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Rosario ROSSI

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

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Pubblicazioni

2024 - Atrial fibrillation before and after transcatheter aortic valve implantation: short- and long-term clinical implications [Articolo su rivista]
Arrotti, Salvatore; Sgura, Fabio Alfredo; Leo, Giulio; Vitolo, Marco; Monopoli, Daniel; Forzati, Nicola; Siena, Valerio; Menozzi, Matteo; Cataldo, Paolo; Stuani, Marco; Morgante, Vernizia; Magnavacchi, Paolo; Gabbieri, Davide; Guiducci, Vincenzo; Benatti, Giorgio; Vignali, Luigi; Rossi, Rosario; Boriani, Giuseppe
abstract

BackgroundPatients with atrial fibrillation (AF) undergoing transcatheter aortic valve implantation (TAVI) have been associated with worse short-term outcomes compared with patients in sinus rhythm but data on long-term outcomes are limited. The aim of our study was to evaluate the association between AF and short- and long-term outcomes in patients undergoing TAVI.MethodsWe retrospectively evaluated patients undergoing TAVI between 2012 and 2022 in four tertiary centres. Two different analyses were conducted: (i) in-hospital and (ii) postdischarge analysis. First, we evaluated the association between preexisting AF and short-term outcomes according to VARC-3 criteria. Second, we analyzed the association between AF at discharge (defined as both preexisting and new-onset AF occurring after TAVI) and long-term outcomes at median follow-up of 3.2 years (i.e. all-cause death, hospitalization and major adverse cardiovascular events).ResultsA total of 759 patients were initially categorized according to the presence of preexisting AF (241 vs. 518 patients). The preexisting AF group had a higher occurrence of acute kidney injury [odds ratio (OR) 1.65; 95%confidence interval ( CI) 1.15-2.38] and major bleeding (OR 1.86, 95% CI 1.06-3.27). Subsequently, the population was categorized according to the presence of AF at discharge. At the adjusted Cox regression analysis, AF was independently associated with an increased risk of all-cause death and cardiovascular hospitalization [adjusted hazard ratio (aHR) 1.42, 95% CI 1.09-1.86], all-cause death and all-cause hospitalization (aHR 1.38, 95% CI 1.06-1.78) and all-cause hospitalization (aHR 1.59, 95% CI 1.14.2.22).ConclusionsIn a real-world cohort of patients undergoing TAVI, the presence of AF (preexisting and new-onset) was independently associated with both short- and long-term adverse outcomes.

2023 - Effects of Ivabradine on Right Ventricular Systolic Function in Patients With Chronic Obstructive Pulmonary Disease and Cor Pulmonale [Articolo su rivista]
Rossi, R.; Coppi, F.; Sgura, F. A.; Monopoli, D. E.; Arrotti, S.; Talarico, M.; Boriani, G.
abstract

Cor pulmonale is a clinical syndrome associated with pulmonary hypertension, frequently complicated by congestive heart failure, commonly caused by chronic obstructive pulmonary disease (COPD). Most patients with cor pulmonale have tachycardia. However, heart rate (HR) reduction represents a primary treatment goal to improve the survival and quality of life in these patients. Ivabradine can selectively slow HR at rest and during exercise. In this prospective study, we tested the hemodynamic effects, invasively determined using right-sided cardiac catheterization, of reducing HR with ivabradine. We selected 18 patients (13 men [72.2%], mean age 67 ± 10 years) with COPD and cor pulmonale, presenting with sinus tachycardia. All patients performed clinical evaluation, electrocardiogram, spirometry, echocardiogram, 6-minute walking distance, and right-sided cardiac catheterization within 1 month of enrollment. All tests were repeated after 6 months of ivabradine treatment (median assumed dose 11.9 mg/die). We noticed a significant decrease of HR (from 98 ± 7 to 77 ± 8 beats/min, p = 0.0001), with a concomitant reduction of the congestion index (from 25.9 ± 5.1 to 19.4 ± 5.7 mm Hg, p = 0.001), and the consequent improvement of the right ventricular systolic performance (right ventricular stroke volume augmented from 56.7 ± 7.9 to 75.2 ± 8.6 ml/beat, p = 0.0001). This allows an improvement in clinical status and exercise tolerance (Borg scale score decreased from 5.2 ± 1.4 to 4.1 ± 1.3, p = 0.01 and the 6-minute walking distance increased to 252 ± 65 to 377 ± 59 m, p = 0.001). In conclusion, HR reduction significantly improves hemodynamic and clinical status of patients with tachycardia affected by COPD and cor pulmonale.

2023 - The Importance of Mehran Score to Predict Acute Kidney Injury in Patients with TAVI: A Large Multicenter Cohort Study [Articolo su rivista]
Arrotti, S.; Sgura, F. A.; Monopoli, D. E.; Siena, V.; Leo, G.; Morgante, V.; Cataldo, P.; Magnavacchi, P.; Gabbieri, D.; Guiducci, V.; Benatti, G.; Vignali, L.; Boriani, G.; Rossi, R.
abstract

Background: Transcatheter aortic valve implantation (TAVI) has developed as an alternative to surgery for symptomatic high-risk patients with aortic stenosis (AS). An important complication of TAVI is acute kidney injury. The purpose of the study was to investigate if the Mehran Score (MS) could be used to predict acute kidney injury (AKI) in TAVI patients. Methods: This is a multicenter, retrospective, observational study including 1180 patients with severe AS. The MS comprised eight clinical and procedural variables: hypotension, congestive heart failure class, glomerular filtration rate, diabetes, age >75 years, anemia, need for intra-aortic balloon pump, and contrast agent volume use. We assessed the sensitivity and specificity of the MS in predicting AKI following TAVI, as well as the predictive value of MS with each AKI-related characteristic. Results: Patients were categorized into four risk groups based on MS: low (≤5), moderate (6–10), high (11–15), and very high (≥16). Post-procedural AKI was observed in 139 patients (11.8%). MS classes had a higher risk of AKI in the multivariate analysis (HR 1.38, 95% CI, 1.43–1.63, p < 0.01). The best cutoff for MS to predict the onset of AKI was 13.0 (AUC, 0.62; 95% CI, 0.57–0.67), whereas the best cutoff for eGFR was 42.0 mL/min/1.73 m2 (AUC, 0.61; 95% CI, 0.56–0.67). Conclusions: MS was shown to be a predictor of AKI development in TAVI patients.

2022 - Anthropometric parameters and radiation doses during percutaneous coronary procedures [Articolo su rivista]
Manicardi, Marcella; Nocetti, Luca; Brigidi, Alessio; Cadioli, Cecilia; Sgreccia, Daria; Valenti, Anna Chiara; Vitolo, Marco; Arrotti, Salvatore; Monopoli, Daniel Enrique; Sgura, Fabio; Rossi, Rosario; Guidi, Gabriele; Boriani, Giuseppe
abstract

Body size is a major determinant of patient's dose during percutaneous coronary interventions (PCI). Body mass index, body surface area (BSA), lean body mass and weight are commonly used estimates for body size. We aim to identify which of these measures and which procedural/clinical characteristics can better predict received dose.

2022 - Impact of body mass index on the outcome of elderly patients treated with transcatheter aortic valve implantation [Articolo su rivista]
Sgura, F. A.; Arrotti, S.; Monopoli, D.; Valenti, A. C.; Vitolo, M.; Magnavacchi, P.; Tondi, S.; Gabbieri, D.; Guiducci, V.; Benatti, G.; Vignali, L.; Rossi, R.; Boriani, G.
abstract

Underweight or overweight patients with cardiovascular diseases are associated with different outcomes. However, the data on the relation between body mass index (BMI) and outcomes after transcatheter aortic valve implantation (TAVI) are not homogeneous. The aim of this study was to assess the role of low BMI on short and long-term mortality in real-world patients undergoing TAVI. We retrospectively included patients undergoing TAVI for severe aortic valve stenosis. Patients were classified into three BMI categories: underweight (< 20 kg/m2), normal weight (20–24.9 kg/m2) and overweight/obese (≥ 25 kg/m2). Our primary endpoint was long-term all-cause mortality. The secondary endpoint was 30-day all-cause mortality. A total of 794 patients were included [mean age 82.3 ± 5.3, 53% females]. After a median follow-up of 2.2 years, all-cause mortality was 18.1%. Patients in the lowest BMI group showed a higher mortality rate as compared to those with higher BMI values. At the multivariate Cox regression analysis, as compared to the normal BMI group, BMI < 20 kg/m2 was associated with long-term mortality independently of baseline risk factors and postprocedural adverse events (hazard ratio [HR] 2.29, 95% confidence interval [CI] 1.30–4.03] and HR 2.61, 95% CI 1.48–4.60, respectively). The highest BMI values were found to be protective for both short- and long-term mortality as compared to lower BMI values even after applying the same adjustments. In our cohort, BMI values under 20 kg/m2 were independent predictors of increased long-term mortality. Conversely, the highest BMI values were associated with lower mortality rates both at short- and long-term follow-up.

2022 - Low Levels of Vitamin D and Silent Myocardial Ischemia in Type 2 Diabetes: Clinical Correlations and Prognostic Significance [Articolo su rivista]
Rossi, R.; Talarico, M.; Pascale, A.; Pascale, V.; Minici, R.; Boriani, G.
abstract

Vitamin D deficiency has a pathogenetic and prognostic role in coronary artery disease and a key role in pain transmission. Diabetic patients have a higher risk of silent myocardial ischemia (SMI) due to diabetic neuropathy. We evaluated the correlation between SMI and Vitamin D serum levels in type 2 diabetic patients and assessed whether SMI patients had a worse survival rate than their symptomatic counterpart. We enrolled 253 patients admitted in our Cardiology Unit and compared them with 50 healthy volunteers. We created three sub-groups: symptomatic MI group (125, 32.4%); SMI group (78, 25.7%), and no-MI group (50, 41.9%). 25(OH)D levels (nmol/L) were lower in the SMI group (34.9 ± 5.8) compared to those in the symptomatic MI (49.6 ± 6.1; p = 0.01), no MI (53.1 ± 6.2; p = 0.001), and control groups (62.1 ± 6.7; p = 0.0001). 25(OH)D levels predicted SMI in diabetic patients, with an inverted odds ratio of 1.11 (p = 0.01). Symptomatic MI group survival was higher than the SMI one (6-year survival rate: 83 vs. 69%; p = 0.01). Diabetic patients with SMI had a higher mortality risk and showed lower 25(OH)D levels than the symptomatic group. This suggests the crucial role that vitamin D has in the pathogenesis of SMI.

