this study is to analyseAMItreatment process duration to identify determining factors. The objective is to better exploittime intervals imposed by spatial distance from the hospital.Method One-year data regarding acute coronary syndromes with elevated ST segment forpatients presenting to Policlinico teaching hospital (Modena, Italy) have been studied.Patients were divided into two groups for hospital access: A – ambulance access toPoliclinico emergency room (ER); B – self-referral to ER.Results Atotal of 141 patients have undergone percutaneous transluminal coronary angioplastyfor AMI at Policlinico, 106 males, 35 females (58.1% males in group A, 82.7% in B,P 0.002), with an average age of 66.09 14.30 years in group A and 60.90 13.47 in B(P 0.047). Mean pre-hospital time for group A was 122.54 130.69 minutes and B171.49 353.60 (P 0.25), mean hospital time in group A was 196.03 67.66 andB 255.14 113.16 (P < 0.001), mean total time in group A was 318.56 146.91 and B426.63 382.01 (P 0.02).Discussion Data show that group B suffered on average a 108-minute delay from symptomsinsurgence to definitive treatment. The duration of hospital time plays more importantrole in this finding than distance from the medical facility. In fact, on the ambulancea medical crew starts the diagnostic and therapeutic process relieving ER from initialevaluation.

2010 - Antialdosterone therapy in liver cirrhosis: a role for prevention of cirrhitc cardiomiopathy ? [Abstract in Rivista]
Ventura, Paolo; Ferrari, Mariachiara; Nuzzo, Anna Chiara; Nascimbeni, Fabio; Romagnoli, Elisa; Rossi, Rosario; Moriondo, Valeria; Vegetti, Alberto; Modena, Maria Grazia; Pietrangelo, Antonello
abstract

Background and aims: Cirrhotic cardiomiopathy (CC) comprises a constellation of cardiac abnormalities associated with liver cirrhosis (LC) progression and due to multiple pathogenetic mechanisms; even if not responsible of overt heart failure, CC plays a major role in cardiac dysfunction complicating OLT or TIPPS placement. Our work aims at assessing the prevalence of CC and the different role of possible CC-associated factors. Materials and methods: 50 patients (17 f) affected by LC and 17 (6f) by chronic hepatitis were studied. Hemochromatosis, cardiopulmonary or alcohol-related diseases were excluded. All subjects were assessed for cardiac parameters (EF, Ea, TAPSE, E/A ratio and Deceleration time (DT), QTc interval); Child-Pugh score; ANF ,BNF, Epinephrine (E), Norepinephrine (NE), PRA, Aldosterone (A), nitric oxide (NO), IL-6 and TNF-a, PIIINP plasma levels; APRI, Fibroscore, 4-parameter scores; drugs history (type and exposition time). Results: We observed a significant prevalence of diastolic dysfunction in LC group (50% of patients had abnormal E/A ratio and 62% abnormal DT) with a higher prevalence in advanced disease (100% and 92 % of Child C patients had abnormal E/A ratio and DT, respectively). Prolonged QT (pQT) was present in 19 LC patients (38%) vs. 1 (6.25%) in ECA subjects (p<.001). At univariate analysis, diastolic dysfunction indices (abnormal DT and E/A ratio) resulted significantly related to NO, TNF-alfa, NE, E , A , PRA, ANP and BNP plasma levels; they both were also significantly related to plasma PIIINP levels , Fibroscore and 4-parameters fibrosis scores. A significant correlation between pQT interval and Child score, duration of disease (years), plasma levels of TNF-a, A, ANP, BNP, PIIINP and Fibroscore and 4-parameters scores was also present. E/A ratio, DT and pQT resulted significantly inversely related to antialdosterone therapy exposition (measured as AUC of time x dose). The table resumes the multivariate analysis’ results (stepwise multiple logistic regression) using E/A ratio <1 as dependent variable. Similar result were obtained when using pQT as dependent variable.  SE OR 95% CI p Antialdosterone exposition -.539 .137 0.66 0.43-0.78 .011 Child Score .621 .292 1.35 1.26-2.13 .019 Aldosterone .728 .325 1.26 1.15-3.58 .026 PIIINP .345 .121 1.06 1.02-1.18 .042 Conclusions: Antialdosterone exposition results inversely and independentely related to CC abnormalities, this suggesting a role for optimized (in terms of dose and timing) antialdosterone therapy in prevention of CC development.

2010 - Cardiovascular prevention in subjects with impaired fasting glucose or impaired glucose tolerance [Articolo su rivista]
Volpe, M.; Borghi, C.; Cavallo Perin, P.; Chiariello, M.; Manzato, E.; Miccoli, R.; Modena, M. G.; Riccardi, G.; Sesti, G.; Tiengo, A.; Trimarco, B.; Vanuzzo, D.; Verdecchia, P.; Zaninelli, A.; Del Prato, S.
abstract

Cardiovascular diseases still represent the leading cause of mortality and hospitalization, particularly in Western countries. As a consequence of the marked changes observed on the demographic characteristics of the general population, the improved survival rate after an acute cardiovascular event, and the progressive rise of costs (mostly due to technological and pharmacological innovations), the estimated burden of cardiovascular diseases will soon become insurmountable for national healthcare systems. In this view, an integrated approach aimed at improving strategies for cardiovascular disease prevention and, thus, limiting the negative outcomes, would probably be successful. Such an approach may not only achieve long-term benefits, but even significant advantages in the short to medium term, mostly in asymptomatic high-risk individuals. Indeed, this latter population of asymptomatic high-risk individuals would mostly benefit from extensive application and improvement of strategies for cardiovascular disease prevention with a favourable cost-benefit ratio.The Italian Society for Cardiovascular Disease Prevention Societ Italiana per la Prevenzione Cardiovascolare (SIPREC) has recognized this strategic aim, focusing a vast majority of its institutional action on the effort for providing educational supports and consensus documents, which represent an overview of the scientific knowledge and personal clinical expertise by national and international key opinion leaders. Expert committees periodically generate 'state-of-the-art' documents on specific scientific topics with relevant socioeconomic implications and large clinical impact. The present article is dedicated to healthcare professionals, and is based on the available evidence, and provides useful information on diagnostic algorithms and therapeutic options. In 2006, the SIPREC Scientific Committee promoted a consensus document on the metabolic syndrome,1 which is still widely used, frequently cited and updated, from which originated a broad educational programme throughout the Italian territory. This programme has certainly contributed to improving knowledge of a widespread clinical condition, such as the metabolic syndrome, which SIPREC interpreted not only as a theoretical pathophysiological concept or a nosographic entity, but rather as a real clinical tool for identifying and 'intercepting' those asymptomatic individuals at risk of cardiovascular events, before the estimated level of risk becomes high.This new article may be viewed in the same strategic line. The relationship between abnormalities in blood glucose metabolism (or dysglycaemia) and cardiovascular complications represents another important and relatively early target for cardiovascular disease prevention. SIPREC Scientific Committee identified even in this clinical setting an excellent group of scientific experts, in order to collect a ultidisciplinary 'task force'. This group has been asked to explain in a short, simple and effective fashion the epidemiological impact and the pathophysiological nature of the problem, its clinical features, potential diagnostic algorithms and therapeutic options, and its influence on the clinical practice of both specialist physicians and general practitioners.The work of this Task Force, which is reported in this article, is primarily a baseline for discussing novel future strategies for cardiovascular prevention. Also, this article is aimed at highlighting the importance of an emerging marker of cardiovascular risk, which is little recognized and often undervalued. Dysglycaemia, in turn, has a clinical significance, which is at least, in part, comparable with that of type 2 diabetes mellitus, both in terms of epidemiological prevalence and of long-term cardiovascular prognosis. © 2010 Adis Data Information BV. All rights reserved.

2010 - Coronary artery disease: clinical presentation, diagnosis and prognosis in women. [Articolo su rivista]
Leuzzi, C; Modena, Maria Grazia
abstract

Recent advances in the field of cardiovascular medicine have not led to significant declines in case-fatality rates for women as in men. There are gender-specific differences in symptoms profile, diagnosis and treatment of coronary disease in women. For women presenting for coronary heart disease (CHD) evaluation, traditional disease management approaches that focus on detection of a 'critical stenosis' often fail to identify those women critically at-risk. Symptoms do not help physicians in differential diagnosis of chest pain in women; indeed the most common presentation of obstructive CHD in women is atypical symptoms. In 50% of the cases, non-obstructive CHD at coronary angiography, due to 'noncardiac chest pain' or coronary microvascular dysfunction is frequently reported. For these reasons, the evidence reviewed suggests that prognostic risk assessment may work relatively better than diagnostic obstructive coronary disease assessment for women.

2010 - Endothelial function affects early carotid atherosclerosis progression in postmenopausal women [Abstract in Atti di Convegno]
Nuzzo, A; Rossi, R; Olaru, Ai; Gorlato, G; Cepeli, E; Bellucci, A; Origliani, G; Modena, Mg
abstract

2010 - Gender-specific aspects in the clinical presentation of cardiovascular disease [Articolo su rivista]
Leuzzi, Chiara; Sangiorgi, Giuseppe Massimo; Modena, Maria Grazia
abstract

More than a quarter of a million women die each year in the industrialized countries from cardiovascular diseases (CVD), and current projections indicate that this number will continue to rise with our ageing population. Important sex-related differences in the prevalence, presentation, management and outcomes of different CVD have discovered in the last two decades of cardiovascular research. Nevertheless, much evidence supporting contemporary recommendations for testing, prevention and treatment of CVD in women is still extrapolated from studies conducted predominantly in men. The compendium of CVD indicates that current research and strategy development must focus on gender-specific issues to address the societal burden and costs related to these incremental shifts in female gender involvement. Indeed, this significant burden of CVD in women places unique diagnostic, treatment and financial encumbrances on our society that are only further intensified by a lack of public awareness about the disease on the part of patients and clinicians alike. This societal burden of the disease is, in part, related to our poor understanding of gender-specific pathophysiologic differences in the presentation and prognosis of CVD and the paucity of diagnostic and treatment guidelines tailored to phenotypic differences in women. In this, scenario is of outmost importance to know these differences to provide the best care for female patients, because under-recognition of CVD in women may contribute to a worse clinical outcome. This review will provide a synopsis of available evidence on gender-based differences in the initial presentation, pathophysiology and clinical outcomes of women affected by CVD. Â© 2010 The Authors Fundamental and Clinical Pharmacology Â© SociÃ©tÃ© FranÃ§aise de Pharmacologie et de ThÃ©rapeutique.

2010 - Hypertension alone or related to the metabolic syndrome in postmenopausal women [Articolo su rivista]
Nuzzo, Annachiara; Rossi, Rosario; Modena, Maria Grazia
abstract

Cardiovascular risk is poorly perceived by women, especially during the peri-and postmenopausal period when susceptibility to cardiovascular events increases. Nevertheless in Europe, 55% of women versus 43% of men currently die of cardiovascular disease. Blood pressure is one of the most powerful and accurate determinants of cardiovascular status and risk. Despite its importance, hypertension is often underestimated and undiagnosed, especially in women. Various mechanisms are implicated to play a role in the blood pressure increase in women at the time of menopause. Hypertension can be considered an isolated disease, more typical of elderly women, or part of the metabolic syndrome, more frequent in early postmenopausal women. The metabolic syndrome, a clustering of lipid and nonlipid cardiovascular risk factors, is estimated to affect approximately 20-30% of the middle-aged population and its prevalence appears to be increasing in the worldwide population. Â© 2010 Expert Reviews Ltd.

2010 - Indexed left atrial volume, C-reactive protein and erythrocyte sedimentation rate as predictors of recurrence of non-valvular atrial fibrillation after successful cardioversion [Abstract in Atti di Convegno]
Marchese, P; Malavasi, V; Rossi, L; Delle Donne, G; Becirovic, Mirza; Nikolskaya, N; Colantoni, A; Luciani, A; Modena, Mg
abstract

Indexed left atrial volume, C-reactive protein and erythrocyte sedimentation rate as predictors of recurrence of non-valvular atrial fibrillation after successful cardioversion

2010 - Lipodystrophy and anti-retroviral therapy as predictors of sub-clinical atherosclerosis in human immunodeficiency virus infected subjects. [Articolo su rivista]
Guaraldi, Giovanni; C., Stentarelli; S., Zona; G., Orlando; F., Carli; Ligabue, Guido; A., Lattanzi; G., Zaccherini; Rossi, Rosario; Modena, Maria Grazia; N., Alexopoulos; F., Palella; P., Raggi
abstract

Although anti-retroviral therapy (ART) prolonged survival in HIV-infected persons, an increase in cardiovascular disease has also been observed. A frequent complication of ART is the development of lipodystrophy (LD) with its multiple phenotypes that may be associated with cardiovascular disease. We assessed the contribution of chronic HIV infection, ART use and LD to the presence of sub-clinical atherosclerosis as evaluated by coronary artery calcium (CAC) imaging. METHODS: Observational cross-sectional study of 372 HIV-infected patients receiving ART who attended a cardiometabolic clinic (48.2+/-8-year old; 74% men). All patients underwent CAC surveillance with computed tomography and the Agatston score was used to quantitate CAC. Presence of CAC was defined as a score >10. Multivariable logistic regression was used to evaluate associations between HIV clinical factors, ART and LD with the presence of CAC. FINDINGS: CAC was found in 134 patients (36%) with a median CAC score of 50 (range 10; 1243). Lipoatrophy alone (OR 3.82, 95% CI: 1.11; 13.1), fat accumulation alone (OR 7.65, 95% CI: 1.71; 37.17) and mixed lipodystrophy phenotypes (OR 4.36, 95% CI: 1.26; 15.01) were strongly associated with presence of CAC after adjusting for age, sex, hypertension and cumulative exposure to ART. CONCLUSION: CAC is common among long-term ART users. The association between CAC and LD underscores the potential atherosclerosis risk inherent with ART and the need to undertake routine cardiovascular surveillance in patients treated with these drugs.

2010 - Longitudinal study of the endothelial function in children and adolescents affected by type 1 diabetes mellitus [Abstract in Rivista]
Iughetti, Lorenzo; Rossi, Rosario; Predieri, Barbara; Nuzzo, A; Bruzzi, Patrizia; Salvini, Anna; Patianna, Viviana; Delle Donne, Grazia; Modena, Maria Grazia
abstract

Introduction: Cardiovascular diseases are the main cause of mortality and morbidity in patients affected by Type 1 Diabetes. The endothelial dysfunction, a precocious stage of the atherosclerotic process, can be analyzed through the brachial flow-mediated dilatation and through the evaluation, of the arterial stiffness. Objective: The aim of this study is to evaluate the presence of subclinical cardiovascular alterations and their development in pediatric patients with T1DM. Methods: A total of 42 patients with T1DM (18 females, 11.5 ± 3.6 years) entered this study. In all patients we analyzed the auxological, laboratory and clinical data (CT, HDL, LDL, TG, Glycemia, HbA1c, blood pressure (SBP-DBP). The evaluation of the endothelial function was obtained through the flow mediated dilation method (FMD), while stiffness was measured using pulse wave analysis (PWA). The measurements were repeated after 2 years and were compared with 30 healthy children and adolescents. Results: At baseline FMD values were significantly reduced in children with T1DM (4.32 ± 8.36%; vs. 9.78 ± 6.1, P = 0.003) and the lipid values result normal with a significant improvement during the study (P < 0.05). After 2 years while FMD significantly impaired, HbA1c and lipid values remained unchanged. The regression model allowed to identify CT (b = 0.683, P = 0.025) and LDL (b = )0.676, P = 0.025) as FMD predictive factors. The PWA analysis showed in females a slight decrease in myocardial perfusion. Conclusions: This study confirms that in children with T1DM the endothelial function can be already altered. The Pulse Wave Analysis results helpful to precociously individuate pathological alterations of the arterial elasticity and stratification of the cardiovascular risk.

2010 - Mehran Contrast-Induced Nephropathy Risk Score Predicts Short- And Long-term Clinical Outcomes In Patients With ST-Elevation Myocardial Infarction [Abstract in Atti di Convegno]
Bertelli, L; Sgura, Fa; Monopoli, D; Guerri, E; Leuzzi, C; Sparta, I; Politi, L; Aprile, A; Amato, A; Rossi, R; Modena, Mg; Sangiorgi, Gm
abstract

Mehran Contrast-Induced Nephropathy Risk Score Predicts Short- And Long-term Clinical Outcomes In Patients With ST-Elevation Myocardial Infarction

2010 - Mehran contrast-induced nephropathy risk score predicts short and long-term clinical outcomes in patients with ST-elevation myocardial infarction [Abstract in Atti di Convegno]
Sgura, F; Bertelli, L; Monopoli, D; Sparta, I; Guerri, E; Politi, L; Rossi, R; Sangiorgi, Gm; Modena, Mg
abstract

Mehran contrast-induced nephropathy risk score predicts short and long-term clinical outcomes in patients with ST-elevation myocardial infarction

2010 - Mehran contrast-induced nephropathy risk score predicts short- and long-term clinical outcomes in patients with ST-elevation-myocardial infarction. [Articolo su rivista]
Sgura, Fa; Bertelli, L; Monopoli, D; Leuzzi, C; Guerri, E; Spartà, I; Politi, L; Aprile, A; Amato, A; Rossi, Rosario; Biondi Zoccai, Giuseppe; Sangiorgi, Gm; Modena, Maria Grazia
abstract

BACKGROUND: The Mehran Risk Score (MRS) has been demonstrated to be clinically useful for prediction of contrast-induced nephropathy (CIN) after nonurgent percutaneous coronary intervention. We aim to validate the MRS in the setting of Primary percutaneous coronary intervention for prediction of both CIN and short- and long-term clinical outcomes.METHODS AND RESULTS: We assigned 891 consecutive patients with ST-elevation-myocardial infarction undergoing primary percutaneous coronary intervention to 4 groups of risk of CIN (RC) according to MRS (low, medium, high, and very high risk). We evaluated CIN, death, and major cardiovascular and cerebrovascular events after 25 months' mean follow-up. At multivariable analysis, mortality in very high-risk group was more than 10-fold higher (hazard ratio [HR], 10.11; 95% confidence interval [CI], 4.83 to 21.1; P<0.001) when compared with the low-risk group and was also increased in the high-risk group (HR, 6.31; 95% CI, 3.28 to 12.14; P<0.001) and medium-risk group (HR, 3.18; 95% CI, 1.83 to 5.51; P<0.001). Similarly, an increasing effect was seen across MRS strata for major cardiovascular and cerebrovascular events both in the very high-risk group (HR, 3.79; 95% CI, 2.27 to 6.6.32; P<0.001), high-risk group (HR, 1.90; 95% CI, 1.31 to 2.75; P=0.001), and medium-risk group (HR, 1.42; 95% CI, 1.10 to 1.85; P=0.007). In addition, the HR for rehospitalization increased with the increasing RC groups (HR, 3.32; 95%CI, 1.96 to 5.63; P<0.001; HR, 3.11; 95% CI, 1.35 to 7.20; P=0.008; HR, 7.73; 95% CI, 2.97 to 20.10; P<0.001, respectively). The odds ratio for CIN was 2.84 (95% CI, 1.16 to 6.92; P=0.021) in the very high RC group, 1.33 (95% CI, 0.68 to 2.61; P=0.398) in the high RC group, and 1.10 (95% CI, 0.67 to 1.79; P=0.699) in the medium RC group, as compared with the lower one.CONCLUSIONS: The MRS may be applied in the primary angioplasty setting population and is able to predict CIN and to stratify patients for poor clinical outcomes both in the short- and long-term follow-up.

2010 - Modified mother-child technique for selective cannulation of complex take-off left coronary artery [Articolo su rivista]
Monopoli, Daniel E; Politi, Luigi; Sangiorgi, Giuseppe M; Modena, Maria G.
abstract

An 85-year-old male patient, with long-standing hypertension, was admitted to our hospital for a late inferior myocardial infarction. An elective coronary angiogram was performed, but due to severe iliac artery tortuosity, thoracic aortic dilatation, high left coronary artery take-off, and separated origin of the left descending coronary artery and circumflex, selective cannulation with different catheter shapes was not possible. Thus, we decided to utilize a modified mother-child technique by cutting the first 10 cm from the hub of a conventional 7 F Judkins left 4 guiding catheter and inserting it into a 7 F valved sheath. Then, we introduced a conventional 6 F Amplatz Left 2 diagnostic catheter inside it. In this way, we were able to easily reach both separate ostia and to perform complete left coronary angiography. The technique we described herewith could represent a valid solution to allow utilization of standard coronary catheters with different shapes commercially available in cases of complex coronary artery origin. Â© 2010 Italian Federation of Cardiology.

2010 - Multivessel revascularisation in ST-elevation myocardial infarction: Too early to change the guidelines [Articolo su rivista]
Politi, Luigi; Sangiorgi, Giuseppe Massimo; Modena, Maria Grazia
abstract

Multivessel revascularisation in ST-elevation myocardial infarction: too early to change the guidelines

2010 - Optical Coherence Tomography comparison of Trapidil versus Paclitaxel Eluting Stent Implanted in non ST Elevation Myocardial Infarction [Abstract in Atti di Convegno]
Aprile, A; Politi, L; Borghi, A; Iaccarino, D; Marzullo, R; Sgura, Fa; Rossi, R; Monopoli, D; Modena, Mg; Sangiorgi, Gm
abstract

Optical Coherence Tomography comparison of Trapidil versus Paclitaxel Eluting Stent Implanted in non ST Elevation Myocardial Infarction

2010 - Peripheral Aneurysm Exclusion Associated to Side Branch Patency with Cardiatis Multilayer Stent Placement: Short and Mid Term Follow-up [Abstract in Atti di Convegno]
Marzullo, R; Aprile, A; Paganelli, C; Politi, L; Amato, A; Martelli, E; Benassi, A; Sgura, F; Modena, Mg; Sangtorgi, Gm
abstract

Peripheral Aneurysm Exclusion Associated to Side Branch Patency with Cardiatis Multilayer Stent Placement: Short and Mid Term Follow-up

2010 - Prognostic Impact of Echocardiographically Determined Left Ventricular Mass Severity According to the Proposed Categorization by the American Society of Echocardiography/European Association of Echocardiography (ASE/EAE) [Abstract in Atti di Convegno]
Barbieri, A; Bursi, F; Mantovani, F; Valenti, Chiara; Quaglia, Michele; Modena, Mg
abstract

Background: The ASE/EAE recommended the use of quantitative estimation of LV mass and defined sex-specific partition values empirically for mild, moderate and severe LV hypertrophy (LVH), based on standard deviation above or below the reference limit derived from a group of healthy people. However, the prognostic implication associated with this categorization is not known. Methods: Among 2545 unselected adult outpatients referred to the Echo Lab for any indication, LVH was assessed by measuring LV mass using the ASE/EAE recommended formula and measurements convention from LV linear dimensions indexed to body surface area. Incident hospitalization for cardiovascular disease (CVD) (coronary heart disease, arrhythmias, heart failure) and death were the outcomes of the study.

2010 - Prognostic implications of functional mitral regurgitation according to the severity of the underlying chronic heart failure: A long-term outcome study [Articolo su rivista]
Bursi, Francesca; Barbieri, Andrea; Grigioni, Francesco; Reggianini, Letizia; Zanasi, Vera; Leuzzi, Chiara; Ricci, Caterina; Piovaccari, Giulia; Branzi, Angelo; Modena, Maria Grazia
abstract

AimsTo examine the independent prognostic role of functional mitral regurgitation (FMR) and its impact across the severity of chronic heart failure (CHF) in a large population of outpatients with systolic CHF followed at two multidisciplinary clinics.Methods and resultsEchocardiography was performed upon enrolment in 469 CHF patients. Follow-up for death and heart transplant was updated on January 2007. Five-year transplant-free survival was 82.7 in patients with no or Grade I FMR, 64.4 in Grade II, 58.5 in Grade III, and 46.5 in Grade IV (P < 0.0001). There was a strong graded association between FMR and the long-term risk of death and heart transplant, which remained significant after multivariable adjustment (P = 0.0003). The association between FMR and events was strong and independent in patients with less severe symptoms and in those at lower overall risk based on a propensity score analysis, while it was not significant in patients with more advanced CHF or in the high-risk subgroup (P < 0.0001 for interactions).ConclusionThis study clarifies previous apparently discrepant results by demonstrating that FMR is an independent determinant of death and heart transplantation only in less severe CHF and in patients with a lower risk profile. This finding indicates that FMR plays a major role in the early phase of CHF, suggesting that this should be the focus of strategies attempting to reduce it. Â© The Author 2010.

2010 - Prognostic role of anemia in patients with acute myocardial infarction treated with primary angioplasty. A long-term follow-up study [Abstract in Atti di Convegno]
Sgura, F; Bertelli, L; Rossi, R; Sparta, I; Guerri, E; Monopoli, D; Politi, L; Sangiorgi, Gm; Modena, Mg
abstract

Prognostic role of anemia in patients with acute myocardial infarction treated with primary angioplasty. A long-term follow-up study

2010 - Rationale and study design of the OISTER trial: optical coherence tomography evaluation of stent struts re-endothelialization in patients with non-ST-elevation acute coronary syndromes--a comparison of the intrEpide tRapidil eluting stent vs. taxus drug-eluting stent implantation. [Articolo su rivista]
Iaccarino, D; Politi, L; Rossi, Rosario; Sgura, F; Monopoli, D; Modena, Maria Grazia; Sangiorgi, Gm
abstract

BACKGROUND: Drug-eluting stents (DES) have been designed to prevent restenosis, but long-term clinical outcome may be offset by an increased risk of stent thrombosis, which is associated with suboptimal stent implantation or delayed re-endothelialization. DES implantation has also been associated with local persistent endothelial dysfunction. Conversely, Trapidil is a potent anti-inflammatory, vasodilatator and antiproliferative drug and several studies have shown anti-restenotic effects, suggesting substantial clinical benefits through the use of Trapidil-eluting DES.STUDY DESIGN: This is a longitudinal, single-blind, double-arm, randomized multicenter study. Forty patients with non-ST-elevation acute coronary syndromes who present at the index procedure with multivessel coronary disease in the major epicardial coronary arteries will be enrolled. Patients should present a culprit lesion with stenosis 70% or more associated with another stenosis 70% or more in another coronary artery. Patients will be randomized in a 1: 1 fashion to receive either an Intrepide trapidil-eluting stent or a Taxus paclitaxel-eluting stent on the culprit lesion. After 90 days, the nonculprit lesion will be treated with the stent of the opposite randomization arm and optical coherence tomography (OCT) analysis of the index stented segment will be performed. Follow-up angiography, combined with vasomotor analysis of endothelial function by rapid atrial pacing, will be done at 12 months after the index procedure on both stents. To further characterize the status of the endothelium, serum measurement of vascular endothelial growth factor gradient between the aorta and 15 mm distal to the implanted stent will be performed at 12 months. The primary endpoint of the study is to compare stent struts re-endothelialization at 90 days by OCT. The secondary endpoint is to compare angiographic outcome and coronary endothelial function 12 months after the index procedure and to compare clinical outcome at 1 and 2 years between trapidil-eluting DES versus paclitaxel-eluting DES.CONCLUSION: We hypothesize that the utilization of trapidil-eluting DES in the setting of acute coronary syndromes will be characterized by a greater early re-endothelialization associated with an antiproliferative effect offering a similar efficacy with a better safety profile compared with first-generation DES

2010 - Recanalization of Superficial Femoral Artery Occlusion by Antegrade vs. Retrograde Approach utilizing Coronary Techniques: Acute and Long Term Clinical Outcomes [Abstract in Atti di Convegno]
Colantonio, R; Politi, L; Martelli, E; Godino, C; Colombo, Asher Daniel; Modena, Mg; Sangiorgi, Gm
abstract

Recanalization of Superficial Femoral Artery Occlusion by Antegrade vs. Retrograde Approach utilizing Coronary Techniques: Acute and Long Term Clinical Outcomes

2010 - Reduction Of Scatter Radiation During Transradial Percutaneous Coronary Angiography: A Randomized Trial Using A Lead-free Radiation Shield [Abstract in Atti di Convegno]
Politi, Luigi Vincenzo; Aprile, A; Amato, Angelo; Marzullo, Raffaella; Sgura, F; Rossi, R; Monopoli, Daniel Enrique; Modena, Mg; Sangiorgi, Gm
abstract

Reduction Of Scatter Radiation During Transradial Percutaneous Coronary Angiography: A Randomized Trial Using A Lead-free Radiation Shield

2010 - Ritardo evitabile: è un problema solo extraospedaliero? [Articolo su rivista]
Grassi, L.; Casali, E.; Bonfreschi, V.; Molinari, R.; Reggianin, L.; Callegaro, A.; Fruggeri, L.; Barbieri, Alberto; Pasetto, A.; Modena, Maria Grazia
abstract

...

2010 - Sinus venosus atrial septal defect: the importance of multimodality approach [Articolo su rivista]
Malagoli, A; Barbieri, A; Pacini, D; Ligabue, Guido; Fiocchi, F; Modena, Maria Grazia
abstract

A multidisciplinary approach to congenital heart diseases in adults is a primary element for modern medicine. The diagnosis of a sinus venosus atrial septal defect is a typical example of disease that requires the different skills of the cardiologist, cardiac surgeon and radiologist

2010 - Specific aspects of womens health in relation to coronary artery disease and referral path. The SPIRIT Women clinical trial [Abstract in Atti di Convegno]
Mikhail, G; Morice, Mc; Windecker, S; Modena, Mg; Mauri, F; Strasser, R; Grinfeld, L; Papeleu, P; Spaepen, E.
abstract

Specific aspects of womens health in relation to coronary artery disease and referral path. The SPIRIT Women clinical trial

2010 - Stent-triggered 'electric shock' during leg bending 2 years after emergency iliac artery percutaneous revascularization. [Articolo su rivista]
Iaccarino, D; Politi, L; Curti, T; Modena, Maria Grazia; Sangiorgi, Gm
abstract

We report a case of a 41-year-old woman who underwent surgical removal of an uterine leiomyoma, complicated by accidental injury of the left external iliac artery, treated by suturing. A few days after the intervention the patient was treated with emergency percutaneous stent implantation for acute thrombotic occlusion of the external iliac artery. Two years later, the patient began to complain of pain in the left leg, as an 'electric shock' sensation in the leg during squatting and leg adduction on the trunk. An angiographic control showed a critical in-stent restenosis at the level of a misplaced stent. Thus the patient was submitted to surgical exploration and stent removal.

2010 - Strategie differenziate nelle popolazioni target: Le donne [Articolo su rivista]
Leuzzi, Chiara; Modena, Maria Grazia
abstract

Strategie differenziate nelle popolazioni target: Le donne

2010 - The ACEF Score: A User-Friendly And Powerful Predictor of Short-Term Mortality In Patients With ST-Elevation Myocardial Infarction [Abstract in Atti di Convegno]
Bertelli, L; Sangiorgi, Gm; Zoccai, Gb; Sgura, Fa; Monopoli, D; Leuzzi, C; Politi, L; Aprile, A; Amato, A; Rossi, R; Modena, Mg
abstract

The ACEF Score: A User-Friendly And Powerful Predictor of Short-Term Mortality In Patients With ST-Elevation Myocardial Infarction

2010 - The ACEF score: a simple but powerful predictor of short-term mortality in patients with ST-elevation myocardial infarction [Abstract in Atti di Convegno]
Sangiorgi, Gm; Bertelli, L; Zoccai, Gb; Sgura, F; Monopoli, D; Politi, L; Rossi, R; Modena, Mg
abstract

Background: several clinical risk scores are available for the risk stratification of patients with ST-elevation myocardial infarction (STEMI), such as the CADILLAC, GRACE, PAMI, TIMI, and Zwolle, but all are complex to use and there is uncertainty on the best one. The age-creatinine-ejection fraction (ACEF) score, has been recently proven effective and proficient as a risk score in cardiac surgery despite its user-friendliness. We thus aimed to compare the performance of the ACEF score in comparison to the other available risk scores in patient with STEMI. Methods: subjects with STEMI undergoing primary percutaneous coronary intervention at our Institution from 2001 to 2009 were enrolled. The primary end-point was in-hospital all-cause death, whereas long-term all-cause death, long-term cardiac death were appraised as secondary outcomes. ACEF, CADILLAC, GRACE, PAMI, TIMI, and Zwolle risk scores were compared with receiver-operating characteristics (ROC) curves with areas under the curve (AUC), and binary multivariable logistic regression analysis with odds ratios (OR), plus 95% confidence intervals.

