116 results on '"Pietro Guida"'
Search Results
2. Safety and efficacy of direct oral anticoagulants versus vitamin K antagonists in atrial fibrillation electrical cardioversion: An update systematic review and meta-analysis
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Federica Troisi, Pietro Guida, Nicola Vitulano, Federico Quadrini, Antonio Di Monaco, and Massimo Grimaldi
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Cardiology and Cardiovascular Medicine - Published
- 2023
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3. Functional outcome after cardiac rehabilitation and its association with survival in heart failure across the spectrum of ejection fraction
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Domenico Scrutinio, Pietro Guida, Maria Teresa La Rovere, Maurizio Bussotti, Ugo Corrà, Giovanni Forni, Rosa Raimondo, Simonetta Scalvini, and Andrea Passantino
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Internal Medicine - Published
- 2023
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4. Prognostic value of functional capacity after transitional rehabilitation in older patients hospitalized for heart failure
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Domenico Scrutinio, Pietro Guida, Roberta Ruggieri, and Andrea Passantino
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Aged, 80 and over ,Heart Failure ,Hospitalization ,Humans ,Stroke Volume ,Geriatrics and Gerontology ,Prognosis ,Ventricular Function, Left ,Aged - Abstract
Poor functional status is highly prevalent among older patients hospitalized for HF and marks a downward inflection point in functional and prognostic trajectories. We assessed the prognostic value of 6-min walk test after transitional cardiac rehabilitation in older patients hospitalized for heart failure (HF).We studied 759 patients aged ≥60 years who had been transferred to six inpatient rehabilitation facilities (IRF) from acute care hospitals after a hospitalization for acute HF. The primary outcome was 3-year all-cause mortality. We used multivariable Cox analysis to determine the association between 6-min walk distance (6MWD) at discharge from the IRFs and the primary outcome, adjusting for established predictors of death. The optimal cutoff for 6MWD was considered as the one that maximized the chi-square statistic.Mean age was 75 ± 8 years. 6MWD significantly increased from admission to discharge (145 to 210 m; p 0.001). The optimal cutoff for 6MWD was 198 m. After full adjustment, the hazard ratio for each 50 m-increase in discharge 6MWD was 0.90 (0.87-0.94; p 0.001) and that for discharge 6MWD dichotomized at the optimal cutoff 0.48 (0.38-0.60; p 0.001). The incidence rate of death/100 person-years for the patients who walked198 m was 13.0 (10.0-15.5) compared with 30.8 (26.9-35.4) for those who walked198 m. A statistically significant interaction of discharge 6MWD with left ventricular ejection fraction (EF) on the risk of death was observed (p value for interaction 0.047).A rehabilitation intervention provided in the critical hospital-to-home transition period to older patients hospitalized for HF resulted in improved functional capacity. Increasing levels of functional capacity following rehabilitation were closely associated with decreasing risk of death; this association was significantly stronger for the subgroup with preserved EF.
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- 2022
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5. Age and comorbidities are crucial predictors of mortality in severe obstructive sleep apnoea syndrome
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Maria Aliani, P. Guido, Domenico Scrutinio, Giorgio Castellana, Pietro Guida, and Mauro Carone
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medicine.medical_specialty ,Polysomnography ,Population ,Comorbidity ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Internal Medicine ,Humans ,Medicine ,030212 general & internal medicine ,education ,Sleep Apnea, Obstructive ,COPD ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Proportional hazards model ,Mortality rate ,medicine.disease ,Standardized mortality ratio ,Cardiovascular Diseases ,business ,Kidney disease - Abstract
Background Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent disorder. The prognostic role of comorbidity in patients with OSAS and their role for risk stratification remain poorly defined. Methods We studied 1,592 patients with severe OSAS diagnosed by polysomnography. The primary outcome was all-cause mortality. The standardized mortality ratio (SMR) was estimated as the ratio of observed deaths to expected number of deaths in the general population. The expected numbers of deaths were derived using mortality rates from the general Apulian population. The association of comorbidities with all-cause mortality was assessed using multivariable Cox regression analysis. Finally, recursive-partitioning analysis was applied to identify the combinations of comorbidities that were most influential for mortality and to cluster the patients into risk groups according to individual comorbidities Results During 11,721 person-years of follow-up, 390 deaths (3.33 deaths/100 person-years) occurred. The median follow-up was 7 (4–10) years. The SMR was 1.47 (95% confidence intervals 1.33–1.63). Age, sex, obesity, cardiovascular diseases (CVD), moderate-to-severe chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD) and malignancy were independently associated with mortality risk. Recursive-partitioning analysis allowed distinguishing three clinical phenotypes differentially associated with mortality risk. The combination of CKD with CVDs or with moderate-to-severe COPD conferred the highest risk. Conclusions Severe OSAS is associated with increased risk for all-cause death. Age and comorbidity are crucial predictors of mortality in patients with severe OSAS. Clustering patients according to comorbidities allows identifying clinically meaningful phenotypes.
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- 2021
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6. Minimally invasive aortic valve replacement: short-term efficacy of sutureless compared with stented bioprostheses
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Pietro Guida, Khalil Fattouch, Renato Gregorini, Roberto Coppola, Luigi Martinelli, Mauro Del Giglio, Alberto Albertini, Marco Moscarelli, Domenico Paparella, Giuseppe Speziale, Giuseppe Santarpino, Elisa Mikus, and Adriano De Santis
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Pulmonary and Respiratory Medicine ,Aortic valve ,medicine.medical_specialty ,Blood transfusion ,genetic structures ,medicine.medical_treatment ,Population ,Hemodynamics ,Prosthesis Design ,Aortic valve replacement ,medicine ,Humans ,In patient ,education ,Retrospective Studies ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,education.field_of_study ,Adult Cardiac ,business.industry ,Aortic Valve Stenosis ,medicine.disease ,Surgery ,Treatment Outcome ,Increased risk ,medicine.anatomical_structure ,Aortic Valve ,Heart Valve Prosthesis ,Implant ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES Sutureless aortic valve prostheses have been introduced to facilitate the implant process, speed up the operating time and improve haemodynamic performance. The goal of this study was to assess the potential advantages of using sutureless prostheses during minimally invasive aortic valve replacement in a large multicentre population. METHODS From 2011 to 2019, a total of 3402 patients in 11 hospitals underwent isolated aortic valve replacement with minimal access approaches using a bioprosthesis. A total of 475 patients received sutureless valves; 2927 received standard valves. The primary outcome was the incidence of 30-day deaths. Secondary outcomes were the occurrence of major complications following procedures performed with sutureless or standard bioprostheses. Propensity matched comparisons was performed based on a multivariable logistic regression model. RESULTS The annual number of sutureless valve implants increased over the years. The matching procedure paired 430 sutureless with 860 standard aortic valve replacements. A total of 0.7% and 2.1% patients with sutureless and standard prostheses, respectively, died within 30 days (P = 0.076). Cross-clamp times [48 (40–62) vs 63 min (48–74); P = 0.001] and need for blood transfusions (27.4% vs 33.5%; P = 0.022) were lower in patients with sutureless valves. No difference in permanent pacemaker insertions was observed in the overall population (3.3% vs 4.4% in the standard and sutureless groups; P = 0.221) and in the matched groups (3.6% vs 4.7% in the standard and sutureless groups; P = 0.364). CONCLUSIONS The use of sutureless prostheses is advantageous and facilitates the adoption of a minimally invasive approach, reducing cardiac arrest time and the number of blood transfusions. No increased risk of permanent pacemaker insertion was observed.
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- 2021
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7. Atrial fibrillation ablation: is common practice far from guidelines’ world? The Italian experience from a national survey
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Maria Lucia Narducci, Antonio Di Monaco, Pietro Guida, Gemma Pelargonio, Massimo Grimaldi, Massimo Tritto, Pier Luigi Pellegrino, and Pasquale Vergara
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medicine.medical_specialty ,medicine.medical_treatment ,Population ,Catheter ablation ,030204 cardiovascular system & hematology ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Atrial Fibrillation ,medicine ,Humans ,Vitamin K Inhibitors ,030212 general & internal medicine ,education ,education.field_of_study ,business.industry ,General surgery ,Atrial fibrillation ,Patient data ,medicine.disease ,Ablation ,Treatment Outcome ,Italy ,Pulmonary Veins ,Catheter Ablation ,Oral anticoagulant ,Cardiology and Cardiovascular Medicine ,business - Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, occurring in 1–2% of the general population. Catheter ablation has become an important treatment modality for patients with symptomatic drug-refractory AF. We report data regarding the AF ablation approaches and modalities in the Italian “real world.” The survey was set-up to collect data on ablation procedure across Italy. All centers performing AF ablation were invited, regardless of the number of annual procedures, to complete a questionnaire regarding their ablation approaches. All centers reported data regarding procedures performed during the year 2017. A total of 3260 procedures were reported from 49 participating hospitals. Most of Italian regions were included in the study. The majority of the centers performed “Always” pulmonary vein isolation (PVI) in paroxysmal and persistent AF catheter ablation, while adjunctive lesions in persistent AF ablation were planned in most of them but not all, and 16% never performed lesions other than PVI. During ablation procedure, vitamin k inhibitors were uninterrupted in 55% of centers, while direct oral anticoagulant in 44% of centers was used uninterruptedly. No relationship was observed between patient data and the number of procedures performed at each center. This survey suggests that the adherence of Italian centers to the most recent European Society of Cardiology guidelines for AF ablation is reasonably high.
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- 2021
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8. Baseline and incident hypochloremia in chronic heart failure outpatients: Clinical correlates and prognostic role
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Francesco Massari, Miriam Albanese, Francesco Lisi, Marco Matteo Ciccone, Maria Consiglia Bellino, Massimo Iacoviello, Luca Amato, Francesca Di Serio, Raffaella Ursi, Gianmarco Angelini, Pietro Guida, Natale Daniele Brunetti, and Pietro Scicchitano
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Heart Failure ,medicine.medical_specialty ,Future studies ,business.industry ,Hypochloremia ,Water-Electrolyte Imbalance ,030204 cardiovascular system & hematology ,Prognosis ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Furosemide ,Internal medicine ,Heart failure ,Outpatients ,Internal Medicine ,medicine ,Humans ,Serum chloride ,030212 general & internal medicine ,business - Abstract
Electrolyte serum disorders are associated with poor outcome in chronic heart failure. The aim of this study sought to identify the main driver of incident hypochloremia in chronic HF (CHF) outpatients and to determine the prognostic value of baseline and incident hypochloremia.Consecutive CHF outpatients were enrolled and clinical, laboratoristic and echocardiographic evaluations were performed at baseline and repeated yearly in a subgroup of patients. Baseline and incident hypochloremia were evaluated. During an up to 5-year follow-up, all-cause mortality was the primary end-point for outcome.Among 506 patients enrolled, 120 patients died during follow-up. At baseline, hypochloremia was present in 10% of patients and it was associated with mortality at univariate (HR: 3.25; 95%CI: 2.04-5.18; p0.001) and at multivariate analysis (HR 2.14; 95%CI: 1.23-3.63; p: 0.005) after correction for well-established CHF prognostic markers. Among patients with repeated evaluations and without baseline hypochloremia, in 13% of these, incident hypochloremia occurred during follow-up and furosemide equivalent daily dose was its first determinant (HR for 1 mg/die: 1.008; 95%CI: 1.004-1.013; p0.001) at forward stepwise logistic regression analysis. Finally, incident hypochloremia was associated with mortality at univariate (HR: 4.69; 95%CI: 2.69-8.19; p0.001) as well as at multivariate analysis (HR: 2.97; 95%CI: 1.48-5.94; p: 0.002).In CHF outpatients baseline and incident hypochloremia are independently associated with all-cause mortality, thus highlighting the prognostic role of serum chloride levels which are generally unconsidered. Future studies should evaluate if the strict monitoring and correction of hypochloremia could exert a beneficial effect on prognosis.
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- 2021
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9. Risk scores did not reliably predict individual risk of mortality for patients with decompensated heart failure
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Andrea Passantino, Domenico Scrutinio, Enrico Ammirati, Pietro Guida, and Fabrizio Oliva
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Male ,medicine.medical_specialty ,Acute decompensated heart failure ,Epidemiology ,Risk management tools ,Individual risk ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Natriuretic Peptide, Brain ,medicine ,Risk of mortality ,Humans ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,Heart Failure ,Nesiritide ,Framingham Risk Score ,business.industry ,Middle Aged ,Prognosis ,medicine.disease ,Peptide Fragments ,Hospitalization ,Heart failure ,Female ,business ,Risk assessment ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Objective We investigated the performance of four prognostic tools in predicting 180-day mortality for patients admitted for acute decompensated heart failure (ADHF) by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) over a range of risk thresholds, in addition to discrimination and calibration. Study Design and Setting We studied 1,458 patients. The risk assessment was performed using the Acute Decompensated Heart Failure National Registry (ADHERE) model and the Get With The Guidelines (GWTG), ADHF/NT-proBNP, and Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND) risk scores. Results C-statistics ranged from 0.727 for the ADHERE model to 0.767 for the ADHF/NT-proBNP score. The ADHF/NT-proBNP risk score, the ADHERE model, and the ASCEND risk score, but not the GWTG risk score, were also well calibrated. Sensitivity and PPV were modest at the >30% risk threshold and ranged from 55% for the ADHF/NT-proBNP risk score to 38.8% for the ADHERE model and from 46.7% for the ADHF/NT-proBNP risk score to 42.1% for the ASCEND risk score, respectively. There was a modest agreement between the risk scores in classifying the patients across risk strata or in classifying those who died as being at >30% risk of death. Conclusion Although risk assessment tools work well for stratifying patients, their use in estimating the risk of mortality for individuals has limited clinical utility.