2022 - Pulmonary arterial hypertension and right ventricular systolic dysfunction in COVID-19 survivors [Articolo su rivista]
Rossi, R.; Coppi, F.; Monopoli, D. E.; Sgura, F. A.; Arrotti, S.; Boriani, G.
abstract

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 - Effects of sildenafil on right ventricle remodelling in Portopulmonary hypertension [Articolo su rivista]
Rossi, R.; Talarico, M.; Schepis, F.; Coppi, F.; Sgura, F. A.; Monopoli, D. E.; Minici, R.; Boriani, G.
abstract

Portopulmonary hypertension (PoPH) is a clinical condition associated with end‐stage liver disease, described by the coexistence of pulmonary arterial hypertension (PAH) and portal hypertension. In PoPH patients, there is a right ventricle (RV) remodeling to compensate for the increased resistance in the lung circulation. There are no studies on the effects of the PAH-targeted pharmacological treatment on the RV dimension and function. The present study summarizes our experience in patients with PoPH treated with sildenafil in a period of 6 years (from 2013 to 2019). We enrolled 64 consecutive patients identified as PoPH, all treated with sildenafil (57.6% in monotherapy; in the other cases in association with macitentan; in 19.0% with initial combination therapy). A hemodynamic invasive cardiopulmonary study was performed at baseline and after 6 months of sildenafil treatment. In our population we showed a significative improvement in RV performance, with a significant increase in RV stroke volume (+33%), RV ejection fraction (+31%) and RV stroke work index (+17.5%). We registered the reduction of the RV cavity dimension over time in all patients treated with sildenafil (RV end diastolic diameter decreased by 15% after 6 months of follow-up). Regarding diastolic function, we highlighted a very significant reduction in RV end-diastolic pressure (−50% concerning baseline). Sildenafil was effective both when used as monotherapy and in combination with macitentan. In conclusion, Sildenafil had a positive impact on RV systolic and diastolic function in patients with PoPH and was able to conditionate the reverse remodeling of the RV.

2021 - Percutaneous pericardiocentesis for pericardial effusion: predictors of mortality and outcomes [Articolo su rivista]
Pennacchioni, A.; Nanni, G.; Sgura, F. A.; Imberti, J. F.; Monopoli, D. E.; Rossi, R.; Longo, G.; Arrotti, S.; Vitolo, M.; Boriani, G.
abstract

Pericardial effusion can dangerously precipitate patient’s hemodynamic stability and requires prompt intervention in case of tamponade. We investigated potential predictors of in-hospital mortality, a composite outcome of in-hospital mortality, pericardiocentesis-related complications, and the need for emergency cardiac surgery and all-cause mortality in patients undergoing percutaneous pericardiocentesis. This is an observational, retrospective, single-center study on patients undergoing percutaneous pericardiocentesis (2010–2019). We enrolled 81 consecutive patients. Median age was 71.4 years (interquartile range [IQR] 58.1–78.1 years) and 51 (63%) were male. Most of the pericardiocentesis were performed in an urgency setting (76.5%) for cardiac tamponade (77.8%). The most common etiology was idiopathic (33.3%) followed by neoplastic (22.2%). In-hospital mortality was 14.8% while mortality during follow-up (mean 17.1 months) was 44.4%. Only hemodynamic instability (i.e., cardiogenic shock, hypotension refractory to fluid challenge therapy and inotropes) was associated with in-hospital mortality at the univariate analysis (odds ratio [OR] 7.2; 95% confidence interval [CI] 1.76–29.4). Non-neoplastic/non-idiopathic etiology and hemodynamic instability were associated with the composite outcome of in-hospital mortality, need for emergency cardiac surgery, or pericardiocentesis-related complications (OR 5.75, 95% CI 1.65–20.01, and OR 5.81, 95% CI 2.11–15.97, respectively). Multivariate Cox regression analysis adjusted for possible confounding variables (age, coronary artery disease, and hemodynamic instability) showed that neoplastic etiology was independently associated with medium-term mortality (hazard ratio [HR] 4.05, 95% CI 1.45–11.36). In a real-world population treated with pericardiocentesis for pericardial effusion, in-hospital adverse outcomes and medium-term mortality are consistent, in particular for patients presenting with hemodynamic instability or neoplastic pericardial effusion.

2021 - Red cell distribution width and patient outcome in cardiovascular disease: A ‘’real-world” analysis [Articolo su rivista]
Talarico, M.; Manicardi, M.; Vitolo, M.; Malavasi, V. L.; Valenti, A. C.; Sgreccia, D.; Rossi, R.; Boriani, G.
abstract

Red cell distribution width (RDW) has been shown to predict adverse outcomes in specific scenarios. We aimed to assess the association between RDW and all-cause death and a clinically relevant composite endpoint in a population with various clinical manifestations of cardiovascular diseases. We retrospectively analyzed 700 patients (median age 72.7 years [interquartile range, IQR, 62.6–80]) admitted to the Cardiology ward between January and November 2016. Patients were divided into tertiles according to baseline RDW values. After a median follow-up of 3.78 years (IQR 3.38–4.03), 153 (21.9%) patients died and 247 (35.3%) developed a composite endpoint (all-cause death, acute coronary syndromes, transient ischemic attack/stroke, and/or thromboembolic events). With multivariate Cox regression analysis, the highest RDW tertile was independently associated with an increased risk of all-cause death (adjusted hazard ratio [HR] 2.73, 95% confidence interval [CI] 1.63–4.56) and of the composite endpoint (adjusted HR 2.23, 95% CI 1.53–3.24). RDW showed a good predictive ability for all-cause death (C-statistics: 0.741, 95% CI 0.694–0.788). In a real-world cohort of patients, we found that higher RDW values were independently associated with an increased risk of all-cause death and clinical adverse cardiovascular events thus proposing RDW as a prognostic marker in cardiovascular patients.

2020 - AB0611 STRAIN ANALYSIS OF THE RIGHT VENTRICLE USING 2D-SPECKLE TRACKING ECHOCARDIOGRAPHY IN A COHORT OF PATIENTS WITH SYSTEMIC SCLEROSIS [Abstract in Rivista]
Spinella, A; Macripo, P; Cocchiara, E; Galli, E; Lumetti, F; Magnani, L; Coppi, F; Mattioli, Av; Rossi, R; Boriani, G; Salvarani, C; Giuggioli, D
abstract

Background: Systemic Sclerosis (SSc) is a rare and life-threatening connective tissue disease with multiple organ impairment. Cardio-pulmonary involvement is common: pulmonary fibrosis, pulmonary hypertension (PH), and electrical disorders are the most serious complications and causes of increased mortality. Objectives: We evaluated features related with the onset and development of PH in a cohort of SSc patients. We further studied ecocardiographic abnormalities, by means of 2D-speckle tracking echocardiography (STE) with specific reference to the right ventricular strain measure (RV-strain). Methods: We analyzed data from 50 SSc patients (pts) referred to our University-based Rheumatology Centre and SSc Unit from January 2007 to June 2019 (F/M 45/5; lc/dcSSc 45/5; mean age 59.20±14.357 years; mean disease duration 12.08±8.75 years). All pts underwent general and cardio-pulmonary …

2020 - Effect on mortality of different routes of administration and loading dose of aspirin in patients with ST-segment elevation acute myocardial infarction treated with primary angioplasty [Articolo su rivista]
Rossi, Rosario; Bagnacani, Alessandra; Sgura, Fabio; Enrique Monopoli, Daniel; Coppi, Francesca; Talarico, Marisa; Rolando, Cristina; Boriani, Giuseppe
abstract

Aspirin is the cornerstone of the anti-platelet therapy during the acute phase of ST-segment elevation myocardial infarction (STEMI), and it can be administrated orally or intravenously. The oral loading dose of aspirin is well characterized, whereas there are little data on the optimal intravenous (IV) loading dose.

2020 - Protective role of chronic treatment with direct oral anticoagulants in elderly patients affected by interstitial pneumonia in COVID-19 era [Articolo su rivista]
Rossi, R.; Coppi, F.; Talarico, M.; Boriani, G.
abstract

2020 - Protective role of statins in COVID 19 patients: importance of pharmacokinetic characteristics rather than intensity of action [Articolo su rivista]
Rossi, R.; Talarico, M.; Coppi, F.; Boriani, G.
abstract

2019 - Mechanisms of Hydrogen Sulfide against the Progression of Severe Alzheimer’s Disease in Transgenic Mice at Different Ages [Articolo su rivista]
Vandini, Eleonora; Ottani, Alessandra; Zaffe, Davide; Calevro, Anita; Canalini, Fabrizio; Cavallini, Gian Maria; Rossi, Rosario; Guarini, Salvatore; Giuliani, Daniela
abstract

Abstract Backgroud: Alzheimer disease is an age-related severe neurodegenerative pathology. The level of the third endogenous gas, hydrogen sulfide (H2S), is decreased in the brain of Alzheimer’s disease (AD) patients compared with the brain of the age-matched normal individuals; also, plasma H2S levels are negatively correlated with the severity of AD. Recently, we have demonstrated that systemic H2S injections are neuroprotective in an early phase of preclinical AD. Objectives: This study focuses on the possible neuroprotection of a chronic treatment with an H2S donor and sulfurous water (rich of H2S) in a severe transgenic 3×Tg-AD mice model. Method: 3×Tg-AD mice at 2 different ages (6 and 12 months) were daily treated intraperitoneally with an H2S donor and sulfurous water (rich of H2S) for 3 months consecutively. We investigated the cognitive ability, brain morphological alterations, amyloid/tau cascade, excitotoxic, inflammatory and apoptotic responses. Results: Three months of treatments with H2S significantly protected against impairment in learning and memory in a severe 3×Tg-AD mice model, at both ages studied, and reduced the size of Amyloid β plaques with preservation of the morphological picture. This neuroprotection appeared mainly in the cortex and hippocampus, associated with reduction in activity of c-jun N-terminal kinases, extracellular signal-regulated kinases and p38, which have an established role not only in the phosphorylation of tau protein but also in the inflammatory and excitotoxic response. Conclusion: Our findings indicate that appropriate treatments with various sources of H2S, might represent an innovative approach to counteract early and severe AD progression in humans.