2009 - ANTIRETROVIRAL THERAPY AND LIPODYSTROPHY AS PREDICTORS OF SUB-CLINICAL ATHEROSCLEROSIS [Abstract in Rivista]
Guaraldi, Giovanni; N., Alexopoulos; Stentarelli, Chiara; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; A., Lattanzi; Rossi, Rosario; Modena, Maria Grazia; F., Palella; P., Raggi
abstract

Although anti-retroviral therapy (ART) has prolonged survival in human immunodeficiency virus (HIV)-infected persons, an increase in cardiovascular disease (CVD) has been observed. A frequent complication of ART is the development of lipodystrophy (LD) that may be associated with CVD. We assessed the contribution of chronic HIV infection, ART use and LD to the presence and extent of sub-clinical atherosclerosis as evaluated by coronary artery calcium (CAC) imaging.

2009 - Antioxidant factors and endothelial function in children and adolescents with Type 1 diabetes mellitus [Abstract in Rivista]
Iughetti, Lorenzo; A., Lasagni; Rossi, Rosario; P., Appio; G., Delle Donne; A., Nuzzo; Patianna, VIVIANA DORA; Salvini, Annamaria; Modena, Maria Grazia; B., Bergamini; Predieri, Barbara
abstract

Our data demonstrated that in our T1DM patients A) the satisfactory glycemic control was coupled with normal lipid profile but increased oxidative parameters, B) the endothelial function was impaired (especially in boys), and C) there was no correlation between FMD and antioxidant status and glycemia. However, the relationship of FMD with LDL-C underline the possible role of a global metabolic control.

2009 - Arterial stiffness evaluation in patients with systemic sclerosis: an interesting correlation with right ventricular function and cardiopulmonary performance [Abstract in Atti di Convegno]
Marchese, P; Delle Donne, G; Nuzzo, A; Franchi, F; Rollini, F; Giuggioli, D; Ferri, C; Rossi, R; Modena, Mg
abstract

Arterial stiffness evaluation in patients with systemic sclerosis: an interesting correlation with right ventricular function and cardiopulmonary performance

2009 - Assessing coronary heart disease in women [Articolo su rivista]
Rollini, F; Mfeukeu, L; Modena, Maria Grazia
abstract

Coronary heart disease (CHD) is a leading cause of mortality in women worldwide. However CHD is still considered to be a male disease and it is likely to be under-diagnosed in women since symptoms are different in women and diagnostic tests may be less specific or sensitive. This review examines the symptoms and risk factors for CHD in women. The role of invasive and non-invasive tests together with their prognostic implications as well as indications for coronary revascularization will be discussed. New research should focus on the role of gender differences in CHD and trials specifically designed to study women

2009 - CORONARY AGEING IN HIV INFECTED PATIENTS [Abstract in Rivista]
Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; N., Alexopoulos; Ligabue, Guido; F., Fiocchi; Rossi, Rosario; Modena, Maria Grazia; F., Palella; P., Raggi
abstract

The objectives of this study were to assess the coronaryage (CA) of a cohort of HIV infected patients based on the extent of coronary artery calcium (CAC) and to iden-tify the variables associated with it.

2009 - Chronic total coronary occlusion in patients with intermediate viability: value of low-dose dobutamine and contrast-enhanced 3-T MRI in predicting functional recovery in patients undergoing percutaneous revascularisation with drug-eluting stent. [Articolo su rivista]
Fiocchi, F; Sgura, F; Di Girolamo, A; Ligabue, Guido; Ferraresi, S; Rossi, Rosario; D'Amico, Roberto; Modena, Maria Grazia; Torricelli, Pietro
abstract

PURPOSE: Myocardial viability was evaluated by magnetic resonance imaging (MRI) in patients with chronic total coronary occlusion (CTO) treated with a drug-eluting stent. Change in left ventricular ejection fraction (LVEF) was analysed. MATERIALS AND METHODS: Twenty-three patients with CTO underwent delayed-enhancement (DE) and low-dose dobutamine MRI (LD). Diastolic wall thickness (DWT), dobutamine-induced systolic wall thickening (SWT) and DE transmural extension were quantitatively assessed in vessel-related segments, calculating the contribution of viable tissue to SWT, expressed as viability index (VI)=[SWTx(100 - DE)]/100. Patients with transmural enhancement were excluded from revascularisation. At 6 months follow-up, patients underwent coronary angiography (CA) and MRI. Functional recovery was defined as a 2-mm increase in SWT. RESULTS: Transmural enhancement (mean DE 62.88+/-37.18] was present in three patients. Mean DWT, SWT, VI and DE of recanalised patients were 8.03+/-2.35, 2.64+/-1.56, 1.77+/-1.48 mm and 41.97+/-30.32. Revascularisation was successful in 14/16. Follow-up CA showed patency of treated vessels. Functional recovery was achieved in 13 patients. Functional recovery showed significant correlation with SWT (beta 1,779, p=0.015), and even higher correlation with VI (beta 2.032, p=0.011). LVEF improved significantly [Delta 95% confidence interval (CI) -4.47, p=0.0203). CONCLUSIONS: Invasive CTO treatment has beneficial effects on myocardial contractility that can be predicted by VI, and on LVEF.

2009 - Coronary aging in HIV-infected patients [Articolo su rivista]
Guaraldi, G.; Zona, S.; Alexopoulos, N.; Orlando, G.; Carli, F.; Ligabue, G.; Fiocchi, F.; Lattanzi, A.; Rossi, R.; Modena, M. G.; Esposito, R.; Palella, F.; Raggi, P.
abstract

BACKGROUND: Human immunodeficiency virus (HIV)-infected patients often demonstrate accelerated aging processes. We investigated whether the vascular age of a cohort of stable HIV-infected patients receiving antiretroviral therapy (ART) was increased and sought out predictors of increased vascular age. METHODS: In this cross-sectional study, 400 HIV-infected patients (mean age, 48 years) attending a cardiometabolic clinic underwent cardiac computed tomography imaging to identify coronary artery calcium (CAC). Vascular age was estimated on the basis of the extent of CAC by means of previously published equations. RESULTS: Increased vascular age was observed in 162 patients (40.5%), with an average increase of 15 years (range, 1-43 years) over the chronological age. In univariable analyses, chronological age, male sex, systolic blood pressure, duration of ART, fasting glucose level, fasting serum triglyceride level, total cholesterol level, low-density and high-density lipoprotein cholesterol levels, hypertension, and the presence of the metabolic syndrome were associated with increased vascular age. In multivariable linear regression analyses, current CD4+ cell count was the only predictor of increased vascular age (beta = 0.51; P = .005). CONCLUSIONS: Increased vascular age is frequent among HIV-infected patients and appears to be associated with CD4+ cell count. If these findings were to be confirmed in prospective trials, a positive response to ART with an increase in CD4+ cell count may become a marker of increased risk of atherosclerosis development.

2009 - Endothelial function in adolescents with type 1 diabetes mellitus (TIDM) [Funzione endoteliale in adolescenti con diabete di tipo 1], [Articolo su rivista]
Bruzzi, Patrizia; Vellani, Giulia; Predieri, Barbara; Delle Donne, G; Iaccarino, D; Madeo, Simona Filomena; Quitadamo, Al; Pellicanò, F; Rossi, Rosario; Modena, Maria Grazia; Balli, F; Iughetti, Lorenzo
abstract

Patients with type 1 diabetes mellitus (T1DM) have an increased risk of cardiovascular complications related to the duration of diabetes and the degree of glycemic control. Impared flow-mediated dilation (FMD) has been used to evaluate the vascular function. Aim is to evaluate longitudinally changes of FMD in T1DM adolescents. Methods. Twenty-five adolescents (14 males and 11 females, aged 12.9 ± 2.3 years) with T1DM (duration of disease 54.1 ± 41.1 months) entered the study. In all patients glycaemia, glycated haemoglobin (HbA1c), lipid values, and FMD were determined at the beginning and after 30.20 months. Vascular function was assessed by measurement of endothelium-dependent vasodilatation of the brachial artery using a high-sensibility ultrasound system. FMD was expressed as percentage change of diameter of the artery following reactive hyperemia from baseline. Results. At the end of the study, the mean value of FMD was significantly worsted (6.8 ± 11.8 vs 1.4 ± 7.8; p = 0.04). No correlation was demonstrated between FMD and lipid profile and HbA1c. Longitudinally boys had significantly lower FMD than girls (-2.3 ± 6.3 vs 6.4 ± 6.8; p = 0.002). Conclusion. Adolescents with T1DM have a worse FMD, more evident in males, and apparently unrelated to glycemic control.

2009 - Failure of mitral valve repair: Partial detachment of valvular ring by 3D transesophageal echocardiography reconstruction [Articolo su rivista]
Malagoli, Alessandro; Bursi, Francesca; Modena, Maria Grazia
abstract

(ECHOCARDIOGRAPHY, Volume 26, January 2009).

2009 - Influence of body mass index on extent of coronary atherosclerosis and cardiac events in a cohort of patients at risk of coronary artery disease [Articolo su rivista]
Rossi, Rosario; Iaccarino, D; Nuzzo, A; Chiurlia, E; Bacco, L; Venturelli, A; Modena, Maria Grazia
abstract

BACKGROUND AND AIM: To estimate if a meaningful relationship exists between body mass index (BMI) and the entity of coronary atherosclerosis, coronary events and mortality in a cohort of consecutive patients with suspected coronary artery disease (CAD).METHODS AND RESULTS: In this prospective study, we enrolled 1299 consecutive patients (905 [69.7%] males) who had undergone coronary angiography. Our sample consisted of 477 patients (36.8%) of normal weight; 567 (43.6%) overweight and 255 (19.6%) obese, according to the WHO classification. Conventional cardiovascular risk factors, BMI, endothelial function and subclinical inflammation were studied. Different angiographic CAD scores were used to quantify coronary atherosclerotic burden. In overweight and obese patients, respect to normal weight population, there is a higher prevalence of hypertension, hypercholesterolemia and diabetes mellitus, but BMI was not significantly associated with greater extent of coronary atherosclerosis. At follow-up (mean: 40; range: 24-82 months) obese and overweight patients showed a higher incidence of coronary events compared to the normal weight population (74.9% [obese] versus 62.7% [overweight] versus 53.2% [normal weight]; adjusted relative risk [obese versus overweight]: 1.08 [95% confidence interval: 1.02-1.23]; P<0.05; and adjusted RR [obese versus normal weight]: 1.17 [95% CI: 1.10-1.42], P<0.01). Mortality from cardiac events was not significant within the categories. The Cox regression model showed flow mediated dilation (P<0.0001), high-sensitive C reactive protein (P=0.022) and BMI (P=0.045) as independent predictors of acute coronary events.CONCLUSION: BMI is not associated with the extent of coronary atherosclerosis and mortality. The higher incidence of coronary events in obese subjects is only partly explained by conventional associated risk factors. Impaired endothelial function and sub-clinical inflammation could be involved in this association but BMI itself is related to cardiovascular events suggesting that other unknown (or not considered) pathways are involved.

2009 - Influence of body mass index on extent of coronary atherosclerosis and cardiac events in patients at risk of coronary artery disease. role of endothelial function and sub-clinical inflammation [Abstract in Atti di Convegno]
Iaccarino, D; Rossi, R; Chiurlia, E; Nuzzo, A; Bellucci, A; Modena, Mg
abstract

Influence of body mass index on extent of coronary atherosclerosis and cardiac events in patients at risk of coronary artery disease. role of endothelial function and sub-clinical inflammation

2009 - Intra-procedural continuous venous venous hemofiltration in preventing contrast induced nephropathy in patients with very low creatinine clearance undergoing coronary intervention [Abstract in Atti di Convegno]
Politi, L; Sgura, F; Rossi, R; Monopoli, D; Rollini, F; Perrone, S; Sangiorgi, Gm; Modena, Mg
abstract

Intra-procedural continuous venous venous hemofiltration in preventing contrast induced nephropathy in patients with very low creatinine clearance undergoing coronary intervention

2009 - Left Ventricular Pacing and Biventricular Pacing Improve Left Anterior Descending Coronary Artery Flow in Patients With Advanced Heart Failure [Abstract in Atti di Convegno]
Rossi, L; Turco, V; Casali, E; Malavasi, V; Modena, Mg
abstract

Left Ventricular Pacing and Biventricular Pacing Improve Left Anterior Descending Coronary Artery Flow in Patients With Advanced Heart Failure

2009 - Lipide profile, antioxidant factors and endothelial function in children and adolescent with type 1 diabetes mellitus [Abstract in Rivista]
L., Iughetti; A., Lasagni; Bergamini, Barbara Maria; Rossi, Rosario; P., Appio; A., Nuzzo; Modena, Maria Grazia; Salvini, Annamaria; Lami, Francesca; Bruzzi, Patrizia; Vellani, Giulia; Patianna, VIVIANA DORA; Predieri, Barbara
abstract

Type 1 diabetes mellitus (T1DM) is associated with the development of micro- and macro-vascular complication generally related to the duration of disease and glycemic control. Chronic hyperglycemia increases production of free radical intermediates which in turn augments oxidative stress. The oxidative stress can play a key role in the development of diabetic complications affecting also vascular function.In this study we evaluated the lipid profile, the parameters related to oxidative stress and the endothelial function to assess the relationships between these parameters and metabolic control in children and adolescents with T1DM. A total of 58 T1DM patient (11,5±3,49 yr) and 36 healthy children (9,60±3,21 yr) were studied.In all children serum concentration of total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglycerides (TG), Lipoprotein(a) (Lp(a)), homocysteine, fibrinogen, MDA, Vitamin E (VitE), beta-carotene, lycopene, retinol, Vitamin C reduced (Vit C-Red) and oxidized (VitC-Oxid) and hemoglobin glycosilated (HbA1c) were measured. Vascular function was assessed by measurement of endothelium-dependent vasodilatation of brachial artery (FMD) using a high-sensibility of ultrasound system. There were no significant difference in the levels of TC, LDL-C and HDL-C between diabetic patients and the controls. Serum concentrations of TG in T1DM subjects were significantly lower than in control ones. Total antioxidant status (VitE, beta-carotene, lycopene, retinol, Vit C-Red) don't showed significant difference between groups. Only levels of VitC-Oxid were significant higher in patiens with T1DM. Moreover, prepuberal T1DM subjects showed higher MDA serum concentration than controls (p<0,01). FMD (7.99±1.06%) was impaired in 46% of T1DM subjects. There was negative correlation between FMD and serum levels of LDL-C. In our T1DM patients the glycemic control (mean value of HbA1c= 8,33%) was associated with normal lipid profile and normal antioxidant levels. Despite of these data diabetic patients show increased oxidative parameters (MDA, VitC-Oxid). Even if FMD was not apparently related to antioxidant status, the relationship with lipid values emphasizes the role of a global metabolic control to optimize the vascular health of these patients.

2009 - Metabolic disorders induced by highly active antiretroviral therapy and their relationship with vascular remodeling of the brachial artery in a population of HIV-infected patients [Articolo su rivista]
Rossi, Rosario; A., Nuzzo; Guaraldi, Giovanni; N., Squillace; G., Orlando; Esposito, Roberto; A., Lattanzi; Modena, Maria Grazia
abstract

Antiretroviral therapy has positively modified the natural history of HIV infection; but this treatment can induce metabolic abnormalities, including dyslipidemia, fat redistribution, high blood pressure, and insulin resistance. The metabolic syndrome, a clustering of the metabolic disorders, is frequently detected among HIV patients, especially those on antiretroviral treatment. All the arteries can modify their diameter in response to a chronic injury. This process, defined vascular remodeling, was demonstrated for the brachial artery. It is well known that the diameter of the brachial artery was correlated with the number of the elements of the metabolic syndrome and was associated with the severity of coronary artery disease. On this basis, we postulate that brachial arterial enlargement may be a process potentially correlated with the metabolic disorders induced by antiretroviral therapy. We tested this hypothesis in a large population of HIV-infected patients in which we measured brachial artery diameter, as an indicator of artery remodeling, by noninvasive, ultrasonographic technique. Our population consisted of 570 patients, with a mean age of 46.3 +/- 7.1 years. All the patients were chronically treated with highly active antiretroviral therapy. Brachial artery diameter was correlated with insulin resistance, evaluated by the homeostasis model assessment of insulin resistance index (r = 0.18, P < .0001). There was a significant linear increase in brachial artery diameter as the number of components of the metabolic syndrome increased: brachial artery diameter for those with 0, 1, 2, 3, or + characteristics was 39.3 +/- 7.2, 41.0 +/- 6.8, 42.0 +/- 7.3, and 43.8 +/- 7.9 mm, respectively (P < .001 for trend). In multivariable logistic regression analysis, brachial artery diameter was independently correlated with the presence of metabolic syndrome. Our results are in line with the hypothesis that, among HIV-infected patients chronically treated with antiretroviral therapy, those with a larger brachial artery diameter are at high risk for metabolic disorders, including a more severe insulin resistance and the presence of metabolic syndrome.

2009 - Metabolic syndrome and psychiatric comorbidity the modena protocol [Abstract in Rivista]
Po, S; Cameli, M; Ferrari, Silvia; Pingani, L; Chiurlia, E; Iaccarino, D; Modena, Maria Grazia; Rigatelli, Marco
abstract

Not available

2009 - Metabolic syndrome and psychiatric comorbidity: the Modena protocol [Abstract in Rivista]
S., Po; Cameli, Michela; Forghieri, Matilde; C., Giubbarelli; Pingani, Luca; Ferrari, Silvia; Chiurlia, Emilio; Iaccarino, Daniele; Modena, Maria Grazia
abstract

Metabolic syndrome and psychiatric comorbidity: the Modena protocol

2009 - Moving from risk factor assessment to atherosclerosis imaging to select the most appropriate patient for primary prevention [Abstract in Rivista]
Guaraldi, Giovanni; Zona, Stefano; A., Roverato; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Rossi, Rosario; Modena, Maria Grazia; P., Raggi
abstract

All HIV-infected adults should undergo coronary heart disease risk assessment with Framingham Risk Score /FRS) to guide preventive treatment intensity. The European Hypertension Guidelines (ESH-ESC) and the FRS are examples of algorithms used to identify people who qualify for primary prevention: clinical decision making is usually most uncertain in the intermediate risk category (10-20% 10year-risk of events) an in this group imaging for sub-clinical atherosclerosis has been shown to improve risk prediction. The purpose of this study was to identify people who qualify and not qualify for primary prevention for CVD according to ESH-ESC, NCEP.FRS and CAC-FRS across coronary calcium score strata in all HIV infected patients and in the subset of female and young patients (<55 yrs males and <65 if females)

2009 - Multivessel Coronary Disease in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Angioplasty: Different Strategies of Treatment and Long-Term Outcomes [Abstract in Atti di Convegno]
Politi, L; Rossi, R; Sgura, Fa; Monopoli, De; Di Girolamo, A; Guerri, E; Bursi, F; Modena, Mg
abstract

Multivessel Coronary Disease in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Angioplasty: Different Strategies of Treatment and Long-Term Outcomes

2009 - Paclitaxel eluting balloon: from bench to bedside [Articolo su rivista]
Marzullo, R; Aprile, A; Clementi, F; Stella, P; Modena, Maria Grazia; Sangiorgi, Gm
abstract

Despite the impressive progress of percutaneous treatment modalities, restenosis remains the major Achilles heel of interventional cardiology. Approximately 25% of the general population treated for coronary diseases with a bare-metal stent and about 10% of patients treated with a drug-eluting stent develop an overgrowth of vascular tissue and renarrowing inside the stent, or in-stent restenosis. These rates are even greater in diabetics and patients at higher risk of restenosis both for clinical presentation (patients in dialysis, low ejection fraction) or anatomical characteristics (ostial, bifurcation, long lesions). Non-stent based local drug delivery and particularly the use of paclitaxel eluting balloon (PEB) could be one promising strategy to reduce restenosis. This review will briefly explore the different characteristics of PEB devices currently present in the market and summarize the results obtained both in animal models and clinical practice, giving an indication of the potential field of application of this new technology

2009 - Peri-coronary Epicardial Adipose Tissue is Related to Coronary Artery Disease in Patients Undergoing Cardiac Computed Tomography [Abstract in Atti di Convegno]
Iaccarino, D; Chiurlia, E; DI GIROLAMO, Andrea; Fiocchi, F; Rossi, R; Romagnoli, R; Modena, Mg
abstract

Peri-coronary Epicardial Adipose Tissue is Related to Coronary Artery Disease in Patients Undergoing Cardiac Computed Tomography

2009 - Perioperative red blood cell transfusion and outcome in stable patients after elective major vascular surgery. [Articolo su rivista]
Bursi, F; Barbieri, A; Politi, L; Di Girolamo, A; Malagoli, A; Grimaldi, T; Rumolo, A; Busani, S; Girardis, Massimo; Jaffe, As; Modena, Maria Grazia
abstract

OBJECTIVES:Definitive evidence that red blood cell transfusion improves outcome after vascular surgery is lacking. The aims of the study were to determine, among stable consecutive patients who underwent elective major vascular surgery, (1) the association between postoperative transfusion and 30-day death, myocardial infarction, and both, and (2) and if this association differs according to the presence of postoperative anaemia (haemoglobin value less than 9.0 g/dL within 7 days after surgery).METHODS:A retrospective observational study was conducted on 359 patients prospectively screened according to the ACC/AHA guidelines for preoperative risk in non-cardiac surgery. Main outcome was 30-day death; secondary outcomes 30-day myocardial infarction, and composite of 30-day myocardial infarction or death.RESULTS:Of the patients included, 95 (26.5%) received at least one unit of red blood cells. Patients who received transfusion had a significantly increased hazard of 30-day death (hazard ratio [HR] 11.72, 95% confidence interval [CI] 3.92-35.10; p<0.0001), myocardial infarction (HR 3.3, 95% CI 1.7-6.1; p=0.0003), and both (HR 4.0 95% CI 2.2-7.3; p<0.0001). Such associations held even after adjusting for baseline characteristics, surgical risk, bleeding, and propensity to receive transfusion. There was a significant interaction between transfusion and postoperative anaemia (p=0.012). In patients without anaemia, transfusion was associated with higher risk of 30-day death (HR 19.20, 95% CI 3.99-92.45; p=0.007), myocardial infarction (HR 5.05, 95% CI 2.23-11.44; p=0.0001), and both. Conversely, in patients with anaemia this association was not significant.CONCLUSIONS:In patients who underwent elective major vascular surgery, perioperative transfusion was associated with a significantly increased risk of 30-day events which was more attributable to patients with lesser degree of anaemia. Our data caution against the use of liberal transfusion in

2009 - Positive coronary artery remodelling detected by IVUS after stent implantation for ST elevation myocardial infarction [Articolo su rivista]
Di Girolamo, Andrea; Politi, Luigi; Modena, Maria Grazia
abstract

Positive coronary artery remodelling detected by IVUS after stent implantation for ST elevation myocardial infarction.

2009 - Prognostic impact of pulmonary arterial hypertension in patients with severe mitral regurgitation due to flail leflets: a multicenter long-term international study [Abstract in Atti di Convegno]
Bursi, F; Grigioni, F; Barbieri, A; Tribouilloy, C; Avierinos, Jf; Branzi, A; Modena, Mg; Enriquez-Sarano, M.
abstract

Aims To determine the frequency, predictors, and outcome implications of pulmonary hypertension (PH) diagnosed by Doppler echocardiography in a large cohort of patients with the homogenous diagnosis of degenerative mitral regurgitation (MR) due to flail leaflets. Methods and results The Mitral Regurgitation International DAtabase (MIDA) is a registry including patients with MR due to flail leaflets consecutively referred at tertiary centres in Europe and the USA. Between 1987 and 2004, pulmonary artery systolic pressure (PASP) was measured at baseline by Doppler echocardiography in 437 patients (age 67 ± 11 years; 66% men). Pulmonary hypertension (PASP > 50 mmHg) was observed in 102 patients (23%). Independent predictors of PH were age and left atrial size (P < 0.0001). During a mean follow-up of 4.8 ± 2.8 years, PH was a strong independent predictor of death [adjusted HR 2.03 (1.30–3.18) P = 0.002], cardiovascular death [CVD; adjusted HR 2.21 (1.30–3.76) P = 0.003], and heart failure [adjusted HR 1.70 (1.10–2.62) P = 0.018]. Mitral valve surgery at any time during follow-up (performed in 325 patients, 75%) was beneficial [adjusted HR for death 0.22 (0.14–0.36) P < 0.001], but PH was associated with the increased risk of postoperative death and CVD (P = 0.01). Conclusion Pulmonary hypertension is a frequent complication of significant MR due to flail leaflet and is associated with major outcome implications, approximately doubling the risk of death and heart failure after diagnosis. Mitral valve surgery performed during follow-up is beneficial but does not completely abolish the adverse effects of PH once it is established and is particularly beneficial in patients without PH. These data support relieving PH secondary to MR due to flail leaflet, but also careful consideration for mitral surgery before PH is established.

2009 - Prognostic implications of indexed left ventricular end-diastolic diameter by echocardiography to outpatients with chronic systolic heart failure: application of ASE/ESC guidelines [Abstract in Atti di Convegno]
Bursi, F; Barbieri, A; Leuzzi, C; Reggianini, L; Manicardi, C; Copelli, Silvia; Modena, Mg
abstract

Prognostic implications of indexed left ventricular end-diastolic diameter by echocardiography to outpatients with chronic systolic heart failure: application of ASE/ESC guidelines

2009 - Prognostic value of three commonly used different methods of assessing renal function in ambulatory patients with chronic heart failure and systolic dysfunction [Abstract in Atti di Convegno]
Leuzzi, C; Barbieri, A; Bursi, F; Reggianini, Luca; Manicardi, Chiara; Modena, Mg
abstract

Prognostic value of three commonly used different methods of assessing renal function in ambulatory patients with chronic heart failure and systolic dysfunction

2009 - Relationship Between Arterial Stiffness, Assessed Using Pulse Wave Velocity and Coronary Artery Calcification Score as Assessed by 64 Multislice Computed Tomography [Abstract in Atti di Convegno]
DELLE DONNE, Grazia; Marchese, Procolo; DI GIROLAMO, Andrea; Fiocchi, Federica; Ligabue, Guido; Romagnoli, Renato; Rossi, Rosario; Modena, Maria Grazia
abstract

Relationship Between Arterial Stiffness, Assessed Using Pulse Wave Velocity and Coronary Artery Calcification Score as Assessed by 64 Multislice Computed Tomography

2009 - Subclinical coronary artery atherosclerosis in healthy women with nonalcoholic fatty liver disease [Articolo su rivista]
Chiurlia, E; Iaccarino, D; Rossi, R; Nuzzo, Ac; Fiocchi, F; Modena, Mg
abstract

Subclinical coronary artery atherosclerosis in healthy women with nonalcoholic fatty liver disease

2009 - Survival Implication of Left Ventricular End-Systolic Diameter in Mitral Regurgitation Due to Flail Leaflets. A Long-Term Follow-Up Multicenter Study [Articolo su rivista]
Tribouilloy, C; Grigioni, F; Avierinos, Jf; Barbieri, A; Rusinaru, D; Szymanski, C; Ferlito, M; Tafanelli, L; Bursi, F; Trojette, F; Branzi, A; Habib, G; Modena, Maria Grazia; Enriquez Sarano, M; Investigators, Mida
abstract

OBJECTIVES: This study analyzed the association of left ventricular end-systolic diameter (LVESD) with survival after diagnosis in organic mitral regurgitation (MR) due to flail leaflets.BACKGROUND: LVESD is a marker of left ventricular function in patients with organic MR but its association to survival after diagnosis is unknown.METHODS: The MIDA (Mitral Regurgitation International Database) registry is a multicenter registry of echocardiographically diagnosed organic MR due to flail leaflets. We enrolled 739 patients with MR due to flail leaflets (age 65 +/- 12 years; ejection fraction: 65 +/- 10%) in whom LVESD was measured (36 +/- 7 mm).RESULTS: Under conservative management, 10-year survival and survival free of cardiac death were higher with LVESD <40 mm versus > or =40 mm (64 +/- 5% vs. 48 +/- 10%; p < 0.001, and 73 +/- 5% vs. 63 +/- 10%; p = 0.001). LVESD > or =40 mm independently predicted overall mortality (hazard ratio [HR]: 1.95, 95% confidence interval [CI]: 1.01 to 3.83) and cardiac mortality (HR: 3.09, 95% CI: 1.35 to 7.09) under conservative management. Mortality risk increased linearly with LVESD >40 mm (HR: 1.15, 95% CI: 1.04 to 1.27 per 1-mm increment). During the entire follow-up (including post-surgical), LVESD > or =40 mm independently predicted overall mortality (HR: 1.86, 95% CI: 1.24 to 2.80) and cardiac mortality (HR: 2.14, 95% CI: 1.29 to 3.56), due to persistence of excess mortality in patients with LVESD > or =40 mm after surgery (HR: 1.86, 95% CI: 1.11 to 3.15 for overall death, and HR: 1.81, 95% CI: 1.05 to 3.54 for cardiac death).CONCLUSIONS: In MR due to flail leaflets, LVESD > or =40 mm is independently associated with increased mortality under medical management but also after mitral surgery. These findings support prompt surgical rescue in patients with LVESD > or =40 mm but also suggest that best preservation of survival is achieved in patients operated before LVESD reaches 40 mm.