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- 2020
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10. Current trends in mitral valve surgery: A multicenter national comparison between full-sternotomy and minimally-invasive approach
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Giuseppe Speziale, Khalil Fattouch, Roberto Coppola, Luigi Martinelli, Pietro Guida, Mauro Del Giglio, Marco Moscarelli, Renato Gregorini, Giuseppe Santarpino, Domenico Paparella, Giuseppe Nasso, Alberto Albertini, and Vito Margari
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medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,030212 general & internal medicine ,TRICUSPID VALVE REPAIR ,Heart Valve Prosthesis Implantation ,Surgical approach ,business.industry ,Length of Stay ,Sternotomy ,Cardiac surgery ,Surgery ,Treatment Outcome ,Italy ,Thoracotomy ,Concomitant ,Cohort ,Propensity score matching ,Mitral Valve ,Cardiology and Cardiovascular Medicine ,business ,Mitral valve surgery - Abstract
Mitral valve surgery (MVS) is evolving. Compared to standard sternotomy (S-MVS), minimally invasive method (Mini-MVS) has been increasingly adopted in the last years with encouraging results for both repairs and replacements. We evaluated trends of surgical approaches and operative outcomes in a multicenter study involving 10 cardiac surgical centers in Italy.Patients who received isolated mitral valve surgery, including only a concomitant tricuspid valve repair, from January 2011 up to December 2017. Minimally invasive approach (right anterior mini-thoracotomy) and standard sternotomy was performed in 2602 and 1947 patients, respectively. Stratifying by surgery, 1493 patients per group were paired using a propensity matching procedure.The minimally invasive approach has been progressively more frequent over the years (from 27.5% in 2011 to 71.7% in 2017). Compared to S-MVS, Mini-MVS patients were younger with less preoperative comorbidities and less frequently operated for valve replacement or in association with tricuspid repair. The 30-day mortality was lower in the Mini-MVS (overall 1.2% vs 2.7%; p 0.001) as well as the incidence of most postoperative complications. Subjects paired by propensity score had similar 30-day mortality (1.9% vs 1.8%, p = 0.786) but lower blood transfusion and permanent pace-maker insertion. Cardiopulmonary bypass and cross-clamp time, initially longer in the Mini-MVS patients, became shorter in recent years for the minimally invasive approach.In a large multi-institutional recent cohort, minimally invasive mitral valve surgery has drastically increased being the preferred technique and appears to be safe with procedural duration shorter than the beginning.
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- 2020
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11. Comparison of a full sternotomy with a minimally invasive approach for concomitant mitral and tricuspid valve surgery
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Domenico Paparella, Vito Margari, Giuseppe Santarpino, Marco Moscarelli, Pietro Guida, Khalil Fattouch, Alberto Albertini, Luigi Martinelli, Elisa Mikus, Renato Gregorini, and Giuseppe Speziale
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Heart Valve Prosthesis Implantation ,Pulmonary and Respiratory Medicine ,Treatment Outcome ,Humans ,Minimally Invasive Surgical Procedures ,Surgery ,Tricuspid Valve ,General Medicine ,Cardiology and Cardiovascular Medicine ,Sternotomy ,Retrospective Studies - Abstract
OBJECTIVES The need for concomitant tricuspid surgery in patients who need mitral valve surgery casts doubt on its feasibility via a minimally invasive approach. Our goal was to evaluate the short-term outcomes of patients undergoing concomitant mitral and tricuspid valve surgery either with a standard full sternotomy (full-MTS) or a minimally invasive approach (mini-MTS). METHODS The outcomes of patients who had combined mitral and tricuspid valve surgery in 11 centres were retrospectively evaluated. The primary outcome was the incidence of 30-day mortality. A propensity score matched cohort was selected to create 2 comparable groups stratified by surgery (valve replacement or repair). RESULTS During the study period, 1048 consecutive patients had combined mitral and tricuspid valve surgery (730 full-MTS, 318 mini-MTS). The matching procedure paired 192 full-MTS to 192 mini-MTS procedures. After matching, mini-MTS was associated with longer cardiopulmonary bypass [123 min, standard deviation (SD) 46, vs 102 min, SD 36, P = 0.001] and cross-clamping times (89 min, SD 34, vs 78 min, SD 29, P = 0.003). Although the hospital length of stay was shorter (8 days, interquartile range 7-12 vs 9 days, interquartile range 7–14, P = 0.034) with mini-MTS before matching, this difference disappeared after matching. No differences in other major complications or in 30-day mortality were observed: 48 deaths (4.6%), 36 of which (4.9%) occurred in patients who had a full-MTS and 12 (3.8%), in patients who had a mini-MTS (4.7% in both approaches paired by propensity). CONCLUSIONS The mini-MTS approach proved to be safe and effective in patients requiring concomitant mitral and tricuspid surgery. We could not demonstrate any difference in short-term outcomes between the 2 surgical approaches, indicating that there is not a preferred surgical approach.
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- 2022
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12. Paroxysmal Atrial Fibrillation in Elderly: Worldwide Preliminary Data of LINAC-Based Stereotactic Arrhythmia Radioablation Prospective Phase II Trial
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Antonio, Di Monaco, Fabiana, Gregucci, Ilaria, Bonaparte, Federica, Troisi, Alessia, Surgo, Domenico, Di Molfetta, Nicola, Vitulano, Federico, Quadrini, Roberta, Carbonara, Gaetano, Martinelli, Pietro, Guida, Maria Paola, Ciliberti, Alba, Fiorentino, and Massimo, Grimaldi
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Cardiology and Cardiovascular Medicine - Abstract
Treatment approach for elderly patients with atrial fibrillation (AF) is difficult. The present prospective phase-II trial evaluated LINAC-based stereotactic arrhythmia radioablation safety in this population. The reported data of the first 5 patients worldwide, showed no side effects, absence of AF episodes and without antiarrhythmic drugs.Trial Registration:ClinicalTrials.gov, identifier: NCT04575662.
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- 2022
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13. Association of improvement in functional capacity after rehabilitation with long-term survival in heart failure
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Domenico Scrutinio, Pietro Guida, Andrea Passantino, Simonetta Scalvini, Maurizio Bussotti, Giovanni Forni, Valentina Tibollo, Raffaella Vaninetti, and Maria Teresa La Rovere
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Heart Failure ,Hospitalization ,Cardiac Rehabilitation ,Humans ,Walk Test ,Walking ,Cardiology and Cardiovascular Medicine ,Prognosis - Abstract
The prognostic value of change in six-minute walking distance (6MWD) after treatment to predict mortality in heart failure (HF) remains a controversial issue. We assessed the prognostic value of rehabilitation-induced improvement in 6MWD in predicting mortality in patients with HF.We studied 2257 patients admitted to six inpatient rehabilitation facilities after a hospitalization for HF (N. 912) or because of worsening functional capacity and/or deteriorating clinical status (N. 1345). A six-minute walking test was performed at admission and discharge. The primary outcome was 3-year all-cause mortality after discharge from cardiac rehabilitation. We used multivariable Cox proportional hazard modeling to assess the association of increase in 6MWD with 3-year mortality, adjusting for established predictors of mortality.6MWD significantly increased by 61 m (p .001) from admission to discharge and 969 patients (42.9%) achieved an increase in 6MWD50 m. After full adjustment, an increase in 6MWD50 m was associated with a 22% decreased risk for 3-year mortality (HR 0.78 [95% CI 0.68-0.91]; p = .002). When modeled as a continuous variable, improvement in 6MWD remained independently associated with decreased risk for 3-year mortality (HR per each 50 m increase: 0.92 [95% CI 0.88-0.96]).Rehabilitation-induced improvement in 6MWD was associated with a significantly reduced risk for 3-year mortality. Our data also suggest that an improvement in 6MWD of more than 50 m could represent a clinically meaningful endpoint of cardiac rehabilitation for patients with heart failure.
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- 2021
14. Cardiac Rehabilitation for Older Women with Heart Failure
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Domenico Scrutinio, Pietro Guida, Laura Adelaide Dalla Vecchia, Ugo Corrà, and Andrea Passantino
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heart failure ,cardiovascular rehabilitation ,personalized treatment ,Medicine (miscellaneous) - Abstract
Background: the role that sex plays in impacting cardiac rehabilitation (CR) outcomes remains an important gap in knowledge. Methods: we assessed sex differences in clinical and functional outcomes in 2345 older patients with heart failure (HF) admitted to inpatient CR. Three outcomes were considered: (1) the composite outcome of death during the index admission to CR or transfer to acute care; (2) three-year mortality; (3) change in six-minute walking distance (6MWD) from admission to discharge. Sex differences in outcomes were assessed using multivariable Cox or logistic regression models. Results: the hazard ratios of the composite outcome and of three-year mortality for females vs. males were 0.71 (95%CI:0.50–1.00; p = 0.049) and 0.68 (95%CI:0.59–0.79; p < 0.001), respectively. The standardized mean difference in 6MWD increase from admission to discharge between males and females was 0.10. The odds ratio of achieving an increase in 6MWD at discharge to values higher than the optimal sex-specific thresholds for predicting mortality for females vs. males was 2.21 (95%CI:1.53–3.20; p < 0.001). Conclusion: our findings suggest that older females with HF undergoing CR have better prognosis and garner similar improvement in 6MWD compared with their male counterparts. Nonetheless, females were more likely to achieve levels of functional capacity predictive of improved survival.
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- 2022
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15. Gender-specific association of risk factors in patients who underwent to catheter ablation of atrial fibrillation
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Federica Troisi, Pietro Guida, Antonio Di Monaco, Federico Quadrini, Nicola Vitulano, and Massimo Grimaldi
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medicine.medical_specialty ,education.field_of_study ,business.industry ,Public health ,medicine.medical_treatment ,Confounding ,Population ,Cardiac arrhythmia ,Atrial fibrillation ,Catheter ablation ,General Medicine ,Logistic regression ,medicine.disease ,Obesity ,Internal medicine ,medicine ,Cardiology and Cardiovascular Medicine ,education ,business - Abstract
AIMS Atrial fibrillation (AF) has been highlighted as a growing epidemic. Evidence is lacking on the role of different risk factors within both genders especially in AF patients referred for catheter ablation (CA). The objective was the evaluation of differences between men and women in the associations with aging, obesity and hypertension as the most highly contributing factors to AF onset and progression. METHODS Cases selected among patients scheduled for CA as a rhythm-control strategy and controls from a recent Italian national survey on the population's health conditions were analysed to quantify the strength of association and to assess the existence of gender differences. To reduce the effect of possible confounding factors, both cases and controls were selected without preexisting comorbidities other than hypertension. RESULTS At multivariate logistic regression analysis, cases (534 patients, 166 women) were significantly associated with the male sex, higher age, presence of obesity and hypertension in comparison to controls (17,983 subjects, 9,409 women). At analyses gender-stratified, age and obesity had a significant greater association in women than men. On the contrary, hypertension was relatively more frequent in men than women. CONCLUSION Although mechanisms linking risk factors and AF are complex, this study suggests the existence of differences mediated by gender in AF drug-refractory patients who underwent CA. A tailored public health programme to reduce the growing burden of AF needs to be designed to prevent and counter the increasing epidemic of the most common cardiac arrhythmia as well as its progression in more resistant forms.
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- 2021
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16. Cardiopulmonary Support During Catheter Ablation of Ventricular Arrhythmias With Hemodynamic Instability: The Role of Inducibility
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Massimo Grimaldi, Maria Monica Marino, Nicola Vitulano, Federico Quadrini, Federica Troisi, Nicola Caporusso, Vera Perniciaro, Rosa Caruso, Nicola Duni, Giacomo Cecere, Alberto Martinelli, Pietro Guida, Vito Del Monte, Tommaso Langialonga, Luigi Di Biase, and Antonio Di Monaco
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medicine.medical_specialty ,Defibrillation ,medicine.medical_treatment ,Catheter ablation ,Cardiovascular Medicine ,Internal medicine ,catheter ablation ,medicine ,Extracorporeal membrane oxygenation ,Diseases of the circulatory (Cardiovascular) system ,ventricular inducibility ,Original Research ,ventricular arrhythmia ,business.industry ,Cardiogenic shock ,extracorporeal membrane oxygenation ,medicine.disease ,RC666-701 ,Heart failure ,Shock (circulatory) ,Ventricular fibrillation ,Antitachycardia Pacing ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,electrical storm - Abstract
Background: Catheter ablation is a treatment option for sustained ventricular tachycardias (VTs) that are refractory to pharmacological treatment; however, patients with fast VT and electrical storm (ES) are at risk for cardiogenic shock. We report our experience using cardiopulmonary support with extracorporeal membrane oxygenation (ECMO) during catheter ablation of VT.Methods: Sixty-two patients (mean age 68 ± 9 years; 94% male) were referred to our center for catheter ablation of repeated episodes of hemodynamically unstable ventricular arrhythmias. ES was defined as the occurrence of three or more VT/ventricular fibrillation episodes requiring electrical cardioversion or defibrillation in a 24-h period. All patients had hemodynamically unstable VTs.Results: Thirty-one patients (group 1) performed catheter ablation without ECMO support and 31 patients (group 2) with ECMO support. At the end of the procedure, ventricular inducibility was not performed in 16 patients of group 1 (52%) due to significant hemodynamic instability. Ventricular inducibility was performed in the other 15 patients (48%); polymorphic VTs were inducible in eight patients. In group 2, VTs were not inducible in 29 patients (93%); polymorphic VTs were inducible in two patients. The median follow-up duration was 24 months. Four patients of group 1 (13%) and five patients of group 2 (16%) died due to refractory heart failure. An implantable cardioverter-defibrillator intervention (shock or antitachycardia pacing) was documented in 13 patients of group 1 (42%) and six patients of group 2 (19%).Conclusions: Extracorporeal membrane oxygenation support during catheter ablation for hemodynamically unstable VTs is a useful tool to prevent acute procedural heart failure and to reduce arrhythmic burden.