2019 - Reply to: “It takes two “eyes” to see in depth” [Articolo su rivista]
Turco, L.; Garcia-Tsao, G.; Rossi, R.; Villa, E.; Schepis, F.
abstract

2018 - Acute hemodynamic effects of intravenous adenosine in patients with associated pulmonary arterial hypertension: Comparison with intravenous epoprostenol [Articolo su rivista]
Rossi, Rosario; Coppi, Francesca; Sgura, Fabio; Monopoli, Daniel Enrique; Boriani, Giuseppe
abstract

Exogenous intravenous (IV) adenosine and epoprostenol are effective vasodilator agents, causing a substantial reduction in pulmonary vascular resistance in patients affected by idiopathic pulmonary arteriolar hypertension (PAH). Their action, in patients with PAH associated with other pathological conditions, is not well defined. In the present paper the authors retrospectively analyzed the acute hemodynamic effects of intravenous adenosine and epoprostenol in 30 consecutive patients (mean age: 58 ± 15 years; 21 females, and 9 males) affected by PAH associated with other pathological conditions, as determined by changes from baseline in systemic and pulmonary hemodynamic parameters. Acute IV administration of adenosine decreased pulmonary vascular resistance index (PVRI) by 3 Wood U/m(2) (- 20%) compared to baseline (p = 0.02). We noted a slight, not significant, decrease in mean pulmonary artery pressure (mPAP) of 4 mmHg. Cardiac index (CI) increased by 0.5 L/min/m(2) (15% increase respect to baseline; p = 0.03). The heart rate and mean systemic blood pressure (BP) did not change significantly. Acute IV administration of epoprostenol decreased PVRI by 6 mmHg (- 40%) respect to baseline (p < 0.0001). CI increased by 1.4 L/min/m(2) (p < 0.0001); while mPAP decreased by 5 mmHg (nearly 10%) (p = 0.04). This decrease of mPAP was accompanied by a mean BP decrease of 11 mmHg compared to baseline (p = 0.003). Our results indicates that, in patients with PAH associated with other pathological conditions, adenosine is predominantly a positive inotropic agent; and epoprostenol a potent vasodilator of both pulmonary and systemic vessels, and a strong positive inotropic agent.

2018 - Cardiac involvement in systemic sclerosis: identification of high-risk patient profiles in different patterns of clinical presentation [Articolo su rivista]
Coppi, Francesca; Giuggioli, Dilia; Spinella, Amelia; Colaci, Michele; Lumetti, Federica; Farinetti, Alberto; Migaldi, Mario; Rossi, Rosario; Ferri, Clodoveo; Boriani, Giuseppe; Mattioli, Anna Vittoria
abstract

Systemic sclerosis (SSc) is a chronic connective tissue disease characterized by widespread microvascular damage, dysregulation of fibroblasts with collagen overproduction and excessive fibrosis of the skin and internal organs, as well as complex immune system abnormalitie….

2018 - Cardiopulmonary hemodynamics and c-reactive protein as prognostic indicators in compensated and decompensated cirrhosis [Articolo su rivista]
Turco, Laura; Garcia-Tsao, Guadalupe; Magnani, Ilenia; Bianchini, Marcello; Costetti, Martina; Caporali, Cristian; Colopi, Stefano; Simonini, Emilio; De Maria, Nicola; Banchelli, Federico; Rossi, Rosario; Villa, Erica; Schepis, Filippo
abstract

The main stages of cirrhosis (compensated and decompensated) have been substaged based on clinical, endoscopic, and portal pressure (determined by the hepatic venous pressure gradient, HVPG) features. Vasodilatation leading to a hyperdynamic circulatory state is central in the development of a late decompensated stage with inflammation being currently considered a key driver. We aimed to assess hepatic/systemic hemodynamics and inflammation (by C reactive protein, CRP) among the different substages of cirrhosis and to investigate their interrelationship and prognostic relevance.

2018 - Management of cardiopulmonary disease in patients with systemic sclerosis: cardiorheumatology clinic and patient care standardization proposal [Articolo su rivista]
Spinella, Amelia; Coppi, Francesca; Mattioli, Anna Vittoria; Lumetti, Federica; Rossi, Rosario; Cocchiara, Emanuele; Colaci, Michele; Boriani, Giuseppe; Ferri, Clodoveo; Salvarani, Carlo; Giuggioli, Dilia
abstract

Management of cardiopulmonary disease in patients with systemic sclerosis: cardiorheumatology clinic and patient care standardization proposal

2018 - Reply to: “Relationship of hyperdynamic circulation and cardiodynamic states in cirrhosis” [Articolo su rivista]
Turco, Laura; Garcia-Tsao, Guadalupe; Rossi, Rosario; Villa, Erica; Schepis, Filippo
abstract

N/A

2016 - Impegno cardiaco nella sclerosi sistemica [Articolo su rivista]
Colaci, Michele; Giuggioli, Dilia; Spinella, Amelia; Rossi, Rosario; Ferri, Clodoveo
abstract

L'impegno cardiaco in corso di sclerosi sistemia consta di uno spettro variabile di manifestazioni cliniche conseguenti ad alterazioni di natura microangiopatica, elettrica e/o emodinamica. In danno ischemico e/o flogistico autoimmune del miocardio producono, in ultima analisi, il quadro istopatologico caratteristico della 'necrosi a bande' con deposizione di tessuto fibroso, responsabile della riduzione di elasticità e della capacità contrattile muscolare. ....

2016 - PROGRESSIVE ALTERATIONS IN SYSTEMIC AND CARDIOPULMONARY HEMODYNAMICS OCCUR IN PATIENTS WITH CIRRHOSIS AND PREDICT DEATH IN DECOMPENSATED CIRRHOSIS [Abstract in Atti di Convegno]
Turco, L; Garcia-Tsao, G; Magnani, I; Bianchini, M; Costetti, M; Rossi, R; Villa, E; Schepis, F
abstract

Background and Aims: The main stages of cirrhosis (compensated and decompensated) have been substaged based on clinical, endoscopic, and portal pressure (determined by the hepatic venous pressure gradient, HVPG) features. Vasodilation leading to a hyperdynamic circulatory state is central in the development of a late decompensated stage with inflammation being currently considered a key driver. We aimed to assess hepatic/systemic hemodynamics and inflammation (by C reactive protein, CRP) among the different substages of cirrhosis and to investigate their interrelationship and prognostic relevance. Methods: Single center, prospective cohort of patients with cirrhosis undergoing per protocol hepatic and right-heart catheterization and CRP measurement, classified into recently defined prognostic stages (PS) of compensated (PS1: HVPG ≥6mmHg but <10mmHg; PS2: HVPG ≥10 mmHg without gastroesophageal varices; PS3: patients with gastroesophageal varices) and decompensated (PS4: diuretic-responsive ascites; PS5: refractory ascites) disease. Cardiodynamic states based on cardiac index (L/min/m2) were created: relatively-hypodynamic (<3.2), normodynamic (3.2-4.2) and hyperdynamic (>4.2). Results: 238 patients, 151 compensated (PS1=25; PS2=36; PS3=90), 87 decompensated (PS4=48; PS5=39). Mean arterial pressure decreased progressively from PS1 to PS5, cardiac index increased progressively from PS1-to-PS4 but decreased in PS5. HVPG, MELD, and CRP increased progressively from PS1-to-PS5. Among compensated patients, age, HVPG, relatively-hypodynamic/hyperdynamic state and CRP were predictive of decompensation. Among patients with ascites, MELD, relatively-hypodynamic/hyperdynamic state, post-capillary pulmonary hypertension, and CRP were independent predictors of death/liver transplant. Conclusions: Our study demonstrates that, in addition to known parameters, cardiopulmonary hemodynamics and CRP are predictive of relevant outcomes in patients with both compensated and decompensated cirrhosis.

2015 - Automic Function Tests and Pulse wave velocity in HIV Disease: correlation to vascular ageing. [Abstract in Rivista]
Manicardi, Marcella; Guaraldi, P; Santoro, Antonella; Lattanzi, A; Malagoli, Andrea; Salvi, P; Grillo, A; Rossi, Rosario; Mussini, Cristina; Raggi, P; Cortelli, P; Guaraldi, Giovanni
abstract

Autonomic dysfunction is related to increased cardiovascular disease and mortality, being responsible of both subclinical coronary artery disease and cardiac arhythmias. In addition augmented sympathetic activity arises vascular constriction contributing to parietal arterial stiffness. Arterial stiffness can be assessed by measuring the velocity of the initial pulse wave propagation between two sites measured with PulsePen tonometer. We assessed whether subclinical autonomic dysfunction, as evaluated by a complete battery of autonomic function tests, correlates with pulse wave velocity change over 10 year follow up.

2015 - Dissociation of aortic pulse wave velocity from risk factors for cardiovascular disease other than hypertension and age: a prospective study on frailty in HIV-infected patients. [Abstract in Rivista]
Guaraldi, Giovanni; Malagoli, Andrea; Manicardi, Marcella; Grillo, A; Santoro, Antonella; Lattanzi, A; Rossi, Rosario; Mussini, Cristina; Raggi, P; Salvi, P.
abstract

Pulse Wave Velocity (PWV) is a measure of arterial stiffness (arteriosclerosis) and vascular ageing. Both in cross-sectional and prospective studies it was a predictor of cardiovascular disease (CVD)events independent of traditional risk factors for artherosclerosis. CVD is an increasing cause of morbidity and mortality among HIV-infected patients: traditional and non-traditional risk factors are involved. We hypothesized that factors influencing PWV may measure biological ageing in these patients. Therefore we aimed to identify predictors of PWV change over time in HIV-infected patients on stable antiretroviral therapy.