2009 - Terapia antialadosteronica e prevenzione della cardiomiopatia cirrotica [Abstract in Rivista]
Ferrari, Mariachiara; Ventura, Paolo; A., Nuzzo; Nascimbeni, Fabio; Romagnoli, Elisa; Vegetti, Alberto; Rossi, Rosario; Moriondo, Valeria; Marchini, Stefano; Modena, Maria Grazia; Pietrangelo, Antonello
abstract

BACKGROUND: La “cardiomiopatia cirrotica” [CC] comprende una serie di alterazioni funzionali (disfunzione sistolica ma soprattutto diastolica; presenza di alterazioni strutturali e morfologiche a carico degli atri e dei ventricoli; allungamento del tratto QT all’elettrocardiogramma; presenza di markers sierici suggestivi di sofferenza e/o fibrosi cardiaca) che si instaurano a livello miocardico col progredire della malattia epatica. Poiché la CC è indipendente dall’eziologia dell’epatopatia, diversi fattori bioumorali cirrosi-associati sono stati considerati responsabili del suo sviluppo.SCOPO DEL LAVORO: (1) valutare la prevalenza di CC nei pazienti ricoverati presso un centro epatologico specialistico (2) valutare il grado di correlazione e importanza relativa dei vari fattori bioumorali CC-associati (3) costruire un algoritmo predittivo della presenza di coinvolgimento miocardico nel paziente con cirrosi.MATERIALI E METODI : Abbiamo studiato 50 pazienti (17 donne, età media 65 ± 9 anni) affetti da cirrosi epatica. Abbiamo escluso dallo studio pazienti affetti da cirrosi con storia o evidenza clinica di cardiopatia, pneumopatia, anemia grave, o altra patologia sistemica infiammatoria. Lo studio ha incluso anche un secondo gruppo di 17 pazienti (6 donne, età media 63 ± 7 anni) affetti da epatite cronica attiva (ECA) non cirrotica (biopsia con stadio ISHAK ≤ 4) non in trattamento attivo con terapia antivirale (interferone e/o antivirali) al momento dell’inclusione nello studio e senza storia clinica di cardiopatia, pneumopatia o altra patologia sistemica infiammatoria. Tutti i pazienti arruolati sono stati sottoposti a (1) determinazione della pressione arteriosa (2) ECG per valutazione del QT e QT corretto; (3) valutazione dello stadio di malattia (score Child-Pugh Turcotte e MELD); (4) determinazione dei livelli plasmatici di diverse sostanze coinvolte nella patogenesi della CC e/o considerate come marcatori bioumorali di insufficienza cardiaca [Fattori natriuretici (ANF e BNF), Epinefrina (E), Norepinefrina (NE), attività reninica plasmatica (PRA), Aldosterone (A), Ossido nitrico (NO), Interleuchina 6 (IL-6) e Tumor necrosis factor alfa (TNF-)]; (5) determinazione plasmatica di indici diretti [determinazione del pro peptide n-terminale del pro collagene di tipo III (PIIINP)] e indiretti di fibrosi (score non invasivi di fibrosi APRI, 4-parametrs e Fibroscore). (6) anamnesi farmacologica. Tutti i pazienti sono inoltre stati sottoposti a ecocardiogramma mono e bidimensionale per la determinazione degli indici di funzionalità sistolica e diastolica [FE, Ea, TAPSE, E/A ratio, Deceleration time (DT)].RISULTATI : La prevalenza di deficit diastolico nella nostra popolazione di cirrotici è risultata elevata (il 50% dei pazienti con cirrosi epatica presenta un E/A ratio patologico e il 62% presenta un DT patologico); per entrambi i parametri la prevalenza tende ad aumentare col peggiorare dello stadio di malattia (il 100% dei soggetti in Child C hanno un E/A ratio patologico e il 92% dei pazienti un DT patologico). QT allungato era presente in 19 pazienti con cirrosi epatica (38%) rispetto a 1/16 soggetti con ECA (6.25%) (p<.001). All’analisi univariata gli indici di funzione diastolica (DT e E/A ratio) apparivano significativamente correlati coi livelli di NO r=.414, p=.000 e r=.395, p=.001), TNF-alfa r=-514, p=.000, r=.481, p=.000) , NE r=-.615, p=.000, r=.-569, p=.000), E(r= -.605, p=.000, r= -.569,p=.000) Aldosterone (r= -.476,p=.000; r=.587, p=.000) PRA, (r= -.512, p= .012; r=-656, p=.001), ANP (r= - 521, p=.000; r=.560, p=.000) e BNP (r=-574, p=.001; r=669, p=.000); apparivano inoltre entrambi correlati agli indici di fibrosi diretti (PIIINP) (r=-546, p=.000; r=.524, p=.000) e al punteggio ottenuto con gli scores Fibroscore (r=-.490, p=.000) e 4-parameters (r= - .490, p=.000; r= .583, p=.002). Abbiamo osservato una associazione significativa fra presenza di QT lungo e pun

2009 - The Role of the Framingham Risk Score to Predict the Presence of Subclinical Coronary Atherosclerosis in Patients with HIV Infection [Articolo su rivista]
Rossi, Rosario; Nuzzo, A.; Guaraldi, Giovanni; Orlando, G.; Squillace, N.; Ligabue, Guido; Fiocchi, F.; Di Girolamo, A.; Romagnoli, R.; Modena, Maria Grazia
abstract

Patients with HIV infection have an increased mortality, largely attributable to coronary artery disease (CAD),1-3 and there is increasing evidence that these patients have more extensive coronary calcification than age-matched control subjects.4,5 The assessment of the risk to develop CAD is a challenge in patients with HIV infection because there are many aspects that contribute to generate it. It is well known that smoking habit is more frequent in patients with HIV infection; however, a citotoxic direct effect on myocardial cells (mediated by HIV) and the inflammatory reaction associated with HIV infection may play a role in the atherosclerotic process. In addition, the treatment with combination antiretroviral therapy (cART), despite the positive modification of the natural history of HIV infection, is associated with a variety of metabolic abnormalities that determine an increase of CAD risk. Therefore, there is the need to stratify the risk of coronary events in HIV patients, taking into account all the components cited above.

2009 - The management of pre-hypertension and metabolic syndrome [Articolo su rivista]
Rossi, R.; Nuzzo, A.; Modena, M. G.
abstract

The new guidelines for diagnosis and treatment of arterial hypertension introduce the new concept of "pre-hypertension", that comprises those individuals who have either systolic blood pressure (BP) of 120-139 mmHg or diastolic BP of 80-89 mmHg. The Committee recommended the identification of these individuals as they are at increased risk for progression to hypertension and subsequently other cardiovascular disease (CVD). Metabolic syndrome (MS) is a constellation of CVD risk factors, including atherogenic dyslipidemia, elevated BP, impaired glucose regulation, and abdominal obesity. Compared to those without MS, individuals with MS have a 61% increased risk of CVD. The aim of the review was explain the "real" relationship between these two clinical conditions describing the pathogenic mechanisms that put them in correlation. These findings may also offer compelling evidence for screening and early detection in vulnerable groups predisposed to CVD. Randomized intervention studies are needed to quantify the extent of any potential benefit of therapy among individuals with BP levels usually considered normal.

2009 - Valsartan for prevention of recurrent atrial fibrillation (New England Journal of Medicine (2009) 360, (1606-1617)) [Articolo su rivista]
Modena, Maria Grazia
abstract

2009 - Valsartan for prevention of recurrent atrial fibrillation. [Articolo su rivista]
Gissi Af, Investigators; Disertori, M; Latini, R; Barlera, S; Franzosi, Mg; Staszewsky, L; Maggioni, Ap; Lucci, D; Di Pasquale, G; Tognoni, G.; Modena, Mg
abstract

BACKGROUND: Atrial fibrillation is the most common cardiac arrhythmia, and no current therapy is ideal for control of this condition. Experimental studies suggest that angiotensin II-receptor blockers (ARBs) can influence atrial remodeling, and some clinical studies suggest that they may prevent atrial fibrillation. METHODS: We conducted a large, randomized, prospective, placebo-controlled, multicenter trial to test whether the ARB valsartan could reduce the recurrence of atrial fibrillation. We enrolled patients who were in sinus rhythm but had had either two or more documented episodes of atrial fibrillation in the previous 6 months or successful cardioversion for atrial fibrillation in the previous 2 weeks. To be eligible, patients also had to have underlying cardiovascular disease, diabetes, or left atrial enlargement. Patients were randomly assigned to receive valsartan or placebo. The two primary end points were the time to a first recurrence of atrial fibrillation and the proportion of patients who had more than one recurrence of atrial fibrillation over the course of 1 year. RESULTS: A total of 1442 patients were enrolled in the study. Atrial fibrillation recurred in 371 of the 722 patients (51.4%) in the valsartan group, as compared with 375 of 720 (52.1%) in the placebo group (adjusted hazard ratio, 0.97; 96% confidence interval [CI], 0.83 to 1.14; P=0.73). More than one episode of atrial fibrillation occurred in 194 of 722 patients (26.9%) in the valsartan group and in 201 of 720 (27.9%) in the placebo group (adjusted odds ratio, 0.89; 99% CI, 0.64 to 1.23; P=0.34). The results were similar in all predefined subgroups of patients, including those who were not receiving angiotensin-converting-enzyme inhibitors. CONCLUSIONS: Treatment with valsartan was not associated with a reduction in the incidence of recurrent atrial fibrillation. (ClinicalTrials.gov number, NCT00376272.) 2009 Massachusetts Medical Society

2009 - Vascular age as a marker of premature biological ageing in HIV-infected patients [Abstract in Atti di Convegno]
Guaraldi, G; Alexopoulos, N; Zona, S; Orlando, G; Carli, F; Ligabue, G; Rossi, R; Modena, Mg; Palella, F; Raggi, P.
abstract

Vascular age as a marker of premature biological ageing in HIV-infected patients

2009 - Visceral fat but not general adiposity is a predictor of sub-clinical atherosclerosis in HIV-infected patients with lipodystrophy. [Abstract in Rivista]
Guaraldi, Giovanni; Zona, Stefano; A., Roverato; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Rossi, Rosario; Modena, Maria Grazia; F. J., Palella; P., Raggi
abstract

General and visceral adiposity are associated with risk of cardiovascular disease. HIV lipodystrophy offers a unique patho-physiological model to study visceral adiposity, best described in the abdominal fat accumulation or mixed phenotypes, not necessarily associated with general adiposity. The object of this study was to evaluate the association of general adiposity and visceral adiposity with presence and extent of subclinical atherosclerosis as evaluated by coronary artery calcium imaging in HIV infected patients.

2008 - 3-Tesla MRI for the evaluation of myocardial viability: a comparative study with 1.5-Tesla MRI [Articolo su rivista]
Ligabue, Guido; Fiocchi, F; Ferraresi, S; Barbieri, A; Rossi, Rosario; Modena, Maria Grazia; Romagnoli, R; Torricelli, Pietro
abstract

PURPOSE: We compared 3-Tesla (3-T) and 1.5-Tesla (1.5-T) cardiac magnetic resonance imaging (MRI) for the assessment of myocardial viability in nearly identical experimental conditions. MATERIALS AND METHODS: Thirty-five patients (mean age 63+/-11; 94.2% men) submitted to primary coronary angioplasty underwent both 3-T and 1.5-T cardiac MRI, which was considered the gold standard. Comparison was performed on the basis of the same viability imaging protocol, which included resting cine-MR [balanced fast-field echo (B-FFE) sequence] followed by contrast-enhanced MR to evaluate perfusion and delayed enhancement (DE). We then performed functional index measurements and visual estimation of kinesis, perfusion and DE referring to a 5-point scale. Image quality was assessed on the basis of signal to noise ratio (SNR) and contrast to noise ratio (CNR). RESULTS: We found nonsignificant differences between the two scanners (P=NS) in measuring the functional and viability parameters. Myocardial SNR was significantly higher with 3-T MRI compared with 1.5-T MRI (61.3% gain). Even though a loss of CNR was recorded in B-FFE and in first-pass perfusion sequences (12.4% and 23.7%, respectively), on DE images, we quantified the increase of SNR and CNR of infarction of 387.8% and 330%, respectively. CONCLUSIONS: We found that 3-T MRI showed high concordance with 1.5-T MRI in the evaluation of functional and viability parameters and provided better evidence of damaged myocardium.

2008 - Age and heart transplantation: results from a heart failure management unit. [Articolo su rivista]
Grigioni, F; Potena, L; Barbieri, A; Bianchi, G; Reggianini, L; Russo, A; Fallani, F; Magnani, G; Coccolo, F; Arpesella, G; Rapezzi, C; Modena, Maria Grazia; Branzi, A.
abstract

BACKGROUND: More evidence is needed to assess the pros and cons of maintaining age-limit policies in heart transplantation (HT). METHODS: We analyzed clinical data from a heart failure management unit to investigate the impact of age on prognosis of two distinct cohorts: (i) 309 patients (median age, 57 yr; 62% male) with severe chronic heart failure (CHF) consecutively screened for HT; (ii) 336 HT recipients (median age 56 yr, 82% male). RESULTS: In CHF patients (screened for HT), prognosis was conditioned by the underlying severity of cardiac disease (i.e., New York Heart Association class III-IV, decreasing blood pressure, presence of atrial fibrillation and severe mitral regurgitation), whereas increasing age showed no sign of predicting all-cause or cardiovascular mortality (both p > or = 0.4). In HT recipients, age did not retain significance at multivariate analysis as an independent predictor (p > or = 0.14 for both all-cause and cardiovascular death), whereas ischemic etiology of pre-existing CHF did (p < or = 0.02). CONCLUSIONS: Age did not appear to be a primary determinant of all-cause or cardiovascular mortality among potential HT candidates or eventual recipients (ischemic etiology of CHF turned out to be the major determinant of post-transplant outcome). These results support the concept that HT may be considered a treatment option in patients with more advanced age strata, particularly when affected by non-ischemic cardiomyopathy

2008 - Association between arterial stiffness and aortic valve calcium score as assessed by 64 multislice computed tomography [Abstract in Atti di Convegno]
DELLE DONNE, Grazia; Marchese, Procolo; Di Girolamo, A; Fiocchi, F; Ligabue, G; Rossi, R; Romagnoli, R; Modena, Mg
abstract

Association between arterial stiffness and aortic valve calcium score as assessed by 64 multislice computed tomography

2008 - Bicuspid aortic valve regurgitation: Quantification of anatomic regurgitant orifice area by 3D transesophageal echocardiography reconstruction [Articolo su rivista]
Malagoli, Alessandro; Barbieri, Andrea; Modena, Maria Grazia
abstract

Bicuspid aortic valve regurgitation: quantification of anatomic regurgitant orifice area by 3D transesophageal echocardiography reconstruction.

2008 - Cardiac delayed enhancement distribution in extralysosomial glycogen storage disease [Articolo su rivista]
Fiocchi, F; Ricci, C; Ligabue, Guido; Reggianini, L; Modena, Maria Grazia; Cenacchi, G; Torricelli, Pietro
abstract

We describe magnetic resonance (MR) aspect of cardiac glycogenesis in a 49-years old man, presented a progressively declining cardiac function and negative coronary angiography. Delayed enhancement MR confirmed non-ischemic pattern with unusual diffuse distribution of Gadolinium. Cardiac biopsy revealed a Glycogen Storage Disease, extralysosomial type. Cardiac MR with analysis of delayed enhancement distribution is an emerging tool that can discriminate between ischemic and non-ischemic diseases; however to identify the precise aetiology of a non-ischemic distribution, myocardial biopsy is still needed

2008 - Cardiovascular risk and prostanoids in systemic sclerosis [Articolo su rivista]
Colaci, Michele; Sebastiani, Marco; Giuggioli, D.; Manfredi, Andreina Teresa; Rossi, Rosario; Modena, Maria Grazia; Ferri, Clodoveo
abstract

OBJECTIVE: Systemic sclerosis (SSc) is characterized by Raynaud's phenomenon and frequent cutaneous ulcers. In patients resistant to oral treatments, i.v. prostanoids are usefully employed. Some anecdotal reports underlined the potential risk to develop cardiovascular ischemic complications in prostanoid-treated SSc patients. METHODS: Fifty SSc patients (group 1: 44 female and 6 male, mean age 60.4 +/- 13.8SD) undergoing long-term prostanoid therapy (iloprost or alprostadil) and 42 control patients (group 2), treated with only oral drugs, were retrospectively evaluated for the cardiovascular risk and incidence of ischemic events. RESULTS: Ischemic cardiovascular complications, i.e., myocardial infarction or stroke, were recorded in a significantly higher number of patients undergoing prostanoid treatment compared to controls (group 1: 7/50, 14% vs. group 2: 1/42, 2.4%; p=0.041). Interestingly, these events were significantly more frequent in the subgroup of patients with high cardiovascular risk (group 1: 6/10, 60% vs. group 2: 1/19, 5.2%; p=0.0026).CONCLUSION: The present study suggests a possible role of prostanoid treatment in the pathogenesis of ischemic cardiovascular complications in SSc patients non-responders to oral vasodilators and high cardiovascular risk. Since prostanoids represent the first choice treatment of the most severe scleroderma ischemic cutaneous lesions, cardiovascular risk should be carefully evaluated in all patients before therapy.

2008 - Chronic kidney disease and outcome in patients with ST-elevation myocardial infarction treated with primary coronary angioplasty: 1 month and 1 year mortality [Abstract in Atti di Convegno]
Sgura, Fa; Briguori, C; Politi, L; Rossi, R; Monopoli, De; Di Girolamo, A; Guerri, E; Leuzzi, C; Modena, Mg
abstract

Chronic kidney disease and outcome in patients with ST-elevation myocardial infarction treated with primary coronary angioplasty: 1 month and 1 year mortality

2008 - Chronic thromboembolic pulmonary hypertension: an update [Articolo su rivista]
Nuzzo, A; Rossi, R; Modena, Mg
abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a condition characterized by single or recurrent pulmonary thromboemboli that obstruct the pulmonary vascular bed, promoting increased pulmonary vascular resistance and progressive pulmonary hypertension and right-heart failure. Some studies have analyzed the risk factors associated with CTEPH, e.g. prior pulmonary embolism, younger age, large perfusion defect, idiopathic pulmonary embolism at presentation, risk factors for venous thromboembolism. The symptoms and signs of pulmonary hypertension are extremely variable. Patients may complain of progressive dyspnea on exertion, hemoptysis and/or signs of right heart dysfunction including fatigue, palpitations, syncope or edema after a single episode or recurrent episodes of overt pulmonary embolism. Echocardiography is widely used as the initial diagnostic tool when pulmonary hypertension is suspected. Imaging technologies including ventilation-perfusion scanning, computed tomography, MRI, and pulmonary angiography are a fundamental part of the diagnostic workup of patients with suspected CTEPH. From the point of view of current treatment of CTEPH pulmonary endarterectomy surgery remains the treatment of choice for symptomatic patients. The most common reasons for rejection of patients referred for pulmonary endarterectomy are severe comorbidity and significant distal disease in combination with excessive pulmonary hypertension. Such patients may benefit from pre-operative reduction of pulmonary vascular resistance by means of medical therapy. In fact over the last decade, several novel therapies have been developed for pulmonary arterial hypertension, including prostacyclin analogs (epoprostenol, beraprost, iloprost), endothelin receptor antagonists (bosentan, sitaxsentan, ambrisentan) and phosphodiesterase-5 inhibitors (sildenafil).

2008 - Diagnosi genetica e valutazione della funzione endoteliale in adolescenti affetti da ipercolesterolemia familiare. [Abstract in Rivista]
Predieri, Barbara; Rossi, Rosario; Bruzzi, Patrizia; Nuzzo, A; Vellani, Giulia; Patianna, V; Iaccarino, D; Mazzali, E; Balli, F; Calandra, S; Modena, Maria Grazia; Iughetti, Lorenzo
abstract

Diagnosi genetica e valutazione della funzione endoteliale in adolescenti affetti da ipercolesterolemia familiare.

2008 - Documento del Gruppo di Lavoro SIPREC (Società Italiana per la prevenzione cardiovascolare): “Prevenzione delle complicanze cardiovascolari nei soggetti con alterazioni della glicemia” [Commento scientifico]
Volpe, ; Stefano Del, Prato; Modena, Maria Grazia
abstract

Le malattie cardiovascolari rappresentano ancora oggi la prima causa di ospedalizzazione e di morte, soprattutto nei Paesi Occidentali. In relazione agli impressionanti cambi demografici, all’aumentato tasso di sopravvivenza agli eventi cardiovascolari acuti ed al veloce aumento dei costi legato al progresso tecnologico e farmacologico, l’incremento stimato dell’incidenza delle malattie cardiovascolari previsto nei prossimi due decenni è destinato a mettere a dura prova la sostenibilità dei Sistemi Sanitari Nazionali. In questa ottica, una strategia che sembra poter avere il maggiore impatto nel contrastare questi sviluppi sfavorevoli è senza dubbio quella legata all’implementazione dei programmi di prevenzione delle malattie cardiovascolari. Tale strategia può assicurare non soltanto risultati nel lungo termine, ma anche significativi vantaggi nel breve-medio termine, soprattutto negli individui che già presentano un profilo di rischio elevato, ma che non hanno ancora la manifestazione clinica della malattia. È soprattutto in questa popolazione, infatti, che l’applicazione e l’implementazione delle strategie di prevenzione può garantire un favorevole rapporto costo-beneficio

2008 - Echocardiographic diastolic dysfunction and magnetic resonance infarct size in healed myocardial infarction treated with primary angioplasty [Articolo su rivista]
Barbieri, A; Bursi, F; Politi, L; Rossi, L; Fiocchi, F; Ligabue, Guido; Pingitore, A; Positano, V; Torricelli, Pietro; Modena, Maria Grazia
abstract

BACKGROUND: After acute myocardial infarction (MI) the severity of diastolic dysfunction by echocardiography represents an independent prognostic marker. However, the mechanisms whereby diastolic dysfunction portends an increased risk after MI are not fully understood. We investigated the relationship between echocardiographic diastolic dysfunction severity and infarct size quantitatively measured by contrast-enhanced magnetic resonance (ce-MR). METHODS: Cross-sectional prospective study. We quantified "healed" infarct size by ce-MR measuring the percentage of delayed enhancement with respect to left ventricular mass and diastolic function by Doppler echocardiography. Both exams were scheduled at least 1 month after a first acute ST segment elevation MI (STEMI) successfully treated with primary angioplasty and stenting. To increase the specificity, individual echocardiographic parameters were integrated to grade global diastolic function in 4 grades: normal diastolic function, impaired relaxation with normal, or near-normal filling pressures; impaired relaxation with moderate elevation of filling pressures, and impaired relaxation with marked elevation of filling pressures, "restrictive filling." RESULTS: We prospectively enrolled 52 patients (mean age 62 +/- 13 years, 77% men). ce-MR and echocardiography were performed 48 +/- 15 days after the MI. There was a significant but modest correlation between diastolic function grade and infarct size (r = 0.423, P = 0.002), which was independent of global and regional systolic function and persisted after further adjustment for age, sex, body surface area, left ventricular mass, end-diastolic volumes, and sphericity index (all P < 0.05). Among single echocardiographic variables, infarct size correlated best with tissue Doppler velocities Em (r =-0.307, P = 0.03), Am (r =-0.39, P = 0.005), and flow propagation velocity (r =-0.34, P = 0.015). CONCLUSIONS: In healed STEMI successfully treated with primary angioplasty and stenting, diastolic function grade was independently albeit weakly correlated with infarct size. Therefore, the increased risk of diastolic dysfunction after MI is not fully explained by infarct size

2008 - Feasibility, Safety and Hemodinamic Changes With a New Ventricular Assist Device During High Risk Percutaneous Coronary Interventions [Abstract in Atti di Convegno]
Sgura, Fa; Politi, L; Di Girolamo, A; Monopoli, De; Rossi, R; Modena, Mg
abstract

Feasibility, Safety and Hemodinamic Changes With a New Ventricular Assist Device During High Risk Percutaneous Coronary Interventions

2008 - Follow-up of Unprotected Left Main Coronary Artery Stent Patency by 64-Slice Computed Tomography. Comparison Between Coronary Angiography, 64 Slice-CT and Intravascular Ultrasound (IVUS) [Abstract in Atti di Convegno]
Di Girolamo, A; Sgura, F; Chiurlia, E; Fiocchi, F; Ligabue, G; Rossi, R; Monopoli, D; Politi, L; Guerri, E; Modena, Mg
abstract

Follow-up of Unprotected Left Main Coronary Artery Stent Patency by 64-Slice Computed Tomography. Comparison Between Coronary Angiography, 64 Slice-CT and Intravascular Ultrasound (IVUS)

2008 - Impaired endothelial function, subclinical inflammation and carotid intima-media thickness in healthy women with depression [Abstract in Atti di Convegno]
Chiurlia, E; Iaccarino, D; Goione, S; Rubino, F; Mazzotta, Rita; Miccoli, G; Modena, Mg
abstract

Impaired endothelial function, subclinical inflammation and carotid intima-media thickness in healthy women with depression

2008 - Impairment of functional integrity of the vasculature is not changed in patients starting abacavir [Abstract in Atti di Convegno]
S., Zona; A., Lattanzi; N., Squillace; G., Orlando; C., Stentarelli; Rossi, Rosario; A. C., Nuzzo; Modena, Maria Grazia; Guaraldi, Giovanni
abstract

In order to explore a possible pathogenetic mechanism of abacavir (ABC) cardiovascular toxicity, we assess the impact of beginning the drug on endothelial function via assessment of brachial artery diameter (BAD) and flow-mediated dilation (FMD).

2008 - Improvement of endothelial function and its relationship with exercise capacity and hemodynamic profile in patients with pulmonary hypertension. A randomized study comparing bosentan and sildenafil [Abstract in Atti di Convegno]
Nuzzo, A; Rossi, R; Rossi, E; Franchi, F; Giuggioli, D; Ferri, C; Modena, Mg
abstract

Improvement of endothelial function and its relationship with exercise capacity and hemodynamic profile in patients with pulmonary hypertension. A randomized study comparing bosentan and sildenafil

2008 - Left atrial volume predicts recurrence of nonvalvular atrial fibrillation after electrical cardioversion [Abstract in Atti di Convegno]
Marchese, P; Delle Donne, G; Bursi, F; Malavasi, V; Barbieri, A; Casali, E; Modena, Mg
abstract

Left atrial volume predicts recurrence of nonvalvular atrial fibrillation after electrical cardioversion

2008 - Left atrium eclassified: application of the American Society of Echocardiography/European Society of Cardiology cutoffs to unselected outpatients referred to the echocardiography laboratory [Articolo su rivista]
Barbieri, A; Bursi, F; Zanasi, V; Veronesi, B; Cioni, E; Modena, Maria Grazia
abstract

OBJECTIVES: We sought to determine whether categorization of abnormal left atrial (LA) size based on volumes indexed to body surface area (LAVi) results in reclassification of LA dilatation if the classic antero-posterior diameter (LAd) was measured. The American Society of Echocardiography/European Society of Cardiology recommended LAVi over linear measurements and recently published cutoffs to qualify LA dilatation. However, many laboratories continue to use the LAd because it appears easier to measure. METHODS: Unselected adult outpatients referred to the echocardiography laboratory for any indication in the period March 2005 to January 2006 prospectively underwent standard Doppler echocardiography, including real-time measurement of LAd and LAVi. RESULTS: We enrolled 578 patients (mean age 66 +/- 14 years, 56% women). There was a good positive linear correlation between LAd and LAVi (r = 0.686, P < .0001). When the published cutoffs for LA enlargement were used, 49.0% of patients were classified as having abnormal LA by LAd and 76.3% by LAVi (P < .001). Of the 295 who had normal LA by LAd, 58.6% patients had abnormal LAVi. Conversely, of the 283 with abnormal LAd, almost all patients (94.7%) had abnormal LAVi. The proportion of overall agreement was 67.5% (kappa = 0.357, P < .001). CONCLUSION: Assessment of LA size by LAVi allows identification of patients with enlarged atria that would have been missed if classified by antero-posterior diameters, especially when cutoffs are applied

2008 - Longitudinal study of endothelial function in children with familial hypercholesterolemia. [Abstract in Rivista]
Iughetti, Lorenzo; Predieri, Barbara; Patianna, VIVIANA DORA; Bruzzi, Patrizia; Rossi, Rosario; G., Delle Donne; F., Balli; Modena, Maria Grazia
abstract

Endothelial function (EF) is impaired in diseases associate with vascular complications, such as diabetes and familialhypercholesterolemia (FH). The impairment of EF assessed as flow mediated dilation (FMD) of brachial artery can predict futurecardiovascular disease. To assess the alteration of EF, we longitudinally evaluate FMD in prepubertal patients with geneticallyconfirmed FH. Twelve children (7 M, 5 F; 8.19±2.90 yr.) with FH and 20 control subjects entered the study. Subjects withdiabetes, obesity or other metabolic disorders were excluded. In all FH patients lipid values and FMD were determined at thebeginning of the study and after 32.8±9.55 mo. of diet low in saturated fat and cholesterol. FMD function was assessed bymeasurement of endothelium-dependent vasodilation of the brachial artery using an ultrasound system. FMD was expressed aspercentage change of diameter following reactive hyperemia from baseline. The lower FMD values obtained in our control patientwas 7% so we considered it as cut-off. The baseline evaluation showed that FMD in FH children was not significantly different thancontrol peers (20.9±23.3 vs 12.5±7.28%; p=0.143). According to sex, M were significantly older than F and had a longer followup (38.1±7.52 vs 25.5±7.09 mo.; p = 0.015). At the end of the study, despite T-CH, LDL, HDL, and TG levels were unmodified,FMD values significantly decreased (20.9±23.3 vs 2.75±9.07%; p=0.034) resulting significantly lower than in normal subjects(p=0.002). The impairment was shown in 75% vs. 25% of children found at the start. No correlation was demonstrated betweenFMD and lipid levels, age and duration of the follow-up. Our data show that after few years patients with FH have a decrease ofFMD values not apparently related to lipid control or to duration of diet. This difference, more evident in males, suggests that furtherstudies are needed to better understand which factors are involved in functional changes of endothelial dysfunction.

2008 - Maximum persisting single lead ST elevation after primary angioplasty: a good predictor of left ventricular dilatation assessed by magnetic resonance imaging [Articolo su rivista]
Barbieri, A; Bursi, F; Politi, L; Rossi, L; Fiocchi, F; Ligabue, Guido; Manicardi, C; Torricelli, Pietro; Modena, Maria Grazia
abstract

AIMS: To determine the frequency and predictors of left ventricular dilatation assessed by magnetic resonance imaging among patients with a first acute myocardial infarction treated with successful primary angioplasty and stent. METHODS AND RESULTS: Cine magnetic resonance imaging and late enhancement imaging were prospectively performed in 42 patients 1 month and more than 1 year after successful early reperfusion of a first acute ST elevation myocardial infarction (age 61 +/- 13 years, 76% men, 55% anterior myocardial infarction, and mean symptom-to-balloon time 199 +/- 130 min). Both at the 1-month and at the 15-month magnetic resonance imaging examinations, 57% of patients had left ventricular dilatation (end-systolic volume indexed > 36 ml/m2, values above the upper 95th percentile based on magnetic resonance imaging reference values for left ventricular size in normal participants). The most accurate predictor of left ventricular dilatation was maximum persisting single lead ST elevation 60 min after reperfusion (area under the curve 0.81, P = 0.001). Maximum single lead ST elevation was significantly and independently associated with larger end-systolic volume indexed (beta = 0.35, P = 0.040) after adjusting for muscle and brain isoenzyme of creatine kinase and echocardiographic wall motion score index. CONCLUSION: More than half of patients with a first acute myocardial infarction have left ventricular dilatation despite successful primary coronary angioplasty. Maximum persisting single lead ST elevation 60 min after mechanical reperfusion represents a simple tool for predicting left ventricular dilatation.

2008 - Metabolic syndrome affects cardiovascular risk profile and response to treatment in hypertensive postmenopausal women [Articolo su rivista]
Rossi, Rosario; Nuzzo, A; Origliani, G; Modena, Maria Grazia
abstract

Metabolic syndrome is increasingly recognized as an important cardiovascular risk factor in hypertension, but its influence on the cardiovascular risk profile in hypertensive postmenopausal women has not been studied. The aim of the present study was to investigate the impact of metabolic syndrome on the cardiovascular risk profile and the response to treatment. We enrolled 350 hypertensive postmenopausal women, 55+/-6 years of age (range 47 to 60 years of age). Patients were divided into 2 groups according to the presence of metabolic syndrome. Compared with those without, women with metabolic syndrome had higher waist circumference, body mass index, and levels of glucose, triglycerides, and HDL cholesterol, as would be expected, based on definition. In addition, patients with metabolic syndrome had a cardiovascular risk profile less favorable, characterized by a significantly higher highly sensitive C-reactive protein (2.2+/-0.6 versus 1.7+/-0.7 ng/L; P<0.01), a more compromised endothelial function (flow-mediated vasodilation 2.4+/-2.2 versus 4.4+/-2.5%; P=0.01), and a significantly higher left ventricular mass (44+/-15 versus 41+/-16 g/m(2.7)). Also, antihypertensive treatment induced a more modest improvement of both endothelial dysfunction and subclinical inflammation in women with metabolic syndrome. The results of our study show that in postmenopausal women, there are 2 different forms of hypertension: that which is isolated, and that which is associated with metabolic syndrome. This last form is related to a more severe risk profile, and response to therapy is less favorable

2008 - Osteoporosis and cardiovascular diseases' cosegregation: Epidemiological features [Articolo su rivista]
Piscitelli, Prisco; Iolascon, Giovanni; Gimigliano, Francesca; Gimigliano, Alessandra; Marinelli, Alessandra; Di Nuzzo, Rosalba; Colã¬, Giuseppe; Di Paola, Lucia; Gianicolo, Elena; Chitano, Giovanna; Sbenaglia, Vincenzo; Gismondi, Raffaella; Greco, Marco; Camilli, Daniele; Modena, Maria Grazia; Brandi, Maria Luisa; Distante, Alessandro; Cozma, Alexandru
abstract

Life expectancy in Italy is estimated to rise to 77.9 and 84.4 years in next years. Increased life expectancy is associated with a greater frailty of elderly people and an increased prevalence of chronic and degenerative illnesses such as cardiovascular diseases and osteoporosis. The impact of osteoporotic hip fractures in Italy is very similar to that of acute myocardial infarction (AMI), and there is a need for further epidemiological investigations concerning both the pathologies, as well as for a better understanding of possible mechanisms of their cosegregation. Actually, calcium metabolism is involved both in the development of osteoporosis and in the raise of cardiovascular risk. We have reviewed the most recent publications concerning epidemiological trends of both osteoporosis and acute myocardial infarction (AMI), and also the trials addressing cosegregation of these pathologies. According to the publications examined, in the Italian population (both â¥ 45 and > 65 years old), the number of hospitalizations following hip fracture and AMI are comparable. Both hip fractures and cardiovascular diseases represent in Italy a serious medical problem and a leading health cost driver, according to what has already been reported for many other Countries in the industrialized world, thus requiring a global clinical approach. Low calcium intake could represent one of the possible pathogenic paths underlining the association between hypertension and osteoporosis. Low calcium serum levels has been proved to enhance PTH and vitamin D3 production, which result in a remarkable lypogenesis performed by adypocites and switch on mechanisms leading to the raise of blood systolic pressure, the development of atherosclerotic plaques and cardiovascular events. Although many trials have suggested that bone mineral density may be included in the list of cardiovascular risk factors, more studies are needed in order to deeply investigate the causal relationships between calcium metabolism and cardiovascular diseases.