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- 2021
17. SARS-CoV-2 antibody response after BNT162b2 mRNA vaccine in healthcare workers: Nine-month of follow-up
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Franco, Mastroianni, Pietro, Guida, Grazia, Bellanova, Edy, Valentina De Nicolò, Giulia, Righetti, Maurizio, Formoso, and Fabrizio, Celani
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Infectious Diseases ,General Veterinary ,General Immunology and Microbiology ,Public Health, Environmental and Occupational Health ,Molecular Medicine - Abstract
We collected sequential serum samples (0, 4, 12 weeks, 9 months) for the determination of S-RDB IgG levels from 103 vaccinated healthy subjects (age 45 ± 13 years; 60 women), in order to evaluate neutralizing antibody response against SARS-CoV-2 in healthy healthcare workers (HCWs) after the administration of two doses of BNT162b2 SARS-CoV-2 mRNA vaccine. Every subject received two doses of mRNA vaccine BNT162b2 (Pfizer-BioNTech), 21 days apart (January-February 2021). Furthermore, antibody titer of 14 subjects who were hospitalized for symptomatic COVID-19 was evaluated. Antibody response was (median, interquartile range) 35 U/mL (10-104) at baseline, 1960 (1241-3221) at 4 weeks, 791 (388-1179) at 12 weeks and 524 (273-931) at 6 months. Antibody response was inversely correlated with age at all timepoints (p 0.001) while gender and Body Mass Index had no significant effect. At multivariate analysis, post-baseline values were significantly higher than baseline (p 0.001) with a reduction at 12 weeks and 9 months (p 0.001). Antibody response of hospitalized subjects who did not receive vaccination, symptomatic for COVID 19 infection, was 103 (25-557) U/mL, significantly higher than baseline (p = 0.007) of study population but lower than all post-baseline determinations (p 0.001). Younger subjects showed a stronger response and a lower decrease of antibody titers compared to the classes of older subjects. SARS-CoV2 infection was excluded by performing 1017 nasopharyngeal RT-PCR swabs on the study cohort. The second dose of mRNA vaccine resulted in an antibody response effective in preventing infection in a population of healthcare professionals. The antibody level was stable through week 12, showing a reduction in the following six months.
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- 2022
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18. Characteristics, Outcomes, and Long-Term Survival of Patients With Heart Failure Undergoing Inpatient Cardiac Rehabilitation
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Pietro Guida, Simonetta Scalvini, Giovanni Forni, Andrea Passantino, Maria Teresa La Rovere, Domenico Scrutinio, Raffaella Vaninetti, and Maurizio Bussotti
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Heart Failure ,Inpatients ,medicine.medical_specialty ,Cardiac Rehabilitation ,Rehabilitation ,Proportional hazards model ,business.industry ,medicine.medical_treatment ,Hazard ratio ,Outcome measures ,Physical Therapy, Sports Therapy and Rehabilitation ,medicine.disease ,Cohort Studies ,Hospitalization ,Acute care ,Heart failure ,Emergency medicine ,Long term survival ,Humans ,Medicine ,business ,Cohort study - Abstract
Objective To investigate the association of CR participation with all-cause mortality after a hospitalization for HF and to describe the characteristics and functional and clinical outcomes of heart failure (HF) patients undergoing inpatient cardiac rehabilitation (CR). Design Multicenter cohort study. The association between CR participation and all-cause mortality from discharge from the acute care setting was assessed using Cox regression analysis adjusting for established prognostic factors. Setting Six inpatients rehabilitation facilities (IRF). Participants 3,219 HF patients admitted to inpatient CR between January 2013 and December 2016. Of these patients, 1,455 had been transferred directly from acute care hospitals after a hospitalization for HF (CR-Group 1) and 1,764 had been admitted from the community due to worsening functional disability or worsening clinical conditions (CR-Group 2). Six hundred thirty-three patients not referred to CR after a hospitalization for HF served as control group (non-CR Group). Intervention Cardiac rehabilitation. Main outcome measure long-term mortality. Secondary outcomes were: 1. Change in functional capacity, as assessed by change in 6-minute walking distance (6MWD) from admission to discharge; 2. Clinical outcomes of the index inpatient rehabilitation admission, including in-hospital mortality and unplanned (re)admission to the acute care. Results Compared with the non-CR Group, the adjusted hazard ratios of mortality at 1, 3, and 5 years for CR-Group 1 patients were 0.82 (0.68-0.97), 0.81 (0.71-0.93), and 0.80 (0.70-0.91). 6MWD increased from 230 to 292 m (p 50 m improvement. Overall, 2.5% of the patients died in hospital and 4.7% of the patients experienced unplanned (re)admissions to acute care, with significant differences between Group 1 and Group 2. Conclusions Our data show that inpatient CR is effective in improving functional capacity and suggest that inpatient CR provided in the earliest period following a hospitalization for HF is associated with long-term improved survival.
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- 2022
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19. Impact of COVID-19 pandemic lockdown on exclusive breastfeeding in non-infected mothers
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Giuseppe Latorre, Luca Maggio, Domenico Martinelli, Pietro Guida, Ester Masi, and Roberta De Benedictis
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Adult ,Population ,Psychological intervention ,Breastfeeding ,Mother-infant dyad ,Breast milk ,Pediatrics ,RJ1-570 ,Social support ,Neonatal ,Pandemic ,Lockdown ,Medicine ,Humans ,Family ,Prospective Studies ,Prospective cohort study ,education ,Maternal Behavior ,Pandemics ,education.field_of_study ,Home confinement ,business.industry ,SARS-CoV-2 ,Research ,Obstetrics and Gynecology ,COVID-19 ,Social Support ,Length of Stay ,Coronavirus ,Breast Feeding ,Italy ,Pediatrics, Perinatology and Child Health ,Cohort ,Quarantine ,Female ,Public aspects of medicine ,RA1-1270 ,business ,Demography - Abstract
Background The COVID-19 pandemic has posed several challenges to the provision of newborn nutrition and care interventions including maternal support, breastfeeding and family participatory care. Italy was the first country to be exposed to SARS-CoV-2 in Europe. One of the measures adopted by the Italian government during COVID-19 pandemic was the total lockdown of the cities with complete confinement at home. We aimed to examine the impact of the lockdown caused by COVID-19 pandemic on exclusive breastfeeding in non-infected mothers. Methods We prospectively enrolled 204 mother-baby dyads during lockdown (9 March to 8 May 2020) that we compared to previously studied 306 mother-baby dyads admitted during the year 2018. To reduce the possible effect of confounding factors on exclusive breastfeeding, a 1:1 matching was performed by using an automatized procedure of stratification that paired 173 mother-baby dyads. Feeding modality was collected at discharge, 30 and 90 days of newborn’s life. Exclusive breastfeeding was considered when the infant received only breast milk and no other liquids or solids were given with the exception of vitamins, minerals or medicines. Results At discharge 69.4% of infants were exclusively breastfed during lockdown versus 97.7% of control group, 54.3% at 30 days vs 76.3 and 31.8% vs 70.5% at 90 days (p p Conclusions Lockdown and home confinement led to a decrease of exclusively breastfeeding in the studied population. Considering the timing to shift from exclusive to non-exclusive breastfeeding, differences between study groups were concentrated during hospital stay and from 30- to 90 days of a newborn’s life, confirming that the hospital stay period is crucial in continuing exclusive breastfeeding at least for the first 30 days, but no longer relevant at 90 days of life.
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- 2020
20. Machine learning to predict mortality after rehabilitation among patients with severe stroke
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Petronilla Battista, Ernesto Losavio, Domenico Scrutinio, Pietro Guida, Carlo Ricciardi, Gaetano Pagano, Giovanni D'Addio, Mario Cesarelli, Leandro Donisi, Scrutinio, Domenico, Ricciardi, Carlo, Donisi, Leandro, Losavio, Ernesto, Battista, Petronilla, Guida, Pietro, Cesarelli, Mario, Pagano, Gaetano, D'Addio, Giovanni, Scrutinio, D., Ricciardi, C., Donisi, L., Losavio, E., Battista, P., Guida, P., Cesarelli, M., Pagano, G., and D'Addio, G.
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United State ,Male ,Logistic Model ,medicine.medical_treatment ,Clinical Decision-Making ,lcsh:Medicine ,Severe stroke ,030204 cardiovascular system & hematology ,Medicare ,Logistic regression ,Machine learning ,computer.software_genre ,Article ,Machine Learning ,03 medical and health sciences ,Engineering ,0302 clinical medicine ,Humans ,Medicine ,Risk threshold ,Mortality ,lcsh:Science ,Severe disability ,Stroke ,Aged ,Multidisciplinary ,Rehabilitation ,Receiver operating characteristic ,business.industry ,lcsh:R ,Stroke Rehabilitation ,Middle Aged ,medicine.disease ,United States ,Random forest ,Algorithm ,Logistic Models ,Neurology ,ROC Curve ,lcsh:Q ,Female ,Artificial intelligence ,business ,computer ,Algorithms ,030217 neurology & neurosurgery ,Human - Abstract
Stroke is among the leading causes of death and disability worldwide. Approximately 20–25% of stroke survivors present severe disability, which is associated with increased mortality risk. Prognostication is inherent in the process of clinical decision-making. Machine learning (ML) methods have gained increasing popularity in the setting of biomedical research. The aim of this study was twofold: assessing the performance of ML tree-based algorithms for predicting three-year mortality model in 1207 stroke patients with severe disability who completed rehabilitation and comparing the performance of ML algorithms to that of a standard logistic regression. The logistic regression model achieved an area under the Receiver Operating Characteristics curve (AUC) of 0.745 and was well calibrated. At the optimal risk threshold, the model had an accuracy of 75.7%, a positive predictive value (PPV) of 33.9%, and a negative predictive value (NPV) of 91.0%. The ML algorithm outperformed the logistic regression model through the implementation of synthetic minority oversampling technique and the Random Forests, achieving an AUC of 0.928 and an accuracy of 86.3%. The PPV was 84.6% and the NPV 87.5%. This study introduced a step forward in the creation of standardisable tools for predicting health outcomes in individuals affected by stroke.
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- 2020
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21. Long-term prognostic potential of microRNA-150-5p in optimally treated heart failure patients with reduced ejection fraction. A pilot study
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Andrea Passantino, Pietro Guida, Domenico Scrutinio, and Francesca Conserva
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Heart Failure ,Heart transplantation ,medicine.medical_specialty ,Framingham Risk Score ,Ejection fraction ,Proportional hazards model ,business.industry ,medicine.medical_treatment ,Hazard ratio ,Pilot Projects ,Stroke Volume ,Recursive partitioning ,Prognosis ,medicine.disease ,MicroRNAs ,Heart failure ,Ventricular assist device ,Internal medicine ,Chronic Disease ,medicine ,Cardiology ,Humans ,Cardiology and Cardiovascular Medicine ,business - Abstract
In a previous study, we found that miR-150-5p was specifically downregulated in patients with advanced heart failure (HF). Here, we investigated the long-term prognostic potential of miR-150-5p.We studied optimally-treated HF outpatients with reduced ejection fraction. The primary outcome comprised the composite of death, urgent heart transplantation (HT) and ventricular assist device (VAD) implantation within 30 months. We used recursive partitioning analysis to identify the optimal log miR-150-5p cut-off. The association of log miR-150-5p with the primary outcome was examined using Cox regression analysis. We used the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score for adjustment in multivariable analysis. Finally, we compared the global fit of three models (MAGGIC score + miR-150-5p, MAGGIC score + NT-proBNP, and NT-proBNP + miR-150-5p) using Akaike Information Criterion.Recursive partitioning analysis identified the value of -2.22 as the optimal cut-off for log miR-150-5p. Thirty-month survival free of urgent HT/VAD implantation was 31% among the patients with log miR-150-5p-2.22 and 86% among those with log miR-150-5p-2.22. Crude hazard ratio (HR) of the primary outcome for log miR-150-5p expression level-2.22 was 6.70 (95% CI: 2.31-19.38; P0.001). After adjusting for the MAGGIC score in multivariable analysis, the HR was 4.40 (95% CI: 1.52-12.77; P=0.006). Adding log miR-150-5p to the MAGGIC score led to an increase of 0.047 in C-index. The model combining miR-150-5p and MAGGIC score had a 73% likelihood of representing the best-fit model of those evaluated.Our data generate the hypothesis that miR-150-5p may represent a novel risk marker in HF with reduced ejection fraction.