2015 - Importance of the time of initiation of mineralocorticoid receptor antagonists on risk of mortality in patients with heart failure [Articolo su rivista]
Rossi, Rosario; Crupi, Nicola; Coppi, Francesca; Monopoli, Daniel; Sgura, Fabio
abstract

Introduction: Several studies have definitively shown the benefit of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure (HF). However, very few prior studies examined the relationship between the timing of initiation of MRAs and prognosis. In addition, on this topic, there is no information regarding the specific population of patients suffering a first episode of decompensated congestive HF. Methods: We studied a homogenous cohort of patients discharged alive from our hospital after a first episode of decompensated congestive HF, in order to clarify the association between time of aldosterone receptor antagonist (ARA) initiation (within the first 90 days after hospital discharge) and mortality. Our population was composed of a series of consecutive patients. All-cause mortality was compared between patients who initiated MRAs at discharge (early group) and those who initiated MRAs one month later and up to 90 days after discharge (delayed group). We used prescription time distribution matching to control for survival difference between groups. Results: The early and delayed groups consisted of 365 and 320 patients, respectively. During the one-year follow-up, a significant difference in mortality was demonstrated between groups. Adjusted hazard ratios (HRs) for early versus delayed initiation were 1.72 (95% confidence interval (CI) 0.96 to 2.84) at six months, and 1.93 (95% CI 1.18 to 3.14) at one year. Conclusions: Delay of MRA initiation up to 30 to 90 days after discharge implies a significant increase in mortality compared with MRA initiation at discharge, after a first episode of decompensate congestive HF.

2015 - NDP-α-MSH attenuates heart and liver responses to myocardial reperfusion via the vagus nerve and JAK/ERK/STAT signaling [Articolo su rivista]
Ottani, Alessandra; Giuliani, Daniela; Neri, Laura; Calevro, Anita; Canalini, Fabrizio; Vandini, Eleonora; Cainazzo, Maria Michela; Ruberto, Ippazio Antonio; Barbieri, Alberto; Rossi, Rosario; Guarini, Salvatore
abstract

Melanocortin peptides afford cardioprotection during myocardial ischemia/reperfusion via janus kinases (JAK), extracellular signal-regulated kinases (ERK) and signal transducers/activators of transcription (STAT) pathways. Here we investigated whether melanocortin-induced modulation of the JAK/ERK/STAT signaling occurs via the cholinergic anti-inflammatory pathway, focusing our study on cardiac and hepatic responses to prolonged myocardial ischemia/reperfusion. Ischemia was produced in rats by ligature of the left anterior descending coronary artery for 30min; effects of ischemia/reperfusion were evaluated using Western blot of heart and liver proteins. Intravenous treatment, during coronary artery occlusion, with the melanocortin analog (Nle(4), D-Phe(7))α-melanocyte-stimulating hormone (NDP-α-MSH) induced a left ventricle up-regulation of the cardioprotective transcription factors pJAK2, pERK1/2 and pTyr-STAT3 (JAK-dependent), and a reduction in the levels of the inflammatory mediators tumor necrosis factor-α (TNF-α) and pJNK (a transcription factor also involved in apoptosis), as assessed at the end of the 2-h reperfusion period. Further, these beneficial effects of NDP-α-MSH were associated with heart over-expression of the pro-survival proteins heme oxygenase-1 (HO-1) and Bcl-XL, and decrease of ventricular arrhythmias and infarct size. In the liver NDP-α-MSH induced a decrease in the pJAK2 and pTyr-STAT3 levels, and strongly reduced pERK1/2 expression. In the liver of ischemic rats NDP-α-MSH also blunted pJNK activity and TNF-α expression, and up-regulated Bcl-XL. Bilateral cervical vagotomy prevented all effects of NDP-α-MSH, both in the heart and liver. These results indicate that melanocortins inhibit heart and liver damage triggered by prolonged myocardial ischemia/reperfusion likely, as main mechanism, via the vagus nerve-mediated modulation of the JAK/STAT/ERK signaling pathways.

2015 - Number of Cardiometabolic disorders is associated with degree of frailty among people aging with HIV. [Abstract in Rivista]
Brothers, Td; Wallace, Lmk; Malagoli, Andrea; Rossi, Rosario; Manicardi, Marcella; Santoro, Antonella; Theou, O; Kirkland, S; Rockwood, K; Guaraldi, Giovanni
abstract

Inflammatory cardiometabolic disorders become more common and can accumulate with age. Frailty also worsens with age and is associated with pro-inflammatory states. We sought to assess the burden of cardiometabolic disorders in a large ongoing HIV-positive cohort study, the relationship between cardiometaolic disorders and frailty, and whether they independently contribute to mortality.

2015 - Retained embolized fragment of totally implantable central venous catheter in right ventricle: it is really necessary to remove? [Articolo su rivista]
Tazzioli, Giovanni; Gargaglia, Eleonora; Vecchioni, Ilaria; Papi, Simona; DI BLASIO, Petronilla; Rossi, Rosario
abstract

IIntroduction: Central venous catheters are often required in oncologic patients for long-term safe administration of chemotherapeutic agents, antibiotics, and parenteral nutrition. Rupture of these devices and intracardiac migration is a rare complication. Methods: We report one spontaneous rupture and embolization of a totally implantable vascular access device (TIVAD) in an asymptomatic patient. Results: A 50-year-old woman received a TIVAD silicone catheter 8 FR for adjuvant chemotherapy. After 3 years of port time in situ, during a follow-up control, a catheter malfunction was found and radiologic investigations showed a rupture and migration of the catheter to the right ventricle. The attempt to remove the fragment under fluoroscopic control using the femoral route was unsuccessful. We did not try a surgical approach because of the complete absence of symptomatology and hemodynamic impairment. Conclusions: The catheter rupture and intracardiac embolization is a rare complication associated with totally implantable or tunneled central venous catheters. When such an event happens, the patient should be managed by expert hemodynamists or interventional radiologists making an effort to remove the fragment without surgical measures. When the intravascular percutaneous route fails, the possibility to leave the fragmented catheter in heart chambers should be evaluated, being surgery questionable in asymptomatic patients.

2014 - Consultation-liaison psychiatry and the “Women Wellness Project”: analysis of the association between cardiovascular risk factors and psychiatric comorbidity [Abstract in Rivista]
Mattei, Giorgio; Simoni, Elena; Borghi, Ambra; Bursi, S; Capitani, C; Coppi, Francesca; Ferrari, Silvia; Gorlato, Giulia; Pingani, Luca; Rigatelli, Marco; Rossi, Rosario
abstract

INTRODUCTION The Consultation-Liaison Psychiatry Service of the Modena General Hospital collaborates regularly with the Cardiology Clinic, within the Woman Wellness Project (WWP). Aim of this collaboration is detection and prevention of post-menopausal correlated diseases, including psychiatric syndromes. AIM To investigate the association between cardiovascular risk factors (BMI, blood pressure, hyperglycemia, hypertrygliceridemia) and psychiatric symptoms in peri-post menopausal. METHODS Ecological study. Data between January 2008 and December 2012 were collected. Correlations, logistic regessions and categorial regressions were performed with STATA. RESULTS 675 outpatients attended the WWP. 90 (13.3%) were referred to the psychiatrist; 9 refused the examination. Of the remaining 57.7% had a positive psychiatric history and 22.03% already receaved a psychiatric therapy. 40.6% had at least two medical diseases, mainly: overweight (54.2%), hypertension (40.7%) and dyslipidemia (49.1%). After psychiatric consultation emerged that: 11.9% had anxiety symptoms, 27.1% had depressive symptoms and 47.5% presented both anxiety and depressive symptoms. Only 7 patients (11.9%) had a negative psychiatric examination. The regression analysis pointed out no significant association between the cardiometabolic risk-factors and the psychiatric symptomatology. Differently, the outcome at the end of the psychiatric consultation was associated with BMI (r = -.26; p = .05) and heart rate (r = .33; p = .01). CONCLUSIONS Heart rate and BMI emerge as factors associated with the psychiatric symptomatology presented by the patient. This finding is consistent with previous researches. The absence of significant associations at the regression analysis could be explained by the small sample considered in the present study.

2014 - Coronary artery disease concomitant with chronic obstructive pulmonary disease [Articolo su rivista]
Sara, Roversi; Pietro, Roversi; Giuseppe, Spadafora; Rossi, Rosario; Fabbri, Leonardo
abstract

BackgroundNumerous epidemiologic studies have linked the presence of chronic obstructive pulmonary disease (COPD) to coronary artery disease (CAD). However, prevalence, pathological processes, clinical manifestations and therapy are still debated, as progress towards uncovering the link between these two disorders has been hindered by the complex nature of multimorbidity. MethodsArticles targeting CAD in patients with COPD were identified from the searches of MEDLINE and EMBASE databases in July 2013. Three authors reviewed available evidence, focusing on the latest development on disease prevalence, pathogenesis, clinical manifestations and therapeutic strategies. Both clinical trial and previous reviews have been included in this work. ResultsThe most accredited hypothesis asserts that the main common risk factors, that is, cigarette smoke and ageing, elicit a chronic low-grade systemic inflammatory response, which affects both cardiovascular endothelial cells and airways/lung parenchyma. The development of CAD in patients with COPD potentiates the morbidity of COPD, leading to increased hospitalizations, mortality and health costs. Moreover, correct diagnosis is challenging and therapies are not clearly defined. ConclusionsEvidence from recently published articles highlights the importance of multimorbidity in patient management and future research. Moreover, many authors emphasize the importance of low-grade systemic inflammation as a common pathological mechanism and a possible future therapeutic target

2014 - Erratum: A randomised trial of target-vessel versus multivessel revascularisation in ST-elevation myocardial infarction: Major adverse cardiac events during long-term follow-up (Heart (2010) 96 (662-7)) [Articolo su rivista]
Politi, L.; Sgura, F.; Rossi, R.
abstract