2008 - Outcomes in Mitral Regurgitation Due to Flail Leaflets. A Multicenter European Study [Articolo su rivista]
Grigioni, Francesco; Tribouilloy, Christophe; Avierinos, Jean Francois; Barbieri, Andrea; Ferlito, Marinella; Trojette, Faouzi; Tafanelli, Laurence; Branzi, Angelo; Szymanski, Catherine; Habib, Gilbert; Modena, Maria G.; Enriquez-Sarano, Maurice
abstract

Objectives: The purpose of this study was to assess incidence and predictors of events associated with nonsurgical and surgical management of severe mitral regurgitation (MR) in European institutions. Background: The management of patients with MR remains disputed, warranting multicenter studies to define clinical outcome in routine clinical practice. Methods: The MIDA (Mitral Regurgitation International DAtabase) is a registry created for multicenter study of MR with echocardiographically diagnosed flail leaflet as a model of pure, organic MR. Our cases were collected from 4 European centers. We enrolled 394 patients (age 64 Â± 11 years; 67% men; 64% in New York Heart Association functional class I to II; left ventricular ejection fraction 67 Â± 10%). Results: During a median follow-up of 3.9 years, linearized event rates/year under nonsurgical management were 5.4% for atrial fibrillation (AF), 8.0% for heart failure (HF), and 2.6% for death. Mitral valve (MV) surgery was performed in 315 (80%) patients (repair in 250 of 315, 80%). Perioperative mortality, defined as death within 30 days from the operation, was 0.7% (n = 2). Surgery during follow-up was independently associated with reduced risk of death (adjusted hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.21 to 0.84; p = 0.014). Benefit was largely driven by MV repair (adjusted HR vs. replacement 0.37, 95% CI 0.18 to 0.76; p = 0.007). In 102 patients strictly asymptomatic and with normal ventricular function, 5-year combined incidence of AF, HF, or cardiovascular death (CVD) was 42 Â± 8%. In these patients, surgery also reduced rates of CVD/HF (HR 0.26, 95% CI 0.08 to 0.89; p = 0.032). Conclusions: In this multicenter study, nonsurgical management of severe MR was associated with notable rates of adverse events. Surgery especially MV repair performed during follow-up was beneficial in reducing rates of cardiac events. These findings support surgical consideration in patients with MR due to flail leaflets for whom MV repair is feasible. Â© 2008 American College of Cardiology Foundation.

2008 - Prevention of Contrast-Induced Nephropathy by Continous Venous-Venous Hemofiltration in High Risk Patients Undergoing Percutaneous Coronary Interventions: a Pilot Randomized Study [Abstract in Atti di Convegno]
Politi, L; Sgura, Fa; Perronte, S; Di Girolamo, A; Guerri, E; Monopoli, De; Rollini, Fabiana; Rossi, R; Modena, Mg
abstract

Prevention of Contrast-Induced Nephropathy by Continous Venous-Venous Hemofiltration in High Risk Patients Undergoing Percutaneous Coronary Interventions: a Pilot Randomized Study

2008 - Prognostic role of flow-mediated dilation and cardiac risk factors in post-menopausal women [Articolo su rivista]
Rossi, Rosario; Nuzzo, A; Origliani, G; Modena, Maria Grazia
abstract

OBJECTIVES: The aim of this study was to examine the association between brachial artery flow-mediated dilation (FMD) and cardiovascular events in a cohort of initially asymptomatic post-menopausal women, with adjustment for the presence of the major cardiovascular risk factors. BACKGROUND: Conventional major cardiovascular risk factors (cigarette smoking, hypercholesterolemia, hypertension, and diabetes) fail to explain nearly 50% of cardiovascular events. Defining the magnitude of future risk for the development of clinical events is a major focus of effective primary prevention. Evaluation of endothelial function, utilizing the noninvasive measurement of the brachial artery FMD, may serve as a screening tool to individualize high-risk patients. METHODS: We conducted a prospective study on 2,264 post-menopausal women, age 54 +/- 6 years. The length of the follow-up was 45 +/- 13 months (range 6 to 65 months). RESULTS: During observation, 90 major events were recorded. Risk-adjusted relative risk values resulted 1.0, 1.33 (95% confidence interval [CI] 1.09 to 4.09), and 4.42 (95% CI 2.97 to 8.01) for women in the higher, intermediate, and lower tertile of FMD, respectively (p < 0.0001 for trend). The event rate for women in the lower tertile (FMD <or=4.5%) was greater than the combined event rate noted in the other 2 tertiles (women in the lower tertile accounted for 51 events [56.6% of total events]). When added to age and other conventional cardiovascular risk factors (smoking habits, presence of hypercholesterolemia, history of diabetes, hypertension), FMD contributed significantly to the model predicting cardiovascular events (likelihood ratio chi-square change: 10.22; p < 0.0001). CONCLUSIONS: In post-menopausal women, the knowledge of FMD provided incremental prognostic information regarding the risk of developing cardiovascular events

2008 - ST-segment elevation myocardial infarction with concomitant multiple coronary arteries thromboses in a young patient with hyperhomocysteinaemia [Articolo su rivista]
Politi, L; Monopoli, De; Modena, Maria Grazia
abstract

ST-segment elevation myocardial infarction with concomitant multiple coronary arteries thromboses in a young patient with hyperhomocysteinaemia

2008 - Sildenafil improves endothelial function in patients with pulmonary hypertension [Articolo su rivista]
Rossi, Rosario; Nuzzo, A; Lattanzi, A; Coppi, F; Modena, Maria Grazia
abstract

BACKGROUND: Sildenafil has been shown to be effective in the treatment of pulmonary hypertension, and has favourable effects on endothelial function. Our hypothesis is that a part of the beneficial effects of sildenafil in patients with pulmonary hypertension is due to the improvement of the endothelial function. METHODS: Nine patients (seven females, age 67+/-9 years) with thromboembolic pulmonary hypertension were treated with sildenafil, at a mean dose of 150+/-75 mg/die. At baseline and after 6 months all patients underwent: right-heart catheterization, 6-min walking distance, and a study of endothelial function, including the measure of the flow-mediated vasodilation of the brachial artery, and the dosage of plasma levels of endothelin-1 and von Willebrand factor. RESULTS: During follow-up we found a significant reduction of mean pulmonary artery pressure and arteriolar resistances. Accordingly, the functional capacity improved (an average of+37 m). Sildenafil improved endothelial-dependent vasodilation and reduced plasma concentrations of endothelin-1 (from 4.5+/-0.6 to 3.1+/-0.7 pg/mL; p<0.0001) and von Willebrand factor (from 183.1+/-10.1 to 149.1+/-17.6 mU/mL; p<0.0001). CONCLUSION: Improvement of the endothelial function may represents one of the mechanisms able to explain the favourable effects sildenafil has shown in patients with pulmonary hypertension

2008 - Spontaneous echocardiographic wall motion abnormalities in variant angina [Articolo su rivista]
Politi, Luigi; Monopoli, Daniel Enrique; Sgura, Fabio Alfredo; Rossi, Rosario; Bursi, Francesca; Modena, Maria Grazia
abstract

Variant angina, defined as spontaneous angina pectoris associated with transient ST-segment elevation, is usually caused by episodic coronary spasm. At present, coronary artery spasm is a reversible coronary stenosis that limits coronary blood flow under resting conditions. Prinzmetal first described this type of angina pectoris as a distinct entity in 1959.1 Although several hypotheses have been suggested, the precise mechanism for coronary vasospastic disease remains unclear. Natural history of variant angina is heterogeneous. In most of the cases, the prognosis is good; however, it can lead to myocardial infarction (MI), life-threatening ventricular arrhythmias, and sudden death

2008 - Takotsubo cardiomyopathy: a consensus document [Articolo su rivista]
Novo, S; Akashi, Y; Arbustini, E; Assennato, P; Azzarelli, S; Barbaro, G; Fazio, G; Fedele, F; Giordan, M; Mazzarotto, P; Modena, Maria Grazia; Novo, G; Parodi, G; Previtali, M; Rapezzi, C; Sconci, F; Sganzerla, P; Tona, F; Salerno Uriarte, J. A.
abstract

Takotsubo cardiomyopathy is a syndrome characterized by acute regional systolic dysfunction of the left ventricle, frequently related to psycho-physical acute stress, and usually reversible. This rare syndrome involves more often the female sex with the highest frequency of occurrence between the seventh and eighth decade of life. Etiology has not been clarified yet and several hypotheses have been postulated: multiple epicardial coronary artery damage, abnormal coronary microcirculation, catecholamine-mediated cardiac toxicity, and neurogenic stunning. Clinical presentation is not easy to distinguish from an acute coronary syndrome: chest pain at rest or dyspnea, new-onset electrocardiographic changes, characterized by ST-segment elevation or T-wave inversion. Coronary angiography, which should be performed within 48 h of symptom onset in order to be diagnostic, excludes the presence of significant atherosclerotic stenosis or plaque rupture. Ventricular angiography shows the typical regional wall motion abnormalities (apical akinesia and hyperkinesia of the mid-basal segments) that give to the syndrome its name (takotsubo is a traditional Japanese octopus trap or pot). Echocardiography performed in the acute phase also evidences wall motion abnormalities that characteristically regress in the following days. There is no specific treatment for this syndrome, but supportive and symptomatic therapy is usually administered.

2008 - Treatment of ST-Elevation Myocardial Infarction With Three New Generation Bare Metal Stents: 6 Month Clinical and Angiographic Follow-up [Abstract in Atti di Convegno]
Sgura, Fa; Politi, L; Di Girolamo, A; Rossi, R; Monopoli, De; Guerri, E; Modena, Mg
abstract

Treatment of ST-Elevation Myocardial Infarction With Three New Generation Bare Metal Stents: 6 Month Clinical and Angiographic Follow-up

2007 - Age and heart transplantation: results from a heart failure unit [Articolo su rivista]
Grigioni, F; Bianchi, G; Barbieri, A; Potena, L; Russo, Antonino; Masetti, M; Quarta, ANNA CHIARA; Magnani, G; Modena, Mg; Branzi, A.
abstract

Age and heart transplantation: results from a heart failure unit

2007 - Anti- and pro-oxidant factors and endothelial dysfunction in chronic cigarette smokers with coronary heart disease [Articolo su rivista]
Rocchi, E; Bursi, F; Ventura, Paolo; Ronzoni, A; Gozzi, C; Casalgrandi, G; Marri, L; Rossi, Rosario; Modena, Maria Grazia
abstract

BACKGROUND: Endothelial dysfunction in cigarette smokers has been ascribed to increased oxidative damage. The aims of the present study were to compare the endothelial function of normotensive smokers with that of non-smokers and to examine its relation to some parameters representative of oxidative damage and of antioxidant capacity. METHODS: We investigated 32 chronic smokers (15-30 cigarettes daily) affected by coronary heart disease, ranging from acute myocardial infarction to instable angina pectoris, and 28 matched non-smokers without any definite risk factors. All subjects underwent assessment of nitric oxide (NO)-dependent endothelial function, measured as brachial artery vasodilatation in response to reactive ischemia, using a standardized echographic method. Plasma and urinary levels of NO were also measured in all subjects, as were urinary 15-isoprostane F(2t), plasma serum lipids, homocysteine (Hcy), ascorbic acid, retinol, tocopherol, and alpha- and beta-carotene (by high-performance liquid chromatography). RESULTS: Smokers showed a significantly lower NO-mediated vasodilatation response (3.50% vs. 6.18%, p<0.001) and higher levels of urinary NO metabolites and 15-isoprostane F(2t). They also had higher levels of Hcy (p<0.001); these values were significantly and inversely related to NO serum levels (r=-0.512, p<0.001). Moreover, smokers had a significant and corresponding reduction in circulating levels of ascorbic acid, tocopherol, and alpha- and beta-carotene. CONCLUSIONS: The present study shows a clear relation between endothelial dysfunction (NO production impairment) and cigarette smoking, especially in the presence of high levels of LDL-cholesterol. It also defines some markers of both oxidative damage and antioxidant protective capacity in this condition. The monitoring of these factors may be advisable in order to assess the amount of endothelial damage

2007 - Assessment of mitral regurgitation is useful to predict death in chronic heart failure patients followed at a dedicated outpatient clinic [Abstract in Atti di Convegno]
Bursi, F; Ricci, C; Reggianini, L; Barbieri, A; Zanasi, V; Cioni, Elena; Leuzzi, C; Grigioni, F; Branzi, A; Modena, Mg
abstract

Assessment of mitral regurgitation is useful to predict death in chronic heart failure patients followed at a dedicated outpatient clinic

2007 - Calcificazioni coronariche in una popolazione di donne in post-menopausa affette da sindrome metabolica [Articolo su rivista]
Ratti, Carlo; Grassi, Laura; Chiurlia, Emilio; Bursi, Francesca; Bompani, Bruno; Ferramosca, Emiliana; Modena, Maria Grazia
abstract

Background. The aim of this study was to evaluate the burden of coronary calcifications in a subgroup of post-menopausal women with metabolic syndrome (MS) in agreement with the National Cholesterol Educational Program-Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-ATP III) definition. Methods. We studied 81 women (43 control subjects and 38 women with MS) in agreement with the NCEP-ATP III definition undergoing multislice computed tomography for evaluation of coronary calcifications. The patients were similar for Framingham risk score. Results. The severity and extent of coronary artery calcifications were higher in individuals with MS (10.8 Â± 15.8 vs 3.02 Â± 5.6; p = 0.006). In all patients total cholesterol, low-density lipoproteins and triglycerides were correlated with calcium score (p <0.05) while high-density lipoproteins were inversely correlated with coronary calcifications. In women with MS total cholesterol and low-density iipoprotein cholesterol were correlated with calcium score. Conclusions. Women with MS have a higher burden of subclinical coronary atherosclerosis. The correlation between MS and calcium score concerned more the presence rather than the severity of coronary calcifications. Moreover, no correlation was observed among single components of MS in agreement with the NCEP-ATP III definition. Â© 2007 AIM Publishing Srl.

2007 - Comparison of 64-slice computed tomography with conventional coronary angiography for the detection of in-stent restenosis in the left main coronary artery [Abstract in Atti di Convegno]
Chiurlia, E; Sgura, Fa; Di Girolamo, A; Guerri, Elisa; Fiocchi, F; Ligabue, G; Modena, Mg
abstract

Comparison of 64-slice computed tomography with conventional coronary angiography for the detection of in-stent restenosis in the left main coronary artery

2007 - Does 16-slice multidetector computed tomography improve stent patency and in-stent restenosis evaluation? [Articolo su rivista]
Ligabue, Guido; Fiocchi, F; Ferraresi, S; Rossi, Rosario; Modena, Maria Grazia; Ratti, C; Torricelli, Pietro; Romagnoli, R.
abstract

To assess the value of multidetector computed tomography (MDCT) in the non-invasive evaluation of stents.We studied 88 patients (142 stents): 48 with 1.2-mm MDCT, 40 with 0.6-mm MDCT considering accuracy in assessing the vessel lumen, stent patency and intra-stent restenosis. Coronary angiography comprised the gold standard.Occlusion was detected, respectively, in three of 72 versus four of 70 cases. Patency was assessed in all cases. In-stent restenosis was diagnosed in two of eight cases with thin-slice MDCT.0.6-mm MDCT allows a better visualization of stent lumen and in-stent restenosis versus 1.2-mm MDCT.

2007 - Endothelial dysfunction in postmenopausal women and hypertension [Articolo su rivista]
Nuzzo, Annachiara; Rossi, Rosario; Modena, Maria Grazia
abstract

‘Menopause is a cardiovascular risk factor for endothelial dysfunction … It also represents a unique opportunity to study the effect of endothelial dysfunction in healthy women and predicts the development of atherosclerosis and atherosclerosis-related disease

2007 - Endothelial function in children with type 1 diabetes mellitus: a longitudinal study. [Abstract in Rivista]
Iughetti, Lorenzo; Predieri, Barbara; D., Iaccarino; S., Madeo; A. L., Quitadamo; G., Delle Donne; Bruzzi, Patrizia; F., Balli; Rossi, Rosario; Modena, Maria Grazia
abstract

n.a.

2007 - II coure delle donne [Articolo su rivista]
Modena, Maria Grazia; Arbustini, Eloisa; Borghi, Claudio; Giampaoli, Simona; Panico, Salvatore; Rossi, Rosario; Vanuzzo, Diego; Volpe, Massimo; Zaninelli, Augusto
abstract

Heart diseases in women have a very different incidence and prognosis from that of men. However, the selected diagnostic tools are very different in relation to gender. In a gender-related approach to atherosclerotic disease, one of the most important topic is the evaluation of risk to develop cardiovascular events in women. This review represents the opinion of a task force of the Italian Society of Cardiology, on all debated issues regarding the relationship between women and heart diseases. This working group has analyzed the literature published in the last years, integrating the concepts emerged from the experience of physicians accustomed to the study and treatment of women with heart diseases. First of all, we analyzed the epidemiology of coronary heart disease in women, emphasizing the differences in the risk of developing cardiovascular events between European and American women. Then, we illustrated the new risk factors for ischemic heart disease that have specifically been studied in large female populations. These new risk factors could be used for a better evaluation of the cardiovascular risk, and for analyzing gender differences in diagnosis, response to therapy and prognosis of atherosclerotic disease. Some considerations about postmenopausal hormone replacement therapy were done, by providing suggestions for a corrected diagnosis and therapeutic approach in women with known cardiovascular disease. Atherosclerosis represents a really different disease in females with respect to males. The analysis of the literature supports the hypothesis that the pathophysiological mechanisms of this disease may be different or peculiar according to gender. We therefore suggest a tailored approach to this disease, in order to better quantify global cardiovascular risk, treat and prevent cardiovascular diseases, with the aim to reduce cardiovascular mortality and morbidity.

2007 - Italian position statement on hormone replacement therapy following the National Conference on Menopause and Hormone Replacement Therapy, Villa Tuscolana, Frascati (Rome), May 8-9, 2007 [Articolo su rivista]
Genazzani, Andrea Ricardo; Gambacciani, Marco; Simoncini, Tommaso; Anniverno, R.; Becorpi, A. M.; Biglia, N.; Brandi, M. L.; Guaschino, S.; Lello, S.; Massobrio, M.; Melis, G. B.; Mencacci, C.; Modena, M. G.; Nappi, C.; Nappi, R. E.; Pecorelli, S.; Petraglia, F.; Rosano, G. M.; Serra, G. B.; Sismondi, P.; Taddei, S.; Tonelli, F.
abstract

Italian position statement on hormone replacement therapy following the National Conference on Menopause and Hormone Replacement Therapy, Villa Tuscolana, Frascati (Rome), May 8-9, 2007.

2007 - Longitudinal study of endothelial function in children with type 1 diabetes mellitus [Abstract in Rivista]
Iughetti, Lorenzo; Predieri, Barbara; S., Madeo; A. L., Quitadamo; Bruzzi, Patrizia; G., Delle Donne; D., Iaccarino; Modena, Maria Grazia
abstract

Patients with type 1 diabetes (T1DM) have increased risk of vascular complications which development is related to the duration of diabetes and the degree of glycemic control. Impaired flow-mediated dilation (FMD) has been detected in children with diabetes, and we previously reported that a good glycemic control gets a better vascular function.Aim of our study was to evaluate longitudinally changes of FMD in T1DM patients.Thirty two children (18 male, 14 female; 11.6±3.33 yr.) with T1DM (duration of disease 49.1±39.5 months) entered the study; lipid profile, HbA1c and FMD were determined at the beginning and after 30.3±7.42 months. Vascular function was assessed by measurements of endothelium-dependent vasodilation of the brachial artery using high-sensibility ultrasound system. FMD was expressed as percentage change of diameter following reactive hyperemia from baseline.No significantly change of HbA1c (7.99±1.06 vs 8.12±1.11%; p=0.28) and FMD (6.41±10.6 vs 2.57±9.01%; p=0.09) was demonstrated; however, half of the children had FMD <7% while at the follow-up abnormal FMD was demonstrated in 75% of cases. No correlation was demonstrated between FMD and lipid profile, HbA1C or duration of the disease. Considering the glycemic control during follow-up, no difference was shown in FMD values between children with poor (>8%) and good HbA1c (≤8%) (2.69±8.55 vs 2.33±10.2%; p=0.91), despite significantly difference in the months from diagnosis (91.6±42.7 vs 56.2±26.1 months; p=0.01). According to sex, no difference of age, months of disease, HbA1c and FMD was revealed, while longitudinally boys had significantly lower FMD than girls (-0.95±8.15 vs 7.10±8.19%; p=0.009).Our data show that after several years patients had a worse FMD not apparently related to glycemic control or to duration of T1DM. This difference, more evident in males, suggests that further studies are needed to better understand which factors are involved in functional changes of endothelial dysfunction.

2007 - Role of low-dose dobutamine and contrast enhanced cardiac MRI to predict functional recovery in patients with chronic coronary total occlusion and benefits of percutaneous revascularization. MRI, coronary angiography and clinic follow up at 6 months after successful PCI intervention [Abstract in Atti di Convegno]
Sgura, Fa; Di Girolamo, A; Fiocchi, F; Guerri, E; Ligabue, G; Leuzzi, C; Modena, M.
abstract

Role of low-dose dobutamine and contrast enhanced cardiac MRI to predict functional recovery in patients with chronic coronary total occlusion and benefits of percutaneous revascularization. MRI, coronary angiography and clinic follow up at 6 months after successful PCI intervention

2007 - Sarcoma primitivo del cuore. Descrizione di un caso [Articolo su rivista]
Tremosini, Silvia; Vegetti, Alberto; D., Arioli; Ventura, Paolo; G., Rossi; Modena, Maria Grazia; M. L., Zeneroli
abstract

Primary cardiac tumors are rare events. We describe here a case of undifferentiated pleomorphic sarcoma (so-called pleomorphic malignant fibrous histiocytoma) obliterating mostly the left side and the anterior wall of pericardium in a 84-year-old man admitted for mild dyspnea at rest. The diagnosis was suspected after excluding the lung origin of the mass (observed by plain chest radiography) by thorax computed tomography but it was confirmed only by cardiac-gated magnetic resonance imaging and transthoracic biopsy. Considering both patient's age and comorbidity, and local extension of the lesion, after counseling with cardiac surgeons and oncologists, the patient was treated only by conservative medical therapy. The patient died 6 months after the diagnosis due to a superior vena cava syndrome as an effect of infiltration and obstruction of superior vena cava by the tumor at the site of vein entry in the right atrium. This case is an example of a primary cardiac tumor that causes relative myocardial sufferance both by infiltration and by limitation of normal heart diastolic function.

2007 - The founder of a key European association [Articolo su rivista]
Modena, Maria Grazia
abstract

Female cardiologists prepared to sacrifice a family for a career are doing well in Italy, according to Maria Grazia Modena, MD, FESC, past-president of the Italian Society of Cardiology and chief, Institute of Cardiology, University of Modena and Reggio Emilia, Italy. But she is frustrated that some of her colleagues seem more interested in medical politics than cooperation. She talks to Barry Shurlock, MA, PhD

2007 - Viewpoint: Maria Grazia Modena MD, FESC [Articolo su rivista]
Modena, M. G.
abstract

2006 - Blood transfusion death and myocardial infarction after elective major vascular surgery [Abstract in Atti di Convegno]
Bursi, F; Grimaldi, T; Barbieri, A; Politi, L; Malagoli, A; Di Girolamo, A; Coppi, G; Modena, Mg
abstract

Blood transfusion death and myocardial infarction after elective major vascular surgery

2006 - Coronary calcification in cardiovascular risk stratification [Articolo su rivista]
Ratti, C; Chiurlia, E; Grimaldi, T; Malagoli, A; Ligabue, Guido; Modena, Maria Grazia
abstract

The correlation between coronary calcifications and subclinical atherosclerotic disease has been well known for some years now. Today we are able to quantify coronary calcium deposits, the calcium score, by means of new imaging techniques such as electron beam computed tomography and multislice spiral computed tomography. A large number of studies performed using these methods has confirmed the association between coronary calcifications and atherosclerotic disease and has opened up the possibility of early diagnosis of any subclinical atherosclerotic disease in various subpopulations such as diabetics and nephropatics. The etiopathogenesis of coronary calcium has not yet been made clear; it appears to be an active process similar to bone formation that involves cells similar to those involved in the reabsorption of bone matrix. The calcium score, therefore, provides physicians with a further diagnostic tool able to better determine cardiovascular risk patients and supplements the Framingham risk score. International guidelines have not yet illustrated with any precision in which ambits to apply screening for the quantification of coronary calcium and consequently, for the time being, the use of such methods must be restricted to cases in which the possibility of any benefit can be scientifically shown. This review represents the state of the art on coronary calcification and its role in clinical practice.

2006 - Endothelial-dependent vasodilation and prognosis in postmenopausal women [Abstract in Rivista]
Rossi, Rosario; Nuzzo, Anna Chiara; G., Origliani; Modena, Maria Grazia
abstract

Annual congress of the american college of Cardiology

2006 - Multislice computed tomography for assessing coronary calcification and the aetiology of dilated cardiomyopathy [Abstract in Rivista]
Rossi, R; Nuzzo, Anna Chiara; Ligabue, Guido; Pecchi, Ar; Romagnoli, R; Modena, Maria Grazia
abstract

2006 - Prognostic Stratification of Women With Chronic Heart Failure Referred for Heart Transplantation: Relevance of Gender as Compared With Gender-related Characteristics [Articolo su rivista]
Grigioni, Francesco; Barbieri, Andrea; Russo, Antonio; Reggianini, Letizia; Bonatti, Silvia; Potena, Luciano; Fabbri, Francesca; Coccolo, Fabio; Magnani, Gaia; Bursi, Francesca; Magelli, Carlo; Modena, Maria G.; Branzi, Angelo
abstract

Background: Few studies are available regarding prognostic stratification of women with severe chronic heart failure (CHF). Although women seem to have a better outcome than men, this may be due to favorable baseline characteristics. Methods: We analyzed a cohort of CHF patients referred for heart transplantation (HT) who underwent clinical/laboratory/instrumental evaluation. Women and men were frequency matched for baseline age (53 Â± 14 vs 53 Â± 9 years, p = 0.92), left ventricular ejection fraction (33 Â± 10 vs 31 Â± 8%, p = 0.90) and ischemic etiology (17 vs 22%, p = 0.50). Results: A total of 198 patients were analyzed (109 women matched to 89 men). In addition to matching parameters, prevalence of severe symptoms, diabetes and hypertension were also comparable (p â ¥ 0.25). After 3 years, cardiovascular death or need for HT (CD/HT) event-free survival was 78 Â± 4% in women and 50 Â± 6% in men (p = 0.005). On multivariate analysis, female gender was associated with a lower risk of CD/HT (relative risk [RR] 0.52; 95% confidence interval [CI] 0.30 to 0.89; p = 0.017), independently of symptoms, blood pressure (BP), left ventricular end-diastolic diameter (LVEDD) and mitral regurgitation (MR). Nevertheless, CD/HT event-free survival at 3 years was 49 Â± 9% for women with New York Heart Association (NYHA) Class III or IV status, who presented with either severe MR, mean BP â ¤60 mm Hg or LVEDD â ¥35 mm/m2. Conclusions: In advanced CHF, women patients seem to have a better prognosis irrespective of baseline characteristics, supporting the hypothesis that female gender is protective against myocardial injury. However, women with severe symptoms accompanied by either hypotension, severe left ventricular enlargement or MR are at high risk and deserve cautious follow-up and consideration for HT. Â© 2006 International Society for Heart and Lung Transplantation.

2006 - Prognostic role of endothelial dysfunction in patients with dilated cardiomyopathy [Abstract in Atti di Convegno]
Rossi, R; Nuzzo, A; Modena, Mg
abstract

Prognostic role of endothelial dysfunction in patients with dilated cardiomyopathy

2006 - Relevance of cardioverter defibrillators for the prevention of sudden cardiac death on the timing of heart transplantation. [Articolo su rivista]
Grigioni, F; Boriani, Giuseppe; Barbieri, A; Russo, A; Reggianini, L; Bursi, F; Potena, L; Ricci, C; Fallani, F; Coccolo, F; Magnani, G; Magelli, C; Modena, Maria Grazia; Branzi, A.
abstract

Information on the incidence of decompensation of chronic heart failure (CHF) in heart transplantation (HT) candidates eligible for prophylactic implantable cardioverter defibrillators (ICD) could provide insights into the influence of ICD on the timing for HT.

2006 - Role of severe functional mitral regurgitation in predicting electrical remodeling in idiopathic dilated cardiomyopathy. [Articolo su rivista]
Barbieri, A; Grigioni, F; Bursi, F; Reggianini, L; Bonatti, S; Ricci, C; Boriani, Giuseppe; Russo, A; Magelli, C; Branzi, A; Modena, Maria Grazia
abstract

OBJECTIVE: To investigate incidence and predictors of clinically relevant QRS widening (predefined as >/= 10% with respect to baseline) in idiopathic dilated cardiomyopathy (IDC) and particularly the prognostic role of functional mitral regurgitation (MR). Although QRS widening in left ventricular systolic dysfunction carries relevant prognostic and therapeutic implications, its incidence and predictors in patients with IDC remain unknown. METHODS: We analyzed 114 patients with IDC receiving optimized medical treatment (age 52 +/- 10 years; 44% males; 36% New York Heart Association class III-IV) who underwent clinical, echocardiographic, hemodynamic, and laboratory evaluations and at least two electrocardiograms >/= 6 months after the index evaluation. RESULTS: During follow-up (median 20 months), 19 (17%) patients developed clinically relevant QRS widening, corresponding to an incidence of 8% per year. At multivariable analysis, the presence of echocardiographically detected severe MR (P = 0.029) and mean right atrial pressure (RAP) by right heart catheterization (P = 0.021) independently predicted clinically relevant QRS widening. CONCLUSIONS: Clinically relevant QRS widening is relatively frequent in IDC despite optimized medical treatment, and is independently predicted by MR severity and high RAP. IDC patients presenting either of these risk-factors might benefit from strict follow-up, which could also allow timely detection of the onset of indications for cardiac resynchronization therapy.

2006 - Screening for silent ischemia with coronary artery calcium and nuclear stress testing in nondiabetic patients prior to kidney transplant. [Articolo su rivista]
E., Ferramosca; A. D., Felice; C., Ratti; Ligabue, Guido; D., Ibrahim; Modena, Maria Grazia; R., Romagnoli; B., Bagni; A., Albertazzi; P., Raggi
abstract

Whether coronary artery calcium (CAC) screening in pretransplant patients may help predict silent myocardial ischemia is unknown. Accordingly, we performed CAC imaging on 46 nondiabetic patients awaiting kidneytransplant. All patients underwent multidetector computed tomography imaging for CAC quantification, and a vasodilator myocardial perfusion stress (MPS) test was performed only in patients with a total CAC score>300 or>100 in a single coronary artery. The mean patient's age was 46+/-14 years and the median dialysis vintage was 33 months (interquartile range 19-53). The median CAC score was 82 (interquartile range 0-700) and correlated with patients' age (p=0.006) and dialysis vintage (p=0.02). Nineteen patients qualified for MPS, but 5 refused the test. Of the remaining 14 patients, 7 patients had normal scans and 7 showed a minimal perfusion defect in the inferoposterior segment of the left ventricle. At the time of writing, 12 patients have undergone successful kidney transplantation without untoward complications. CAC screening does not appear to be associated with silent ischemia in pretransplant patients. Though CAC is extensive in dialysis patients, calcium may be associated with nonobstructive atherosclerotic lesions or calcification of the media layer of the vessel wall.

