Contributo della riserva coronarica indagata con metodica non invasiva alla determinazione del rischio di mortalità nella cardiopatia ischemica

Scopo del lavoro. In letteratura vengono riportati una serie di dati eterogenei che riguardano l’influenza della riserva di flusso coronarico (CFR) sull’outcome dei pazienti affetti da malattia coronarica. Scopo del nostro lavoro è quello di determinare il valore prognostico della CFR misurata con ecocardiografia transtoracica Doppler ad alta risoluzione in un gruppo di pazienti seguiti con follow-up a distanza. Metodi. Sono stati arruolati nello studio 826 pazienti sottoposti a valutazione noninvasiva della CFR nel territorio dell’arteria discendente anteriore (LAD) e talvolta nel territorio dell’arteria discendente posteriore (PD) mediante ecocardiografia transtoracica Doppler ad alta risoluzione in un periodo di tempo compreso tra il 26/10/99 e il 26/01/07 e seguiti per un follow-up di circa 24±15 mesi. La CFR veniva definita dal rapporto tra velocità coronarica di flusso all’acme dell’infusione venosa di adenosina e velocità basale. La CFR veniva misurata nel tratto medio-distale dell’arteria discendente anteriore ed in alcuni casi nell’arteria discendente posteriore (PD) mediante ecocardiografia transtoracica Doppler ad alta risoluzione e infusione endovenosa di adenosina (140mcg/kg/min per 90 sec). La morte (per cause cardiache e non), l’infarto del miocardio (MI) e la rivascolarizzazione del vaso target (TVR) sono stati considerati come eventi cardiaci maggiori. I pazienti sono stati stratificati dal punto di vista prognostico in due gruppi considerando come cut-off un valore di CFR pari a 2 per cui una CFR< 2 risultava predittiva di eventi mentre una CFR> o pari a 2 non era predittiva di eventi avversi. Risultati. E’ stato possible ottenere un follow-up completo in 780 pazienti mentre 46 pazienti (5.6%) sono stati considerati “lost” al follow-up. Inoltre 227 pazienti (27.5%) sono stati esclusi dall’analisi finale perchè sottoposti a procedure di rivascolarizzazione coronarica prima della valutazione della CFR. In conclusione, abbiamo considerato una popolazione di studio di 553 pazienti nell’analisi finale: di questi 190 venivano sottoposti a procedura di rivascolarizzazione percutanea o chirurgica dopo la valutazione della CFR mentre 328 pazienti venivano definiti come “event-free” (nessun evento al follow-up). Per quanto concerne gli eventi cardiaci maggiori abbiamo registrato un totale di 35 eventi: 9 morti per cause cardiache, 2 decessi per cause non cardiache, 1 infarto miocardico acuto, 10 episodi anginosi, 7 ricoveri per aritmie ed infine 6 ricoveri per scompenso cardiaco. L’analisi della varianza (ANOVA) eseguita nella popolazione di studio dei 553 pazienti ha mostrato valori medi della CFR nel territorio della LAD di 2.48 +/-1.1. Abbiamo poi suddiviso la popolazione in tre sottogruppi: pazienti liberi da eventi al follow-up, pazienti con eventi al follow-up, e pazienti sottoposti a rivascolarizzazione dopo la CFR. L’analisi statistica eseguita sia con metodi logistici che con modelli neurali ha confermato che la CFR è un potente predittore indipendente di eventi cardiaci maggiori nella nostra popolazione di studio (curva ROC 0.92) Conclusioni. I dati preliminari derivati da questo studio di follow-up dimostrano che la CFR è un indicatore accurato della probabilità di sviluppare eventi cardiaci maggiori al follow-up e si configura come potente predittore della prognosi di pazienti affetti da malattia coronarica. Key words: riserva di flusso coronarico (CFR), malattia coronarica (CAD), infarto del miocardio (MI), outcome, arteria discendente anteriore (LAD)Background. Heterogeneous data have been reported in the literature, concerning the impact of coronary flow reserve (CFR) on clinical outcome. We sought to determine the prognostic value of non-invasive CFR measurements in a large patient cohort undergoing long-term follow-up. Methods. We enrolled 826 patients undergoing non-invasive assessment of CFR in the left anterior descending coronary artery (LAD) and sometimes in posterior descending coronary artery (PD) in the period between 26/10/99 and 26/01/07 and followed for 24±15 months. CFR was defined as the ratio between adenosine-induced hyperaemia and baseline coronary blood flow velocity and measured in the middle-distal segment of the LAD and in some cases also in posterior descending coronary artery (PD) by transthoracic Doppler echocardiography and intravenous injection of adenosine (140 mcg/kg/min over 90sec). Death (cardiac, non cardiac), myocardial infarction (MI) and target vessel revascularization (TVR) were considered as hard clinical end-points. Patients were stratified according to a CFR < 2 (predictor of events) and a CFR >2.0 (not predictor of events). Results. A complete follow-up was available in 780 patients. A total of 46 patients (5,6%) were considered lost to follow-up. We excluded 227 patients (27.5%) who underwent revascularization before CFR assessment. Therefore we considered a population of 553 patients in the final statistical analysis. 190 patients underwent revascularization after CFR assessment while 328 patients showed no events at follow-up. On the other hand, a total of 35 events occurred as follows: 9 cardiac deaths, 2 non cardiac deaths, 1 myocardial infarction, 10 angina, 7 arrythmias and 6 heart failure. Anova analysis performed in the study group of 553 patients showed a CFR LAD 2.48 +/-1.1. We divided this population in three subgroups: event-free, cardiac events and patients undergoing revascularization after CFR evaluation. Statistical analysis performed with logistic and neural models showed that CFR is a strong predictor of hard events in our cohort of patients (ROC curve 0.92) Conclusions. These preliminary follow-up data show that CFR is a potential and accurate indicator of the likelihood of cardiac events and a predictor of clinical outcome