N/A

2014 - Huge postmyocardial infarction left ventricular pseudoaneurysm in a patient with previous self-inflicted thoracic stab wounds [Articolo su rivista]
Monopoli, D. E.; Cimato, P.; Rossi, R.
abstract

2014 - Intact parathyroid hormone levels are associated with increased carotid intima media thickness in HIV infected patients [Articolo su rivista]
Antonio, Bellasi; Paolo, Raggi; Rossi, Rosario; Rochira, Vincenzo; Stentarelli, Chiara; Zona, Stefano; Antonella, Lattanzi; Carli, Federica; Mussini, Cristina; Guaraldi, Giovanni
abstract

Aim. Preliminary evidence suggests that intact parathyroid hormone (iPTH) and bone mineral abnormalities may contribute to the development of vascular disease and are associated with reduced survival in the general population. Whether iPTH is associated with subclinical atherosclerosis in HIV-infected individuals has not been elucidated. Methods. Cross-sectional study of 470 consecutive HIV-infected patients in whom we measured carotid intima-media thickness (cIMT), and collected demographical, clinical and laboratory data. High-cIMT was defined as a mean IMT above the 75th percentile for the study cohort. Parametric, non-parametric tests and logistic regression analyses were used to compare patients' characteristics between low- and high-cIMT and to test the association between high-cIMT and log-transformed iPTH. Results. Of the 470 patients, 130 had high-cIMT. High-cIMT subjects were older and more likely to be male and have a history of cardiovascular disease. Glucose, lipid and iPTH levels were lower among low-cIMT subjects (p < 0.05). Unadjusted and multivariable adjusted analyses demonstrated an independent association between high-cIMT and iPTH (fully adjusted OR: 1.74; 95%CI: 1.08–2.79; p = 0.021). Bootstrap and sensitivity analyses confirmed these findings. Conclusions. Elevated iPTH was associated with subclinical atherosclerosis in HIV-infected subjects. Of note this association was statistically significant even for iPTH values within the range of normality. The existence of a causal relationship between iPTH and atherosclerosis needs to be fully explored in future investigations.

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 - Protective effects of the melanocortin analog NDP-α-MSH in rats undergoing cardiac arrest [Articolo su rivista]
Ottani, Alessandra; Neri, Laura; Canalini, Fabrizio; Calevro, Anita; Rossi, Rosario; Cappelli, Gianni; Ballestri, M; Giuliani, Daniela; Guarini, Salvatore
abstract

We previously reported that melanocortins afford cardioprotection in conditions of experimental myocardial ischemia/reperfusion, with involvement of the janus kinases (JAK), extracellular signal-regulated kinases (ERK) and signal transducers and activators of transcription (STAT) signalings. We investigated the influence of the melanocortin analog [Nle(4), D-Phe(7)]α-melanocyte-stimulating hormone (NDP-α-MSH) on short-term detrimental responses to cardiac arrest (CA) induced in rats by intravenous (i.v.) administration of potassium chloride, followed by cardiopulmonary resuscitation (CPR) plus epinephrine treatment. In CA/CPR rats i.v. treated with epinephrine (0.1mg/kg) and returned to spontaneous circulation (48%) we recorded low values of mean arterial pressure (MAP) and heart rate (HR), alteration of hemogasanalysis parameters, left ventricle low expression of the cardioprotective transcription factors pJAK2 and pTyr-STAT3 (JAK-dependent), increased oxidative stress, up-regulation of the inflammatory mediators tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), and down-regulation of the anti-inflammatory cytokine IL-10, as assessed at 1h and 3h after CPR. On the other hand, i.v. treatment during CPR with epinephrine plus NDP-α-MSH (340μg/kg) almost completely restored the basal conditions of MAP and HR, reversed metabolic acidosis, induced left ventricle up-regulation of pJAK2, pTyr-STAT3 and IL-10, attenuated oxidative stress, down-regulated TNF-α and IL-6 levels, and improved survival rate by 81%. CA/CPR plus epinephrine alone or in combination with NDP-α-MSH did not affect left ventricle pSer-STAT3 (ERK1/2-dependent) and pERK1/2 levels. These results indicate that melanocortins improve return to spontaneous circulation, reverse metabolic acidosis, and inhibit heart oxidative stress and inflammatory cascade triggered by CA/CPR, likely via activation of the JAK/STAT signaling pathway.

2013 - Coronary artery bypass grafting vs percutaneous coronary intervention in a 'real-world' setting: A comparative effectiveness study based on propensity score-matched cohorts [Articolo su rivista]
Fortuna, Daniela; Nicolini, Francesco; Guastaroba, Paolo; De Palma, Rossana; Di Bartolomeo, Stefano; Saia, Francesco; Pacini, Davide; Grilli, Roberto; Passerini, F.; Vignali, L.; Manari, A.; Magnavacchi, P.; Rossi, R.; Benassi, A.; Sangiorgio, P.; Saia, F.; Marzocchi, A.; Valgimigli, Maria; Percoco, G.; Varani, E.; Cremonesi, A.; Tarantino, F.; Piovaccari, G.
abstract

OBJECTIVES: Most studies comparing coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI) showed that fewer patients who had undergone CABG required repeat revascularizations , but no difference in survival, with the exception of some subgroups of patients. However, long-term real-world evidence on patients in whom both procedures are technically feasible is yet not available. The aim of this study was to compare 5-year rates of death, myocardial infarction (MI), target vessel revascularization (TVR) and stroke in a large cohort of patients with left main coronary artery (LMCA) or multivessel disease, treated with CABG or PCI (with or without DES) or PCI with DES only. METHODS: Two propensity score (PS)-matched cohorts of patients undergoing revascularization procedures at the regional public and private centres of Emilia-Romagna over the period July 2002-December 2008 were used to compare long-term outcomes of PCI (6246 patients) and CABG (5504 patients). RESULTS: PCI was associated with higher risk of death (HR = 1.6; 95% CI 1.4-1.8, P < 0.0001), MI (HR = 3.3; 95% CI 2.7-4.0, P < 0.0001) and TVR (HR = 4.5; 95% CI 3.8-5.2, P < 0.0001) at 5 years. No significant difference was shown for stroke (HR = 1.1; 95% CI 0.9-1.4, P = 0.43). CABG benefit was more evident in the risk of death in patients with two-vessel disease plus LMCA and in those with threevessel disease, LVEF <35%, congestive heart failure and diabetes. Adjusted comparison with PS between PCI with DES only and CABG confirmed significant differences in favour of CABG for mortality, MI and TVR rates. Competing risk analysis showed that the difference in the mortality rate was due to higher rate of MI in PCI. CONCLUSIONS: In the 'real-world' setting of this study, CABG was associated with significantly lower rates of death, MI and TVR in patients with LMCA or multivessel disease, so it remains the standard of care, particularly for patients with more extensive coronary disease and diabetes. ©The Author 2013.Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

2013 - Flow-mediated dilatation (FMD) assessment as a marker of endothelial dysfunction in liver cirrhosis [Abstract in Rivista]
Marcacci, Matteo; Fiorini, Massimo; A., Lattanzi; Venturelli, Giorgia; G., Roveri; C., Boni; F., Zappia; Pietrangelo, Antonello; Rossi, Rosario; Ventura, Paolo; Mario Coppo Liver Research, Group; Cardiology Unit, University of Modena; Reggio, Emilia; Modena, Italy
abstract

Background/aims: Portal hypertension (PH) complications are leading causes of death in patients with liver cirrhosis (LC). PH development in chronic liver disease depends on increased vascular intra-hepatic resistance and on hyperdynamic splanchnic circulation. Disturbances in “Endothelium-dependent” vasodilation, a condition known as “endothelial dysfunction” (ED), has been claimed as an important factor responsible for increased vascular hepatic resistance and PH development in LC. Aims of this study were to assess in LC patients: (1) the presence of ED and its correlation with disease stage and (2) correlation between of ED serum markers (MED) and flow-mediated dilatation (FMD), the gold standard test for evaluating ED. Material and methods: 60 consecutive LC patients (mean age 65±10 years, 17 female) without portal thrombosis (40 with compensated and 20 with decompensated disease) underwent a complete clinical, radiological and biochemical evaluation in order to assess the stage of disease and drug history; all subjects were assessed for MED [P-selectin, von Willebrand factor (vWF), endothelin-1 (ET-1), thrombomodulin (TM) and nitric oxide (NO)] serum levels and FMD (measured by ultrasound at brachial artery according to guidelines). MED and FMD were also assessed in 11 healthy subjects (mean age 26±6.6 female; controls). Results: MED plasma levels increased with the degree of liver dysfunction (p for trend <0.001 in all cases); accordingly, FMD values decreased with worsening of the stage of liver cirrhosis [controls (9.9±1.1%), compensated cirrhosis (6.1±1.8%), decompensated cirrhosis (5±1.3%), p for trend <0.01]. In LC patients a statistically significant correlation between MED markers and FMD was observed for ET-1: r= –0.4427 (p=0.0004) and P-selectin: r= –0.477 (p=0.0001), vWF (r= –0.166, p=0.05), but not for TM (r= –0.245, p=0.05951) and NO (p=0.961). At multivariate analysis, ET-1 and P-selectin remained significantly associated to FMD. Conclusions: Our data confirm the presence of ED in LC patients, as indicated by the significant increase in serum MED and by FMD reduction observed in LC patients. All these parameters show also a significant correlation with the severity of liver disease. Significant correlation and association of FMD with serum MED values also suggest that FMD may be a reliable marker of ED in patients with LC.