2006 - Short- and long-term mortality in patients with ST-elevation myocardial infarction treated with primary angioplasty: predictive value of four different risk scoring systems [Abstract in Atti di Convegno]
Menozzi, M; Monopoli, De; Geraci, G; Sgura, Fa; Modena, Mg
abstract

Predictive value of different risk scoring systems for short-term mortality in a population of patients with ST-elevation myocardial infarction treated with primary angioplasty

2006 - Type 2 diabetes mellitus is a risk factor for the development of hypertension in postmenopausal women [Articolo su rivista]
Rossi, Rosario; V., Turco; G., Origliani; Modena, Maria Grazia
abstract

Objective Hypertension and type 2 diabetes mellitus are common diseases that are frequently found concomitantly in postmenopausal women. These findings suggest a close and/or synergistic nature in the relationship between the two disease processes; however, no prospective data exist on the incidence rate of hypertension in postmenopausal women with type 2 diabetes mellitus. Methods The present study assessed the risk of developing hypertension in 840 postmenopausal women: 102 women (12.1% of the cohort) with type 2 diabetes mellitus and 738 (87.9%) free of diabetes. The mean +/- SD follow-up was 3.2 +/- 0.9 years (range 0.5-6.0 years). Results The incidence rate (cases of hypertension per 100 person-years) was 1.1 for the group of women without diabetes versus 5.6 in women with diabetes (P < 0.0001). Compared with the non-diabetic group, women with type 2 diabetes mellitus had a statistically significant higher risk of developing hypertension. The relative risks for women with diabetes was 5.09 [crude: 95% confidence interval (CI) U 3.52-7.36; P < 0.0001]; 3.43 (adjusted for body mass index and waist circumference: 95% CI U 2.25-5.14; P < 0.001); and 2.95 (adjusted for all potential confounders: 95% CI = 1.86-4.32; P < 0.01). Conclusion In our prospective study, on the incidence of hypertension, the presence of type 2 diabetes was found to be a potent independent risk determinant. This suggests that postmenopausal women affected by type 2 diabetes mellitus comprise a population at high risk for the subsequent development of hypertension.

2005 - Acute myocardial infarction - are women different? [Articolo su rivista]
Modena, Maria Grazia
abstract

Should we still debate whether women are biologically different or simply at a treatment disadvantage, compared with men? An analysis of the most recent scientific papers reveals some valid peculiarities and interesting considerations. Cardiologists, in general, know little about female peculiarities and clinical expressions of CAD and consequent therapeutic options in women. Regarding AMI, there is a well-known male model, and women have always been treated like men. Therefore, I thinkthat the Yentl syndrome is real and that it consists in the particular pathophysiology of atherosclerotic disease inwomen. Women are protected from atherosclerotic disease in their fertile phase, probably to assure species perpetuation.Menopause confers a new vulnerability in women, potentially a high risk of future cardiac events. Specific studies dedicated to a better understanding of female CAD, and particularprimary preventive interventions for aggressive treatment of risk factors in women are needed, in order to render post-menopause a phase of well being rather than a period of morbidity.

2005 - Calcificazioni arteriose mammarie e calcificazioni coronariche: Un "link" comune con la malattia aterosclerotica subclinica? [Articolo su rivista]
Ratti, Carlo; Chiurlia, Emilio; Grimaldi, Teresa; Barbieri, Andrea; Romagnoli, Renato; Modena, Maria Grazia
abstract

Coronary artery calcifications seem to be correlated with a high risk of coronary heart disease. Computed tomography has been shown to be capable of providing accurate, non-invasive measurements of coronary artery calcifications. Coronary calcium is a recognized marker of atherosclerosis. Atherosclerotic burden of coronary arteries correlates strongly with the amount of coronary artery calcifications measured by computed tomography. The presence and extent of breast arterial calcifications detected at mammography has been associated with diabetes and hypertension and it seems to be correlated with the extent of coronary atherosclerosis. This review analyzes the relationship between coronary artery calcifications, breast arterial calcifications and the increased risk of subsequent cardiovascular events. Â© 2005 CEPI Srl.

2005 - Correlation between coronary calcification and endothelial dysfunction in asymptomatic subjects at risk of coronary artery disease [Abstract in Rivista]
Rossi, Rosario; Turco, V; Ratti, C; Ligabue, Guido; Romagnoli, R; Modena, Maria Grazia
abstract

Annual Congress of the American College of Cardiology

2005 - Diabetes duration and glycaemic control have a different effect on endothelial dysfunction in children with type 1 diabetes. [Abstract in Rivista]
Rossi, Rosario; Cioni, E; Nuzzo, A; Iughetti, Lorenzo; Predieri, Barbara; Modena, Maria Grazia
abstract

N.A.

2005 - Early aggressive versus conservative managment on one year outcome in octogenarians patients with unstable angina and non-st-elevation myocardial infarction [Abstract in Atti di Convegno]
Sgura, Fa; Guerri, E; D'Amico, R; Chiurlia, E; Rossi, R; Leuzzi, C; Modena, Mg
abstract

Early aggressive versus conservative managment on one year outcome in octogenarians patients with unstable angina and non-st-elevation myocardial infarction

2005 - Endothelial-Dependent Vasodilation and Incidence of Type 2 Diabetes in a Population of Healthy Postmenopausal Women [Articolo su rivista]
Rossi, Rosario; Elena, Cioni; Annachiara, Nuzzo; Giorgia, Origliani; Modena, Maria Grazia
abstract

OBJECTIVE: Both postmenopausal state and diabetes are associated with endothelial dysfunction and are well-known risk factors for atherosclerosis. However, the relationship of endothelium-dependent vasodilation and diabetes has never been prospectively evaluated. This study provided the opportunity to assess the association between endothelial vasodilation function and the incidence of diabetes in a cohort of apparently healthy postmenopausal women. RESEARCH DESIGN AND METHODS: We conducted a prospective cohort study that began in 1997 with 840 apparently healthy, nonobese, postmenopausal women, aged 53 +/- 6 years, initially with normal glucose tolerance at the oral glucose tolerance test. All participants were followed up for a mean period of 3.9 +/- 0.7 years (range 0.5-6.9). Endothelial function was measured as flow-mediated dilation (FMD) of the brachial artery, using high-resolution ultrasound. RESULTS: There were no significant differences in demographic, blood pressure, and biochemical profiles among each tertile group at baseline or at follow-up review. During follow-up, 102 women developed type 2 diabetes. The adjusted relative risk (RR) for women with FMD </=4.3 (lowest tertile) was 5.87 (95% CI 4.34-8.10) versus women with FMD >/=5.6 (highest tertile reference). Each 1-unit decrease of FMD was associated with a significant 32% (22-48%) increase in the multiple-adjusted RR of incident diabetes. CONCLUSIONS: These prospective data indicate a significant increase in the RR of diabetes with each unit decrease of FMD. This could suggest that an impaired endothelial function may play a fundamental role in diabetogenesis in postmenopausal women

2005 - Follow-up of coronary artery bypass graft patency by multislice computed tomography [Articolo su rivista]
E., Chiurlia; M., Menozzi; C., Ratti; Romagnoli, Renato; Modena, Maria Grazia
abstract

Fifty-two consecutive asymptomatic patients with a total of 166 bypass grafts were investigated by 16-slice computed tomography (CT) 15 +/- 5 days before invasive coronary angiography. Overall, 165 grafts (99.40%) were assessable with multislice CT (MSCT). Coronary angiography showed that 111 grafts (67%) were patent and 54 (33%) were occluded. of the patent grafts, 22 had high-grade stenoses. MSCT correctly classified 1 grafts as patent and 54 as occluded. Of the patent grafts, 16-slice CT correctly detected 21 bypass stenoses (95%). These results yielded 100% sensitivity and specificity of 16-slice CT for detecting bypass grafts occlusion and 96% sensitivity and 100% specificity for detecting high-grade stenoses in patent grafts.

2005 - Il calcio coronarico come marker precoce di aterosclerosi [Articolo su rivista]
Ratti, Carlo; Chiurlia, Emilio; Menozzi, Mila; Barbieri, Andrea; Modena, Maria Grazia
abstract

Non-invasive diagnostic techniques such as electron beam computed tomography and multislice spiral computed tomography are able to detect and quantify coronary calcifications. Several clinical studies have shown how the amount of coronary calcifications correlates to the coronary plaque burden. The detection of coronary calcium therefore provides a unique opportunity to identify and quantify coronary atherosclerosis in a subclinical stage. Measures of subclinical atherosclerosis may also help in recognizing factors related to atherosclerosis in asymptomatic populations. In addition, a significant proportion of subjects who develop premature clinical disease are not identified as being at high risk by current strategies. A scan negative for coronary calcium has a high negative predictive value indicating the absence of stenotic coronary artery disease. The aim of this review was to describe the potentials of coronary calcium detection and to summarize its clinical relevance. Â© 2005 CEPI Srl.

2005 - Menopause-related blood pressure increase and its relationship to age and body mass index: the SIMONA epidemiological study [Articolo su rivista]
Alberto, Zanchetti; Rita, Facchetti; GIAN CARLO, Cesana; Modena, Maria Grazia; Anna, Pirelli; Roberto, Sega
abstract

BACKGROUND: Menopause is commonly associated with some blood pressure (BP) rise, but cross-sectional or longitudinal studies completed so far were often too small and were unable to indicate whether this BP increase is really dependent on menopause, or was caused by age or changes in body mass index (BMI). METHODS AND RESULTS: The SIMONA study (Study on Hypertension Prevalence in Menopause in the Italian population) was a large cross-sectional study on 18 326 women of age range 46-59 years, consecutively seen by 302 practitioners all over Italy, and representing 60% of the women of that age in the National Health care list of those doctors. BP was measured three times in the seated position by the same automatic machine, and demographic and clinical data were taken. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were slightly but significantly higher in postmenopausal than premenopausal and perimenopausal women, but so were age and BMI. Within seven biannual strata, differences in age and BMI were minimized, but SBP/DBP remained significantly higher (by 3.4/3.1 mmHg) in postmenopausal than in premenopausal subjects in the youngest stratum (46-47 years), and was also significantly higher in the stratum 48-49 years. The differences remained significant after the exclusion of 1809 women with surgical menopause or 695 women with cardiovascular disease. Even when the confounding effects of age, BMI, smoking and contraceptive or replacement therapies were excluded by analysis of covariance, menopause was significantly and positively associated with SBP and DBP (approximately 2 mmHg difference in the age range 46-49 years). CONCLUSION: Menopause is associated with a slightly but significantly higher BP, even after adjustment for age and BMI, as well as other confounding factors, but the association is evident only in the younger end of the age range related to menopause.

2005 - New evidence regarding hormone replacement therapies is urgently required - Transdermal postmenopausal hormone therapy differs from oral hormone therapy in risks and benefits [Articolo su rivista]
Modena, Maria Grazia; P., Sismondi; Ao, Mueck; F., Kuttenn; B., Lignieres; J., Verhaeghe; Jm, Foidart; A., Caufriez; Ar, Genazzani
abstract

Controversies about the safety of different postmenopausal hormone therapies (HTs) started 30 years ago and reached a peak in 2003 after the publication of the results from the Women Health Initiative (WHI) trial and the Million Women Study (MWS) [Writing group for the women´s health initiative investigations. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA 2002;288:321-33; Million women study collaborators. Breast cancer and hormone-replacement therapy in. the million women study. Lancet 2003;362:419-27]. The single HT formulation used in the WHI trial for non hysterectomized women-an association of oral conjugated equine estrogens (CEE-0.625 mg/day) and a synthetic progestin, medroxyprogesterone acetate (MPA-2.5 mg/day)-increases the risks of venous thromboembolism, cardiovascular disease, stroke and breast cancer. The MWS, an observational study, showed an increased breast cancer risk in users of estrogens combined with either medroxyprogesterone acetate (MPA), norethisterone, or norgestrel. It is unclear and questionable to what extent these results might be extrapolated to other HRT regimens, that differ in their doses, compositions and administration routes, and that were not assessed in the WHI trial and the MWS. Significant results were achieved with the publication of the WHI estrogen-only arm study [Anderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women´s Health Initiative randomized controlled trial. JAMA 2004;291:1701-1712] in which hormone therapy was reserved to women who had carried out hysterectomy. What emerged from this study will allow us to have some important argument to develop.

2005 - Non-invasive diagnosis of acute ischemic bowel disease detected as hepatic portal venous gas during intra-aortic balloon percutaneous counterpulsation [Articolo su rivista]
Grimaldi, T; Barbieri, A; Ratti, C; Ligabue, Guido; Romagnoli, R; Modena, Maria Grazia
abstract

The authors report a very unusual case of non-invasive diagnosis of acute ischemic bowel disease detected as hepatic portal venous gas during intra-aortic balloon percutaneous counterpulsation. A 64-year-old man with acute ST-elevation myocardial infarction complicated by cardiogenic shock was treated with percutaneous angioplasty and intra-aortic balloon percutaneous counterpulsation. The post-procedural period was complicated by severe abdominal pain. Abdominal computed tomography revealed hepatic portal venous gas. Multiple kidney and splenic ischemic areas were also identified. Colonoscopy showed signs referring to acute ischemic colitis. Computed tomography detection of hepatic portal venous gas has permitted the non-invasive diagnosis of bowel necrosis.

2005 - Non-invasive, three-dimensional visualization of coronary artery bypass grafts by multislice spiral computed tomography [Articolo su rivista]
Ratti, C; Barbieri, A; Ligabue, Guido; Grimaldi, T; Chiurlia, E; Rossi, Rosario; Modena, Maria Grazia
abstract

...

2005 - Prodromal symptoms in myocardial infarction [Articolo su rivista]
Ottolini, Fedra; Modena, Maria Grazia; Rigatelli, Marco
abstract

BACKGROUND: Little is known about the prodromal phase of myocardial infarction (MI). The aim of this study was to explore this phase with methodologies which have been standardized in affective disorders. The psychological evaluation of patients with MI diagnosis is currently based on DSM-IV criteria. An alternative diagnostic and conceptual framework has been proposed by an international group of psychosomatic investigators. In this study, we are going to compare these new criteria, i.e. the Diagnostic Criteria for Psychosomatic Research (DCPR), with DSM-IV in a population where a high prevalence of psychological problems is expected. METHODS: A semistructured research interview based on Paykel's Clinical Interview for Depression for eliciting prodromal symptoms was administered to a consecutive series of 92 patients with a first episode MI diagnosis. Two interviews for the evaluation of psychological problems were administered according to DSM-IV and DCPR criteria. RESULTS: Most of the patients reported prodromal symptoms. Irritability, depressed mood and somatic anxiety were the most common prodromal symptoms. The results also show that the number of DCPR diagnoses was higher than the number of DSM-IV diagnoses. At least one DCPR diagnosis was found in all patients, whereas at least one DSM-IV diagnosis was present in 42 (46\%) patients. CONCLUSIONS: The prodromal phase of MI was found to be characterized by prodromal symptoms of affective type. The joint use of DSM-IV and DCPR criteria was found to improve the identification of psychological factors which could affect this phase. The results should alert the physician to the fact that patients presenting with irritability, depressed mood (including demoralization), anxiety and insomnia may be at risk of developing coronary artery disease.

2005 - Prognostic value of cardiac troponin after elective major vascular surgery in patients perioperatively evaluated according to the ACC/AHA guidelines for non cardiac surgery [Abstract in Atti di Convegno]
Barbieri, A; Bursi, F; Politi, L; Zennaro, M; Grimaldi, T; Rumolo, A; Gargiulo, M; Stella, Andrea; Modena, Mg
abstract

Prognostic value of cardiac troponin after elective major vascular surgery in patients perioperatively evaluated according to the ACC/AHA guidelines for non cardiac surgery

2005 - Radiofrequency catheter ablation of common atrial flutter in a patient with anomalous inferior vena cava and azygos continuation [Articolo su rivista]
Malavasi, Vl; Casali, E; Rossi, L; Modena, Maria Grazia
abstract

We describe a case of isthmus-dependant atrial flutter ablation with a superior approach due to an anomalous inferior vena cava (IVC), azygos, and emiazygos continuation. A 56-year-old man was referred to our institution for the treatment of a common atrial flutter. Two years prior, the patient had an attempted electrophysiological study not performed due to the inability to advance the guidewire through IVC. A computed tomography of the abdominal venous system revealed the absence of the subrenal IVC, azygos, and emiazygos continuation. Following double puncture of the left subclavian vein, two catheters were inserted into the coronary sinus and into the right atrium. Programmed atrial stimulation was performed and a sustained isthmus-dependant right atrial tachycardia was obtained. After 11 applications of rodiofrequency energy with on inversion technique, sinus rhythm was restored and a repeat atrial programmed stimulation failed to induce any arrhythmia.

2005 - Subclinical coronary artery atherosclerosis in patients with erectile dysfunction [Articolo su rivista]
E., Chiurlia; D'Amico, Roberto; C., Ratti; Ar, Granata; Romagnoli, Renato; Modena, Maria Grazia
abstract

OBJECTIVES The purpose of our study was to assess the prevalence and extent of coronary artery atherosclerosis in asymptomatic patients with vascular erectile dysfunction (ED). BACKGROUND An association between ED and ischemic heart disease has been suggested, but it is unknown if it represents a marker of subclinical coronary atherosclerosis. METHODS We studied 70 consecutive patients with vascular ED, evaluated by penile Doppler, and 73 control subjects with no history of coronary artery disease. We measured traditional coronary risk factors, circulating levels of C-reactive protein (CRP), endothelial function by ultrasound of brachial artery, and coronary artery calcification by multi-slice computed tomography. RESULTS The patients and the control group were similar for age, race, and coronary risk score. Patients with ED had significantly higher high-sensitivity C-reactive protein levels (2.62 vs. 1.03 mg/l, p < 0.001). Flow-mediated dilation of the brachial artery was more impaired in patients with ED than in controls (2.36 vs. 3.92, p < 0.001). Coronary artery calcification was more frequent in individuals with ED than in control subjects (p = 0.01). Multiple logistic regression analysis showed that patients with ED had an overall odds ratio of 3.68 for having calcium score above the 75th percentile, compared to the controls. CONCLUSIONS Coronary atherosclerosis is more severe in patients with vascular ED; ED predicts the presence and extent of subclinical atherosclerosis independent of traditional risk factors for cardiovascular disease. Thus, ED may be considered an additional, early warning sign of coronary atherosclerosis.

2005 - Vascular endothelial function in children with familial hypercholesterolemia [Abstract in Rivista]
Predieri, Barbara; A., Nuzzo; L., Laudizi; S., Madeo; A. L., Quitadamo; A., Stendardo; F., Balli; Modena, Maria Grazia; Iughetti, Lorenzo
abstract

Impaired endothelial function is detectable in patients with disease associated with vascular complications, such as familial hypercholesterolemia (FH). Impaired endothelial function, assessed as flow mediated dilation (FMD) of the brachial artery, can predict future cardiovascular disease (CVD). In the present study we evaluate whether children with FH are characterized by an impairment of endothelial function and if there are differences between children with and without familial CVD.Fifteen heterozygous FH children (10 girls and 5 boys) age 9.31±3.39 yr., were enrolled in the study. In all subjects FH diagnosis was made by family history, clinical and laboratory findings, and it was confirmed by detection of a mutation in the LDL receptor gene. Vascular function of conduit arteries was assessed by measurement of endothelium-dependent vasodilation of the brachial artery using high-sensibility ultrasound system. FMD was expressed as percentage change of diameter following reactive hyperemia from baseline.Plasma total cholesterol and low-density lipoprotein levels were above the 95th percentile for age and gender (329.9±47.5 and 257.0±36.7 mg/dl, respectively). Only in 1 out of 15 children FMD impairment was demonstrated (FMD <7%; mean FMD 16.0±6.6%). Moreover, no difference in FMD between FH children with versus without CVD in the family history was revealed (13.5±6.78 and 20.1±4.78%, respectively; P=0.19). A significant correlation between FMD and chronological age of children was found (r=-0.75; P=0.03).Our data suggest that FH children have an endothelial function comparable to matched control children reported in other studies. We demonstrate that in childhood the degree of FMD is not already associated with the presence of a family history for CVD. However, the negative correlation between FMD and chronological age suggests a progressive damage of endothelial function that apparently appears in later life. Further studies are required to understand if there are factors able to delay the beginning of endothelial dysfunction.

2005 - Vascular surgery patients: perioperative and long-term risk according to the ACC/AHA guidelines, the additive role of post-operative troponin elevation [Articolo su rivista]
Francesca, Bursi; Luciano, Babuin; Andrea, Barbieri; Luigi, Politi; Mauro, Zennaro; Teresa, Grimaldi; Antonio, Rumolo; Mauro, Gargiulo; Andrea, Stella; Modena, Maria Grazia; ALLAN S., Jaffe
abstract

AIMS: The objectives of this study are to evaluate the prognostic role of pre-operative stratification in patients undergoing elective major vascular surgery, the timing of adverse outcomes, and the predictive role of troponin (cTn). METHODS AND RESULTS: Consecutive vascular surgery candidates (n=391) were prospectively stratified and treated according to the ACC/AHA guidelines. The patients were categorized into three groups: (1) with coronary revascularization in the past 5 years, (2) with intermediate clinical risk predictors, and (3) with minor or no clinical risk predictors. cTnI was measured post-operatively. By 18 months, 18.7% of subjects had experienced death or acute myocardial infarction (MI) (by the ACC/ESC criteria). The hazard ratio (HR) was 5.21 (95% CI=2.60-10.43; P<0.0001) in group 1 and 2.58 (95% CI=1.27-4.38; P=0.004) in group 2 when compared with group 3. Most events occurred within 30 days. Elevations of cTnI were associated with adverse outcomes even after multivariable adjustment at long-term (adjusted overall HR=4.73, 95% CI=2.92-7.65; P<0.0001) and at 30 days (adjusted HR=5.52, 95% CI=3.23-9.42; P<0.0001). CONCLUSION: After pre-operative stratification, patients undergoing elective major vascular surgery remain at high risk of MI and death. Events occur mainly early after surgery. cTnI elevations are frequent and independently associated with increased risk. These findings suggest the need for a major re-evaluation of our approach to these patients.

2004 - A novel mtDNA point mutation in tRNAVal is associated with hypertrophic cardiomyopathy and MELAS [Articolo su rivista]
Menotti, Francesca; Brega, Agnese; Diegoli, Marta; Grasso, Maurizia; Modena, Maria Grazia; Arbustini, Eloisa
abstract

Background. Pathological mutations of mitochondrial (mt) DNA may cause specific diseases such as cardiomyopathies or hearing loss, or syndromes such as mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episode (MELAS) syndrome. We describe a novel mtDNA mutation in a patient with severe hypertrophic cardiomyopathy associated with MELAS. The familial phenotype included 1) hypertrophic cardiomyopathy and MELAS, 2) clinically mild cardiac hypertrophy, and 3) deafness. Methods. The proband and her first degree relatives underwent echo and electrocardiograms, and biochemical tests. Magnetic resonance imaging of the brain was performed in the proband. mtDNA was fully analyzed by sequencing. DNA purification, polymerase chain reaction and direct automated sequencing were performed following standard procedures. Heteroplasmy of the novel mutation was quantified by densitometric analysis. Results. A novel G1644A transition affecting the tRNAVal was identified in the proband and maternal relatives. The mutation has been interpreted as pathological because the G at the 1644 position is a highly conserved base, is heteroplasmic with higher levels of mutant DNA in the proband than in the relatives, is located in the unique tRNAVal, is very close to a mutation described as causative of MELAS, and finally has not been found in 100 healthy controls. Conclusions. Although it is rare for patients with MELAS to be referred to cardiological evaluation because of coexisting cardiomyopathy, cardiologists should be aware of this association as well as of the non cardiac signs that may address the diagnosis to mtDNA defect-related disease in families with a variable phenotype. Â© 2004 CEPI Srl.

2004 - Acute idiopathic pericarditis with transient constriction [4] [Articolo su rivista]
Barbieri, Andrea; Grimaldi, Teresa; Bursi, Francesca; Ratti, Carlo; Bellone, Andrea; Modena, Maria Grazia
abstract

The etiology and the clinical pattern of acute pericarditis change frequently and some classic assumption and descriptions are outdated. We report on a case of transient constrictive pericarditis in a healthy young man.

2004 - Coronary calcifications in patients with diabetes mellitus [Articolo su rivista]
Modena, Maria Grazia
abstract

The use of noninvasive imaging techniques like electron beam and multislice computed tomography, to measure coronary artery calcium, is becoming increasingly accepted for risk stratification in both symptomatic and asymptomatic populations. The National Cholesterol Education Panel guidelines indicate that measurement of coronary calcium is an option for advanced risk assessment in appropriately selected persons. Because of the recognized high risk for cardiovascular events in patients with diabetes, they belong to the same high-risk category previously reserved for patients with known coronary heart disease. Diabetic patients might benefit from risk stratification with these noninvasive techniques. Indeed, absence of coronary calcium might indicate a low risk for events, while the presence of moderate to high calcium scores may help physicians to better gauge the intensity of medical therapy provided to their patients. © 2004 CEPI Srl.

2004 - Effects of progestins on estrogen-induced increase in C-reactive protein in postmenopausal women [Articolo su rivista]
Rossi, Rosario; Bursi, F; Veronesi, B; Cagnacci, Angelo; Modena, Maria Grazia
abstract

Background: C-reactive protein (CRP) represents an independent risk factor for coronary disease and stroke. Because oral estrogens increase CRP levels, with inflammatory and thrombotic consequences, we determined whether the co-administration of a progestin might modify the estrogenic effect on CRP. Methods: In a non-randomized, non-blinded study, we measured C-reactive protein serum concentrations with high-sensitivity technique (hs-CRP) in 163 healthy postmenopausal women divided into groups as follow: 52 not taking hormones (referent group), and 111 taking hormone replacement therapy (HRT) (42 of whom treated with unopposed estrogen, and 69 with an estrogen/progestin combination). Results: Compared with non-users of hormones, median CRP levels were 66% (95% confidence interval: from 44 to 89%) higher and 112% (95% confidence interval: from 89 to 168%) higher among women using a combined estrogen/progestin regimen and, respectively, among women taking unopposed estrogen [1.54 mg/L in the referent group; 2.56 mg/L in the estrogen/progestin group (P = 0.032), and 3.27 mg/L in the unopposed estrogen group (P = 0.004)]. Furthermore, there was no difference in CRP distributions between women taking different types of progestins. Conclusion: concurrent progestin administration may attenuate estrogen's pro-inflammatory effects, independently on the type of used progestin. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

2004 - Evidence of reverse remodeling after long-term biventricular stimulation for resynchronization in patients with wide QRS selected on the basis of echocardiographic electromechanical delays [Articolo su rivista]
Barbieri, Andrea; Bursi, Francesca; Bonatti, Silvia; Coppi, Francesca; Zanasi, Vera; Reggianini, Letizia; Casali, Edoardo; Malavasi, Vincenzo Livio; Modena, Maria Grazia
abstract

Background. There is increasing evidence that cardiac resynchronization therapy (CRT) may trigger an inverse remodeling process leading to decreased left ventricular (LV) volumes in patients with heart failure and wide QRS. However, it is still important to simplify patient selection and achieve a widely applicable parameter to better stratify patients who are candidates for CRT. Methods. Eighteen patients (13 males, 5 females, mean age 67.5 Â± 7.2 years) with advanced heart failure due to ischemic (n = 12) or idiopathic dilated cardiomyopathy (n = 6) and complete left bundle branch block received biventricular pacing. The patients were considered eligible in the presence of echocardiographic evidence of intra- and interventricular asynchrony, defined on the basis of LV electromechanical delay. Investigations were performed before pacemaker implantation (at baseline), the day after, and 3 and 6 months later. Results. Two patients died before the first outpatient examination. There were 15 (83%) responders to reverse remodeling among the remainder. In the overall population, there was a significant and progressive improvement in LV sphericity indexes, ejection fraction, mitral regurgitation area and LV volumes (p < 0.001). The improvement in the interventricular mechanical delay after CRT was significantly correlated with the decrease in LV end-systolic volume (r2= 0.2558, p = 0.04). Conclusions. CRT reduces LV volumes in patients with advanced heart failure, complete left bundle branch block and detailed documentation of ventricular asynchrony prior to therapeutic pacing. Broadly applicable Doppler echocardiographic measures may increase the specificity of the longterm response to CRT in terms of LV performance. Â© 2004 CEPI Srl.

2004 - Flow-mediated vasodilation and the risk of developing hypertension in healthy postmenopausal women [Articolo su rivista]
Rossi, Rosario; E., Chiurlia; A., Nuzzo; E., Cioni; G., Origliani; Modena, Maria Grazia
abstract

OBJECTIVES This study provided the opportunity to assess the relationship between endothelial vasomotor function and incidence of hypertension in a cohort of postmenopausal women. BACKGROUND Both menopause and hypertension are associated with endothelial dysfunction and are well-known risk factors for atherosclerotic-related disease. METHODS We conducted a prospective cohort study that began in 1996 on 952 apparently healthy postmenopausal women, age 53 +/- 5 years (range 44 to 60 years), with initially normal levels of blood pressure and no history of hypertension. All participants were followed up for a mean period of 3.6 +/- 0.7 years (range 0.5 to 6.9 years). Endothelial function was measured as flow-mediated dilation of the brachial artery using high-resolution ultrasound. RESULTS During follow-up 112 women developed hypertension. The adjusted relative risk for women with flow-mediated dilation of 3.5 or less (lowest quartile) was 5.77 (95% confidence interval 4.34 to 8.10) versus women with flow-mediated dilation of 5.5 or greater (highest quartile, referent). Each one-unit decrease of flow-mediated dilation was associated with a significant 16% (95% confidence interval 12% to 33%) increase in the multiple-adjusted relative risk of incident hypertension. CONCLUSIONS These prospective data indicate a significant increase in the relative risk of hypertension with each unit decrease of flow-mediated dilation that is independent of age and baseline systolic and diastolic pressure values. This could suggest that an impaired endothelial vasomotor function precedes and predicts the future development of hypertension in postmenopausal women. (C) 2004 by the American College of Cardiology Foundation.

2004 - Limitations of cardiac risk stratification in vascular surgery. [Articolo su rivista]
A., Rumolo; M., Gargiulo; I., Polverini; Barbieri, Alberto; F., Bursi; Lonardi, Roberto; R., Corradi; Modena, Maria Grazia
abstract

...

2004 - Noninvasive assessment of coronary artery bypass graft patency by multislice computed tomography. [Articolo su rivista]
Rossi, Rosario; E., Chiurlia; C., Ratti; Ligabue, Guido; R., Romagnoli; Modena, Maria Grazia
abstract

Follow-up of coronary artery bypass after cardiac surgery is routinely performed by means of X-ray coronary angiography. However, this is an invasive procedure, expensive and includes ionizing radiation exposure, hospitalization and a small risk of complications. Multislice computed tomography is a noninvasive diagnostic tool that permits the visualization of the cardiac structures, including the coronary arteries. The purpose of our study was to compare multislice computed tomography with conventional angiography for the evaluation of graft patency following cardiac surgery.Forty-seven asymptomatic patients (44 men and 3 women, mean age 67 +/- 7 years) who had undergone coronary bypass surgery at least 10 years previously, were retrospectively investigated by means of ECG-gated multislice computed tomography, within 6 months of coronary angiography.Overall, 116 out of the possible 127 (91.4\%) grafts were assessable at computed tomography, including 87 saphenous vein grafts, 26 left internal mammary artery, 2 right internal mammary artery, and 1 gastroepiploic artery. Coronary angiography showed that 79 of 116 grafts (68.1\%) were patent and that 37 (31.9\%) were occluded. All grafts which were patent and occluded at coronary angiography were correctly identified at multislice computed tomography, with a sensitivity and specificity of 100\%.Multislice computed tomography with retrospective gating permits an accurate and noninvasive evaluation of coronary artery bypass patency, and could replace conventional angiography for the follow-up of asymptomatic, stable patients.