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- 2020
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22. Subject Preferences and Psychological Implications of Portable Oxygen Concentrator Versus Compressed Oxygen Cylinder in Chronic Lung Disease
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Michele Vitacca, Salvatore Fuschillo, Antonio Molino, Alberto De Felice, Mauro Maniscalco, Pasquale Moretta, Pietro Guida, Andrea Motta, Michele Martucci, Moretta, Pasquale, Molino, Antonio, Martucci, Michele, Fuschillo, Salvatore, De Felice, Alberto, Guida, Pietro, Motta, Andrea, Vitacca, Michele, and Maniscalco, Mauro
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Oxygen concentrator ,Critical Care and Intensive Care Medicine ,rehabilitation ,03 medical and health sciences ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Oxygen therapy ,medicine ,Humans ,ambulatory oxygen ,Oxygen saturation (medicine) ,Original Research ,COPD ,business.industry ,Interstitial lung disease ,Oxygen Inhalation Therapy ,portable oxygen concentrator ,General Medicine ,Portable oxygen concentrator ,medicine.disease ,Respiration Disorders ,long-term oxygen therapy ,Oxygen ,030228 respiratory system ,Ambulatory ,Physical therapy ,Breathing ,Quality of Life ,business ,Lung Diseases, Interstitial - Abstract
BACKGROUND: Oxygen therapy represents the elective therapy to improve the quality of life for patients with chronic respiratory diseases like COPD and interstitial lung disease. Lightweight portable oxygen concentrators (POCs) are a valid alternative to traditional systems such as portable compressed oxygen cylinders. However, patient preference and the possible psychological implications related to the use of both devices have been poorly assessed. We sought to evaluate patient preference between the ambulatory oxygen systems (ie, a POC or a small cylinder) for patients with COPD and interstitial lung disease experiencing exertional desaturation in a rehabilitation setting. Furthermore, the use of one device in comparison with the other was related to specific mechanical characteristics and related to perceived quality of life, anxiety, and depressive symptoms. METHODS: 30 subjects with COPD and interstitial lung disease, who demonstrated exertional desaturation on room air during 6-min walk test (6MWT), were recruited. Each subject performed 2 6MWTs, in random order: one breathing oxygen via a POC and one with a portable compressed oxygen cylinder. Both devices were set up to ensure oxyhemoglobin saturation between 92% and 95% during the 6MWTs. All subjects completed a questionnaire assessing anxiety, depression, and quality of life. Each device was randomly assigned to each subject for 1 week, and then replaced with the other in the following week. At the end of the trial period, all subjects completed a questionnaire evaluating several aspects of the oxygen therapy devices. RESULTS: There were no significant differences in oxygen saturation or the mean distances achieved during the 6MWTs between the 2 portable oxygen devices. The subjects expressed greater preference for the POC (73.3%), basing their choice mainly on ease of transport and lower weight. Subjects’ age also correlated with preferences: younger subjects were more negatively focused on the weight of the portable compressed oxygen cylinder, whereas older subjects considered the POC easier to manage. No significant differences in preferences were present between COPD and interstitial lung disease. CONCLUSIONS: The POC and the portable compressed oxygen cylinder performed in a comparable manner during 6MWT for subjects with COPD and interstitial lung disease and exertional desaturation. Subjects preferred the POC because it was associated with better mobility.
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- 2020
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23. The Modified Five-Point Test (MFPT): normative data for a sample of Italian elderly
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Petronilla Battista, Davide Rivolta, Fabio Castellana, Rosanna Tortelli, Giancarlo Logroscino, Chiara Griseta, and Pietro Guida
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Adult ,Aging ,Adolescent ,Population ,Sample (statistics) ,Context (language use) ,Dermatology ,Neuropsychological Tests ,03 medical and health sciences ,Fluency ,Young Adult ,0302 clinical medicine ,Cognition ,Reference Values ,Linear regression ,Humans ,030212 general & internal medicine ,Cognitive skill ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,General Medicine ,Middle Aged ,Executive functions ,Psychiatry and Mental health ,Italy ,Normative ,Educational Status ,Neurology (clinical) ,Psychology ,030217 neurology & neurosurgery ,Demography - Abstract
Non-verbal figural fluency is related to executive functions and specifically to the ability to create as many unique designs as possible, while minimizing their repetitions. An Italian version of figural fluency is the Modified Five-Point Test (MFPT), which is highly employed in the clinical practice of neuropsychologists. To date, reference data of Italian population are limited to a sample aged between 16 and 60 years old. Thus, the current study aims to provide normative data of the MFPT in the context of a population-based setting, conducted in Southern Italy. We collected N = 340 Italian healthy subjects, aged over 65 years old (range: 65–91), pooled across subgroups for age, sex, and education. Multiple regression analyses were performed to estimate the effect of age, education, and sex on the participant’s performance. Equivalent scores and cut-off scores were also defined for the number of unique designs (UDs) and the number of strategies (CSs). Multiple regression analyses revealed that UDs increase with decreasing age and increasing educational level. CSs are influenced by higher educational levels but neither by age nor sex. A significant inverse correlation between the UDs and percentage of errors occurred, suggesting that a higher number of UDs are associated with a fewer number of errors and higher CSs employed. The MFPT provides a measure of cognitive functioning in terms of the ability to initiate and realize designs, affording useful hints for clinical settings. The MFPT may represent a handy and useful tool with a specific focus in the differentiation of healthy versus pathological aging.
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- 2020
24. Catheter ablation of atrial fibrillation with uninterrupted anticoagulation: a meta-analysis of six randomized controlled trials
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Pietro Guida, Antonio Di Monaco, Tommaso Langialonga, Massimo Grimaldi, Nicola Vitulano, Federica Troisi, and Federico Quadrini
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Ablation of atrial fibrillation ,Catheter ablation ,Hemorrhage ,030204 cardiovascular system & hematology ,Risk Assessment ,Drug Administration Schedule ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Stroke ,Aged ,Randomized Controlled Trials as Topic ,business.industry ,Anticoagulants ,Atrial fibrillation ,General Medicine ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Treatment Outcome ,Meta-analysis ,Cardiology ,Catheter Ablation ,Female ,Warfarin ,Cardiology and Cardiovascular Medicine ,business ,Factor Xa Inhibitors - Abstract
Aims Uninterrupted anticoagulation is recommended during the ablation of atrial fibrillation. This meta-analysis compared the safety and efficacy of uninterrupted direct oral anticoagulants (DOACs) to uninterrupted vitamin K antagonists (VKAs) during atrial fibrillation ablation. Methods The meta-analysis included eligible randomized controlled trials from 2009 to 2019. Odds ratios (ORs) and 95% confidence intervals were pooled using a random effects model and a sensitivity analysis was performed by sequentially removing one study or DOAC at a time. Results Six studies were included; 1288 received DOAC and 1081 VKA. Pooled ORs indicated a lower nonsignificant incidence in DOACs vs. VKA of composite outcome of major bleeding, stroke, or transient ischemic attack, and mortality (0.69; 0.28-1.71; 31 vs. 45 events), major bleeding alone (0.66; 0.30-1.47; 27 vs. 41 events), and cardiac tamponade (0.56; 0.21-1.45; eight vs. 13 events) with a slightly higher occurrence of minor bleeding (1.17; 0.89-1.56; 139 vs. 106 events) and silent cerebral thromboembolic events (1.12; 0.75-1.66; 72 vs. 58 among 442 and 376 patients performing MRI study). Sensitivity analyses confirmed overall results: pooled ORs ranged from 0.56 to 1.00 for the composite outcome and from 0.54 to 0.92 for major bleedings. Conclusion Uninterrupted DOAC is a safe and effective alternative to uninterrupted VKA during atrial fibrillation ablation.
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- 2020
25. Development and Validation of a Predictive Model for Functional Outcome After Stroke Rehabilitation
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Pietro Guida, Chiara Ferretti, Bernardo Lanzillo, Filippo Mastropasqua, Giovanna Russo, Gianluigi Calabrese, Domenico Scrutinio, Caterina Guarnaschelli, Vincenzo Monitillo, Monica Pusineri, and Roberto Formica
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Male ,030506 rehabilitation ,medicine.medical_specialty ,medicine.medical_treatment ,Logistic regression ,Cohort Studies ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Physical medicine and rehabilitation ,Predictive Value of Tests ,Activities of Daily Living ,medicine ,Humans ,Prospective Studies ,Stroke ,Aged ,Aged, 80 and over ,Advanced and Specialized Nursing ,Models, Statistical ,Rehabilitation ,business.industry ,Hazard ratio ,Age Factors ,Stroke Rehabilitation ,Recovery of Function ,Middle Aged ,Prognosis ,medicine.disease ,Survival Analysis ,Functional Independence Measure ,Confidence interval ,Treatment Outcome ,Predictive value of tests ,Physical therapy ,Female ,Neurology (clinical) ,0305 other medical science ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,Cohort study - Abstract
Background and Purpose— Prediction of outcome after stroke rehabilitation may help clinicians in decision-making and planning rehabilitation care. We developed and validated a predictive tool to estimate the probability of achieving improvement in physical functioning (model 1) and a level of independence requiring no more than supervision (model 2) after stroke rehabilitation. Methods— The models were derived from 717 patients admitted for stroke rehabilitation. We used multivariable logistic regression analysis to build each model. Then, each model was prospectively validated in 875 patients. Results— Model 1 included age, time from stroke occurrence to rehabilitation admission, admission motor and cognitive Functional Independence Measure scores, and neglect. Model 2 included age, male gender, time since stroke onset, and admission motor and cognitive Functional Independence Measure score. Both models demonstrated excellent discrimination. In the derivation cohort, the area under the curve was 0.883 (95% confidence intervals, 0.858–0.910) for model 1 and 0.913 (95% confidence intervals, 0.884–0.942) for model 2. The Hosmer–Lemeshow χ 2 was 4.12 ( P =0.249) and 1.20 ( P =0.754), respectively. In the validation cohort, the area under the curve was 0.866 (95% confidence intervals, 0.840–0.892) for model 1 and 0.850 (95% confidence intervals, 0.815–0.885) for model 2. The Hosmer–Lemeshow χ 2 was 8.86 ( P =0.115) and 34.50 ( P =0.001), respectively. Both improvement in physical functioning (hazard ratios, 0.43; 0.25–0.71; P =0.001) and a level of independence requiring no more than supervision (hazard ratios, 0.32; 0.14–0.68; P =0.004) were independently associated with improved 4-year survival. A calculator is freely available for download at https://goo.gl/fEAp81 . Conclusions— This study provides researchers and clinicians with an easy-to-use, accurate, and validated predictive tool for potential application in rehabilitation research and stroke management.
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- 2017
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26. The Effects of Steroids on Coagulation Dysfunction Induced by Cardiopulmonary Bypass: A Steroids in Cardiac Surgery (SIRS) Trial Substudy
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Micaela De Palo, Veronica Myasoedova, Domenico Paparella, Francesco Alamanni, Andre Lamy, Crescenzia Rotunno, Salim Yusuf, Jessica Vincent, Pietro Guida, Richard P. Whitlock, Philip J. Devereaux, Vito Margari, and Alessandro Parolari
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Male ,Time Factors ,medicine.medical_treatment ,Blood Loss, Surgical ,030204 cardiovascular system & hematology ,law.invention ,Coronary artery bypass surgery ,0302 clinical medicine ,Risk Factors ,law ,Medicine ,030212 general & internal medicine ,Blood coagulation test ,Aged, 80 and over ,Ontario ,Cardiopulmonary Bypass ,Fibrinolysis ,Thrombin ,General Medicine ,Middle Aged ,Treatment Outcome ,Italy ,Methylprednisolone ,Anesthesia ,Administration, Intravenous ,Female ,Blood Coagulation Tests ,Fresh frozen plasma ,Cardiology and Cardiovascular Medicine ,medicine.drug ,Pulmonary and Respiratory Medicine ,Platelet Function Tests ,Postoperative Hemorrhage ,Drug Administration Schedule ,03 medical and health sciences ,Double-Blind Method ,Thrombocyte activation ,Cardiopulmonary bypass ,Humans ,Platelet activation ,Cardiac Surgical Procedures ,Blood Coagulation ,Glucocorticoids ,Aged ,business.industry ,Platelet Activation ,Surgery ,business ,Biomarkers - Abstract
Cardiopulmonary bypass (CPB) surgery, despite heparin administration, elicits activation of coagulation system resulting in coagulopathy. Anti-inflammatory effects of steroid treatment have been demonstrated, but its effects on coagulation system are unknown. The primary objective of this study is to assess the effects of methylprednisolone on coagulation function by evaluating thrombin generation, fibrinolysis, and platelet activation in high-risk patients undergoing cardiac surgery with CPB. The Steroids In caRdiac Surgery study is a double-blind, randomized, controlled trial performed on 7507 patients worldwide who were randomized to receive either intravenous methylprednisolone, 250 mg at anesthetic induction and 250 mg at initiation of CPB (n = 3755), or placebo (n = 3752). A substudy was conducted in 2 sites to collect blood samples perioperatively to measure prothrombin fragment 1.2 (PF1+2, thrombin generation), plasmin-antiplasmin complex (PAP, fibrinolysis), platelet factor 4 (PF4 platelet activation), and fibrinogen. Eighty-one patients were enrolled in the substudy (37 placebo vs 44 in treatment group). No difference in clinical outcome was detected, including postoperative bleeding and need for blood products transfusion. All patients showed changes of all plasma biomarkers with greater values than baseline in both groups. This reaction was attenuated significantly in the treatment group for PF1.2 (P = 0.040) and PAP (P = 0.042) values at the first intraoperative measurement. No difference between groups was detected for PF4. Methylprednisolone treatment attenuates activation of coagulation system in high-risk patients undergoing CPB surgery. Reduction of thrombin generation and fibrinolysis activation may lead to reduced blood loss after surgery.