2013 - IS FLOW-MEDIATED DILATATION (FMD) ASSESSMENT A RELIABLE MARKER OF ENDOTHELIAL DYSFUNCTION IN LIVER CIRRHOSIS? [Abstract in Atti di Convegno]
Marcacci, Matteo; Fiorini, Massimo; Lattanzi, Antonella; Venturelli, Giorgia; Roveri, Giulia; Boni, Chiara; Zappia, Federica; Pietrangelo, Antonello; Rossi, Rosario; Ventura, Paolo
abstract

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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 - Pulmonary hypertension in systemic sclerosis: prevalence, incidence and predictive factors in a large multicentric Italian cohort. [Articolo su rivista]
Iudici, M; Codullo, V; Giuggioli, D; Riccieri, V; Cuomo, G; Breda, S; Manfredi, Andreina Teresa; Iannace, N; D'Alto, M; Ghio, S; Rossi, R; Vizza, Cd; Caporali, R; Valesini, G; Ferri, Clodoveo; Valentini, G.
abstract

OBJECTIVES: This paper aims to investigate the prevalence, the incidence of pulmonary hypertension (PH) and its subtypes in Italian patients with systemic sclerosis (SSc) and to characterise features associated with and predictive of development of PH. METHODS: Eight-hundred and sixty-seven consecutive SSc patients recruited at 4 Italian centres were enrolled. At admission, all patients underwent a careful history, physical examination, EKG, lung high resolution computed tomography (HRCT), pulmonary function tests, B-mode echocardiography and right heart catheterisation (RHC), if indicated. Patients were then visited every 6-12 months. A RHC was performed in those patients in whom PH was suspected for the presence of pre-specified criteria. RESULTS: Among the 212 patients in whom it was suspected, PH was confirmed by RHC in 69 patients. On 31st December 2010, the point prevalence of P-arterial-H(PAH) and PH associated with interstitial lung disease (PH-ILD) was 3.7% and 1.4%, respectively; that of postcapillary PH was 1.3%. The estimated incidence rates of PH and PAH were respectively 1.85/100 patient-years and 1.02/100 patient-years. Multivariate analysis indicated that diffusing lung capacity for CO (DLCO) ≤55% (HR 4.45, 95%CI 2.24-8.83; p&lt;0.001) and sPAP &gt;40 mmHg (HR 18.03, 95%CI 9.01-36.06; p&lt;0.001) were associated with an increased risk to develop PAH. SystolicPAP &gt;40 mmHg resulted the only predictor of PH-ILD (HR 5.17, 95%CI 1.37-19.5; p=0.018) and post-capillary PH (HR 7.91, 95%CI 1.88-33.1; p=0.005) development. CONCLUSIONS: Our study confirms a lower prevalence of PH in Italy compared to Anglo-Saxon cohorts. We also identified patients at high risk, who should be carefully monitored.

2012 - Abacavir and Tenofovir impact on endothelial. [Abstract in Rivista]
Guaraldi, Giovanni; Zona, Stefano; Roverato, A; Orlando, Gabriella; Carli, Federica; Lattanzi, A; Manzini, L; Bisi, L; Cicognani, A; Rossi, Rosario
abstract

Flow mediated dilation (FMD) of the brachial artery is an endothelial function test, that has been used to assess the impact of cardiovascular induced drug toxicity. The objective of the study was to analyse the impact of abacavir and tenofovir on endothelial function.

2012 - Aortic pulse wave velocity measurement in systemic sclerosis patients. [Articolo su rivista]
Colaci, Michele; Giuggioli, Dilia; Manfredi, Andreina Teresa; Sebastiani, Marco; Coppi, Francesca; Rossi, Rosario; Richeldi, Luca; Ferri, Clodoveo
abstract

Background. Systemic sclerosis (SSc) is characterized by endothelial dysfunction and widespread microangiopathy. However, a macrovascular damage could be also associated. Aortic pulse wave velocity (aPWV) is known to be a reliable indicator of arterial stiffness and a useful prognostic predictor of cardiovascular events. Moreover, aPWV may be easily measured by non-invasive, user-friendly tool. Aim of our study was to evaluate aPWV alterations in a series of SSc patients. Methods. The aPWV was evaluated in 35 consecutive female SSc patients and 26 sex- and age-matched healthy controls. aPWV alterations were correlated with cardiopulmonary involvement. Results. A significant increase of aPWV was observed in SSc patients compared to controls (9.4±3.2 m/s vs 7.3±1 m/s; P=0.002). In particular, 14/35 (40%) SSc patients and only 1/26 (4%) controls (P=0.0009) showed increased aPWV (&gt;9 m/s cut-off value). Moreover, echocardiography evaluation showed an increased prevalence of right atrial and ventricular dilatation (atrial volume: 23.6±6.2 mL vs 20.3±4.3 mL, P=0.026; ventricular diameter 19.5±4.9 mm vs 15.9±1.6 mm; P=0.001) associated to higher values of pulmonary arterial systolic pressure (PAPs) in SSc patients (31.5±10.4 mmHg vs 21.6±2.9 mmHg; P&lt;0.0001; 40% of SSc patients showed an abnormal PAPs). Clinically, SSc patients presented a reduction of six-minute walking test (413±96 m vs 491±49 m; P=0.001), not correlated with pulmonary function tests. Increased aPWV values were evidenced only in SSc patients &gt;50 years old. Furthermore, altered aPWV was more frequently associated with limited cutaneous pattern, longer disease duration (≥5 years), and/or presence of anticentromere antibody (ACA). Conclusions. A significantly higher prevalence of abnormally increased aPWV was evidenced in SSc patients compared to healthy controls. The possibility of more pronounced and diffuse vascular damage in a particular SSc subset (ACA-positive subjects with limited cutaneous scleroderma and longer disease duration) might be raised.

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 - 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 - 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 &lt; 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 - 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. © 2011 SIMI.

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. © 2010 Springer.

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 ± 1.0% at baseline vs. 10.6 ± 1.5% after follow-up; p < 0.001), but it had not changed or worsened in others (n = 63 [19.7%]; FMD = 8.2 ± 1.2% at baseline vs. 7.6 ± 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. © SAGE Publications 2011.

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 &gt;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 - Erectile Dysfunction Does Not Mirror Endothelial Dysfunction in HIV-Infected Patients [Abstract in Rivista]
Santi, Daniele; Mattia, Beggi; Brigante, Giulia; Zona, Stefano; Kety, Luzy; Orlando, Gabriella; Rossi, Rosario; Pierre, Bouloux; Guaraldi, Giovanni; Rochira, Vincenzo
abstract

Non classical risk factors are associated with HIV-related erectile dysfunction

2011 - Erectile dysfunction does not mirror endothelial dysfunction in hiv-infected patients [Abstract in Rivista]
Santi, Daniele; Mattia, Beggi; Brigante, Giulia; Zona, Stefano; Luzi, Kety; Orlando, Gabriella; Rossi, Rosario; Pierre, Bouloux; Guaraldi, Giovanni; Rochira, Vincenzo
abstract

This study confirms that the classical predictors of erectile dysfunction are not associated to impaired erectile function, probably since other factor are more important in HIV , the latter mask the role of classic risk factors

2011 - Erratum: Vitamin D deficiency is associated with type 2 diabetes mellitus in HIV infection (AIDS (2011) 25 (707-711)) [Articolo su rivista]
Szep, Z.; Guaraldi, G.; Shah, S.; Lo Re, V.; Ratcliffe, S. J.; Orlando, G.; Carli, F.; Rossi, R.; Rochira, V.; Tebas, P.
abstract

N/A

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 - Long-term clinical outcomes after drug eluting stent implantation in women with de novo coronary lesions: Results from the REAL (REgistro Regionale AngiopLastiche Emilia-Romagna) multicenter registry [Articolo su rivista]
Ortolani, Paolo; Solinas, Emilia; Guastaroba, Paolo; Casella, Gianni; Manari, Antonio; Piovaccari, Giancarlo; Balducelli, Marco; Tondi, Stefano; Percoco, Gianfranco; Tarantino, Fabio; Passerini, Francesco; Rossi, Rosario; Vignali, Luigi; De Palma, Rossana; Grilli, Roberto; Marzocchi, Antonio
abstract

Background: The long-term effectiveness of drug eluting stents (DESs) in a real-world setting of female patients is currently unclear. Methods and results: We analyzed long-term follow-up (up to 3 years) data from all female patients with de novo lesions enrolled in a prospective web-based multicenter registry (REAL Registry; study period, July 2002-June 2006) including all 15 hospitals performing PCI in the Emilia-Romagna region of Italy. Among the 3549 women without ST elevation myocardial infarction, 2434 were treated with BMSs alone and 1115 with DESs alone. At 3 years, use of DESs was associated with a lower propensity score adjusted incidence of MACE [cardiac mortality, non-fatal myocardial infarction and target vessel revascularization (TVR); 19.5% vs. 24.4%; HR 0.75, p = 0.006)] and TVR (11.6% vs. 15.6%; HR 0.68, p = 0.004) compared with BMSs. No difference was apparent in terms of adjusted 3-year cardiac mortality or myocardial infarction. Nevertheless, after the first 6 months of follow-up, a non significantly increased risk of myocardial infarction and stent thrombosis was found in the DES group. Conclusions: In this real-world female registry, the use of DESs was associated with a 3-year reduction of TVR and MACE in comparison with the use of BMSs. However, the observed (non-significant) increment of late AMI makes performing larger studies to clarify the long-term safety of DESs mandatory. © 2009 Elsevier Ireland Ltd.