2004 - Noninvasive evaluation of coronary artery stents patency after PTCA: role of Multislice Computed Tomography. [Articolo su rivista]
Ligabue, Guido; Rossi, Rosario; C., Ratti; M., Favali; Modena, Maria Grazia; R., Romagnoli
abstract

Restenosis of a coronary artery treated with stent implantation is a well-known process that can compromise over time the success of a coronary angioplasty and, accordingly, treated patients must undergo periodic controls. We have recently witnessed a shift towards a greater use of Multi-slice CT (msCT) in the study of coronary disease without its precise indications and limits having yet been underlined. The purpose of our study is to assess the role of msCT in the follow-up of patients treated with coronary angioplasty.Forty-eight patients, for a total of 72 lesions, who underwent treatment with a slotted tube stent implant, had an msCT examination 1 week before scheduled coronary angiography, and the results were compared. 34 stents/72 (47.2\%) were inserted on the left anterior descending; 21/72 (29.2\%) on the right coronary; 17/72 (23.6\%) on the circumflex artery or obtuse marginal branches.The observation of the opacification of the vessel located distally to treated segments allowed us to assess the patency of all stents. Coronary angiography identified a significant intrastent restenosis or a stent occlusion in 12 of the 72 stents analysed (16.7\%). msCT enabled easier visualization of the lumen of the treated artery and its differentiation from the stent struts in the ones located on the left anterior descending artery than those on the circumflex (28 stents out of 34 [82.4\%] vs 13/17 [76.5\%]; p<0.05), and on the right coronary artery, which were difficult to evaluate (11/21 [52.4\%]). We were also able to visualize the lumen of 14/15 stents with a calibre over 3.5 mm [93.3\%] vs 35/45 stent with dimensions between 3.1 e 3.4 mm [77.8\%], and only 4 stents <3 mm/12 [33.3\%]. On multivariate analysis, the characteristics that were significantly and independently associated with accurate visualization of the lumen of a stented vessel were location on the proximal anterior descending artery (OR 4.03 [IC 95\%: from 2.34 to 8.05]; p<0.0001) and stent size of >3.5 mm (OR 2.97 [IC 95\%: from 1.67 to 4.86]; p<0.01).The msCT technology available at present makes the study of smaller stents and those positioned on the right coronary artery and circumflex rather complex; on the other hand msCT appears a promising study method for stents greater then 3.5 mm and for those positioned on the proximal segment of the left anterior descending artery.

2004 - Results of a screening program for abdominal aortic aneurysm during transthoracic echocardiography in hypertensive patients [Abstract in Atti di Convegno]
Colli, A; Navazio, A; Grimaldi, T; Catellani, Elena; Piazza, Annarita; Montanari, R; Modena, Mg; Gherli, Tiziano
abstract

Results of a screening program for abdominal aortic aneurysm during transthoracic echocardiography in hypertensive patients

2004 - Three-Tesla cardiac magnetic resonance imaging in a Marfan patient with asymptomatic aortic dissection. [Articolo su rivista]
Chiurlia, E.; Menozzi, M.; Ligabue, Guido; Romagnoli, Renato; Modena, Maria Grazia
abstract

2004 - Transdermal 17-beta-estradiol and risk of developing type 2 diabetes in a population of healthy, nonobese postmenopausal women. [Articolo su rivista]
Rossi, Rosario; Origliani, Giorgia; Modena, Maria G.
abstract

OBJECTIVE: Various observational and randomized studies have demonstrated a reduction in the incidence of type 2 diabetes in postmenopausal women who received estrogen orally. No studies have been performed on the incidence of type 2 diabetes in postmenopausal women treated with transdermal 17-beta-estradiol. The purpose of our study was to assess the influence of transdermal 17-beta-estradiol on the incidence of type 2 diabetes in a population of healthy, nonobese postmenopausal women. RESEARCH DESIGN AND METHODS: Between January 1998 and December 2002, 673 healthy, nonobese postmenopausal women (mean age 54 +/- 5 years) were enrolled: 144 (21.4%) of these took transdermal 17-beta-estradiol and 529 (78.6%) had never taken hormones during their postmenopausal period. Final elaboration of the data took place in July 2003, with a mean follow-up of 3.7 +/- 0.7 years (ranging from 0.5 to 5 years). RESULTS: Type 2 diabetes developed in 60 patients during the follow-up period, which is the equivalent of 22 cases per 1,000 women-years. In the "hormones nonusers" group, diabetes developed in 10% (54 of 529 women; equivalent of 26.5 cases/1,000 women-years), whereas in the "hormones users" group, diabetes developed in 4.16% (6 of 144 women; equivalent of 12.1 cases/1,000 women-years). Transdermal 17-beta-estradiol emerged as a treatment that significantly reduced the risk of developing diabetes (RR 2.19, 95% CI 1.79-3.56; P=0.006). CONCLUSIONS: Our results suggest a significant reduction in the incidence of type 2 diabetes in our population of nonobese, healthy postmenopausal women who used transdermal 17-beta-estradiol. This could suggest that, in some women, the estrogen deficiency that occurs after menopause could represent a fundamental step in the process of diabetogenesis.

2004 - Valutazione del rischio cardiologico nell’arteropatia diabetica [Capitolo/Saggio]
Modena, Maria Grazia; Annachiara, Nuzzo; Teresa, Grimaldi
abstract

Arteriopatia diabetica degli arti inferiori

2004 - ascular Endothelial Function and Glycemic Control in Girls with Type 1 Diabetes; [Abstract in Rivista]
Predieri, Barbara; Iughetti, Lorenzo; Rossi, Rosario; A. C., Nuzzo; E., Cioni; F., Balli; Modena, Maria Grazia
abstract

N.A.

2003 - Associazione di calcificazioni arteriose mammarie, valutate con mammografia e calcificazioni arteriose coronariche quantificate con Tomografia Computerizzata multistrato in una popolazione di donne in postmenopausa [Articolo su rivista]
Pecchi, Annarita; Rossi, Rosario; Coppi, Francesca; Ligabue, Guido; Modena, Maria Grazia; Romagnoli, Renato
abstract

Purpose. To assess the correlation between the presence and extent of breast arterial calcifications (BAC) detected at mammography and the extent of coronary atherosclerosis, as evaluated by multislice computed tomography (MSCT) coronary calcium quantification in a population of post-menopausal women. Materials and methods. Seventy-four post-menopausal women aged under 65 years who had undergone mammography at our Department were studied by MSCT for coronary calcium quantification. The mammograms were screened for vascular calcifications which were graded according to severity and extension. The presence of coronary artery calcifications was assessed by MSCT using the Â«Smart ScoreÂ» cardiac reconstruction software. The data obtained were analyzed using the statistical package SPSS (version 10.1) for Windows. Results. The presence and severity of breast arterial calcifications showed a strong correlation with coronary calcifications in both models. Discussion and conclusions. The study demonstrated that the presence of BAC is strongly correlated with the amount of coronary calcium detected by MSCT and therefore with the extent of coronary atherosclerosis. Moreover, there is a linear correlation between BAC severity and coronary calcium content, each incremental increase in BAC severity being associated with an average increase in coronary calcium content. Therefore, the presence and severity of BAC may provide indirect qualitative and quantitative information on the calcium present in the coronaries. As mammography is increasingly used as a screening test for breast carcinoma, breast arterial calcifications may represent an important sign with epidemiological and clinical significance for primary prevention.

2003 - Cuore di Donna [Capitolo/Saggio]
Modena, Maria Grazia; T., Grimaldi
abstract

Perché bisogna parlare oggi di un cuore al femminile? Come riconoscere i sintomi dell'infarto? Che cosa raccomandare a una donna che ha avuto un infarto? Quali sono allora i presidi di una buona prevenzione?

2003 - Endothelial-dependent vasodilatation and the incidence of atrial fibrillation in hypertensive postmenopausal women. A long-term follow-up study [Abstract in Rivista]
Rossi, Rosario; Origliani, G; Modena, Maria Grazia
abstract

Annual Congress of the European Society of Cardiology

2003 - Evaluation of coronary artery disease by multislice spiral computed tomography in dialysis patients [Abstract in Atti di Convegno]
Ferramosca, E; Malaguti, V; Di Felice, A; Magistroni, R; Ratti, C; Modena, Mg; Ligabue, G; Romagnoli, R; Bagni, B; Albertazzi, A.
abstract

Evaluation of coronary artery disease by multislice spiral computed tomography in dialysis patients

2003 - Gender differences in diagnostic procedures [Articolo su rivista]
Modena, Maria Grazia; Nuzzo, Annachiara; Rossi, Rosario
abstract

This review examines the contribution of the literature to the controversial issue of diagnostic procedures in women affected by coronary artery disease (CAD), on which a large number of papers have been published. It has been reported that cerebro- and cardiovascular diseases represent the first cause of death in the New as well as in the Old World, Italy included. Some studies are conditioned by bias; one of these is the Framingham study, in which angina was reported and defined only clinically and for a relatively young age range, as a benign condition in women. Angiographic studies, such as the CASS, considered a super elected group of women referred to the hemodynamic laboratory for chest pain, which in the female gender often has atypical characteristics. In our opinion, it is mandatory to take into account: 1) what chest pain really means in women; 2) the fact that there are gender differences: women have a different biological and hormonal status, lifestyle, and perception of the disease; 3) that there is a different approach of the physicians to a woman with possible or suspected CAD. We suggest, therefore, a more peculiar and individualized diagnostic approach to women suspected as having CAD. This approach should also take the pre-test probability of disease into consideration. The first investigational step we recommend is the exercise ECG test; should this be unfeasible or not interpretable, an imaging and/or pharmacological stress test is advisable. In case of positive first test results, coronary angiography should be performed. Â© 2003 CEPI Srl.

2003 - Ipertensione, diabete, fumo, dislipidemia e altri fattori di rischio cardiologici. [Monografia/Trattato scientifico]
Modena, Maria Grazia; P., Verdecchia
abstract

Cardioform. Corso di formazione e autovalutazione in Cardiologia. Fascicolo 8. Ipertensione, diabete, fumo, dislipidemia e altri fattori di rischio cardiologici

2003 - L'infarto miocardico acuto nella donna [Relazione in Atti di Convegno]
Rossi, Rosario; T., Grimaldi; B., Veronesi; Modena, Maria Grazia
abstract

Atti 37° Convegno Internazionale del Dipartimento Cardio-Toracico-Vascolare A De Gasperi

2003 - Luci ed ombre della terapia ormonale sostitutiva nella prevenzione cardiovascolare. [Monografia/Trattato scientifico]
Modena, Maria Grazia; Chiurlia, E.; Rossi, Rosario
abstract

MONOGRAFIA MENOPAUSA

2003 - Postmenopausal hormone replacement therapy (multiple letters) [Articolo su rivista]
Mascitelli, Luca; Pezzetta, Francesca; Rossi, Rosario; Modena, Maria Grazia
abstract

Postmenopausal hormone replacement therapy (multiple letters)

2003 - Quantificazione del calcio coronarico (calcium score) attraverso l'utilizzo di nuove tecniche di imaging e suo ruolo prognostico in vari sottogruppi di pazienti [Articolo su rivista]
Ratti, Carlo; Grimaldi, Teresa; Ligabue, Guido; Favali, Marco; Bursi, Francesca; Rossi, Rosario; Modena, Maria Grazia; Romagnoli, Renato
abstract

Coronary artery disease is the first cause of mortality in industrialized countries notwithstanding the diagnostic and therapeutic progresses. Electron beam computed tomography and multislice computed tomography with calcium score software seem to have an important role in the early diagnosis of coronary artery disease. Coronary calcium is associated with a high probability of subclinical atherosclerosis. In particular the area of calcification has a positive correlation with the histologically analyzed area of the atheromatous burden plaque. The pathophysiological mechanism may be that the calcium adherent to the plaque makes unstable the plaque with possible rupture. Several studies have analyzed the predictive value of calcium score in various subgroups of patients (asymptomatic, with chest pain, with diabetes) and they have confirmed the presence of large calcific deposits in subjects with a high cardiovascular risk. The correlation of the other risk factors with calcium score is unclear and whether this is due to genetic predisposition requires further investigation. Â© 2003 CEPI Srl.

2003 - The strengths and frailties of women with cardiovascular disease [Articolo su rivista]
Andreotti, Felicita; Modena, Maria Grazia
abstract

Shakespeare and popular belief have tended to reinforce the view that females are weak. Scientific methodology applied to the field of cardiovascular disease suggests, to the contrary, that women are strong and enduring. Compared to males, females live at least 4 years longer, develop ischemic heart disease about 10 years later, require more risk factors before manifesting heart disease5, are less subject to sudden cardiac death6, and appear to have a more favorable outcome after the onset of heart failure.

2003 - Type IV dual left anterior descending coronary artery evaluated using multislice computed tomography: Anatomy of a rare coronary anomaly [Articolo su rivista]
Chiurlia, Emilio; Ligabue, Guido; Ratti, Carlo; Modena, Maria Grazia
abstract

Images in cardiovascular medicine Type IV dual left anterior descending coronary artery evaluated using multislice computed tomography: anatomy of a rare coronary anomaly

2002 - A comprehensive approach to target organ damage in hypertensive women [Articolo su rivista]
Modena, Maria Grazia; Rossi, Rosario
abstract

Purpose The aim of the present study was to demonstrate how the regression of target organ damage (TOD) in patients with hypertension really improves prognosis. This issue has already been demonstrated in the general population but no data have been provided in postmenopausal women, which represents a particular group of high-risk hypertensive patients. Study selection We initially chose to select a number of studies focused on the regression of left ventricular hypertrophy since this plays an extremely important prognostic role and is among the restricted number of risk factors that may be corrected with adequate treatment. We also focused our attention on the issue of endothelial dysfunction, considering that this relatively new pathophyslological entity may represent sensu strictu real organ damage of hypertension that has often been demonstrated in postmenopausal women Results of data analysis All the reviewed studies agree that the regression of left ventricular hypertrophy is a positive prognostic factor. Moreover, antihypertensive therapy itself is associated with some changes in the degree of endothelial dysfunction. Our preliminary data seem to suggest that the regression of endothelial dysfunction plays a very important prognostic role in terms of event reduction in postmenopausal patients with hypertension. Conclusion Despite a large amount of research remaining to be carried out on the mechanism and the prognostic role of the modifications of TOD in patients with hypertension, the available data demonstrate that the achievement of a reduction in the extent of TOD is extremely important for the evaluation of the efficacy of the treatment in the general hypertensive population, and also in postmenopausal women.

2002 - Cigarette smokers and vascular damage: analysis of mechanisms that impair endothelium dependent vasodilatation [Abstract in Atti di Convegno]
Bursi, F; Rossi, R; Nuzzo, Ac; Grimaldi, T; Modena, Mg
abstract

Cigarette smokers and vascular damage: analysis of mechanisms that impair endothelium dependent vasodilatation

2002 - Effects of adding an aldosterone receptor antagonist to an angiotensin converting enzyme inhibitor in patients with hypertension [Abstract in Atti di Convegno]
Rossi, R; Bursi, F; Bonatti, S; Fari, G; Modena, Mg
abstract

Effects of adding an aldosterone receptor antagonist to an angiotensin converting enzyme inhibitor in patients with hypertension

2002 - Effects of hormone replacement therapy on C-reactive protein levels in healthy postmenopausal women: Comparison between oral and transdermal administration of estrogen [Articolo su rivista]
Modena, Maria Grazia; Bursi, F; Fantini, G; Cagnacci, Angelo; Carbonieri, A; Fortuna, A; Rossi, Rosario
abstract

C-reactive protein, an acute phase reactant, is a sensitive marker of inflammation. High plasma levels of C-reactive protein are associated with an increased risk of myocardial infarction and stroke among apparently healthy subjects, as well as among those at higher risk because of age, smoking, or previous coronary artery disease, and are useful in cardiovascular risk stratification. Moreover, statins have been shown to lower C-reactive protein levels. contrast, oral hormone replacement therapy appears to increase C-reactive protein levels. However, the effects of different hormonal preparations and their routes of administration are not known. We therefore compared the effects of oral estrogen and transdermal estradiol on C-reactive protein plasma levels in healthy postmenopausal women

2002 - Endothelial dependent vasodilatation and incidence of cerebrovascular events in healthy postmenopausal women [Abstract in Atti di Convegno]
Rossi, R; Fantini, Gregorio; Monopoli, D; Zennaro, M; Modena, Mg
abstract

Endothelial dependent vasodilatation and incidence of cerebrovascular events in healthy postmenopausal women

2002 - Menopause and cardiovascular risk [Articolo su rivista]
Rossi, Rosario; T., Grimaldi; G., Origliani; G., Fantini; F., Coppi; Modena, Maria Grazia
abstract

Menopause is not a disease, but a physiologic phase of a woman's life, due to the changes of their hormonal status. Fastidious symptoms may be associated with changes in the metabolism together with new cardiovascular risk factors, particularly aggressive for the female cardiovascular system, unprepared because of the protection due to the fertile period. Changes of the lipid profile, obesity, hypertension, glucose intolerance and diabetes mellitus may intervene as severe risk factors. Cardiovascular disease represents therefore the most frequent cause of mortality and morbidity also in the female gender more than cancer either in the United States as in Europe. The risks related to post-menopause are mainly due to the abrupt interruption of estrogen, which has indirect protective effects on lipid, glycidic metabolism and direct effects on vessel function. They have, in fact, vasodilator action due to nitric oxide release, calcium-antagonist like action and an antiproliferative effect on smooth muscle cells. Post-menopause is also frequently associated with hypertension, the most frequent related factor to coronary artery disease. Hypertension is due to increased body mass index, with insulin-resistance, sodium retention, increased blood viscosity and estrogen deficiency with increased smooth muscle cell proliferation which determines an increase in systemic vascular resistance. Age and estrogen deficiency are together the most important cause of cardiovascular risk in post-menopause. The discovery of alpha and recently beta estrogen receptors on coronary female vessels unaffected by atherosclerosis either during pre and post-menopause phase are possible key of interpretation of pathophysiology of coronary artery disease in women, with important therapeutic consequence

2002 - New unusual markers in coronary syndromes [Relazione in Atti di Convegno]
Modena, Maria Grazia
abstract

VI International Learning Meeting on New Perspectives in Ischemic Heart Disease, Heart Failure Atherosclerosis and Hypertension in the Third Millenium – Course on Noninvasive Coronary Doppler: from Normal to Acute Myocardial Infarction

2002 - Postmenopausal hormone replacement therapy and prevention: no chance for celebration? What should doctors do? A personal opinion [Articolo su rivista]
Rossi, Rosario; Modena, Maria Grazia
abstract

Postmenopausal hormone replacement therapy and prevention: no chance for celebration? What should doctors do? A personal opinion.

2002 - Prognostic role of reversible endothelial dysfunction in hypertensive postmenopausal women [Articolo su rivista]
Modena, Maria Grazia; Bonetti, L; Coppi, F; Bursi, F; Rossi, Rosario
abstract

OBJECTIVES The aim of the present study was to assess whether optimized antihypertensive treatment is effective in modifying endothelial function and whether an improvement in flow-mediated vasodilation (FMD) in response to treatment, as an expression of reversible endothelial dysfunction, could predict a more favorable prognosis in a population of postmenopausal women. BACKGROUND Hypertensive postmenopausal women have been shown to have abnormal endothelium-dependent vascular function. However, FMD may change over time, according to antihypertensive treatment; the prognostic value of these changes has not been investigated. METHODS A total of 400 consecutive postmenopausal women with mild-to-moderate hypertension and impaired FMD underwent ultrasonography of the brachial artery at baseline and after six months, while optimal control of blood pressure was achieved using antihypertensive therapy. They were then followed up for a mean period of 67 months (range 57 to 78). Endothelial function was measured as FMD of the brachial artery, using high-resolution ultrasound. RESULTS After six months of treatment, FMD had not changed (less than or equal to10% relative to baseline) in 150 (37.5%) of 400 women (group 1), whereas it had significantly improved (>10% relative to baseline) in the remaining 250 women (62.5%) (group 2). During follow-up, we noticed 32 events (3.50 per 100 person-years) in group 1 and 15 events (0.51 per 100 person-years) in group 2 (p < 0.0001). CONCLUSIONS This study demonstrates that a significant improvement in endothelial function may be obtained after six months of antihypertensive therapy and clearly identifies patients who possibly have a more favorable prognosis. (C) 2002 by the American College of Cardiology Foundation.

2002 - The use of diagnostic criteria (DCPR) for assessing psychological distress in the setting of acute myocardial infarction [Abstract in Rivista]
Rigatelli, Marco; Ottolini, F; Modena, Maria Grazia
abstract

Not available

2001 - Aldosterone inhibition limits collagen synthesis and progressive left ventricular enlargement after anterior myocardial infarction [Articolo su rivista]
Modena, Maria Grazia; P., Aveta; A., Menozzi; Rossi, Rosario
abstract

Background The reparative process after myocardia[ infarction is related to active collagen synthesis. Previous experimental studies demonstrated that cardiac fibrosis is mediated by angiotensin II and aldosterone; this mechanism is not clearly confirmed in patients who have had a myocardial infarction. The aim of this study was to evaluate whether the suppression of aldosterone may be helpful in reducing postinfarction collagen synthesis land progressive left ventricular dilation) in patients treated with an angiotensin-converting enzyme inhibitor for a recent myocardial infarction. Methods We enrolled 46 patients (ages 60 +/- 11 years, 34 males) with a first episode of anterior transmural thrombolized myocardial infarction. At hospital discharge patients were randomized to receive potassium canrenoate, an oral aldosterone inhibitor, 50 mg once daily (group 1, n = 24) or placebo (group 2, n = 22). All enrolled patients were on angiotensin-converting enzyme inhibitor therapy. The serum concentration of the aminoterminal propeptide of type III procollagen was used to measure the collagen synthesis rate; dosage was obtained before enrollment, at hospital discharge, and after 3, 6, and 12 months of follow-up. Results After 3, 6, and 1 2 months of treatment, the aminoterminal propeptide of type III procollagen serum levels was significantly higher in the placebo group compared with the aldosterone inhibitor group; after 6 and 12 months we observed significantly smaller left ventricular volumes in the active treatment group. Conclusion Potassium canrenoate, combined with an angiotensin-converting enzyme inhibitor, may reduce postinfarction collagen synthesis and progressive left ventricular dilation.

2001 - Effects of hormone replacement therapy on C-reactive protein in healthy postmenopausal women: Comparison between oral and transdermal administration. [Abstract in Rivista]
Modena, Maria Grazia; Fontanesi, L; Lenoci, A; Rossi, Rosario
abstract

Annual Congress of the American Congress of Cardiology

2001 - Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: The ASSENT-3 randomised trial in acute myocardial infarction [Articolo su rivista]
Van de Werf, F.; Armstrong, P. W.; Granger, C.; Wallentin, L.; Adgey, A. A. J.; Aylward, P.; Binbrek, A. S.; Califf, R.; Cassim, S.; Diaz, R.; Fanebust, R.; Fioretti, P. M.; Huber, K.; Husted, S.; Lindahl, B.; Lopez-Sendon, J. L.; Makijarvi, M.; Meyer, J.; Navarro Robles, J.; Pfisterer, M.; Seabra-Gomes, R.; Soares-Piegas, L.; Sugrue, D.; Tendera, M.; Theroux, P.; Toutouzas, P.; Vahanian, A.; Verheugt, F.; Sarelin, H.; Goetz, G.; Bluhmki, E.; Daclin, V.; Danays, T.; Houbracken, K.; Kaye, J.; Reilly, P.; Hacke, W.; von Kummer, R.; Lesaffre, E.; Bogaerts, K.; Peeters, C.; Fox, K. A. A.; Brower, R.; Hirsh, J.; Maggioni, A.; Tijssen, J.; Weaver, D.; Beernaert, A.; Beysen, N.; Broos, K.; De Prins, E.; D'Hollander, K.; Dupon, L.; Fomyna, N.; Fransen, A.; Genesse, D.; Goffin, L.; Hendrickx, R.; Jansen, B.; Jorissen, F.; Luys, C.; Luyten, A.; Marschal, C.; Moreira, M.; Munsters, K.; Salerno, R.; Schoovaerts, C.; Sinnaeve, P.; Schildermans, C.; Vandenberghe, K.; Vandeschoot, K.; Van Gucht, H.; Van Rompaey, P.; Vlassak, S.; Watzeels, M.; Wittockx, H.; Galan, K.; Humeniuk, L.; Seidel, A.; Molina, M.; Hafley, G.; Alexander, J.; Pascual, A.; Bestilny, S.; Temple, T.; Ahuad Guerrero, R.; Albisu, J. P.; Bassani Arrieta, C. A.; Bono, J.; Caccavo, A.; Cagnolatti, A.; Cartasegna, L. R.; Castellanos, R.; Chekerdemian, S.; Covelli, G.; Cuello, J. L.; Cuneo, C. A.; Fernandez, A.; Ferrara, C.; Ferro-Queirel, E.; Gambarte, A.; Garcia-Duran, R.; Hasbani, E.; Hrabar, A.; Keller, L.; Lobo Marquez, L. L.; Luciardi, H.; Macin, S. M.; Marinig, A.; Marzetti, E.; Muntaner, J.; Nordaby, R.; Orlandini, A. D.; Piombo, A. C.; Pomposiello, J. C.; Quijano, R. A.; Amerena, J.; Aroney, G.; Buckmaster, N.; Carroll, P.; Fitzpatrick, M.; Newman, R.; Rowe, M.; Singh, B.; Thomson, A.; Winter, C.; Eber, B.; Gaul, G. B.; Klein, W.; Leisch, F.; Mayr, H.; Mlczoch, J.; Niessner, H.; Pachinger, O.; Pall, H.; Pichler, M.; Roggla, G.; Schaflinger, E.; Schreiber, W.; Slany, J.; Traindl, O.; Zenker, G.; Beckers, J.; Bekaert, I.; Berthe, C.; Bodur, G.; Carlier, B.; Carlier, M.; Carpentier, J.; Celen, H.; Charlier, F.; Clement, A.; Coenen, A.; Crochelet, L.; De Keyser, F.; De Man, F.; de Meester, A.; Dendale, P.; Dhondt, E.; Dhooghe, G.; El Allaf, D.; Elshot, S.; Emmerechts, C.; Foret, F.; Gatera, E.; Geraedts, J.; Gerardy, A. C.; Gysbrechts, M.; Hallemans, R.; Hellemans, S.; Herssens, H.; Huygens, L.; Janssens, L.; Lalmand, J.; Maamar, R.; Marechal, P.; Mertens, D.; Michel, P.; Morandini, E.; Nannan, M.; Nguyen, D.; Odeurs, W.; Peerenboom, P.; Pirenne, B.; Quinonez, M.; Raymenants, E.; Renard, M.; Silance, P. G.; Standaert, A. M.; Striekwold, H.; Thiels, H.; Valadi, D.; van Brabandt, H.; Van Dormael, M.; Van Iseghem, P.; Van Walleghem, U.; Vanden Bosch, H.; Vandenbossche, J. L.; Vermylen, J.; Verstraete, S.; Vo Ngoc, P.; Willems, P.; Zenner, R.; Campos de Albuquerque, D.; Coutinho, M.; de Camargo Carvalho, A. C.; Fernandes Manenti, E. R.; Ferreira Azevedo, A.; Golin, V.; Gun, C.; Marin Neto, J. A.; Marino, R. L.; Miranda Abrantes, J. A.; Nicolau, J. C.; Porto Alegre Dancini, E. M.; Rabelo, A.; Ramos, R. F.; Rizzi Coelho, O.; Alexander, D.; Bata, I. R.; Bhargava, R. K.; Bogaty, P.; D'Amours, G.; Darcel, I.; Finnie, K. J. C.; Fowlis, R.; Gupta, M. K.; Henderson, M.; Howlett, M. K.; Javier, J. J.; Kieu, C. V.; Kumar, G.; Lebouthillier, P.; Leduc, F.; Lepage, S.; Mcavinue, T.; Mcgillen, J. E.; Mcmeekin, J. D.; Morse, J. W.; Pistawka, K.; Raimondo, E. F.; Sandrin, F.; Smith, H.; Smylie, P. C.; Tran, K.; Turabian, M.; Wagner, K. R.; Winkler, L. H.; Woo, K. S.; Falstie-Jensen, N.; Lind Rasmussen, S.; Lomholt, P.; Markenvard, J.; Nielsen, H.; Petersen, J.; Romer, F.; Ahonen, J.; Huttunen, M.; Kokkonen, L.; Luukkonen, J.; Mantyla, P.; Melin, J.; Mustonen, J.; Valli, J.; Voutilainen, S.; Agraou, B.; Allam, S.; Baradat, G.; Battistella, P.; Bazin, P.; Bouvier, J. -M.; Destrac, S.; Fouche, R.; Fournier, P. -Y.; Funck, F.; Garnier, H.; Grall, J. -Y.; Gully, C.; Lallement, P. -Y.; Loiselet, P.;
abstract

Background: Current fibrinolytic therapies fail to achieve optimum reperfusion in many patients. Low-molecular-weight heparins and platelet glycoprotein IIb/IIIa inhibitors have shown the potential to improve pharmacological reperfusion therapy. We did a randomised, open-label trial to compare the efficacy and safety of tenecteplase plus enoxaparin or abciximab, with that of tenecteplase plus weight-adjusted unfractionated heparin in patients with acute myocardial infarction. Methods: 6095 patients with acute myocardial infarction of less than 6 h were randomly assigned one of three regimens: full-dose tenecteplase and enoxaparin for a maximum of 7 days (enoxaparin group; n=2040), half-dose tenecteplase with weight-adjusted low-dose unfractionated heparin and a 12-h infusion of abciximab (abciximab group; n=2017), or full-dose tenecteplase with weight-adjusted unfractionated heparin for 48 h (unfractionated heparin group; n=2038). The primary endpoints were the composites of 30-day mortality, in-hospital reinfarction, or in-hospital refractory ischaemia (efficacy endpoint), and the above endpoint plus in-hospital intracranial haemorrhage or in-hospital major bleeding complications (efficacy plus safety endpoint). Analysis was by intention to treat. Findings: There were significantly fewer efficacy endpoints in the enoxaparin and abciximab groups than in the unfractionated heparin group: 233/2037 (11.4%) versus 315/2038 (15.4%; relative risk 0.74 [95% CI 0.63-0.87], p=0.0002) for enoxaparin, and 223/2017 (11.1%) versus 315/2038 (15.4%; 0.72 [0.61-0.84], p<0.0001) for abciximab. The same was true for the efficacy plus safety endpoint: 280/2037 (13.7%) versus 347/2036 (17.0%; 0.81 [0.70-0.93], p=0.0037) for enoxaparin, and 287/2016 (14.2%) versus 347/2036 (17.0%; 0.84 [0.72-0.96], p=0.01416) for abciximab. Interpretation: The tenecteplase plus enoxaparin or abciximab regimens studied here reduce the frequency of ischaemic complications of an acute myocardial infarction. In light of its ease of administration, tenecteplase plus enoxaparin seems to be an attractive alternative reperfusion regimen that warrants further study.