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- 2017
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27. Thyroid Disorders and Prognosis in Chronic Heart Failure: A Long-Term Follow-Up Study
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Edoardo Guastamacchia, Pietro Guida, Vito Angelo Giagulli, Brunella Licchelli, Dario Grande, Vincenzo Triggiani, Caterina Rizzo, Francesca Di Serio, Margherita Ilaria Gioia, Massimo Iacoviello, Francesco Lisi, and Giuseppe Parisi
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Male ,medicine.medical_specialty ,Thyroid Hormones ,Time Factors ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,030204 cardiovascular system & hematology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Diabetes mellitus ,medicine ,Immunology and Allergy ,Humans ,Euthyroid ,Mortality ,Aged ,Aged, 80 and over ,Heart Failure ,Aldosterone ,business.industry ,Thyroid ,Low T3 Syndrome ,Middle Aged ,medicine.disease ,Prognosis ,Thyroid Diseases ,medicine.anatomical_structure ,chemistry ,Heart failure ,Chronic Disease ,Etiology ,Female ,business ,Hormone ,Follow-Up Studies - Abstract
Background: Thyroid disorders may have a negative impact on the prognosis of patients affected by chronic heart failure (CHF). Objective: The aim of the current study was to evaluate the prognostic role of all thyroid disorders over a long term follow-up in a single centre large sample of CHF outpatients. Methods: In all patients, the function of the thyroid was evaluated at the enrolment and during the follow- up. On the basis of free triiodothyronine (T3), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) serum levels, patients were classified into one of the following four categories: euthyroid subjects, patients affected by hypothyroidism, low T3 (LT3) syndrome and hyperthyroidism. During the follow-up, death for all causes was assessed as primary end-point, whereas time to the first hospitalization for heart failure worsening was the secondary end-point analyzed. Results: Among 762 patients, 190 patients were affected by hypothyroidism (Hypo). LT3 syndrome was diagnosed in 15 patients and 59 patients were affected by hyperthyroidism (Hyper). During a long term follow-up (5.1±3.7 years), 303 patients died. Patients with Hypo showed an increased risk of death as well as of hospitalization due to heart failure worsening at univariate regression analysis. At multivariate regression analysis, Hypo remained associated with hospitalization after correction for age >75 years, ischemic aetiology, diabetes, therapy with ACE-inhibitors or ARBs, therapy with betablockers and with aldosterone antagonists, NYHA class 3, systolic arterial pressure 1000 pg/ml. At multivariate analysis, the independent association with death was significant only for the subgroup of patients with TSH >10 mIU/L. LT3 was independently associated with both heart failure hospitalization and death, whereas Hyper was not associated with any of the two considered end-points. Conclusion: Hypo is associated with a worse prognosis over a long-term follow-up. The association with heart failure hospitalization is not dependent on the baseline TSH levels, whereas the association with death is significant only when TSH >10 mIU/L. Finally, Hyper does not have any association with a worse prognosis.
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- 2019
28. Long-term blood pressure variability and development of chronic kidney disease in type 2 diabetes
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Antonio Ceriello, Roberto Pontremoli, Barbara Bonino, Francesca Viazzi, Carlo Giorda, Antonio Mirijello, Paola Fioretto, Giuseppina T. Russo, Salvatore De Cosmo, and Pietro Guida
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Male ,medicine.medical_specialty ,Physiology ,Renal function ,Blood Pressure ,Type 2 diabetes ,030204 cardiovascular system & hematology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,blood pressure variability ,chronic kidney disease ,glomerular filtration rate ,hypertension ,type 2 diabetes ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Renal Insufficiency, Chronic ,Aged ,Glycated Hemoglobin ,business.industry ,Blood Pressure Determination ,Odds ratio ,Middle Aged ,medicine.disease ,Blood pressure ,chemistry ,Diabetes Mellitus, Type 2 ,Hypertension ,Cardiology ,Albuminuria ,Kidney Failure, Chronic ,Female ,Glycated hemoglobin ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease ,Glomerular Filtration Rate - Abstract
OBJECTIVE Long-term visit-to-visit SBP variability (VVV) has been shown to predict cerebro-cardiovascular events and end-stage renal disease in chronic kidney disease (CKD) patients. Whether SBP VVV is also a predictor of CKD development in diabetes is currently uncertain. We assessed the role of SBP VVV on the development of CKD in patients with type 2 diabetes (T2D) and hypertension in real life. METHODS Clinical records from 30 851 patients with T2D and hypertension, with normal estimated glomerular filtration rate (eGFR) and regular visits during a 4-year follow-up were analyzed. SBP variability was measured by three metrics: coefficient of variation; SD of the mean SBP and average absolute difference of successive values in each individual. CKD was defined as eGFR less than 60 and/or a reduction in eGFR at least 30% from baseline. RESULTS Over the 4-year follow-up, 9.7% developed eGFR less than 60 and 4.5% an eGFR reduction at least 30% from baseline. Several clinical characteristics (older age, male sex, SBP, DBP, albuminuria, glycated hemoglobin, insulin treatment) were related to intraindividual SBP variability. Patients with VVV in the upper quintile showed an increased risk of developing both components of CKD [adjusted odds ratio (OR) 1.21, P
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- 2019
29. Bilateral left lateral ridge ablation increases the long-term success of patients ablated for atrial fibrillation
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Giacomo Cecere, Antonio Di Monaco, Massimo Grimaldi, Tommaso Langialonga, Pietro Guida, Federico Quadrini, Federica Troisi, and Nicola Vitulano
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Male ,medicine.medical_specialty ,Time Factors ,Paroxysmal atrial fibrillation ,medicine.medical_treatment ,Action Potentials ,Catheter ablation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Recurrence ,Risk Factors ,Internal medicine ,Heart rate ,Atrial Fibrillation ,Medicine ,Humans ,Sinus rhythm ,030212 general & internal medicine ,Heart Atria ,Vein ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Cardiac Pacing, Artificial ,Atrial fibrillation ,General Medicine ,Middle Aged ,medicine.disease ,Ablation ,medicine.anatomical_structure ,Treatment Outcome ,Pulmonary Veins ,Cardiology ,Catheter Ablation ,Electrocardiography, Ambulatory ,Female ,Cardiology and Cardiovascular Medicine ,business ,Electrophysiologic Techniques, Cardiac ,Electrocardiography - Abstract
Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation in paroxysmal atrial fibrillation (PAF). Studies reported that the PVI single procedure was able to achieve durable sinus rhythm without the need of antiarrhythmic drugs in 60-80% of patients with PAF. In this study, we report data regarding bilateral left lateral ridge ablation for PAF.We retrospectively collected data of 120 consecutive patients (mean age 56 ± 10 years; 62% male) referred to our center to perform PVI. In 60 patients we performed PVI (group 1) and in 60 patients performed PVI and bilateral left lateral ridge ablation (group 2). All patients performed a clinical follow-up after 24 months from the ablation procedure.PVI was achieved in all patients. The mean radiofrequency time to perform ablation on the left atrial appendage ostium was 216 ± 49 s. In all patients of group 2 we obtained disappearance of local electrograms and the loss of local capture during pacing on posterior wall of left atrial appendage ridge. No significant differences were found between the two groups regarding mean contact force during ablation (14 ± 4 vs. 15 ± 4 g; groups 1 and 2, respectively, P = 0.34). At 24-month follow-up, single procedure success rate was significantly higher in group 2 compared with group 1 (88 vs. 74%, respectively; P = 0.03). No significant procedural complications were documented.Bilateral left lateral ridge ablation is a safe technique able to improve the success rate of PVI in patients with PAF.
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- 2019
30. Incremental utility of prognostic variables at discharge for risk prediction in hospitalized patients with acutely decompensated chronic heart failure
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Fabrizio Oliva, Piergiuseppe Agostoni, Simona Sarzi Braga, Enrico Ammirati, Andrea Passantino, Domenico Scrutinio, Rocco Lagioia, Pietro Guida, and Maria Frigerio
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Male ,Pulmonary and Respiratory Medicine ,Prognostic variable ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Humans ,Medicine ,cardiovascular diseases ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Heart Failure ,Heart transplantation ,business.industry ,Incidence ,Bayes Theorem ,Retrospective cohort study ,Prognosis ,medicine.disease ,Hospitalization ,Blood pressure ,Italy ,Heart failure ,Predictive value of tests ,Ventricular assist device ,Disease Progression ,Cardiology ,Heart Transplantation ,Female ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment ,Follow-Up Studies - Abstract
Objectives To assess the incremental prognostic utility of discharge serum creatinine (SCr), systolic blood pressure (SBP), and NT-proBNP and sodium concentrations in hospitalized patients with acutely decompensated chronic heart failure. Background Whether key prognostic variables at discharge provide incremental prognostic information beyond that provided by a model based on admission variables (referent) remains incompletely defined. Methods The primary outcome was a composite of death, urgent heart transplantation, or ventricular assist device implantation at 1 year. The gain in predictive performance was assessed using C index, Bayesian Information Criterion, and Net Reclassification Improvement. Results The best fit was obtained when discharge NT-proBNP was added to the referent model. No interaction between admission and discharge NT-proBNP was found. Discharge SCr, SBP, and sodium did not improve goodness-of-fit. Conclusions Admission and discharge NT-proBNP provide complementary and independent prognostic information; as such, they should be taken into account concurrently.
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- 2016
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31. Acutely decompensated heart failure with chronic obstructive pulmonary disease: Clinical characteristics and long-term survival
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Domenico Scrutinio, Pietro Guida, Andrea Passantino, Mario Venezia, Enrico Ammirati, Rosa Raimondo, Rocco Lagioia, Maria Frigerio, and Fabrizio Oliva
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Adrenergic beta-Antagonists ,Comorbidity ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Internal medicine ,Cause of Death ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Survival analysis ,Cause of death ,Aged ,Heart transplantation ,Aged, 80 and over ,Heart Failure ,COPD ,business.industry ,Middle Aged ,medicine.disease ,Prognosis ,Survival Analysis ,Italy ,Heart failure ,Ventricular assist device ,Relative risk ,Multivariate Analysis ,Cardiology ,Heart Transplantation ,Female ,Heart-Assist Devices ,business - Abstract
Background Chronic obstructive pulmonary disease (COPD) is among the most common comorbidities in patients hospitalized with heart failure and is generally associated with poor outcomes. However, the results of previous studies with regard to increased mortality and risk trajectories were not univocal. We sought to assess the prognostic impact of COPD in patients admitted for acutely decompensated heart failure (ADHF) and investigate the association between use of β-blockers at discharge and mortality in patients with COPD. Methods We studied 1530 patients. The association of COPD with mortality was examined in adjusted Fine-Gray proportional hazard models where heart transplantation and ventricular assist device implantation were treated as competing risks. The primary outcome was 5-year all-cause mortality. Results After adjusting for establisked risk markers, the subdistribution hazard ratios (SHR) of 5-year mortality for COPD patients compared with non-COPD patients was 1.25 (95% confidence intervals [CIs] 1.06–1.47; p = .007). The relative risk of death for COPD patients increased steeply from 30 to 180 days, and remained noticeably high throughout the entire follow-up. Among patients with comorbid COPD, the use of β-blockers at discharge was associated with a significantly reduced risk of 1-year post-discharge mortality (SHR 0.66, 95%CIs 0.53–0.83; p ≤.001). Conclusions Our data indicate that ADHF patients with comorbid COPD have a worse long-term survival than those without comorbid COPD. Most of the excess mortality occurred in the first few months following hospitalization. Our data also suggest that the use of β-blockers at discharge is independently associated with improved survival in ADHF patients with COPD.
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- 2018
32. Publisher Correction: Predictors of chronic kidney disease in type 1 diabetes: a longitudinal study from the AMD Annals initiative
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Giuseppina T. Russo, Antonio Ceriello, Pietro Guida, Stefano Genovese, Paola Fioretto, Roberto Pontremoli, Salvatore De Cosmo, Francesca Viazzi, Carlo Giorda, and Pamela Piscitelli
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medicine.medical_specialty ,Type 1 diabetes ,Longitudinal study ,Multidisciplinary ,business.industry ,lcsh:R ,lcsh:Medicine ,medicine.disease ,Annals ,Internal medicine ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,medicine ,lcsh:Q ,lcsh:Science ,business ,Kidney disease - Abstract
A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.