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 - 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 - 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 - Vitamin D deficiency is associated with type 2 diabetes mellitus in HIV infection. [Articolo su rivista]
Szep, Z; Guaraldi, Giovanni; Shah, Ss; Lo Re V., 3rd; Ratcliffe, Sj; Orlando, Gabriella; Carli, Federica; Rossi, Rosario; Rochira, Vincenzo; Tebas, P.
abstract

BACKGROUND: Metabolic complications, including type 2 diabetes mellitus and metabolic syndrome, are increasingly recognized among HIV-infected individuals. Low vitamin D levels increase the risk of type 2 diabetes mellitus, and vitamin D supplementation has been shown to decrease the risk of type 2 diabetes mellitus in patients without HIV infection.OBJECTIVES: The primary objective was to determine whether vitamin D deficiency (serum 25-hyrdoxyvitamin D &lt;20 ng/ml) was associated with type 2 diabetes mellitus among HIV-infected patients. Our secondary objective was to determine whether vitamin D deficiency was associated with metabolic syndrome in HIV.METHODS: We conducted a cross-sectional study among participants enrolled in the prospective Modena (Italy) HIV Metabolic Clinic Cohort. Clinical and laboratory data, including history of type 2 diabetes mellitus, fasting blood glucose, components of metabolic syndrome, and 25-hydroxyvitamin D levels, were obtained for all participants.RESULTS: After adjusting for vitamin D supplementation, sex, age, body mass index, and hepatitis C virus co-infection, vitamin D deficiency was associated with type 2 diabetes mellitus [adjusted odds ratio (OR) 1.85; 95% confidence interval (CI) 1.03-3.32; P = 0.038]. The association between vitamin D deficiency and metabolic syndrome was not significant after adjusting for vitamin D supplementation, sex, age and body mass index (adjusted OR 1.32; 95% CI 1.00-1.75; P = 0.053).CONCLUSIONS: Our study demonstrates an association between vitamin D deficiency and type 2 diabetes mellitus. Clinical trials are needed to better characterize the association between vitamin D deficiency and type 2 diabetes mellitus in HIV infection and to evaluate whether vitamin D is able to prevent or delay the onset of type 2 diabetes mellitus.

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

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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 - Comparison of 2-year clinical outcomes with sirolimus and paclitaxel-eluting stents for patients with diabetes: Results of the REgistro regionale AngiopLastiche Emilia-Romagna registry [Articolo su rivista]
Balducelli, Marco; Ortolani, Paolo; Marzaroli, Paolo; Piovaccari, Giancarlo; Menozzi, Alberto; Manari, Antonio; Sangiorgio, Pietro; Tarantino, Fabio; Rossi, Rosario; Maresta, Aleardo; Tondi, Stefano; Passerini, Francesco; Guastaroba, Paolo; Grilli, Roberto; Marzocchi, Antonio
abstract

Background: Long-term outcomes of percutaneous coronary interventions (PCI) with sirolimus-eluting stents (SES) compared to paclitaxel-eluting-stents (PES) in unselected diabetics in routine practice is still debated. Objective: This study compared the 2-year incidence of MACE (all-cause mortality, nonfatal myocardial infarction and target vessel revascularization) of SES and PES in a real-world setting of patients with diabetes. Design: Observational, multicenter, nonrandomized study. Setting: Prospective web-based registry (REAL Registry; study period, 2002-2005) comprising all 13 hospitals performing PCI. Patients: Among the 945 eligible patients treated with either SES alone (n = 606) or PES alone (n = 339), 29% were insulin-requiring, 72% had multivessel coronary disease, 26% had prior myocardial infarction and 10% had poor left ventricular function. Measurements: Unadjusted and propensity score-adjusted 2-year clinical outcome. Results: After propensity score adjustment, 2-year MACE incidence in the SES and PES groups was equivalent (23.3% vs. 23.7%, HR 1.01, 95%CI 0.72-1.42, P = 0.96). Adjusted 2-year angiographic stent thrombosis occurred in 1.1% of the SES patients versus 2.6% of the PES patients (P = 0.15). In this large, real-world, diabetic population treated with DES, there was no difference in outcome between SES and PES. Further studies are needed to demonstrate the long-term safety of different types of DES in patients with diabetes. © 2009 Wiley-Liss, Inc.

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

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.

2010 - Erectile dysfunction does not mirror sub-clinical atherosclerosis in HIV infected males. [Abstract in Rivista]
Guaraldi, Giovanni; K., Luzi; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Rochira, Vincenzo; Rossi, Rosario; Esposito, Roberto; P., Raggi
abstract

In the general population erectile dysfunction (ED) and coronary artery disease share the same risk factors and endothelial dysfunction appear to be the common denominator. ED appears to be one of the earliest signs of systemic vascular disease and might be considered as an early marker for subclinical cardiovascular disease. We hypothesised ED as a nirror of sub-clinical atherosclerosis in HIV infected patients.

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. © 2010 Expert Reviews Ltd.

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 - Long-term clinical outcomes and cost-effectiveness analysis in multivessel percutaneous coronary interventions: Comparison of drug-eluting stents, bare-metal stents and a mixed approach in patients at high and low risk of repeat revascularisation [Articolo su rivista]
Varani, Elisabetta; Guastaroba, Paolo; Tanna, Gian Luca Di; Saia, Francesco; Balducelli, Marco; Campo, Gianluca; Vignali, Luigi; Rossi, Rosario; Manari, Antonio; Piovaccari, Giancarlo; De Palma, Rossana; Marzocchi, Antonio
abstract

Aims: To evaluate the long-term effectiveness and cost-efficacy of drug-eluting stents (DES) in a real world setting of multivessel percutaneous coronary intervention (PCI). Methods and results: We evaluated the 2-year outcome of all multivessel PCI in de novo lesions enrolled in a prospective web-based multicentre registry from July 2003 to December 2006. Among the 2,898 eligible patients, 1,315 were treated with bare-metal stent (BMS) alone, 657 with DES alone, and 926 with both. At 2-years, use of DES was associated with a lower propensity score adjusted incidence of major adverse cardiac events (MACE), death and myocardial infarction, and target vessel revascularisation (TVR) compared with BMS but only in patients at high risk of TVR. No difference was apparent between "pure" DES and the mixed approach. The matched cost-effectiveness analysis revealed DES to be more costly and more effective with a reasonable incremental cost-efficacy ratio for any MACE avoided only in patients with a high risk of TVR and only in comparison with "pure" BMS patients. Conclusions: In this real-world multivessel PCI registry, the use of DES and a mixed approach were associated with a 2-year reduction of adverse clinical outcomes in comparison with BMS especially in patients with a high risk of TVR. DES were cost-effective only in patients at high risk of TVR. © Europa Edition 2010. All rights reserved.

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 - 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 - 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 - 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 - 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 - Abstract: P784 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; Mc, Modena; F., Palella; P., Raggi
abstract

Although antiretroviral therapy (ART) has prolonged survival in 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 subclinical atherosclerosis as evaluated by coronary artery calcium 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 - 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 ageing in hiv-infected patients [Abstract in Rivista]
Alexopoulos, N; Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Fiocchi, F; Rossi, Rosario; Modena, Mc; Palella, F; Raggi, P.
abstract

The objectives of this study were to assess the coronary age of a cohort of HIV infected patients based on the extent of coronary artery calcium and to identify the variables associated with it.

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 - 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 - La valutazione del rischio cardiovascolare nel paziente con infezione da HIV. [Capitolo/Saggio]
Guaraldi, Giovanni; Garlassi, E.; Rossi, Rosario
abstract

Il trattamento dell'infezione da HIV con farmaci antiretrovirali appare oggi più complesso rispetto al passato. Ai determinanti viro-immunologici e di resistenza bisogna necessariamente affiancare i determinanti relativi alle comorbosità presenti nel paziente, prime fra tutte le malattie cardiovascolari. In quest'ambito, la prevenzione rimane il cardine degli interventi, imponendo una gestione oculata e saggia dei farmaci da utilizzare, ma soprattutto la contestualizzazione della terapia antiretrovirale nell'ambito della stima della vulnerabilità del soggetto a rischio.

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 - 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 - 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 - 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 - 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 - 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 - 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 - 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 - 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 - 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 - 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 - 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 - 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 - 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 - Subclinical coronary artery atherosclerosis and endothelial dysfunction are not predictors of erectile dysfunction in HIV-infected males [Abstract in Rivista]
Zona, Stefano; Luzi, Kety; Murri, R.; Granata, A.; Orlando, Gabriella; Squillace, Nicola; Ligabue, Guido; Rochira, Vincenzo; Rossi, Rosario; Guaraldi, Giovanni
abstract

To evaluate the association between erectile dysfunction and subclinical coronary artery atherosclerosis to endothelial dysfunction in HIV-infected people.

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 - 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 - 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.

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

ND

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 - 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 - 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 - 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

...

2004 - Cardiac involvement in malignancies. Case 2. Right ventricular lesion as presenting feature of acute promyelocytic leukemia [Articolo su rivista]
Potenza, Leonardo; Luppi, Mario; Morselli, M; Riva, Giovanni; Saviola, A; Ferrari, Alberto; De Santis, M; Rossi, Rosario; Torelli, Giuseppe
abstract

N/A

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 - 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 - 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&lt;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 &lt;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&lt;0.0001) and stent size of &gt;3.5 mm (OR 2.97 [IC 95\%: from 1.67 to 4.86]; p&lt;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 - 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 - 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 «Smart Score» 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 - 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 - 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. © 2003 CEPI Srl.

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. © 2003 CEPI Srl.