Growing and slaughtering performance of Apennine heavy lamb finished at pasture in Central Italy.

Twenty-six Apennine male lambs were allotted into 2 groups, under different finishing systems: group P (maximum pasture allowance) and group S (intensive finishing). Lambs were slaughtered either at 30 kg of weight or at 110 days of age (in case they couldn't reach final weight because of a sharp decline in pasture productivity in summer). Post-weaning ADG were significantly higher in the S group (about 77 g/d) and P lambs had lower weights, dressing percentage (due to higher gastro-intestinal apparatus content) and SEUROP conformation scores. Finishing lambs at pasture could have better results after an early weaning or using different mating strategies to escape the dramatic fall in pasture dry matter availability during summer

Italian translation and cultural adaptation of the communication assessment tool in an outpatient surgical clinic

The aim of the study is to translate and cross-culturally adapt, for use in the Italian context, the Communication Assessment Tool (CAT) developed by Makoul and colleagues

Decrypting the Origin and Pathogenesis in Pregnant Ewes of a New Ovine Pestivirus Closely Related to Classical Swine Fever Virus

This study shows the origin and the pathogenic role of a novel ovine pestivirus (OVPV) isolated in 2017 in Italy, as a pathogenic agent causing severe abortions after infection in pregnant ewes and high capacity for virus trans-placental transmission as well as the birth of lambs suffering OVPV-persistent infection. The OVPV infection induced early antibody response detected by the specific ELISA against classical swine fever virus (CSFV), another important virus affecting swine. The neutralizing antibody response were similar against CSFV strains from genotype 2 and the OVPV. These viruses showed high identity in the B/C domain of the E2-glycoprotein. Close molecular diagnostics cross-reactivity between CSFV and OVPV was found and a new OVPV molecular assay was developed. The phylodynamic analysis showed that CSFV seems to have emerged as the result of an inter-species jump of Tunisian sheep virus (TSV) from sheep to pigs. The OVPV and the CSFV share the TSV as a common ancestor, emerging around 300 years ago. This suggests that the differentiation of TSV into two dangerous new viruses for animal health (CSFV and OVPV) was likely favored by human intervention for the close housing of multiple species for intensive livestock production.info:eu-repo/semantics/publishedVersio