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- 2018
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33. Application of competing risks analysis improved prognostic assessment of patients with decompensated chronic heart failure and reduced left ventricular ejection fraction
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Andrea Passantino, Domenico Scrutinio, Pietro Guida, Enrico Ammirati, Rocco Lagioia, Maria Frigerio, and Fabrizio Oliva
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Male ,medicine.medical_specialty ,Epidemiology ,medicine.medical_treatment ,Decompensated chronic heart failure ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Bias ,Risk Factors ,Internal medicine ,Covariate ,Medicine ,Humans ,030212 general & internal medicine ,Competing risks analysis ,Proportional Hazards Models ,Heart transplantation ,Heart Failure ,Ejection fraction ,business.industry ,Incidence (epidemiology) ,Stroke Volume ,Middle Aged ,medicine.disease ,Prognosis ,Ventricular assist device ,Heart failure ,Cardiology ,Heart Transplantation ,Female ,Heart-Assist Devices ,business - Abstract
Objective The Kaplan–Meier method may overestimate absolute mortality risk (AMR) in the presence of competing risks. Urgent heart transplantation (UHT) and ventricular assist device implantation (VADi) are important competing events in heart failure. We sought to quantify the extent of bias of the Kaplan–Meier method in estimating AMR in the presence of competing events and to analyze the effect of covariates on the hazard for death and competing events in the clinical model of decompensated chronic heart failure with reduced ejection fraction (DCHFrEF). Study Design and Setting We studied 683 patients. We used the cumulative incidence function (CIF) to estimate the AMR at 1 year. CIF estimate was compared with the Kaplan–Meier estimate. The Fine–Gray subdistribution hazard analysis was used to assess the effect of covariates on the hazard for death and UHT/VADi. Results The Kaplan–Meier estimate of the AMR was 0.272, whereas the CIF estimate was 0.246. The difference was more pronounced in the patient subgroup with advanced DCHF (0.424 vs. 0.338). The Fine–Gray subdistribution hazard analysis revealed that established risk markers have qualitatively different effects on the incidence of death or UHT/VADi. Conclusion Competing risks analysis allows more accurately estimating AMR and better understanding the association between covariates and major outcomes in DCHFrEF.
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- 2018
34. Response by Guida and Scrutinio to Letter Regarding Article, 'Development and Validation of a Predictive Model for Functional Outcome After Stroke Rehabilitation: The Maugeri Model'
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Domenico Scrutinio and Pietro Guida
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medicine.medical_specialty ,Barthel index ,medicine.medical_treatment ,MEDLINE ,Outcome (game theory) ,03 medical and health sciences ,0302 clinical medicine ,Modified Rankin Scale ,Humans ,Medicine ,030212 general & internal medicine ,Stroke ,Advanced and Specialized Nursing ,Rehabilitation ,business.industry ,Stroke Rehabilitation ,Recovery of Function ,medicine.disease ,Clinical trial ,Treatment Outcome ,Categorization ,Physical therapy ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
We thank Dijkland et al for their interest in our article1 on prediction of functional outcome after stroke rehabilitation. Dr Dijkland raises some issues about the outcome measures and the predictive model for the secondary outcome. In general, models predictive of dichotomous clinical outcomes are most relevant in medical applications. Consistently, dichotomized outcome measures, including the Barthel index and the modified Rankin Scale, have been used to assess the effects of stroke treatment in clinical trials. For patients undergoing rehabilitation after a moderate-to-severe stroke, regaining minimal levels of disability or physical independence are clinically highly relevant outcomes. According to the article of Altman cited by Dijkland, we did not convert continuous explanatory variables to 2 (dichotomization) or multiple (categorization) groups, but …
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- 2018
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35. Rehabilitation Outcomes of Patients With Severe Disability Poststroke
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Chiara Ferretti, Domenico Scrutinio, Simona Spaccavento, Nicola Montrone, Pietro Guida, Anna Loverre, and Bernardo Lanzillo
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Male ,030506 rehabilitation ,medicine.medical_specialty ,medicine.medical_treatment ,Motor Disorders ,Minimal Clinically Important Difference ,Physical Therapy, Sports Therapy and Rehabilitation ,Logistic regression ,Medicare ,Rehabilitation Centers ,Risk Assessment ,Decision Support Techniques ,03 medical and health sciences ,Disability Evaluation ,0302 clinical medicine ,Interquartile range ,Internal medicine ,medicine ,Case mix group ,Humans ,Treatment Failure ,Geriatric Assessment ,Aged ,Retrospective Studies ,Aged, 80 and over ,Framingham Risk Score ,Rehabilitation ,business.industry ,Minimal clinically important difference ,Stroke Rehabilitation ,Retrospective cohort study ,Recovery of Function ,Confidence interval ,United States ,Stroke ,Logistic Models ,Treatment Outcome ,Female ,0305 other medical science ,business ,human activities ,030217 neurology & neurosurgery - Abstract
Objective To characterize rehabilitation outcomes of patients with severe poststroke motor impairment (MI) and develop a predictive model for treatment failure. Design Retrospective cohort study. Correlates of treatment failure, defined as the persistence of severe MI after rehabilitation, were identified using logistic regression analysis. Then, an integer-based scoring rule was developed from the logistic model. Setting Three specialized inpatient rehabilitation facilities. Participants Patients (N=1265) classified as case-mix groups (CMGs) 0108, 0109, and 0110 of the Medicare classification system. Interventions Not applicable. Main Outcome Measure Change in the severity of MI, as assessed by the FIM, from admission to discharge. Results Median FIM-motor (FIM-M) score increased from 17 (interquartile range [IQR] 14-23) to 38 (IQR, 25-55) points. Median proportional recovery, as expressed by FIM-M effectiveness, was 26% (IQR, 12-47). Median FIM-M change was 18 (IQR, 9-34) points. About 38.5% patients achieved the minimal clinically important difference. Eighteen point six percent and 32.0% of the patients recovered to a stage of either mild (FIM-M ≥62) or moderate (FIM-M 38-61) MI, respectively. All between-CMG differences were statistically significant. Outcomes have also been analyzed according to classification systems used in Australia and Canada. The scoring rule had an area under the curve of 0.833 (95% confidence interval, 0.808-0.858). Decision curve analysis displayed large net benefit of using the risk score compared with the treat all strategy. Conclusions This study provides a snapshot of rehabilitation outcomes in a large cohort of patients with severe poststroke MI, thus filling a gap in knowledge. The scoring rule accurately identified the patients at risk for treatment failure.
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- 2018
36. Reply to Nezic
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Giuseppe Santarpino, Pietro Guida, Domenico Paparella, and Marco Moscarelli
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Sternotomy ,Surgery ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Aortic Valve ,Heart Valve Prosthesis ,030220 oncology & carcinogenesis ,medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
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37. Achievement of therapeutic targets in patients with diabetes and chronic kidney disease: insights from the Associazione Medici Diabetologi Annals initiative
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Paolo Di Bartolo, Antonio Nicolucci, Carlo Giorda, Antonio Pacilli, Antonio Ceriello, Francesca Viazzi, Pietro Guida, Maria Chiara Rossi, Sandro Gentile, Giuseppina T. Russo, Roberto Pontremoli, Salvatore De Cosmo, De Cosmo, Salvatore, Viazzi, Francesca, Pacilli, Antonio, Giorda, Carlo, Ceriello, Antonio, Gentile, Sandro, Russo, Giuseppina, Rossi, Maria Chiara, Nicolucci, Antonio, Guida, Pietro, Di Bartolo, Paolo, and Pontremoli, Roberto
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cardiovascular risk factors ,Blood Glucose ,Male ,endocrine system diseases ,Blood Pressure ,Diabetic nephropathy ,chemistry.chemical_compound ,Antihypertensive treatment ,cardiovascular risk factor ,Renal Insufficiency ,Chronic ,hypercholesterolaemia ,Medicine (all) ,arterial hypertension ,diabetic nephropathy ,Aged ,Albuminuria ,Antihypertensive Agents ,Cholesterol, LDL ,Diabetes Mellitus, Type 2 ,Female ,Hemoglobin A, Glycosylated ,Humans ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Renal Insufficiency, Chronic ,Nephrology ,Transplantation ,Hemoglobin A ,Cholesterol ,Cardiology ,medicine.symptom ,Type 2 ,medicine.medical_specialty ,Glycosylated ,LDL ,Diabetes mellitus ,Internal medicine ,Diabetes Mellitus ,medicine ,Glycated Hemoglobin ,Creatinine ,business.industry ,Type 2 Diabetes Mellitus ,medicine.disease ,Blood pressure ,chemistry ,business ,Body mass index ,Kidney disease - Abstract
Background. Chronic kidney disease (CKD) entails a worse cardiovascular outcome. The aim of our work was to study the relationship between CKD and the achievement of recommended targets for glycated haemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-c) and blood pressure (BP) in a real-life sample of patients with type 2 diabetes mellitus (T2DM). Methods. We analysed a sample of 116 777 outpatients from the Network of the Italian Association of Clinical Diabetologists; all patients had T2DM and at least one measurement of HbA1c, LDL-c, BP, serum creatinine and albuminuria in the year 2010. The outcome was the achievement of HbA1c, LDL-c and BP values as recommended by International Guidelines. Results. In the entire sample, themean value ofHbA1c was 7.2± 1.2%, of LDL-c was 102 ± 33 mg/dL and of BP was 138/78 ± 19/ 9 mmHg. CKD and its components were associated with poor glycaemic and BP control, notwithstanding greater use of glucose and BP-lowering drugs, while no association was found with LDL-c values. Factors independently related to unsatisfactory glycaemic control included female gender, body mass index, duration of disease and high albuminuria. Men, older people and those taking statins were more likely to reach LDL-c target levels. Male gender, age and high albuminuria strongly affected the achievement of BP targets. Conclusions. CKD or its components, mainly high albuminuria, are associated with failure to reach therapeutic targets, especially for HbA1c and BP, despite a greater use of drugs in patients with T2DM.
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- 2015
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38. Critical Appraisal of Multivariable Prognostic Scores in Heart Failure: Development, Validation and Clinical Utility
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Andrea, Passantino, Pietro, Guida, Giuseppe, Parisi, Massimo, Iacoviello, and Domenico, Scrutinio
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Heart Failure ,Models, Statistical ,Multivariate Analysis ,Humans ,Reproducibility of Results ,Prognosis - Abstract
Optimal management of heart failure requires accurate risk assessment. Many prognostic risk models have been proposed for patient with chronic and acute heart failure. Methodological critical issues are the data source, the outcome of interest, the choice of variables entering the model, the validation of the model in external population. Up to now, the proposed risk models can be a useful tool to help physician in the clinical decision-making. The availability of big data and of new methods of analysis may lead to developing new models in the future.
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- 2017
39. Measures of hospital competition and their impact on early mortality for congestive heart failure, acute myocardial infarction and cardiac surgery
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Andrea Passantino, Massimo Iacoviello, Pietro Guida, and Domenico Scrutinio
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Adult ,Male ,medicine.medical_specialty ,Valve surgery ,Adolescent ,Myocardial Infarction ,Competition (economics) ,03 medical and health sciences ,Health services ,Coronary artery bypass surgery ,0302 clinical medicine ,Outcome Assessment, Health Care ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Cardiac Surgical Procedures ,Aged ,Aged, 80 and over ,Heart Failure ,business.industry ,030503 health policy & services ,Health Policy ,Mortality rate ,Public Health, Environmental and Occupational Health ,General Medicine ,Middle Aged ,medicine.disease ,Hospitals ,Cardiac surgery ,Cross-Sectional Studies ,Italy ,Heart failure ,Emergency medicine ,Female ,0305 other medical science ,business - Abstract
Objective To measure competition amongst providers and to examine whether a correlation exists with hospitals mortality for congestive heart failure (CHF), acute myocardial infarction (AMI), isolated-coronary artery bypass graft (CABG) or valve surgery. Design Cross-sectional study based on publically available data from the National Outcome Evaluation Program (Edition 2016) of the Italian Agency for Regional Health Services. Setting and participants Patients discharged during 2015 for CHF or AMI, and between 2014 and 2015 for cardiac surgery (respectively, from 662, 395 and 91 hospitals). Main outcome measures Risk-adjusted mortality rates at 30 days and measures of hospital competition for areas centred on hospital' location (fixed-radius 50-150 km, variable-radius to capture 10-30 hospitals and 6-10% of national volume). Competition was estimated as number of providers and Herfindahl-Hirschman Index (HHI). Results Indicators of competitions varied by condition and were sensitive to method used for the area definition. Hospital mortality after AMI and valve surgery increased with competition in areas identified by the variable-radius method (higher rates for a greater number of hospitals or lower HHIs). In area with fixed radius of 100-150 km, competition reduced mortality after CABG procedures (lower rates for a greater number of hospitals or smaller HHIs). Neither the number of hospitals nor HHI correlated with outcomes in CHF. Conclusions The measures of hospital competition changed according to definition of local market and results in mortality correlations varied among conditions. Understanding the relationship between hospital competition and outcomes is important to identify strategies to improve quality of care.