2001 - Malattie cardiovascolari. [Capitolo/Saggio]
Modena, Maria Grazia
abstract

Atti del gruppo di lavoro "Medicina Donna Salute"

2001 - Reversible endothelial dysfunction predicts a more favorable prognosis in hypertensive postmenopausal women [Abstract in Rivista]
Modena, Maria Grazia; Aveta, P; Piccinini, Lino; Cantergiani, A; Rossi, Rosario
abstract

Annual congress of the american college of Cardiology

2001 - beta-blockade in chronic heart failure - Response [Articolo su rivista]
Metra, M; Giubbini, R; Nodari, S; Boldi, E; Modena, Mg; del Cas, L.
abstract

Background—Both metoprolol and carvedilol produce hemodynamic and clinical benefits in patients with chronic heart failure; carvedilol exerts greater antiadrenergic effects than metoprolol, but it is unknown whether this pharmacological difference results in hemodynamic and clinical differences between the 2 drugs. Methods and Results—We randomized 150 patients with heart failure (left ventricular ejection fraction ≤0.35) to double-blind treatment with either metoprolol or carvedilol. When compared with metoprolol (124±55 mg/d), patients treated with carvedilol (49±18 mg/d) showed larger increases in left ventricular ejection fraction at rest (+10.9±11.0 versus +7.2±7.7 U, P=0.038) and in left ventricular stroke volume and stroke work during exercise (both P<0.05) after 13 to 15 months of treatment. In addition, carvedilol produced greater decreases in mean pulmonary artery pressure and pulmonary wedge pressure, both at rest and during exercise, than metoprolol (all P<0.05). In contrast, the metoprolol group showed greater increases in maximal exercise capacity than the carvedilol group (P=0.035), but the 2 drugs improved symptoms, submaximal exercise tolerance, and quality of life to a similar degree. After a mean of 23±11 months of follow-up, 21 patients in the metoprolol group and 17 patients in the carvedilol group died or underwent urgent transplantation. Conclusions—The present study demonstrates that during long-term therapy, carvedilol improves cardiac performance to a greater extent than metoprolol when administered to patients with heart failure in the doses shown to be effective in clinical trials. These differences were likely related to a greater antiadrenergic activity of carvedilol.

2000 - Differential effects of beta-blockers in patients with heart failure - A prospective, randomized, double-blind comparison of the long-term effects of metoprolol versus carvedilol [Articolo su rivista]
M., Metra; R., Giubbini; S., Nodari; E., Boldi; Modena, Maria Grazia; L., Dei Cas
abstract

Background-Both metoprolol and carvedilol produce hemodynamic and clinical benefits in patients with chronic heart failure; carvedilol exerts greater antiadrenergic effects than metoprolol, but it is unknown whether this pharmacological difference results in hemodynamic and clinical differences between the 3 drugs. Methods and Results-We randomized 150 patients with heart failure (left ventricular election fraction less than or equal to 0.35) to double-blind treatment with either metoprolol or carvedilol. When compared with metoprolol (124+/-55 mg/d), patients treated with carvedilol (49+/-18 mg/d) showed larger increases in left ventricular ejection fraction at rest (+10.9+/-11.0 versus +7.2+/-7.7 U, P=0.038) and in left ventricular stroke volume and stroke work during exercise (both P<0.05) after 13 to 15 months of treatment. In addition, carvedilol produced greater decreases in mean pulmonary artery pressure and pulmonary wedge pressure, both at rest and during exercise, than metoprolol (all P<0.05), In contrast, the metoprolol group showed greater increases in maximal exercise capacity than the carvedilol group (P=0.035), but the 3 drugs improved symptoms, submaximal exercise tolerance, and quality of life to a similar degree. After a mean of 23+/-11 months of follow-up, 21 patients in the metoprolol group and 17 patients in the carvedilol group died or underwent urgent transplantation. Conclusions-The present study demonstrates that during long-term therapy, carvedilol improves cardiac performance to a greater extent than metoprolol when administered to patients with heart failure in the doses shown to be effective in clinical trials. These differences were likely related to a greater antiadrenergic activity of carvedilol.

2000 - Effects of single-drug antihypertensive therapy on endothelium-dependent vasodilation in hypertensive postmenopausal women [Abstract in Rivista]
Rossi, Rosario; Molinari, R; Aveta, P; Muia, N; Modena, Maria Grazia
abstract

Annual congress of the american college of Cardiology

2000 - L'uso di estro-progestinici in prevenzione secondaria [Articolo su rivista]
Modena, M. G.; Origliani, G.; Rossi, R.
abstract

Use of estrogen-progestins in secondary prevention

2000 - La diagnosi di cardiopatia ischemica nella donna [Articolo su rivista]
Modena, M. G.; Origliani, G.; Sansoni, S.; Turco, V.; Rossi, R.
abstract

Risk stratification and therefore evaluation of pre-test probability of coronary artery disease represent an important point in order to choose the ideal noninvasive test in women. Risk evaluation may be performed in relation to the presence of so-called major (hypertension, diabetes, age > 65 years) or minor (dyslipidemia, smoking abuse) risk factors. The standard ECG exercise test represents an important step, but only if easily interpretable and feasible: a complete negative test suggest the absence of coronary artery disease; its positivity should indicate the opportunity to perform coronary angiography in the presence of moderate to severe pre-test probability. If ECG exercise test is not feasible, we would suggest a test of imaging; in the case of high pre-test probability we would recommend a test with high specificity, such as echo-stress test, whereas in the case of lower pre-test probability we would prefer a test with high sensitivity, such as myocardial scintigraphy.

1999 - Career structure and advancement in cardiology in Italy. The Group for the Study of the Italian Status of Cardiologists [Articolo su rivista]
Modena, Maria Grazia; Molinari, R; Lalla, Michele
abstract

Women are less present on the labor market and many studies have demonstrated the existence of gender differences regarding the participation rate and career advancement of women. The processes through which job-, career- and research-related choices are structured within the realm of Italian cardiology is described in this study, emphasizing the effects of productivity, gender and family commitments. In June of 1996, a questionnaire was mailed to all members of the Italian societies of cardiology. It included mainly (pre-coded) set-choice questions concerning individual characteristics, career-related data and information pertaining to teaching, scientific and research activity. Returned questionnaires numbered 1715 (21.4% of the total mailed), with 83% completed by males and 17% by females. For both hospital and academic careers, advancement in rank was influenced by variables denoting productivity, family and individual characteristics. Promotion to the upper ranks of the hierarchy was highly dependent upon time (once the effects of the covariates were eliminated). This is a situation that is typical of the internal labor market or in other words, of an institution in which staff members are ranked on a hierarchical scale according to formal criteria that are "rigid" and institutionalized, partially or totally sheltered from competition. Therefore, once a member has gained access to the first level of the hierarchy, his/her professional career is pre-determined to a certain extent and seniority ends up taking on importance in promotion decisions to an appreciable extent; in this field, the weight of seniority on promotion ranges between 30 and 50%.

1999 - Cine risonanza magnetica con dobutamina dopo infarto del miocardio [Articolo su rivista]
Giovagnoni, Andrea; Ligabue, Guido; Rossi, Rosario; Muia, Nicola; Modena, Maria Grazia; Romagnoli, Renato
abstract

Purpose: Dobutamine Cine MRI is a new diagnostic imaging technique in the pretreatment (revascularization) assessment of myocardial infarction patients. We report the results of a comparative study of the diagnostic yield of dobutamine Cine MRI with that of stress echocardiography in the assessment of viable myocardium. We also propose a new method for analysis of Cine MR images, employing digital subtraction, aimed at decreasing subjectivity in the quantitative assessment of myocardial wall thickening. Materials and methods. Twenty-six patients (21 men and 5 women) with a history of myocardial infarction who were scheduled for revascularization were submitted to stress echocardiography and dobutamine Cine MRI to evaluate contractile recovery of the segments considered akinetic or hypokinetic at baseline echocardiography. Dobutamine was administered in growing doses (5, 10, 15 γ/kg/min). We considered 16 segments of the left ventricle in each patient. We performed a quantitative analysis of systolic wall thickening on individual Cine MR frames both by manual measurements and by digital subtraction. Results. In the 416 segments studied, we found 307 normokinetic, 64 scarred and 45 viable segments with stress echocardiography, versus 302 normokinetic, 83 scarred and 31 viable segments with dobutamine MRI. Wall thickening analysis on Cine MR images showed 268 normal, 68 scarred and 80 viable segments, versus 274 normal, 58 scarred and 84 viable segments with digital subtraction. Three months after revascularization 15 patients were examined to check contractile recovery of the segments considered as viable. Echocardiography had 79% sensitivity and 97% specificity, while Cine MRI had 96% and 86%, respectively. Quantitative assessment of systolic wall thickening by Cine MRI and digital subtraction had 96% sensitivity and 91% specificity, with no statistically significant differences between the two techniques. In patients with anteroseptal wall myocardial infarction stress echocardiography had 75% sensitivity and 97% specificity. In the subgroup of 13 patients with diaphragmatic or inferior wall infarction echocardiography sensitivity dropped to 68%, versus 96% of Cine MRI, but its specificity was higher namely 97% versus 86%. Conclusions. In anteroseptal infarction, echocardiography permits to distinguish viable myocardium and scarred myocardial tissue with good sensitivity and specificity, but Cine MRI performs better. In infero-lateral or diaphragmatic infarction, Cine MRI has much higher sensitivity than stress echocardiography and thus makes the technique of choice to evaluate viable myocardium in these sites. The digital subtraction technique is as accurate as manual measurements, but reduces the error rate and permits quicker evaluation, particularly in subendocardial thickening.

1999 - Determinants of career structure and advancement among Italian cardiologists: an example of segregation and discrimination against women? [Articolo su rivista]
Modena, Maria Grazia; Molinari, R.; Lalla, Michele; Gruppo, Scic
abstract

Aims: The aim of this study was to analyse the processes through which job, career and research-related choices are determined in Italian cardiology, focusing on characteristics such as productivity, gender and family. Methods and Results: In June 1996, a questionnaire surveying individual and career-related data was mailed to all members (8000) of the Italian societies of cardiology. Returned questionnaires numbered 1715 (21.4% of the total mailed), 83% were completed by men and 17% by women. For both hospital and academic careers, advancement in rank was influenced by variables denoting productivity, family and individual characteristics. However, men and women showed slightly different patterns. Conclusions: Promotion to the upper ranks of the hierarchy was highly dependent upon time (once the effects of the covariates were eliminated). This situation is typical of the internal labour market, that is, in institutions in which staff members are ranked on a hierarchical scale according to formal criteria that are 'rigid' and institutionalized, partially sheltered from competition. Therefore, once a member has gained access to the bottom of the hierarchy, the professional career is 'pre-determined' and seniority has an appreciable influence on promotion decisions; in this context, women appear to be at a disadvantage.

1999 - Diabetes mellitus and cardiovascular complications: pathophysiological peculiarities and therapeutic implications [Articolo su rivista]
Modena, M. G.; Barbieri, A.
abstract

Diabetes mellitus is a chronic illness frequently associated with cardiovascular complications. The cardiologist must therefore play an important role in the management of diabetic patients, aware of the different natural history of the insulin-dependent and non-insulin-dependent forms, as well as of the pathophysiological peculiarities of the disease which requires particular diagnosis and therapy. Unfortunately, treatments which have proved to be most effective are still underused. Cardiovascular complications in diabetic patients are aggravated by higher morbidity and mortality rates than in the general population. In an attempt to prevent major cardiovascular events, the cardiologist must identify those patients at greater risk, particularly those with asymptomatic coronary heart disease.

1999 - Double-blind randomized placebo-controlled study of transdermal estrogen replacement therapy on hypertensive postmenopausal women [Articolo su rivista]
Modena, Maria Grazia; R., Molinari; N., Muia; A., Castelli; F., Pala; Rossi, Rosario
abstract

We investigated the effects of transdermal 17 beta-estradiol, combined with standard antihypertensive therapy, on the modification of the cardiovascular risk profile in hypertensive postmenopausal women. In a randomized, double-blind, placebo-controlled study, we enrolled 200 postmenopausal women with mild to moderate hypertension. Patients received 17 beta-estradiol (50 mu g/day, transdermal) and norethisterone acetate (2.5 mg/day, orally) or placebo. At baseline serum total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, glucose, and fibrinogen plasma levels were measured and all subjects underwent complete M-mode and 2-D echocardiograms, which were repeated after 6, 12 and 18 months of hormonal replacement therapy. Compared with. placebo, all values decreased significantly except for HDL cholesterol. In both groups, no modifications were observed in echocardiographic parameters, except for left ventricular mean diastolic and systolic wall thickness and left ventricular mass index, which showed a significant decrease in both groups. The reduction was greater in the treated group; the percentage of patients with left ventricular hypertrophy was 46% before randomization and 17.2% after 18 months of treatment (P < .0001), whereas in group II the percentage was 48% at baseline and 31.5% after 18 months (P < .05). In conclusion transdermal 17 beta-estradiol, associated with antihypertensive therapy,may contribute to the reduction of cardiovascular risk profile in hypertensive postmenopausal women.

1999 - Effect of prolonged administration of transdermal estradiol on flow-mediated endothelium-dependent and endothelium-independent vasodilation in healthy postmenopausal women. [Articolo su rivista]
Cagnacci, Angelo; Modena, Maria Grazia; Malmusi, S; Muia, N; Volpe, Annibale
abstract

In 15 postmenopausal women with no cardiovascular risk factors, hormone replacement with transdermal estradiol (50 microg/day for 2 months) did not enhance flow-mediated endothelium-dependent vasodilation, reduce endothelium-independent vasodilation, and did not modify the pulsatility index and blood flow of the brachial artery. The present data do not support a positive effect of replacement with transdermal estradiol on vessel vasodilation in healthy, postmenopausal women.

1999 - Effects of transdermal 17 beta-estradiol on left ventricular anatomy and performance in hypertensive women [Articolo su rivista]
Modena, Maria Grazia; N., Muia; P., Aveta; R., Molinari; Rossi, Rosario
abstract

To reduce cardiovascular complications, antihypertensive therapy should not only normalize blood pressure but also induce a regression of structural abnormalities, which are the expression of end-organ damage. We investigated the effects of transdermal 17 beta-estradiol, combined with standard antihypertensive therapy, on the modification of left ventricular anatomy and systolic performance in hypertensive postmenopausal women. In a randomized, double-blind, placebo-controlled study, we enrolled 169 postmenopausal women with mild or moderate hypertension. Eighty-six patients (group 1) received transdermal 17 beta-estradiol (50 mu g/d) and norethisterone acetate (2.5 mg/d, orally), and 83 patients (group 2) received placebo. At baseline, all women underwent M-mode and 2-D echocardiogram, which was repeated after 6, 12, and 18 months of follow-up. After 18 months of treatment, we observed a significant decrease in left ventricular diastolic septal and posterior wall thickness and mass in both groups. Furthermore, after 18 months, left ventricular mass was significantly less than in the estrogen-treated group. No significant modifications were observed in left ventricular systolic and diastolic dimensions or in systolic performance, as expressed by left ventricular fractional shortening. In conclusion, transdermal 17 beta-estradiol, which is associated with antihypertensive therapy, may contribute in the reduction of left ventricular mass in hypertensive postmenopausal women.

1999 - Is a direct effect on vessels important for estradiol primary prevention of cardiovascular diseases in healthy women? [Altro]
Renzi, A; Cagnacci, Angelo; Malmusis, S; Muia, N; Modena, Maria Grazia; Volpe, Annibale
abstract

1999 - Relazione tra depressione maggiore e cardiopatia ischemica/ipertensiva nella donna in post-menopausa [Articolo su rivista]
Rigatelli, Marco; Cappella, F; Bertoni, D; Muia, N; Molinari, R; Pala, F; Modena, Maria Grazia
abstract

Not available

1999 - Strategie di prevenzione primaria e secondaria nella donna [Articolo su rivista]
Modena, M. G.; Muia, N.; Origliani, G.; Aveta, P.; Rossi, R.
abstract

N/A

1999 - Structure and career advancement in cardiology in Italy [Articolo su rivista]
Modena, M. G.; Molinari, R.; Lalla, M.
abstract

Women are less present on the labor market and many studies have demonstrated the existence of gender differences regarding participation rate and career advancement of women. The process through which job-, career- and research-related choices are structured within the realm of Italian cardiology, is described in this study emphasizing the effects of productivity, gender and family commitments. In June 1996, a questionnaire was mailed to all members of the Italian societies of cardiology. It included mainly (pre-coded) set-choice questions concerning individual characteristics, career-related data, and information pertaining to teaching, scientific and research activity. Returned questionnaires numbered 1715 (21.4% of the total mailed), 83% were completed by males and 17% by females. For both hospital and academic careers, advancement in rank was influenced by variables denoting productivity, family and individual characteristics. Promotion to the upper ranks of the hierarchy was highly dependent upon time (once the effects of the covariates were eliminated). This is a situation that is typical of the internal labor market, that is, of an institution in which staff members are ranked on a hierarchical scale according to formal criteria that are "rigid" and institutionalized, partially and totally sheltered from competition. Therefore, once a member has gained access to the first level of the hierarchy, his/her professional career is to a certain extent pre-determined and the seniority ends up taking on importance in promotion decisions to an appreciable extent; in this field, the weight of seniority on promotion ranges between 30 and 50%.

1999 - Struttura e avanzamento di carriera in cardiologia in Italia [Articolo su rivista]
Modena, Maria Grazia; Molinari, R.; Lalla, Michele; Gruppo, Scic
abstract

Women are less present in the labour market and many studies have demonstrated the existence of gender differences regarding participation rate and career advancement of women. The process through wich job-, career- and research-related choices are structured within the realm of Italian cardiology, is described in this study emphasizing the effects of productivity, gender and family commitments. In June 1996, a questionnaire was mailed to all members (8000) of the Italian society of cardiology. It included mainly (pre-coded) set-choice concerning individual characteristics, career-related data, and information pertaining to teaching, scientific and research activity. Returned questionnaires numbered 1715 (21.4% of the total mailed), 83% were completed by men and 17% by women. For both hospital and academic careers, advancement in rank was influenced by variables denoting productivity, family and individual characteristics. However, men and women showed slightly different patterns. Promotion to upper ranks of hierarchy was highly dependent upon time (once the effects of the covariates were eliminated). This situation is typical of the internal labour market, that is, in institutions in which staff members are ranked on a hierarchical scale according to formal criteria that are ‘rigid’ and institutionalized, partially sheltered from competition. Therefore, once member has gained access to the bottom of the hierarchy, the professional career is ‘pre-determined’ and seniority has an appreciable influence on promotion decisions; in this context, women appear to be at a disadvantage.

1998 - Detection of viable myocardium: Comparison between dobutamine echocardiography and dobutamine cine magnetic resonance in patients with Q-wave myocardial infarction scheduled for revascularization [Abstract in Rivista]
Modena, Maria Grazia; Rossi, Rosario; Molinari, R; Barbieri, Alberto; Muia, N; Sgura, Fa; Montanari, N; Romagnoli, R.
abstract

Detection of viable myocardium: Comparison between dobutamine echocardiography and dobutamine cine magnetic resonance in patients with Q-wave myocardial infarction scheduled for revascularization

1998 - Effect of melatonin on vascular reactivity: A cross-over double blind study in post-menopausal women [Abstract in Rivista]
Modena, Maria Grazia; Rossi, Rosario; Molinari, R; Muia, N; Origliani, G; Cionini, F; Andria, A; Castelli, A.
abstract

Abstract Annual Congress of the American College of Cardiology

1998 - Effect of prolonged transdermal estradiol administration in endothelium-dependent and-endothelium-independent vasodilation [Altro]
Cagnacci, Angelo; Malmusi, S; Muia, N; Modena, Maria Grazia; Volpe, Annibale
abstract

1998 - HRT e apparato cardiovascolare [Altro]
Volpe, Annibale; Cagnacci, Angelo; Modena, Maria Grazia; Rossi, Rosario; Malmusi, S; Giulini, Simone
abstract

1998 - La progressione delle carriere: i percorsi in cardiologia [Working paper]
Lalla, Michele; Molinari, Roberto; Modena, Maria Grazia
abstract

Il lavoro riporta i risultati di una indagine condotta per raccogliere i dati relativi ai percorsi delle carriere in cardiologia e ai fattori che possono influenzarle, come la produttività e il genere. Nel giugno del 1996 si è condotta una indagine tramite questionario postale inviato agli aderenti della Società italiana di cardiologia: il 21% dei questionari inviati è stato compilato e, tra questi, l’83% erano uomini e il 17% erano donne. Le promozioni dipendono dal tempo di permanenza nello stato, dopo che si sono eliminati gli effetti delle covariate. Le donne sono svantaggiate.

1998 - Modification in serum concentrations of aminoterminal propeptide of type III procollagen in patients with previous transmural myocardial infarction [Articolo su rivista]
Modena, Maria Grazia; R., Molinari; Rossi, Rosario; Njr, Muia; A., Castelli; Mattioli, Giorgio; L., Bacchella; Gobba, Fabriziomaria
abstract

The aim of our study was to evaluate the modification of serum concentration of aminoterminal propeptide of type III procollagen (PIIINP) in 70 patients with previous transmural myocardial infarction. In 38 patients (group 1) PIIINP levels increased at 6 and 12 months after infarction; in 32 patients (group 2) PIIINP increased at 6 months, returning to baseline at 12 months. At the same time we observed a significant left ventricular enlargement and worsening of the performance in group 1, whereas in group 2 an improvement was seen in left ventricular volumes and performance. In conclusion, rearrangement of collagen myocardial matrix plays an important role in left ventricular postinfarction modification. This process can be easily followed over time in a noninvasive manner by dosing serum PIIINP concentrations.

1998 - Short-term results of transdermal estrogen replacement therapy in cardiovascular disease-free postmenopausal females with and without hypertension [Articolo su rivista]
Modena, Maria Grazia; Rossi, Rosario; Muia N., Jr; Origliani, G; Rombolà, O; Molinari, R.
abstract

BACKGROUND: Many studies have shown that estrogen replacement with oral micronized 17 beta-estradiol reduces the risk of cardiovascular disease. The aim of the present study was to evaluate the efficacy of transdermal estrogen replacement therapy in improving the risk profile of cardiovascular disease in postmenopausal women. METHODS: Two hundred and fifty postmenopausal women were enrolled from the "Bene Essere Donna" Center and grouped according to the absence (Group I, n = 175; mean age 54.6 +/- 3.5) or presence of mild to moderate hypertension (Group II, n = 75; mean age 54.1 +/- 4.5). Total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, glucose and fibrinogen levels were tested in all women. The total study population was treated with estrogen replacement therapy for 12 months: hysterectomized women received 17 beta-estradiol (0.05 mg/die), while non-hysterectomized women received 17 beta-estradiol 0.05 mg/die plus 5 mg/die of medroxyprogesterone acetate for 12 days during every 28-day cycle. After 12 months, blood pressure and blood chemistry were measured as baseline. RESULTS: Total cholesterol, LDL cholesterol and glucose levels decreased in both groups. HDL cholesterol levels increased significantly only in the sub-group of Group II treated with estrogen plus progesterone. Triglycerides glucose and fibrinogen blood levels decreased in both groups. No cardiovascular events were recorded during the first year of follow-up. CONCLUSION: Transdermal estrogen replacement therapy should be considered as a therapeutic support in order to contrast the elevated cardiovascular risk in postmenopausal women

1997 - Changes in serum levels of N-terminal procollagen type III propeptide as an index of postinfarction ventricular remodeling [Articolo su rivista]
Molinari, R.; Rossi, R.; Muia, Jr. N.; Castelli, A.; Modena, M. G.; Mattioli, G.; Bacchella, L.; Gobba, F.
abstract

The levels of aminoterminal propeptide of type III procollagen (PIIINP) can be used as an index of collagen breakdown. The aim of our study was to evaluate modifications in serum concentration of PIIINP (PIIINPs) in patients with a first episode of myocardial infarction. We examined 70 patients admitted at our Institution for acute myocardial infarction and 10 normal subjects. PIIINPs dosage was obtained by radioimmunoassay method utilizing a commercial available kit. All patients underwent three PIIINPs dosages: within 24 hours after admission, at 6 and 12 months after myocardial infarction. Control values were 0.4 +/- 0.1 U/ml. In 38 patients (Group I) PIIINPs levels increased at 6 and 12 months after infarction: 0.53 +/- 0.2, 0.75 +/- 0.2 and finally 0.76 +/- 0.1 U/ml. In the remaining 32 patients (Group II) PIIINPs values increased at 6 months and then returned to baseline at 12 months: 0.56 +/- 0.2, 0.75 +/- 0.1 and then 0.46 +/- 0.1 U/ml. The end-diastolic volume index did not change significantly in Group I (from 93.7 +/- 21 to 79.7 +/- 20 ml/m2) while it decreased after 12 months in Group II (from 88.9 +/- 13 to 58.6 +/- 11 ml/m2; confidence interval 95% from 2 to 55 ml/m2; p = 0.03). Similarly, there was no significant variation in end-systolic volume index (ESVI, from 39.7 +/- 11 to 36.9 +/- 11 ml/m2) and ejection fraction (from 60 +/- 10 to 59 +/- 15%) in Group I; while in Group II ESVI decreased significantly (from 33.6 +/- 13 to 20 +/- 5 ml/m2, confidence interval 95% from 3 to 24 ml/m2; p = 0.02) and ejection fraction improved (from 62 +/- 11 to 72 +/- 15%; confidence interval 95% from -20 to -1%; p = 0.04). In conclusion, patients with elevated levels of PIIINPs at 12 months did not improve ventricular function while patients with PIIINPs returning to baseline at 12 months had an improvement. Our results suggest an active participation of newly formed collagen in post-infarct ventricular remodeling. Therefore PIIINPs may be a marker of this process.

1997 - Early predictors of late dilation and remodeling after thrombolized anterior transmural myocardial infarction [Articolo su rivista]
Modena, Maria Grazia; Rossi, Rosario; Sgura, Fa; Muia, N; Molinari, R; Mattioli, Giorgio
abstract

Background and hypothesis: Dilation of the left ventricle after myocardial infarction is associated with an adverse prognosis. There are no clinical studies on the role viable myocardium in the infarcted area assumes in relation to the development of late ventricular remodeling. The hypothesis of this study was to define the relation between remodeling and the presence of viable but akinetic myocardium in the infarct area and to identify early predictors of left ventricular (LV) dilation at 1 year. Methods: In all, 92 consecutive patients with myocardial infarction were divided into two groups according to their ventricular volumes. Group I included 57 patients with normal volumes at discharge (9 +/- 3 days after acute infarction) and after 12 months or with LV dilation at discharge who had a normalization of their volumes over a 12-month period. Group II included 35 patients who, independent of their initial volumes, developed LV dilation during follow-up. Low-dose dobutamine infusion was utilized at discharge for echocardiographic evaluation of contractile recovery of viable myocardial segments. Results: At the first control patients in Group I presented an end-diastolic volume index (EDVI) of 100 +/- 7 ml/m(2) which decreased to 68.8 +/- 6.5 ml/m(2) 12 months later (p<0.0001), and an end-systolic volume index (ESVI) of 47.6 +/- 6.7 ml/m(2) at the first control and 30.5 +/- 8.8 ml/m(2) after 12 months (p<0.001). Patients in Group II presented a mean EDVI of 116.2 +/- 8.1 ml/m(2) at the first control and 138.8 +/- 8 ml/m(2) 12 months later (p<0.001), and a mean ESVI of 68.8 +/- 6.5 ml/m(2) at the first control and 79.5 +/- 5.4 after 12 months (p<0.01). Ventricular mass index (VMI) in Group I increased from 106.4 +/- 11 to 122.3 +/- 15 g/m(2) (p<0.01), while in Group II it decreased from 101.1 +/- 10 to 98.7 +/- 8 g/m(2) (p = NS). In Group I, mass-to-volume ratio was 1.15 +/- 0.1 g/ml at the first control and 1.67 +/- 0.1 g/ml 12 months later (p<0.001), while in Group II it declined from 0.88 +/- 0.1 to 0.69 +/- 0.1 g/ml (p<0.01). The multivariate analysis revealed that ejection fraction less than or equal to 40%, restrictive filling pattern, wall motion score index >2.5 in response to dobutamine infusion, and mass-to-volume ratio less than or equal to 1 g/ml, all at discharge, as well as an occluded left anterior descending artery discriminate in favor of late LV dilation and remodeling. Conclusions: Correct use of noninvasive strategies should result in early identification of postinfarct patients who are at risk of developing LV remodeling.

1997 - Echocardiographic aspects of hypertensive myocardiopathy [Articolo su rivista]
Modena, M. G.; Mattioli, G.
abstract

1997 - La somministrazione prolungata di estradiolo transdermico, modifica la vasodilatazione arteriosa endotelio-dipendente ed endotelio-indipendente [Altro]
Malmusi, S; Muia, N; Rossi, Rosario; Zanni, A; Cagnacci, Angelo; Modena, Maria Grazia; Volpe, Annibale
abstract

1997 - Left atrial size is the major predictor of cardiac death and overall clinical outcome in patients with dilated cardiomyopathy: A long-term follow-up study [Articolo su rivista]
Modena, Maria Grazia; Muia, N; Sgura, Fa; Molinari, R; Castelli, A; Rossi, Rosario
abstract

Hypothesis: This study was undertaken to determine whether echo-derived left atrial dimension and other echocardiographic, clinical, and hemodynamic parameters detected at the time of entry into the study may influence prognosis in patients with dilated cardiomyopathy during a long-term follow-up. Methods: This was a prospective cohort analysis of 123 patients with dilated cardiomyopathy. Clinical evaluation, chest x-ray, M-mode and two-dimensional echocardiogram, exercise test, 72-h ambulatory electrocardiogram monitoring, and cardiac catheterization study were performed in all patients. The study was divided into two phases: in the first phase, patients were divided into two groups according to the left atrial size (greater than or equal to 45 mm; < 45 mm), with cardiac death as the end point. In the second phase, all patients were further divided into two groups according to their clinical course. A multivariate analysis was performed to determine independent correlated parameters of cardiac mortality and overall clinical outcome. Results: Cardiac mortality rate was 47.9%: 29% in the group without left atrial dilation and 54.3% in the group with dilated left atrium. Multivariate analysis revealed that left atrium greater than or equal to 245 mm, New York Heart Association functional classes III/IV, and the presence of one or more episodes of ventricular tachycardia at Holter monitoring were independent predictors of cardiac mortality, while left atrium greater than or equal to 45 mm, left Ventricular end-diastolic pressure > 17 mmKg, and exercise tolerance less than or equal to 15 min were independent predictors of poor clinical outcome. Conclusions: Our results revealed that left atrial size is the principal independent predictor of prognosis in patients with dilated cardiomyopathy in that patients with left atrial dilation had an increase in mortality and a worse clinical outcome compared with those without left atrial dilation.

1997 - Relationship between atrial function, left ventricular isovolumic relaxation time, and early filling in dual chamber-paced patients [Articolo su rivista]
Rossi, Rosario; Muia, N; Modena, Maria Grazia
abstract

This investigation was performed to study atrial systolic function in response to modification of atrioventricular delay in a sample of 36 patients with a DDD pacemaker implanted for complete atrioventricular block. The relation between atrial systolic performance and diastolic-related parameters was also evaluated. Isovolumic relaxation time, early diastolic peak velocity, late (atrial) diastolic peak velocity, atrial filling fraction, and atrial ejection force were recorded at a pacing rate of 70 impulses/min and at atrioventricular delay of 200, 150, and 100 msec. Our data showed that the progressive shortening of atrioventricular delay induced a gradual increase in early peak velocity (median value 46 to 53 to 61.5 cm/sec, respectively, at 200, 150, and 100 msec intervals) and a gradual decrease in isovolumic relaxation time (median 92.6 to 81.5 to 69.7 msec at 200, 150, and 100 msec, respectively), atrial peak velocity (59 to 52 to 44.5 cm/sec at 200, 150, and 100 msec, respectively), atrial filling fraction (50.5% to 40% to 23.5% at 200, 150, and 100 msec, respectively), and atrial ejection force (17.2 to 14.7 to 8.5 kilodynes at 200, 150, and 100 msec, respectively). For every atrioventricular delay value detected, we found a significant correlation between isovolumic relaxation time and early peak velocity with atrial filling fraction and atrial ejection force. In addition, atrial ejection force was related directly to atrial filling fraction at studied atrioventricular delays. The two indexes of atrial systolic performance showed a parallel decrease by shortening the atrioventricular delay, and they can quantify atrial systolic performance equally in sequentially paced patients. Furthermore, our results are in accordance with the hypothesis that the interaction between the effectiveness of active left atrial emptying and isovolumetric relaxation time may play an important role in maintaining an ideal ventricular filling despite changes in atrial systolic function.