Decrypting the Origin and Pathogenesis in Pregnant Ewes of a New Ovine Pestivirus Closely Related to Classical Swine Fever Virus

This study shows the origin and the pathogenic role of a novel ovine pestivirus (OVPV) isolated in 2017 in Italy, as a pathogenic agent causing severe abortions after infection in pregnant ewes and high capacity for virus trans-placental transmission as well as the birth of lambs suffering OVPV-persistent infection. The OVPV infection induced early antibody response detected by the specific ELISA against classical swine fever virus (CSFV), another important virus affecting swine. The neutralizing antibody response were similar against CSFV strains from genotype 2 and the OVPV. These viruses showed high identity in the B/C domain of the E2-glycoprotein. Close molecular diagnostics cross-reactivity between CSFV and OVPV was found and a new OVPV molecular assay was developed. The phylodynamic analysis showed that CSFV seems to have emerged as the result of an inter-species jump of Tunisian sheep virus (TSV) from sheep to pigs. The OVPV and the CSFV share the TSV as a common ancestor, emerging around 300 years ago. This suggests that the differentiation of TSV into two dangerous new viruses for animal health (CSFV and OVPV) was likely favored by human intervention for the close housing of multiple species for intensive livestock production

Age-Related Differences in Takotsubo Syndrome: Results From the Multicenter GEIST Registry

Background: The role of age in the short- and long-term prognosis of takotsubo syndrome (TTS) is controversial. The aim of the present study was to evaluate age-related differences and prognostic implications among patients with TTS. Methods and results: In total, 2492 consecutive patients with TTS enrolled in an international registry were stratified into 4 groups (&lt;45, 45-64, 65-74, and ≥75 years). The median long-term follow-up was 480 days (interquartile range, 83-1510 days). The primary outcome was all-cause mortality (in-hospital and out-of-hospital mortality). The secondary end point was TTS-related in-hospital complications. Among the 2479 patients, 58 (2.3%) were aged &lt;45 years, 625 (25.1%) were aged 45 to 64 years, 733 (29.4%) were aged 65 to 74 years, and 1063 (42.6%) were aged ≥75 years. Young patients (&lt;45 years) had a higher prevalence of men (from youngest to oldest, 24.1% versus 12.6% versus 9.7% versus 11.4%; P&lt;0.01), physical triggers (46.6% versus 27.5%, 33.9%, and 38.4%; P&lt;0.01), and non-apical forms of TTS (25.9% versus 23.7%, 12.7%, and 9%; P&lt;0.01) than those aged 45 to 64, 65 to 74, and ≥75 years. During hospitalization, young patients experienced a higher rate of in-hospital complications (32.8% versus 23.4%, 27.4%, and 31.9%; P=0.01), but in-hospital mortality was higher in the older group (0%, 1.6%, 2.9%, and 5%; P=0.001). Long-term all-cause mortality was significantly higher in the older cohort (5.6%, 6.4%, 11.3%, and 22.3%; log-rank P&lt;0.001), as was long-term cardiovascular mortality (0%, 0.9%, 1.9%, and 3.2%; log-rank P=0.01). Conclusions: Young patients with TTS have a typical phenotype characterized by a higher prevalence of male sex, non-apical ballooning patterns, and in-hospital complications. However, in-hospital and long-term mortality are significantly lower in young patients with TTS