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- 2017
40. Female gender and mortality risk in decompensated heart failure
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Domenico Scrutinio, Fabrizio Oliva, Enrico Ammirati, Maria Frigerio, Rosa Raimondo, Rocco Lagioia, Miriam Stucchi, Andrea Passantino, Mario Venezia, and Pietro Guida
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Male ,medicine.medical_specialty ,Acute decompensated heart failure ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Age Distribution ,Sex Factors ,Internal medicine ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Sex Distribution ,Propensity Score ,Aged ,Proportional Hazards Models ,Heart transplantation ,Aged, 80 and over ,Heart Failure ,Proportional hazards model ,business.industry ,Mortality rate ,Incidence ,Hazard ratio ,Middle Aged ,medicine.disease ,Prognosis ,Confidence interval ,Hospitalization ,Italy ,Heart failure ,Propensity score matching ,Acute Disease ,Heart Transplantation ,Female ,Heart-Assist Devices ,business - Abstract
Background Still there is conflicting evidence about gender-related differences in prognosis among patients with heart failure. This prognostic uncertainty may have implications for risk stratification and planning management strategy. The aim of the present study was to explore the association between gender and one-year mortality in patients admitted with acute decompensated heart failure (ADHF). Methods We studied 1513 patients. The Cumulative Incidence Function (CIF) method was used to estimate the absolute rate of mortality, heart transplantation (HT)/ventricular assist device (VAD) implantation, and survival free of HT/VAD implantation at 1 year. An interaction analysis was performed to assess the association between covariates, gender, and mortality risk. Propensity score matching and Cox regression were used to compare mortality rates in the gender subgroups. Results The CIF estimates of 1-year mortality, HT/VAD implantation, and survival free of HT/VAD implantation at 1 year were 33.1%, 7.0%, and 59.9% for women and 30.2%, 10.2%, and 59.6% for men, respectively. Except for diabetes, there was no significant interaction between gender, covariates, and mortality risk. In the matched cohort, the hazard ratio of death for women was 1.19 (95% confidence intervals [CIs]: 0.90–1.59; p = .202). After adjusting for age and baseline risk, the hazard ratio of death for women was 1.18 (95% CIs: 0.95–1.43; p = .127). The use of gender-specific predictive models did not allow improving the accuracy of risk prediction. Conclusions Our data strongly suggest that women and men have comparable outcome in the year following a hospitalization for ADHF.
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- 2017
41. Myocardial protection during minimally invasive cardiac surgery through right mini-thoracotomy
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Giosuè Lionetti, Pietro Guida, Daniela Nanna, Micaela De Palo, Domenico Paparella, Ruggiero Rociola, Florinda Mastro, and Teresa Quagliara
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Adult ,Male ,medicine.medical_specialty ,Adverse outcomes ,Cardiac Output, Low ,030204 cardiovascular system & hematology ,Independent predictor ,Potassium Chloride ,03 medical and health sciences ,0302 clinical medicine ,Minimally invasive cardiac surgery ,Medicine ,Creatine Kinase, MB Form ,Humans ,Minimally Invasive Surgical Procedures ,Radiology, Nuclear Medicine and imaging ,Blood Transfusion ,Mannitol ,Cardiac Surgical Procedures ,Cardioplegic Solutions ,Aged ,Retrospective Studies ,Advanced and Specialized Nursing ,business.industry ,Troponin I ,Arrhythmias, Cardiac ,Heart ,General Medicine ,Middle Aged ,Mini thoracotomy ,Cardiac surgery ,Surgery ,Key factors ,Glucose ,030228 respiratory system ,Thoracotomy ,Anesthesia ,Heart Arrest, Induced ,Female ,Cardiology and Cardiovascular Medicine ,business ,Safety Research ,Procaine - Abstract
Background: Myocardial damage is an independent predictor of adverse outcome following cardiac surgery and myocardial protection is one of the key factors to achieve successful outcomes. Cardioplegia with Custodiol is currently the most used cardioplegia during minimally invasive cardiac surgery (MICS). Different randomized controlled trials compared blood and Custodiol cardioplegia in the context of traditional cardiac surgery. No data are available for MICS. Aim: The aim of this study was to compare the efficacy of cold blood versus Custodiol cardioplegia during MICS. Method: We retrospectively evaluated 90 patients undergoing MICS through a right mini-thoracotomy in a three-year period. Myocardial protection was performed using cold blood (44 patients, CBC group) or Custodiol (46 patients, Custodiol group) cardioplegia, based on surgeon preference and complexity of surgery. Results: The primary outcomes were post-operative cardiac troponin I (cTnI) and creatine kinase MB (CKMB) serum release and the incidence of Low Cardiac Output Syndrome (LCOS). Aortic cross-clamp and cardiopulmonary bypass times were higher in the Custodiol group. No difference was observed in myocardial injury enzyme release (peak cTnI value was 18±46 ng/ml in CBC and 21±37 ng/ml in Custodiol; p=0.245). No differences were observed for mortality, LCOS, atrial or ventricular arrhythmias onset, transfusions, mechanical ventilation time duration, intensive care unit and total hospital stay. Conclusions: Custodiol and cold blood cardioplegic solutions seem to assure similar myocardial protection in patients undergoing cardiac surgery through a right mini-thoracotomy approach.
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- 2017
42. Early mortality following percutaneous coronary intervention and cardiac surgery: Correlations within providers and operators
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Massimo Iacoviello, Domenico Scrutinio, Andrea Passantino, and Pietro Guida
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medicine.medical_specialty ,Valve surgery ,medicine.medical_treatment ,New York ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Cardiologists ,Percutaneous Coronary Intervention ,Cardiac interventions ,Internal medicine ,Medicine ,Humans ,030212 general & internal medicine ,Hospital Mortality ,Cardiac Surgical Procedures ,Coronary Artery Bypass ,National data ,Heart Valve Prosthesis Implantation ,business.industry ,Mortality rate ,Percutaneous coronary intervention ,Hospitals ,Cardiac surgery ,medicine.anatomical_structure ,Treatment Outcome ,Hospital Bed Capacity ,Conventional PCI ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
It is not clear whether correlations exist within hospitals or operators among risk-adjusted mortality rates (RAMRs) for the most common cardiac interventions and how much of variations in outcomes are residually explained by providers and physicians. We examined these aspects by using recent national data on percutaneous coronary intervention (PCI) and cardiac surgery.Publically available data from New York State aggregated at hospital and operator level were downloaded by Department of Health website for in-hospital/30-day mortality after PCI, coronary artery bypass graft (CABG) and valve surgery. Correlations between RAMRs were evaluated by using Spearman's coefficient (rho). The proportion of mortality variation attributed to hospitals and operators was estimated.During the period 2008-2013, 390 cardiologists from 63 hospitals and 163 surgeons from 41 centres were evaluated. The RAMRs during 2008-2010 correlated with the RAMRs during 2011-2013 for valve surgery within providers (rho=0.55;p0.001) and within interventionists for PCI (rho=0.21;p0.001), isolated CABG (rho=0.25;p=0.009), and any valve surgery or CABG procedure (rho=0.49;p0.001). The most recent hospital's RAMRs (year 2012 and 2013) significantly correlated in PCI (rho=0.40;p=0.002) but not in CABG (rho=0.13;p=0.413).2% of mortality variations was attributed to providers and 2-3% to difference between operators.A correlation exists at provider and operator level in RAMRs for PCI and cardiac surgery procedures performed in New York State. Beyond patient's risk profile, that is the strongest predictor of early mortality after a cardiac procedure, hospitals and operators have a small but statistically significant contribution to variation in post-operative outcome.
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- 2017
43. Critical Appraisal of Multivariable Prognostic Scores in Heart Failure: Development, Validation and Clinical Utility
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Pietro Guida, Andrea Passantino, Domenico Scrutinio, Giuseppe Parisi, and Massimo Iacoviello
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medicine.medical_specialty ,education.field_of_study ,Multivariate analysis ,business.industry ,Multivariable calculus ,Population ,Big data ,030204 cardiovascular system & hematology ,medicine.disease ,Outcome (game theory) ,03 medical and health sciences ,Critical appraisal ,0302 clinical medicine ,Heart failure ,medicine ,030212 general & internal medicine ,Intensive care medicine ,education ,business ,Risk assessment - Abstract
Optimal management of heart failure requires accurate risk assessment. Many prognostic risk models have been proposed for patient with chronic and acute heart failure. Methodological critical issues are the data source, the outcome of interest, the choice of variables entering the model, the validation of the model in external population. Up to now, the proposed risk models can be a useful tool to help physician in the clinical decision-making. The availability of big data and of new methods of analysis may lead to developing new models in the future.
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- 2017
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44. Hemoglobin and Renal Replacement Therapy after Cardiopulmonary Bypass surgery: A predictive score from the Cardiac Surgery Registry of Puglia
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Cataldo Labriola, Giuseppe Speziale, Domenico Paparella, Carmine Carbone, Vitantonio Fanelli, Salvatore Zaccaria, Valerio Mazzei, Giuseppe Scrascia, and Pietro Guida
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Renal function ,urologic and male genital diseases ,Severity of Illness Index ,law.invention ,Cohort Studies ,Hemoglobins ,Postoperative Complications ,Predictive Value of Tests ,law ,Internal medicine ,medicine ,Cardiopulmonary bypass ,Humans ,Prospective Studies ,Registries ,Renal replacement therapy ,Aged ,Aged, 80 and over ,Cardiopulmonary Bypass ,Ejection fraction ,business.industry ,Acute kidney injury ,Middle Aged ,medicine.disease ,female genital diseases and pregnancy complications ,Surgery ,Cardiac surgery ,Renal Replacement Therapy ,Transplantation ,Italy ,Female ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Acute Kidney Injury (AKI) after cardiac surgery is a complication influencing postoperative outcome. Preoperative hemoglobin is a predictor of postoperative AKI. We aimed to identify preoperative predictors of Renal Replacement Therapy (RRT) and to develop a new risk-scoring system including hemoglobin to better stratify the risk of events.We evaluated 3288 consecutive patients of the Regional Cardiac Surgery Registry of Puglia operated in 2011-2012. Chronic dialysis and renal transplantation patients were excluded. Primary outcome was post-operative RRT incidence.The study sample was divided in two cohorts: 1642 patients (70 RRT) operated during the year 2011 as derivation cohort and 1646 patients (69 RRT) of the year 2012 as validation. In a multivariable logistic regression model using a stepwise method, six preoperative risk factors were associated with RRT in the derivation cohort: creatinine clearance, preoperative hemoglobin, neurological dysfunction, left ventricular ejection fraction, urgency and combined procedures (discrimination c-index 0.844 and 0.818 in the validation cohort). Scoring system included risk factors obtained from derivation cohort adjusting their relative weight with updated rounded coefficients in the validation cohort: creatinine clearance50ml/min (1 point), hemoglobin≤12.5g/dl (1 point), left ventricular ejection fraction≤30% (1 point), urgent operation (1 point), emergency-salvage surgery (2 points), and combined procedures (1 point). In both cohorts, outcomes were strongly correlated with score points.Our simple bedside prognostic score demonstrates good performance in predicting RRT. Hemoglobin plays an important role and future studies will clarify if preoperative anemia correction will lead to decreased RRT risk.
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- 2014
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45. Perioperative Steroids Administration in Pediatric Cardiac Surgery
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Pietro Guida, Daniela Codazzi, Domenico Paparella, Crescenzia Rotunno, Lillà Amorese, Debora Polieri, and Giuseppe Scrascia
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Mechanical ventilation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Odds ratio ,Perioperative ,Cochrane Library ,Critical Care and Intensive Care Medicine ,Placebo ,law.invention ,Cardiac surgery ,Randomized controlled trial ,law ,Anesthesia ,Meta-analysis ,Pediatrics, Perinatology and Child Health ,medicine ,business - Abstract
Objective: To evaluate the effects of prophylactic perioperative corticosteroid administration, compared with placebo, on postoperative mortality and clinical outcomes (renal dysfunction, duration of mechanical ventilation, and ICU length of stay) in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. Data Sources: MEDLINE and Cochrane Library were screened through August 2013 for randomized controlled trials in which perioperative steroid treatment was adopted. Study Selection: Included were randomized controlled trials conducted on pediatric population that reported clinical outcomes about mortality and morbidity. Data Extraction: Eighty citations (PubMed, 48 citations; Cochrane, 32 citations) were identified, of which 14 articles were analyzed in depth and six articles fulfilled eligibility criteria and reported mortality data (232 patients), two studies reported ICU length of stay and mechanical ventilation duration (60 patients), and two studies reported renal dysfunction (49 patients). Data Synthesis: A nonsignificant trend of reduced mortality was observed in steroid-treated patients (11 [4.7%] vs 4 [1.7%] patients; odds ratio, 0.41; 95% CI, 0.14–1.15; p = 0.089). Steroids had no effects on mechanical ventilation time (117.4 ± 95.9 hr vs 137.3 ± 102.4 hr; p = 0.43) and ICU length of stay (9.6 ± 4.6 d vs 9.9 ± 5.9 d; p = 0.8). Perioperative steroid administration reduced the prevalence of renal dysfunction (13 [54.2%] vs 2 [8%] patients; odds ratio, 0.07; 95% CI, 0.01–0.38; p = 0.002). Conclusion: Despite a demonstrated attenuation of cardiopulmonary bypass–induced inflammatory response by steroid administration, a systematic review of randomized controlled trials performed so far reveals that steroid administration has potential clinical advantages (lower mortality and significant reduction of renal function deterioration). A larger prospective randomized study is needed to verify clearly the effects of steroid prophylaxis in pediatric patients.