1997 - Rischio Cardiovascolare. [Altro]
Volpe, Annibale; Cagnacci, Angelo; Salgarello, M; Malmusi, S; Giulini, S; Rossi, Rosario; Modena, Maria Grazia
abstract

1997 - Serum iron and myocardial infarction [Articolo su rivista]
Mattioli, G.; Modena, M. G.; Cipressi, F.
abstract

The serum iron has been measured in patients with myocardial ischemia, compared with a control group. Serum iron was low in patients with complications as pericarditis and bulge caused by wide akinesis area. The low serum iron in complicated infarction could be due to the continuous local release of lactoferrin in necrosis focus.

1997 - Sex differences in noninvasive diagnosis of multivessel coronary artery disease [Abstract in Rivista]
Modena, Maria Grazia; Rossi, Rosario; Muia, N; Sgura, Fa; Origliani, G; Molinari, R.
abstract

ABSTRACT OF THE ANNUAL CONGRESS OF THE AMERICAN COLLEGE OF CARDIOLOGY

1997 - Short atrioventricular delay reduces the degree of mitral regurgitation in patients with a sequential dual-chamber pacemaker [Articolo su rivista]
Rossi, Rosario; Muia N., Jr; Turco, V; Sgura, Fa; Molinari, R; Modena, Maria Grazia
abstract

This study was performed in a population of sequential dual-chamber pacemaker-patients with isolated mitral regurgitation (MR) to identify the "ideal atrioventricular (AV) delay" and to determine the effect of sequential pacing with the ideal AV delay on MR degree. Twenty consecutive patients (age 69 +/- 7 years; 45% men) hospitalized at our institution for symptomatic III degree AV block and isolated MR were studied. All received a dual-chamber pacemaker programmed in DDD at a rate of 70 pulses/minute. The ideal AV delay was selected using echo-color Doppler parameters; it was defined as that resulting in a lower degree of MR and in the highest cardiac output. The mean "optimal short" AV delay resulted in 98 +/- 7 ms. At short AV delay we observed a significant reduction in MR severity (regurgitant fraction from 48 +/- 12% to 25 +/- 10% and jet area from 15 +/- 2 to 9 +/- 2 cm2; p <0.0001) together with an increase in stroke volume (68 +/- 16 vs 88 +/- 15 ml; p = 0.007) and mitral early-to-late peak velocity ratio (0.79 +/- 0.33 vs 1.38 +/- 0.37; p <0.0001). In conclusion, a short AV delay may be used to improve cardiac output in sequential paced patients with pure, isolated MR

1997 - The effectiveness of oral flecainide and propafenone in the cardioversion and prophylaxis of paroxysmal atrial fibrillation [Abstract in Rivista]
Navazio, A; Modena, Maria Grazia; Chesi, G; Catellani, E; Montanari, P.
abstract

Abstract Annual Congress of the American College of Cardiology

1996 - Effect of chemical vs electrical cardioversion of chronic atrial fibrillation on left atrial function [Abstract in Rivista]
Navazio, A; Modena, Maria Grazia; Chesi, G; Catellani, E; Montanari, P; Poci, V; Marani, L.
abstract

Abstracts From the 69th Scientific Sessions. American Heart Association

1996 - Imaging in the diagnosis of acute aortic dissection: Report on time-benefit and risk-benefit [Articolo su rivista]
Modena, M. G.
abstract

Acute aortic dissection is a dramatic event in which the outcome is strongly influenced by the time necessary for the diagnosis. Surgically untreated type A aortic dissection has a mortality rate ranging from 60% within the first hours to 90% within 3 months; type B, medically treated dissection, has a survival rate of 80% within the first year. For both types a rapid diagnosis is of extreme importance in experience and the technologic advances of each hospital. Standard chest X-ray can be useful especially if it shows an enlargement of the mediastinum, which guides to the second step in diagnostic testing which is, depending on the setting, echocardiography or computed tomography, and rarely angiography. Standard echocardiography has a very low sensitivity and a moderate specificity. Transesophageal echocardiography can give information about: intimal flap entry (color flow Doppler), extension of the dissection (up to the supradiaphragmatic level), distinction between true and false lumen, left ventricular function and presence of aortic regurgitation. Computed tomography is more accurate in detecting the total extension of the side branch involvement. Aortic angiography, still widely requested by the majority of cardiovascular surgeons, represents a higher risk procedure although giving important information similar to those already mentioned. Magnetic resonance imaging offers the best imaging by multiplane approach but cannot be performed in critically ill patients. In terms of risk-benefit and time-benefit the best diagnostic sequence in the unstable patient should consist in: chest X-ray, transesophageal echocardiography acid/or computed tomography scan. Aortic angiography may be avoided and the surgeon must become familiar to all new imaging techniques.

1996 - Shortening of atrioventricular interval improves ventricular filling and clinical outcome in patients with DDD pacemaker and left ventricular hypertrophy [L’accorciamento dell’intervallo atrio-ventricolare migliora il riempimento ventricolare e il quadro clinico in pazienti con pace-maker DDD e ipetrofia ventricolare sinistra] [Articolo su rivista]
Rossi, Rosario; Molinari, R; Carcagnì, A; Mattioli, Anna Vittoria; Modena, Maria Grazia
abstract

The influence and clinical consequences of different atrioventricular delays on ventricular filling have been studied in 30 patients (mean age 60 +/- 5 years) who implanted DDD pacemaker for complete A-V block. All patients presented a normal ejection fraction: 63.9 +/- 6.5%. In 18 subjects (Group I) an echo-Doppler examination revealed ventricular hypertrophy (mean end-diastolic wall thickness of 1.4 +/- 0.16 cm; left ventricular mass index 155 +/- 17 g/m2) and an abnormal relaxation pattern (isovolumic relaxation time 124 +/- 11: early to late peak velocity 0.6 +/- 0.03; deceleration time of the early diastolic peak 296 +/- 34 ms). Group II included the remaining 12 patients without left ventricular hypertrophy and normal filling pattern. In all 30 patients the filling pattern was reassessed following modification of the A-V delay (200, 150, 100 and 75 ms). Patients at baseline (200 ms of A-V delay) underwent an exercise test with determination of respiratory gas exchange. In Group I, 13 (72.5%) patients were classified as Weber class B (VO2 max 16.8 +/- 1.7 ml/min/kg) and 5 (27.5%) as class A (VO2 max 22.5 +/- 1.4 ml/min/kg). In Group II, all 12 patients were classified as Weber class A (VO2 max 23.1 +/- 1.1 ml/ min/kg). In Group II, changes in A-V delay caused no homogeneous variation in filling pattern. A-V delay was not modified in this group. In Group I, the reduction of A-V delay to 100 ms resulted in filling normalization. In this group A-V delay was programmed definitely to 100 ms. Graded exercise test repeated at 6 months follow-up showed an improved Weber class in 13 patients (from B to A) and greater VO2 max in the remaining 5 already in class A. We conclude that, in sequential paced patients with normal ejection fraction but abnormal relaxation pattern, a modification of A-V delay can induce filling normalization and improve cardiac functional capacity

1996 - The importance of different atrioventricular delay for left ventricular filling in sequential pacing: Clinical implications [Articolo su rivista]
Modena, Maria Grazia; Rossi, Rosario; Carcagni, A; Molinari, R; Mattioli, Giorgio
abstract

We assessed the influence and clinical consequences of different AV delay on ventricular filling in 30 patients (mean age 60+/-5 years) who had DDD pacemakers for AV block. All 30 patients presented a normal ejection fraction, but in 18 cases (Group I), an echo-Doppler examination revealed ventricular hypertrophy (mean end-diastolic wall thickness of 1.4+/-0.16 cm, LV mass index 155+/-17 g/m(2)), and an abnormal relaxation pattern (isovolumetric relaxation time= 124.72+/-11.82; early to late peak velocity=0.6+/-0.03; deceleration time=296.83+/-34.02 ms). Group II included the remaining 22 patients who had a normal filling pattern. In all 30 patients, the pattern was reassessed following modification of the AV delay (200, 150, 100, and 75 ms). Patients at baseline (AV delay of 200 ms) also underwent an exercise test with determination of respiratory gas exchange. In Group 1, 13 (72.5%) patients were classified as Weber class B (VO2 Max 16.8+/-1.7 mL/min per kg); and 5 (27.5%) were Class A (VO2 Max 22.5+/-1.4 mL/min per kg). In Group II, all 12 patients were classified as Weber Class A. In Group II, changes in AV delay caused no consistent variations in filling pattern, and therefore AV delay was not modified. In Group I patients, since reduction to 100 ms resulted in normalization of the filling pattern, the AV delay tvas programmed to 100 ms. A graded exercise test repeated after 6 months' follow-up showed an improved Weber class in 13 patients (from B to A) and greater VO2 Max in the remaining five already in Class A. We concluded that, in sequential paced patients with normal ejection fraction but abnormal relaxation pattern, modification in AV delay can induce normalization of filling and improvement in cardiac functional capacity.

1995 - Diagnostic, therapeutic and prognostic evaluation of dilated cardiomyopathy with ultrasonography [Articolo su rivista]
Modena, Maria Grazia
abstract

1995 - Ipertrofia miocardica transitoria e terapia corticosteroidea [Relazione in Atti di Convegno]
Biagioni, O; Modena, Maria Grazia; Bosi, Mp; Capriotti, T; Gargano, G; Barbani, Mt; Roversi, Mf; Ferrari, Fabrizio
abstract

No abstract

1994 - EFFECT OF PERSISTING LEFT-VENTRICULAR HYPERTROPHY ON FUNCTIONAL-CAPACITY AND PROGNOSIS IN HYPERTENSIVE PATIENTS [Abstract in Rivista]
Modena, Maria Grazia; Masciocco, G; Mattioli, G.
abstract

ABSTRACT OF THE ANNUAL CONGRESS OF THE AMERICAN COLLEGE OF CARDIOLOGY

1994 - EVALUATION OF THE EFFECTIVENESS OF ISRADIPINE SRO IN THE TREATMENT OF HYPERTENSIVE PATIENTS WITH LEFT-VENTRICULAR HYPERTROPHY [Articolo su rivista]
Modena, Maria Grazia; Masciocco, G; Rossi, Rosario; Baraldi, P; Mattioli, Giorgio
abstract

Myocardial hypertrophy is a response to many diseases, above all hypertension, that involves morphological and functional damage and may be the basis for the development of myocardial dysfunction. We attempted to verify the effectiveness of a new calcium antagonist, isradipine 5 mg SRO, on the reversal of left ventricular hypertrophy. For this purpose 13 hypertensive patients (pts) were treated for 12 weeks, which is the minimum period described in the literature for the regression of hypertrophy. At the end of the study, blood pressure in all patients returned to normal levels (mean blood pressure from 120.15 +/- 4.4 to 108 +/- 6.4 mmHg, p < 0.001); end-systolic stress (from 128 +/- 30 to 65 +/- 14 g/ cm(2), p < 0.001), and left ventricular mass index (from 142 +/- 31 to 97 +/- 23 g/m(2), p < 0.001) showed significant reduction. Moreover, Doppler-derived indexes of left ventricular filling improved, particularly early to late peak velocity of the mitral valve (EIA ratio) and deceleration time (from 235 +/- 37 to 198 +/- 17 msec, p < 0.001), which were normalized after 12 weeks. In conclusion isradipine shows rapid effects in the reversal of morphofunctional damage in hypertension. For this reason it also appears to be useful for the treatment of myocardial hypertrophy in the absence of chronic hypertension.

1994 - Hemodynamic modification induced by left bundle branch block [Capitolo/Saggio]
Modena, Maria Grazia; Mattioli, Anna Vittoria; G., Mattioli
abstract

Hemodynamic modification induced by left bundle branch block

1994 - Possible influence of hemodynamic and neurohormonal factors on the heart's response to arterial hypertension [Articolo su rivista]
Modena, Maria Grazia; Masciocco, G; Mattioli, Giorgio
abstract

Hypertrophy represents a frequent but inconstant response of the heart to hypertension and probably other nonhemodynamic factors are involved. We have performed 2D and Doppler echocardiography and assessed of neurohumoral pattern in 85 untreated patients with hypertension (diastolic blood pressure: 101 +/- 12.8 mmHg). Left ventricular hypertrophy was defined as a mass index greater than 134 g/m2 in males and 110 g/m2 in females. Doppler evaluation of left ventricular filling pattern was performed to detect the possible association of hypertrophy and diastolic dysfunction. In all patients the following neurohumoral substances were sampled and tested: plasmatic renin activity (PRA), aldosterone and norepinephrine. At Doppler echocardiography, 27 patients had hypertrophy and diastolic dysfunction, 15 only hypertrophy and 43 only diastolic dysfunction. The presence or absence of morpho-functional anomalies were independent of age, duration of hypertension and blood pressure levels. The mean value of neurohumoral substances were: norepinephrine 323.3 +/- 245 pg/ml, PRA 2.5 +/- 4 ng/ml/h, aldosterone 153.58 +/- 102 pg/ml. A significant correlation was found between PRA and blood pressure, and between aldosterone and all the Doppler-derived parameters of diastolic dysfunction. In conclusion, left ventricular hypertrophy seems to be related to alteration in ventricular geometry rather than to hemodynamic factors. Among nonhemodynamic factors, aldosterone may be the most responsible for abnormal filling, presumably through the activation of collagen matrix growth

1993 - Cardiopatie congenite [Capitolo/Saggio]
G., Mattioli; Mattioli, Anna Vittoria; F., Cipressi; R. G., Zennaro; Modena, Maria Grazia
abstract

Trattato di Medicina Interna - Cardipatie Congenite

1992 - Effect of antihypertensive treatment with nitrendipine on left ventricular mass and diastolic filling in patients with mild to moderate hypertension [Articolo su rivista]
Modena, Maria Grazia; Mattioli, Anna Vittoria; Parato, Vm; Mattioli, Giorgio
abstract

Nitrendipine is a dihydropyridine calcium antagonist that may be active when administered once daily. The aim of the study was to assess the effect of antihypertensive treatment with nitrendipine (20-40 mg) on left ventricular mass and diastolic function. Forty patients with mild to moderate hypertension (diastolic pressure greater than or equal to 90 and less than or equal to 114 mm Hg) were enrolled; a complete echo Doppler examination was performed at baseline, and 8 and 12 months after treatment in order to measure left ventricular mass and diastolic and systolic function. Only 28 patients completed the study follow-up. At month 8 nitrendipine had already successfully reduced blood pressure (mean 122 +/- 9 to 92 +/- 10 mm Hg) without modifying heart rate, and left ventricular mass index (150 +/- 48 to 123 +/- 34 g/m2), with a further reduction at month 12. Isovolumic relaxation time was reduced at month 8 from 138 +/- 28 to 111 +/- 17 ms, but the diastolic pattern was completely modified only after 1 year, with a normalization of deceleration time (from 220 +/- 35 to 188 +/- 12). Systolic function did not change. Our results indicate that nitrendipine is a powerful antihypertensive agent that reduces left ventricular mass, but requires a longer period of time to improve diastolic filling pattern

1992 - Effectiveness of the antihypertensive action of lisinopril on left ventricular mass and diastolic filling [Articolo su rivista]
Modena, Maria Grazia; Mattioli, Anna Vittoria; Parato, Vm; Mattioli, Giorgio
abstract

The effect of antihypertensive treatment with lisinopril (10 to 20 mg) on left ventricular mass and diastolic function was studied in 35 patients with mild to moderate hypertension. At baseline 6 and 12 months after treatment responders to lisinopril were examined by complete echo Doppler in order to measure left ventricular mass, diastolic and systolic function. Only 30 patients concluded the study follow-up. Lisinopril successfully reduced mean blood pressure (from 122 +/- 10 to 110 +/- 11 mmHg), without modification in heart rate, and left ventricular mass index (from 145 +/- 57 to 116 +/- 42 g.m-2) at month 6, with mild additional reduction at month 12. Isovolumic relaxation time was reduced but still abnormal at months 6 and 12, whereas deceleration time significantly changed only (from 230 +/- 40 to 195 +/- 35 msec) at month 12. Our results indicate that lisinopril is more successful in reducing left ventricular mass than in improving diastolic filling.

1992 - Influence of the neurohumoral system on left ventricular performance in chronic congestive heart failure [Articolo su rivista]
Mattioli, Anna Vittoria; Modena, Maria Grazia; Masciocco, L; Fantini, G; Mattioli, Giorgio
abstract

The influence of the neurohumoral system, as adrenergic system or renin-angiotensin system, on cardiac performance in heart failure is not yet know. In order to evaluate the influence of neurohumoral activation in chronic heart failure we followed 51 patients, 47 males and 4 females of mean age 58 +/- 10 years. They suffered from chronic heart failure of different origin and were classified according to NYHA classification: 42 patients were in class III and 9 were in class II. They were treated with digoxin and diuretics since long time. Ejection fraction (EF) was obtained by RVG at baseline and 8 months later. In order to test the influence of adrenergic system on EF we checked plasmatic norepinephrine levels and we divided the patients in two groups: Group A with high levels of plasmatic norepinephrine (1114 +/- 594 pg/ml) and Group B with normal level (426 +/- 139 pg/ml). Group A showed a reduction of EF (-3.73 +/- 1.27%) while, Group B showed a small increase of EF (+ 2.57 +/- 4.32%). To test the influence of renin-angiotensin system we also evaluated the patients according to the value of plasmatic renin activity: normal or high level. We did not observe a significant difference between the 2 groups. Patients with high plasmatic norepinephrine value presented a significant reduction of EF compared to those with low plasmatic norepinephrine. The adrenergic system seems to be more important than renin-angiotensin system or cardiac performance

1991 - Left ventricular remodelling [Articolo su rivista]
Modena, Maria Grazia
abstract

An acute myocardial infarction, particularly one that is large and transmural, can produce expansion and alterations in the topography of both the infarcted and non-infarcted regions or the ventricle. This remodelling can importantly affect the function of the ventricle and the prognosis. Side-to-side slippage of myocytes in the myocardium occurring in association with ventricular dilatation is responsible for wall thinning. The increased internal load that is sustained through the cardiac cycle is thought to promote further stress, dilatation and hypertrophy of the non-infarcted area. The collagen network has been showed to be high responsible for the remodelling of the interstitium and therefore for the scar formation involved in the expansion. The process for ventricular enlargement can be influenced by infarct size, healing end ventricular wall stresses. The process of scarification can be interfered with during the acute infarct period by the administration of glucorticosteroids and non-steroidal anti-inflammatory agents, which results in thinner infarct and further expansion. A most effective way to prevent or minimize the increase in ventricular size is to limit the initial insult. Acute thrombolytic reperfusion therapy may work in this way. Finally early and long-term therapy with an angiotensin converting enzyme inhibitor can favorably alter the loading conditions of the left ventricle, reducing progressive enlargement with a prolongation in survival

1991 - Right ventricular pacing and left ventricular filling pattern. An echo-Doppler study [Articolo su rivista]
Modena, Maria Grazia; Mattioli, Anna Vittoria; Mattioli, Giorgio
abstract

The influence of right ventricular pacing on left ventricular filling has not been completely clarified. The aim of the study was to analyze the possible alteration in and effects on left ventricular filling resulting from right ventricular pacing. The study population consisted of two groups; group A was comprised of 12 patients with a spontaneous left bundle branch block, and group B had 12 patients without left bundle branch block. All the patients underwent an interrogation of the mitral valve inflow by Doppler echocardiography, in order to measure isovolumic relaxation time, early and late peak velocity (E and A wave), E/A ratio and deceleration time. The study was performed at spontaneous rhythm and after, inhibition of the pacemaker. In group A, there were no changes in the Doppler parameters when passing from a spontaneous to an 80/min electrically induced rhythm. Analysis of group B revealed a statistically significant lengthening of IVR and Dec t with electrical stimulation. No statistically significant differences were found when we compared the Doppler parameters of the two populations at the same pacing frequency. Right ventricular pacing causes interventricular asynchrony and abnormalities in diastolic filling times, which resulted in a lengthening of either IVR and Dec t, simulating a pattern of abnormal relaxation.

1990 - Atenolol in dilated cardiomyopathy: a clinical instrumental study [Articolo su rivista]
Mattioli, Anna Vittoria; Modena, Maria Grazia; G., Fantini; Mattioli, Giorgio
abstract

.....

1990 - European consensus on standard and guidelines for global and regional ventricular function from echocardiography: Overview and choice of parameters to assess myocardial contractility [Articolo su rivista]
Modena, M. G.
abstract

1989 - Echocardiographic monitoring of mental stress test in ischemic heart disease [Articolo su rivista]
Modena, Maria Grazia; Corghi, F; Fantini, G; Mattioli, Giorgio
abstract

Mental stress testing can induce ischemia in coronary patients, but often may not induce chest pain and/or electrocardiographic changes. Therefore, we tested the utility of echocardiography to increase the sensitivity of the method. For this purpose, 56 patients undertook arithmetic mental stress tests and then were subjected to coronary angiography. During the test we evaluated left ventricular function, electrocardiography results, and emotional involvement measured by STAI (State Trait Anxiety Inventory). Echocardiography was positive in 21 patients, and electrocardiogram only in 2 patients. No patient complained of chest pain. The remaining 35 patients were negative. Comparing echo data with coronary angiography, in all the cases, sensitivity was 73.5%, specificity 93.3%. Analysis of the STAI revealed that the negative test we observed could be due to a low stressor efficacy. In conclusion, echocardiography in mental stress testing permits improved sensitivity, with loss of specificity in comparison with conventional electrocardiographic monitoring

1989 - Effects of infusions of different doses of dopamine in dilated cardiomyopathy. Observations during and after treatment with beta-blockers [Articolo su rivista]
Modena, Maria Grazia; Mattioli, Anna Vittoria; Fantini, G; Mattioli, Giorgio
abstract

It is well known that there are abnormalities of the sympathetic nervous system in chronic congestive heart failure. The aim of our study was to verify the effects on heart rate, blood pressure and some echocardiographic parameters of performance and inotropic state of iv infusion of dopamine at different dosages in 14 patients affected by dilated cardiomyopathy. The patients were divided into 3 groups: the first one of patients on standard treatment, the second of subjects on standard treatment and beta blockers, the third of patients who stopped beta blocker therapy and remained on standard therapy. In the first group dopamine at low dosage did not significantly modify heart rate, blood pressure, performance and contractile state, while it did decrease end systolic wall stress. In the second group the same dosage significantly decreased blood pressure and stress, maintaining unchanged the other indexes; the same behaviour was presented by the third group. At high dosage dopamine in the first group significantly increased blood pressure, ejection fraction, contractility and stress. No modifications were observed in the second group, probably because of a pharmacological inhibition of beta receptors. The third group showed a significant increase in blood pressure, stress and inotropic state. From our data it appears that dopamine treatment in chronic congestive heart failure may reveal the presence of the so-called "down regulation" phenomenon

1988 - Valutazione del consumo di O2 e EF in pazienti con insufficienza cardiaca congestizia cronica. [Abstract in Rivista]
Masciocco, L; Mattioli, Anna Vittoria; Barbieri, Alberto; Modena, Maria Grazia; Mattioli, G.
abstract

Valutazione consumo 02 e EF in pazienti con insufficienza cardiaca congestizia cronica

1986 - 2-dimensional and Doppler echocardiography in the study of tricuspid valve defects [Articolo su rivista]
Modena, Maria Grazia
abstract

1986 - Autosomal-dominant dystrophy with humeroperoneal weakness and cardiopathy: a genetic variant of Emery-Dreifuss disease? [Articolo su rivista]
Galassi, G.; Modena, M. G.; Benassi, A.; Nemni, R.; Gibertoni, M.; Volpi, G.; Colombo, A.
abstract

Two females mother and daughter, were affected by a neuromuscular disorder, characterized by slow progression, humeroperoneal weakness and wasting, limited neck flexion, elbow and ankle joint contractures, cardiopathy and myopathic pattern on EMG. Muscle histology and histochemistry showed type I fiber atrophy and predominance in both. Cardiac abnormalities, in the first case, were suggestive of a hypertrophic cardiomyopathy while in the second hypotension and chronic bradycardia were present. Neurological signs, EMG and morphology seemed to point to a genetic variant of the form of dystrophy named Emergy-Dreifuss disease. The mode of transmission and cardiac abnormalities, however, raise the problem of variability even in this well-defined, usually X-linked, disorder. © 1986 Masson Italia Periodici S.r.l.

1986 - Left partial absence of the pericardium [Articolo su rivista]
Romagnoli, R.; Guicciardi, N.; Bertolani, M.; Benassi, A.; Modena, M. G.
abstract

1986 - The efficacy of ibopamine in long-term treatment of dilated cardiomyopathy. A clinical and instrumental evaluation [Articolo su rivista]
Benassi, A.; Modena, M. G.; Mattioli, G.
abstract

The aim of this study was to investigate whether long-term treatment with ibopamine (SB-7505), the 3,4-diisobutyryl ester of N-methyldopamine, in patients with severe symptomatic congestive cardiomyopathy is associated with an improvement in cardiovascular conditions. The investigation was carried out in 18 outpatients with idiopathic or post-ischemic dilated cardiomyopathy and chronic severe heart failure (NYHA (New York Heart Association) Class III-IV). Patients were randomly assigned to a protocol in which either digitalis and diuretis (8 patients, Group 2) or the same treatment plus ibopamine (10 patients, Group 1) were given. There were no significant differences between the two groups in age, weight, height, functional class and duration of symptoms. The results obtained showed that cardiovascular conditions worsened dramatically in the group of controls during the 10-week period, irrespective of the treatment with digitalis and diuretics. Some of the parameters deteriorated significantly (p < 0.05 or < 0.01) such as systolic and diastolic left ventricular diameters, fractional shortening, end-systolic stress and pressure/diameter ratio, and other parameters showed a tendency to become worse (exercise time, cardiothoracic ratio). On the contrary, in patients of group 1, ibopamine in association with digitalis and diuretics appeared to preserve left ventricle function from a progressive worsening. None of the parameters deteriorated with ibopamine by contrast with a sharp decrease in the control group. Some of the parameters (fractional shortening, pressure/diameter ratio, exercise time) showed a tendency to improve although not significantly. The data suggest that 10 weeks treatment with ibopamine may prevent any deterioration or even produce a mild improvement in patients with very severe congestive heart failure.

1985 - Computerized tomography and ultrasound in the noninvasive evaluation of coarctation of the aorta [Articolo su rivista]
Modena, M. G.; Benassi, A.; Mattioli, G.; Guicciardi, N.; Romagnoli, R.; Canossi, G.
abstract

1985 - Dilated cardiomyopathy: prognosis [Articolo su rivista]
Benassi, A.; Modena, M. G.
abstract

1985 - Usefulness of the end-systolic stress-fractional shortening relations in the evaluation of left ventricular function [Articolo su rivista]
Benassi, A.; Modena, M. G.; Mattioli, G.
abstract

1984 - Computerised analysis of M-Mode echocardiography traces in the early stages of haemochromatosis infiltrative heart disease [Articolo su rivista]
Modena, M. G.; Benassi, A.; Massolo, F.; Sardini, S.; Cuoghi, D.; Barbolini, P.; Mattioli, G.
abstract

1984 - Coronary blood flow modifications after administration of Captoril [Altro]
G., Mattioli; A., Benassi; Modena, Maria Grazia; R. G., Zennaro
abstract

Coronary blood flow modifications after administration of Captoril

1984 - Developmental interruption of the intra-hepatic segment of inferior vena cava with azygos-hemiazygos continuation [Articolo su rivista]
Romagnoli, R.; Bertolani, M.; Saviano, M.; Pantusa, M.; Modena, M. G.; Benassi, A.
abstract

A personal observation of a case of 'azygos-hemiazygos continuation' due to congenital absence of hepatic segment of the inferior vena cava is described.

1984 - Echocardiographic evaluation of cardiovascular effects of amrinone [Articolo su rivista]
Modena, Maria Grazia; Benassi, A; Mattioli, Giorgio
abstract

Amrinone, a new inotropic drug, was infused at a dosage of 2.5 mg/kg body weight in 14 patients affected by dilatative cardiomyopathy in New York Heart Association (NYHA) functional class III and IV. Cardiac index, mean arterial pressure, and some echocardiographic parameters were evaluated. Cardiac index (CI) increased from 2.03 +/- 0.24 to 2.82 +/- 0.43 1/min/m2 (p less than 0.001). Fractional shortening (FS) increased from 16.4 +/- 5.2 to 21.5 +/- 5.3% (p less than 0.05). End-diastolic and end-systolic diameters showed a significant reduction. Mean arterial pressure decreased from 90.7 +/- 88 to 87.3 +/- 8.4 mmHg (p less than 0.001), the end-systolic stress (ESS) decreased from 5.8 +/- 1 to 5.2 +/- 1 g/cm (p less than 0.001). Analyzing the relationship between FS and ESS, it was possible in some cases to suppose the presence of an important vasodilator effect of the drug. The afterload in 7 patients was therefore modified before and after infusion of the drug to analyze FS at the same levels of afterload. This was done to evaluate the vasodilator effect of amrinone. Examining the regression line of FS/ESS ratio it was possible to observe a predominant vasodilator effect in some patients, but in most, a sinergic action was noted. This may be useful for chronic treatment of congestive heart failure, reducing amrinone doses, and using it in association with other vasodilator drugs

1983 - Cerebral protection in surgery of the carotid arteries [Articolo su rivista]
Parravicini, R.; Modena, G. M.
abstract

The authors, starting from the larger and larger spreading of the carotid surgery, consider the risks of cerebral ischemia involved and the measures suitable to reduce its incidence. So, they analyse the measures, both pharmacologic and mechanical, which, before, during and after operation, may contribute in reducing the possibility of incidence of such a deprecable complication.

1983 - Long-term survival in myocardial infarct. Analysis of the post-infarct course in relation to the clinical aspects of the acute phase [Articolo su rivista]
Baraldi, P.; Benassi, A.; Modena, M. G.
abstract

1983 - Technical variations in abdominal heterotransplants of the heart [Articolo su rivista]
Modena, Maria Grazia
abstract

The Authors describe the innovations by them introduced in a series of 15 experiments of abdominal heart heterotopic transplantation done in the Institute of Veterinary Physiology and Biochemistry University of Milano. Particularly they recommend the use of cardioplegia and the prolene as suture's material to reduce the ischemic time. Also they signal the importance of a new position of the transplanted heart with the apex looking at the head of the recipient. They think this position should be the best to preserve the anatomical connections between the great vessels of the guest heart.

1982 - Correlation between hemodynamic and ECG findings in pulmonary hypertension [Articolo su rivista]
Modena, M.; Benassi, A.; Mattioli, G.
abstract

1982 - Description of a new experimental cardiac heterotransplant with left ventricular assistance function. Preliminary work [Articolo su rivista]
Modena, Maria Grazia
abstract

1981 - Aorto-coronary bypass with surgical treatment of the mitral valve [Articolo su rivista]
Parravicini, R.; Modena, M. G.; Sandiford, F. M.
abstract

1980 - Surgical valve therapy combined with aorto-coronary bypass (author's transl) [Articolo su rivista]
Parravicini, Roberto; Modena, Maria Grazia; Sandiford, Fm
abstract

The AA. analyse a series of 720 patients who have undergone an aorta coronary by-pass combined with surgical valve therapy at the Texas Heart Institute up to an including 1977. 384 of these cases involved the aortic valve, 306 the mitral valve and 30 both valves. The combined operation was shown to be necessary since the disregarded or untreated coronary lesion in patients with valve pathology increases both the early and late mortality rate or reduces the results after surgical valve therapy. The double operation, on the other hand, reduces mortality, eliminates the symptoms, improves long-term survival and prevents myocardial infarction. Therefore emphasis is placed on the need for coronarographic investigation for valve patients over 40. However, the association of mitral or anuloplastic valve replacement does not lead to a significant improvement in long-term survival when mitral valve insufficiency is accompanied by an ischaemic aetiology

1979 - Echocardiographic aspects of biological valvular prostheses [Articolo su rivista]
Modena, Maria Grazia
abstract

1978 - Effect of infusion of ethanol on metabolism of the ischemic myocardium [Articolo su rivista]
Zennaro, R.; Nardini, M.; Modena, M. G.; Mattioli, G.
abstract

1978 - Relationship between blood levels and hemodynamic effects of diphenylhydantoin [Articolo su rivista]
Modena, Maria Grazia
abstract

Università degli studi di Modena e Reggio Emilia

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