Neurological Disorders in Takotsubo Syndrome: Clinical Phenotypes and Outcomes

Background: Neurological disorders as a risk factor for Takotsubo syndrome (TTS) are not well characterized. The aim of the study was to evaluate TTS-associated neurological phenotypes and outcome. Methods and results: Patients with TTS enrolled in the international multicenter GEIST (German Italian Spanish Takotsubo) registry were analyzed. Prevalence, clinical characteristics, and short- and long-term outcomes of patients with TTS were recorded. A subgroup analysis of the 5 most represented neurological disorders was performed. In total, 400 (17%) of 2301 patients had neurological disorders. The most represented neurological conditions were previous cerebrovascular events (39%), followed by neurodegenerative disorders (30.7%), migraine (10%), epilepsy (9.5%), and brain tumors (5%). During hospitalization, patients with neurological disorders had longer in-hospital stay (8 [interquartile range, 5-12] versus 6 [interquartile range, 5-9] days; P&lt;0.01) and more often experienced in-hospital complications (27% versus 16%; P=0.01) mainly driven by cardiogenic shock and in-hospital death (12% versus 7.6% and 6.5% versus 2.8%, respectively; both P&lt;0.01). Survival analysis showed a higher mortality rate in neurological patients both at 60 days and long-term (8.8% versus 3.4% and 23.5% versus 10.1%, respectively; both P&lt;0.01). Neurological disorder was an independent predictor of both the 60-day and long-term mortality rate (odds ratio, 1.78 [95% CI, 1.07-2.97]; P=0.02; hazard ratio, 1.72 [95% CI, 1.33-2.22]; both P&lt;0.001). Patients with neurodegenerative disorders had the worst prognosis among the neurological disease subgroups, whereas patients with TTS with migraine had a favorable prognosis (long-term mortality rates, 29.2% and 9.7%, respectively). Conclusions: Neurological disorders identify a high-risk TTS subgroup for enhanced short- and long-term mortality rate. Careful recognition of neurological disorders and phenotype is therefore needed

Impact of intra-aortic balloon counterpulsation on all-cause mortality among patients with Takotsubo syndrome complicated by cardiogenic shock: results from the German-Italian-Spanish (GEIST) registry

Aims: Takotsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction and can be complicated by cardiogenic shock (CS). However, few data are available on optimal care in TTS complicated by CS. Aim of this study was to evaluate short- and long-term impact of intra-aortic balloon pumping (IABP) on mortality in this setting. Methods and results: In a multi-centre, international registry on TTS, 2248 consecutive patients were enrolled from 38 centres from Germany, Italy, and Spain. Of the 2248 patients, 212 (9.4%) experienced CS. Patients with CS had a higher prevalence of diabetes (27% vs. 19%), male sex (25% vs. 10%), and right ventricular involvement (10% vs. 5%) (P &lt; 0.01 in all cases). Forty-three patients with CS (20% of 212) received IABP within 8 h (interquartile range 4-18) after admission. No differences in terms of age, gender, cardiovascular risk factors, and admission left ventricular ejection fraction were found among patients with and without IABP. There were no significant differences in terms of 30-day mortality (16% vs. 17%, P = 0.98), length of hospitalization (18.9 vs. 16.7 days, P = 0.51), and need of invasive ventilation (35% vs. 41%, P = 0.60) among two groups: 30-day survival was not significantly different even after propensity score adjustment (log-rank P = 0.73). At 42-month follow-up, overall mortality in patients with CS and TTS was 35%, not significantly different between patients receiving IABP and not (37% vs. 35%, P = 0.72). Conclusions: In a large multi-centre observational registry, the use of IABP was not associated with lower mortality rates at short- and long-term follow-up in patients with TTS and CS

Open data, Science and Society: launching Oasis, the flagship initiative of the Istituto Italiano di Antropologia

The Open Data philosophy has gained considerable momentum in recent years, both in society and the scientific community. The accessibility via web of open data from the public sector has remarkably increased in the last decade, although there are substantial differences among nations (http://datacatalogs.org/). The expectation of many citizens, organizations and pressure groups (the so called “open government” movement) is that the free release of data from public administrations may help increase government transparency and accountability

Interplay between COVID-19, pollution, and weather features on changes in the incidence of acute coronary syndromes in early 2020

Coronavirus disease 2019 (COVID-19) has caused an unprecedented change in the apparent epidemiology of acute coronary syndromes (ACS). However, the interplay between this disease, changes in pollution, climate, and aversion to activation of emergency medical services represents a challenging conundrum. We aimed at appraising the impact of COVID-19, weather, and environment features on the occurrence of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in a large Italian region and metropolitan area