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 - 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 (&gt;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 &lt; 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 - TACHICARDIA PAROSSISTICA SOPRAVENTRICOLARE IN ETA' NEONATALE: DESCRIZIONE DI UN CASO CON SCOMPENSO CARDIACO SEVERO [Relazione in Atti di Convegno]
Ferrari, Fabrizio; Berardi, A; Rossi, K; Bussetti, C; Biagioni, O; Bronzetti, G; Garetti, E; Rota, C; Gargano, G; Cattani, S; Mordini, B; Roversi, Mf; Sturloni, N; Rossi, Rosario; Bonvicini, F; Pellicano', Fa
abstract

no abstract

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 - 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

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 - Intravenous NPA for the treatment of infarcting myocardium early: InTIME-II, a double-blind comparison on of single-bolus lanoteplase vs accelerated alteplase for the treatment of patients with acute myocardial infarction [Articolo su rivista]
Braunwald, E.; Neuhaus, K. -L.; Antman, E.; Chew, P.; Skene, A.; Wilcox, R.; Ambrosioni, E.; Anderson, J.; Apetrei, E.; Bata, I.; Carrageta, M.; Col, J.; Dalby, A.; Davies, R.; Deckers, J.; Eichman, D.; Grande, P.; Greene, R.; Gurfinkel, E.; Heikkilä, J.; Henry, T.; Hillis, D.; Hochman, J.; Huber, K.; Kostis, J.; Klinke, P.; López-Sendón, J.; Mckendall, G.; Móller, B.; Moore, P.; Morris, A.; Mueller, H.; Östör, E.; Oto, A.; Ruda, M.; Sadowski, Z.; Schweiger, M.; Sequeira, R.; Shah, P.; Shannon, R.; Smith, B.; Sobel, B.; Steingart, R.; Tebbe, U.; Toman, J.; Traboulsi, M.; Vahanian, A.; Warnica, J. W.; Willerson, J.; Deitchman, D.; Davidson, L.; Folgia, T.; Foxley, A.; Goodman, J.; Hauck, C.; Henry, D.; Mccabe, C.; Pangerl, A.; Thomson, A.; Wagner, M.; Kennedy, J. W.; Cairns, J.; Demets, D.; Julian, D.; Simoons, M.; Charlesworth, A.; Easton, J. D.; Ferbert, A.; Feske, S.; Kuhn, P.; Moseley, J.; Rogg, J. M.; Reichmann, H.; Sloan, M.; von Kummer, R.; Zamani, A.; Coulter, S.; Giugliano, R.; Skene, A. M.; Ardill, R.; Ince, Y.; Peters, A.; Ward, K.; Wolf, L.; Curtis, N.; De Brés, J.; Stead, S.; Watson, S.; Cutler, S.; Friedman, J.; Helfrick, R.; Williams, S.; Klimovsky, J.; Kumagai, S.; Adams, E.; Anderson, C.; Bauhuber, I.; Bennett, L.; Biro, E.; Boyce, E.; Bregman, B.; Carvalho, P.; Ciganovic, D.; Csukas, M.; Cuenca, P.; De Cuyper, S.; Diez, P.; Dijkhuizen, M.; Dille-Amo, C.; Gonzalez-Santis, A.; Gursoy, M.; Hammarstrom, K.; Harasta, E.; Ingman, E.; Kelemen, B.; Keulen, I.; Koren, A.; Langthaler, G.; Lemaire, F.; Little, I.; Montalban, C.; Nijssen, K.; Neumueller, I.; Palander, M.; Pekuri, T.; Persson, U.; Pilz, J.; Oudotova, S.; Pisklakov, V.; Proinov, F.; Ptaszynska, A.; Read, J.; Retei, S.; Romeyer, F.; Romanini, M.; Saar, L.; Salein, D.; Samsonov, M.; Simeon-Dubach, D.; Simmonds, J.; Skaza, M.; Skvortsova, N.; Smidlova, Z.; Spitzerova, H.; Strijdveen, I.; Szajewski, T.; Ugurnal, B.; Valcarce, M.; van Rompaey, I.; Walker, A.; Zak, E.; Zimova, N.; Barrero, C.; Beck, E.; Bruno, M. L.; Caccavo, A.; Cagide, A.; Campo, A.; Cermesoni, R.; Chahin, M.; Dutra, O.; Estrada, J.; Falu, E. A.; Gagliardi, J.; Garre, L. E.; Liprandi, A. S.; Luciardi, H.; Mautner, B.; Muntaner, J.; Nau, G.; Salzberg, S.; Santopinto, J.; Sinisi, A.; Torres, H.; Eber, B.; Elliott, P.; Hiemetsberger, H.; Juhasz, M.; Kühn, P.; Leisch, F.; Niktardjam, M.; Reisinger, J.; Schmalix, G.; Schuster, R.; Sihorsch, K.; Silberhauer, K.; Slany, J.; Steinbach, K.; Tragl, K. H.; Valentin, A.; Al Shwafi, K.; Dasnoy, P.; De Clippel, M.; de Meester, A.; De Raedt, H. J. L. P.; Emonts, M.; Evrard, P.; Eycken, M.; Geboers, M.; Heyndrickx, G.; Lauwers, K.; Mitrie, K.; Pirenne, B.; Renard, M.; Somers, Y.; Timmermans, P.; Van Kuyk, M.; Van Mieghem, W.; Vermeulen, J.; Verrostte, J. M.; Albuquerque, D.; Ayoub, J. C. A.; Carvalho, A.; Cesar, L.; Gebara, O.; Golin, V.; Knobel, E.; Leaes, P.; Neto, J. A. M.; Nicolau, J. C.; Piegas, L. S.; Rabelo, A.; Rassi, A.; Sila, L.; Simao, A. F.; Ashton, T.; Baillie, H.; Bhargava, R.; Bota, G.; Cameron, W.; Chan, N.; Chan, Y. K.; Daly, P. A.; Darcel, I.; Davies, E.; Desjardin, L.; Dhingra, S.; Ducas, J.; Ervin, F. L.; Fortin, C.; Fowlis, R.; Fulop, J.; Furey, M.; Gagnon, S.; Gebhardt, V.; Giannaccro, P.; Gosselin, G.; Graham, J.; Grondin, F.; Heath, J. W.; Henderson, M.; Hilton, D. R.; Hiscock, J.; Hui, W.; Kaza, L.; Kesselman, T.; Kouz, S.; Kucerak, M.; Lahoude, N.; Lamothe, M.; Lebouthillier, P.; Lenis, J.; Levesque, P.; Lopez, J. F.; Lubelsky, B.; Macritchie, D.; Mayer, J. -P.; Mcdowell, J. D.; Montigny, M.; Orestien-Lyall, T.; Parekh, P.; Pistawka, K.; Price, J. B.; Pruneau, G.; Quinn, B.; Reid, B. R.; Richmond, M.; Rose, B.; Schuld, R.; Sharma, N. K.; Shetty, P.; Stanton, E.; Strauss, H. D.; Sussex, B.; Theroux, P.; Turabian, M.; Turner, C.; Vizel, S.; Walker, M.; Weeks, A.; Winkler, L.; Zacharias, G.; Zimmerman, R.; Bartolucci, J.; Castro, P.; Diaz, M. A.; Illanes, G.; Potthoff, S.; Sanchez, E. C.;
abstract

Aims to compare the efficacy and safety of lanoteplase, a single-bolus thrombolytic drug derived from alteplase tissue plasminogen activator, with the established accelerated alteplase regimen in patients presenting within 6 h of onset of ST elevation acute myocardial infarction. Methods and Results 15 078 patients were recruited from 855 hospitals worldwide and randomized in a 2:1 ratio to receive either lanoteplase 120 KU. kg-1 as a single intravenous bolus, or up to 100 mg accelerated alteplase given over 90 min. The primary end-point was all-cause mortality at 30 days and the hypothesis was that the two treatments would be equivalent. By 30 days, 6.61% of alteplase-treated patients and 6.75% lanoteplase-treated patients had died (relative risk 1.02). Total stroke occurred in 1.53% alteplase- and 1.87% lanoteplase-treated patients (ns); haemorrhagic stroke rates were 0.64% alteplase and 1.12% lanoteplase (P=0.004). The net clinical deficit of 30-day death or non-fatal disabling stroke was 7.0% and 7.2%, respectively. By 6 months, 8.8% of alteplase-treated patients and 8.7% of lanoteplase-treated patients had died. Conclusion Single-bolus weight-adjusted lanoteplase is an effective thrombolytic agent, equivalent to alteplase in terms of its impact on survival and with a comparable risk-benefit profile. The single-bolus regimen should shorten symptoms to treatment times and be especially convenient for emergency department or out-of-hospital administration. (C) 2000 The European Society 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.

2000 - Rottura di cuore da trauma toracico. [Articolo su rivista]
Siniscalchi, A; Barbieri, Alberto; DE PIETRI, L; Rossi, Rosario
abstract

...

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 - 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 - 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 - Postoperative analgesia for early extubation after cardiac surgery. A prospective, randomized trial [Articolo su rivista]
Ranucci, M.; Cazzaniga, Alessio; Soro, G.; Isgrò, G.; Rossi, R.; Pavesi, M.
abstract

BACKGROUND: Early extubation after cardiac surgery is a procedure recently gaining interest due to its ability to shorten intensive care unit and hospital stay and to limit the operation-related costs. Its use, however, raised new problems in terms of pain control in the early postoperative course, due to the need for limiting opioid analgesia. This study deals with non-opioid pain control after cardiac surgery and early extubation. METHODS: Prospective, randomized trial aimed to investigate the effectiveness of three intravenous analgesic drugs (ketorolac, 60 mg i.v.; propacetamol, 2 g i.v.; tramadol, 200 mg i.v.) for the management of postoperative pain in early extubated cardiac surgical patients. Each treatment group comprised 20 patients. RESULTS: The pain assessment (5-item verbal scale) demonstrated a significant (p < 0.05) lower value in patients treated with ketorolac vs propacetamol, while patients treated with tramadol did not significantly differ from the other two groups. There was a significantly (p < 0.05) higher rate of patients with severe pain in propacetamol group. Patients treated with tramadol had a significantly (p < 0.01) higher PaCO2 (48 +/- 6 mmHg) versus patients treated with ketorolac (43.4 +/- 3.7 mmHg) or propacetamol (42.9 +/- 3.4 mmHg). CONCLUSIONS: Tramadol and ketorolac seem to be the best options for treating postoperative pain in the specific setting of early extubation after cardiac surgery; high doses of tramadol may result in a significant even if clinically not relevant respiratory depression.

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

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

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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&lt;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&lt;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&lt;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&lt;0.01). Ventricular mass index (VMI) in Group I increased from 106.4 +/- 11 to 122.3 +/- 15 g/m(2) (p&lt;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&lt;0.001), while in Group II it declined from 0.88 +/- 0.1 to 0.69 +/- 0.1 g/ml (p&lt;0.01). The multivariate analysis revealed that ejection fraction less than or equal to 40%, restrictive filling pattern, wall motion score index &gt;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 - 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

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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

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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

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 - Causes of death in patients with unipolar single chamber ventricular pacing: prevalence and circumstances in dependence on arrhythmias leading to pacemaker implantation. [Articolo su rivista]
Mattioli, Anna Vittoria; Rossi, Rosario; E., Annicchiarico; Mattioli, Giorgio
abstract

analysis of different causes of death in patinets with pacemaker

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.