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- 2014
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46. Antithrombin Administration in Patients With Low Antithrombin Values After Cardiac Surgery: A Randomized Controlled Trial
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Pietro Guida, Simona Finamore, Micaela De Palo, Domenico Paparella, Tommaso Fiore, Gianni Rubino, Luigi de Luca Tupputi Schinosa, and Crescenzia Rotunno
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Placebo ,Antithrombins ,law.invention ,Double-Blind Method ,law ,Fibrinolysis ,Cardiopulmonary bypass ,medicine ,Humans ,Platelet ,Prospective Studies ,Platelet activation ,Aged ,Cardiopulmonary Bypass ,business.industry ,Antithrombin ,Cardiac surgery ,Anesthesia ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Platelet factor 4 ,medicine.drug - Abstract
Background Antithrombin (AT) concentrations are reduced after cardiac surgery with cardiopulmonary bypass compared with the preoperative levels. Low postoperative AT is associated with worse short- and mid-term clinical outcomes. The aim of the study is to evaluate the effects of AT administration on activation of the coagulation and fibrinolytic systems, platelet function, and the inflammatory response in patients with low postoperative AT levels. Methods Sixty patients with postoperative AT levels of less than 65% were randomly assigned to receive purified AT (5000 IU in three administrations) or placebo in the postoperative intensive care unit. Thirty patients with postoperative AT levels greater than 65% were observed as controls. Interleukin 6 (a marker of inflammation), prothrombin fragment 1-2 (a marker of thrombin generation), plasmin–antiplasmin complex (a marker of fibrinolysis), and platelet factor 4 (a marker of platelet activation) were measured at six different times. Results Compared with the no AT group and control patients, patients receiving AT showed significantly higher AT values until 48 hours after the last administration. Analysis of variance for repeated measures showed a significant effect of study treatment in reducing prothrombin fragment 1-2 ( p = 0.009; interaction with time sample, p = 0.006) and plasmin–antiplasmin complex ( p p p = 0.877; interaction with time sample, p = 0.521) and platelet factor 4 ( p = 0.913; interaction with time sample, p = 0.543). No difference in chest tube drainage, reopening for bleeding, and blood transfusion was observed. Conclusions Antithrombin administration in patients with low AT activity after surgery with cardiopulmonary bypass reduces postoperative thrombin generation and fibrinolysis with no effects on platelet activation and inflammatory response.
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- 2014
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47. Risk stratification for in-hospital mortality after cardiac surgery: external validation of EuroSCORE II in a prospective regional registry
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Sergio Caparrotti, Valerio Mazzei, Giuseppe Speziale, Giuseppe Di Eusanio, Vitantonio Fanelli, Mauro Cassese, Renato Gregorini, Luigi de Luca Tupputi Schinosa, Domenico Paparella, Tommaso Fiore, Pietro Guida, and Salvatore Zaccaria
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Logistic regression ,Risk Assessment ,Euroscore ii ,Internal medicine ,Linear regression ,medicine ,Health Status Indicators ,Humans ,Hospital Mortality ,Prospective Studies ,Registries ,Cardiac Surgical Procedures ,Aged ,Models, Statistical ,Framingham Risk Score ,Receiver operating characteristic ,business.industry ,External validation ,General Medicine ,Middle Aged ,Survival Analysis ,Cardiac surgery ,Logistic Models ,Italy ,Cohort ,Cardiology ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES: To evaluate performance of the European System for Cardiac Operation Risk Evaluation (EuroSCORE II), to assess the influence of model updating and to derive a hierarchical tree for modelling the relationship between EuroSCORE II risk factors and hospital mortality after cardiac surgery in a large prospective contemporary cohort of consecutive adult patients. METHODS: Data on consecutive patients, who underwent on-pump cardiac surgery or off-pump coronary artery bypass graft intervention, were retrieved from Puglia Adult Cardiac Surgery Registry. Discrimination, calibration, re-estimation of EuroSCORE II coefficients and hierarchical tree analysis of risk factors were assessed. RESULTS: Out 6293 procedures, 6191 (98.4%) had complete data for EuroSCORE II assessment with a hospital mortality rate of 4.85% and EuroSCORE II of 4.40 ± 7.04%. The area under the receiver operator characteristic curve (0.830) showed good discriminative ability of EuroSCORE II in distinguishing patients who died and those who survived. Calibration of EuroSCORE II was preserved with lower predicted than observed risk in the highest EuroSCORE II deciles. At logistic regression analysis, the complete revision of the model had most of reestimated regression coefficients not statistically different from those in the original EuroSCORE II model. When missing values were replaced with the mean EuroSCORE II value according to urgency and weight of intervention, the risk score confirmed discrimination and calibration obtained over the entire sample. A recursive tree-building algorithm of EuroSCORE II variables identified three large groups (55.1, 17.1 and 18.1% of procedures) with low-to-moderate risk (observed mortality of 1.5, 3.2 and 6.4%) and two groups (3.8 and 5.9% of procedures) at high risk (mortality of 14.6 and 32.2%). Patients with low-to-moderate risk had good agreement between observed events and predicted frequencies by EuroSCORE II, whereas those at greater risk showed an underestimation of expected mortality. CONCLUSIONS: This study demonstrates that EuroSCORE II is a good predictor of hospital mortality after cardiac surgery in an external validation cohort of contemporary patients from a multicentre prospective regional registry. The EuroSCORE II predicts hospital mortality with a slight underestimation in high-risk patients that should be further and better evaluated. The EuroSCORE II variables as a risk tree provides clinicians and surgeons a practical bedside tool for mortality risk stratification of patients at low, intermediate and high risk for hospital mortality after cardiac surgery.
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- 2014
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48. Renal Dysfunction and Accuracy of N-Terminal Pro-B-Type Natriuretic Peptide in Predicting Mortality for Hospitalized Patients With Heart Failure
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Fabrizio Oliva, Vitoantonio Ricci, Enrico Ammirati, Maria Frigerio, Rosa Raimondo, Rocco Lagioia, Pietro Guida, Filippo Mastropasqua, and Domenico Scrutinio
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Male ,medicine.medical_specialty ,Acute decompensated heart failure ,Hospitalized patients ,medicine.drug_class ,Renal function ,Primary outcome ,Internal medicine ,Natriuretic Peptide, Brain ,Natriuretic peptide ,Humans ,Medicine ,Aged ,Aged, 80 and over ,Heart Failure ,business.industry ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Peptide Fragments ,Hospitalization ,Survival Rate ,Heart failure ,Acute Disease ,Cardiology ,Female ,Kidney Diseases ,N terminal pro b type natriuretic peptide ,Cardiology and Cardiovascular Medicine ,business ,hormones, hormone substitutes, and hormone antagonists ,Follow-Up Studies ,Glomerular Filtration Rate - Abstract
Renal dysfunction may confound the clinical interpretation of N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration. This study investigated whether renal dysfunction influences the prognostic accuracy of NT-proBNP in acute decompensated heart failure (ADHF).We studied 908 ADHF patients. The primary outcome was 12-month mortality. Interaction between estimated glomerular filtration rate (eGFR) and NT-proBNP in predicting mortality was tested with the likelihood ratio test. The patients were classified into 3 eGFR strata: ≥60, 30-59, and30 ml·min(-1)·1.73 m(-2). Cox models were used to calculate the adjusted hazard ratios (HR) for NT-proBNP, modeled as a dichotomous or categorized variable, within each level of eGFR. NT-proBNP was categorized using optimal cut-offs defined in ROC analysis for each eGFR level. A total of 234 patients (25.8%) died. Testing for interaction was not significant (χ(2)=0.29; P=0.5928). The adjusted HR for NT-proBNP5,180 pg/ml was 2.09 (P0.001) in the highest, 1.7 (P0.001) in the intermediate, and 3.33 (P=0.010) in the lowest eGFR level. The adjusted HR for NT-proBNP above the optimal cut-offs defined on ROC analysis were 1.5 (P=0.239), 2.2 (P0.001), and 3.24 (P=0.002), respectively. The models incorporating NT-proBNP as a dichotomous or categorized variable had equivalent C-statistics.There was no evidence of interaction between eGFR and NT-proBNP in predicting mortality. The NT-proBNP cut-off of 5,180 ng/L provided independent prognostic information, irrespective of the level of residual renal function.
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- 2014
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49. Comparison of three different exhaled nitric oxide analyzers in chronic respiratory disorders
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Mariasofia Accardo, Pietro Guida, Antonio Molino, Marco Mosella, Mauro Maniscalco, Salvatore Fuschillo, Andrea Motta, Molino, Antonio, Fuschillo, Salvatore, Mosella, Marco, Accardo, Mariasofia, Guida, Pietro, Motta, Andrea, and Maniscalco, Mauro
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Intraclass correlation ,Pulmonary disease ,Nitric Oxide ,01 natural sciences ,lung ,rehabilitation ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Asthmatic patient ,Respiratory system ,Aged ,exhaled ,exercise ,business.industry ,010401 analytical chemistry ,Healthy subjects ,biomarkers ,Exhalation ,Electrochemical Techniques ,Middle Aged ,asthma ,respiratory system ,respiratory ,Confidence interval ,respiratory tract diseases ,0104 chemical sciences ,Breath Tests ,030228 respiratory system ,Exhaled nitric oxide ,Cardiology ,Female ,business - Abstract
Background Fractional exhaled nitric oxide (FeNO) measurement is a simple and non-invasive method for monitoring eosinophilic airway inflammation. New portable analyzers for FeNO measurements are constantly being developed. The aim of our study was to evaluate the agreement of FeNO values measured by new portable analyzers. Materials and methods FeNO was measured in 20 healthy subjects, 20 asthmatic and 20 chronic obstructive pulmonary disease patients using the analyzers Niox-VERO, Vivatmo-PRO and HypAir-FeNO. A linear relationship was estimated with Pearson's coefficient (r), and absolute agreement by the intraclass correlation coefficient (ICC) and bias with the limits of agreement (95% of paired differences) were assessed according to the Bland-Altman method. Results In the study population (58 ± 14 years, 20 females), mean values of FeNO with their 95% confidence interval were 24.0 (18.6-29.4) with the Niox-VERO, 19.6 (13.6-25.7) with the Vivatmo-PRO and 20.4 (15.7-25.1) with the HypAir-FeNO. FeNO measured with the Niox-VERO was higher than the Vivatmo-PRO (mean difference of paired values +4.3; limits -16.0 to 25.7 ppb) and the HypAir-FeNO (+3.6; -12.2 to 19.4 ppb); the Vivatmo-PRO and HypAir-FeNO showed large variability of paired differences (-0.7; -16.5 to 15.0 ppb). Measurements linearly correlated with an imperfect absolute agreement: Niox-VERO versus Vivatmo-PRO r = 0.90 and ICC = 0.87; Niox-VERO versus HypAir-FeNO r = 0.93 and ICC = 0.90, Vivatmo-PRO versus HypAir-FeNO r = 0.96 and ICC = 0.93. Most of the disagreement was greater in some asthmatic patients at high values of FeNO. Conclusions The present study indicates that absolute exhaled NO measurements may differ to a clinically relevant extent using the Niox-VERO, Vivatmo-PRO and HypAir-FeNO analyzers. The devices cannot be used interchangeably.
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- 2019
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50. Anti-Inflammatory Strategies to Reduce Acute Kidney Injury in Cardiac Surgery Patients: A Meta-Analysis of Randomized Controlled Trials
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Giuseppe Scrascia, Crescenzia Rotunno, Luigi de Luca Tupputi Schinosa, Domenico Paparella, and Pietro Guida
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Biomedical Engineering ,Acute kidney injury ,Medicine (miscellaneous) ,Renal function ,Bioengineering ,General Medicine ,Cochrane Library ,Placebo ,medicine.disease ,Surgery ,law.invention ,Biomaterials ,Randomized controlled trial ,law ,Meta-analysis ,Internal medicine ,medicine ,business ,Complication ,Dialysis - Abstract
Acute kidney injury (AKI) after cardiac operations is a serious complication associated with postoperative mortality. Multiple factors contribute to AKI development, principally ischemia-reperfusion injury and inflammatory response. It is well proven that glucocorticoid administration, leukocyte filter application, and miniaturized extracorporeal circuits (MECC) modulate inflammatory response. We conducted a systematic review of randomized controlled trials (RCTs) in which one of these inflammatory system modulation strategies was used, with the aim to evaluate the effects on postoperative AKI. MEDLINE and Cochrane Library were screened through November 2011 for RCTs in which an inflammatory system modulation strategy was adopted. Included were trials that reported data about postoperative renal outcomes. Because AKI was defined by different criteria, including biochemical determinations, urine output, or dialysis requirement, we unified renal outcome as worsening renal function (WRF). We identified 14 trials for steroids administration (931 patients, WRF incidence [treatment vs. placebo]: 2.7% vs. 2.4%; OR: 1.13; 95% CI: 0.53-2.43; P = 0.79), 9 trials for MECC (947 patients, WRF incidence: 2.4% vs. 0.9%; OR: 0.47; 95% CI: 0.18-1.25; P = 0.13), 6 trials for leukocyte filters (374 patients, WRF incidence: 1.1% vs. 7.5%; OR: 0.18; 95% CI: 0.05-0.64; P = 0.008). Only leukocyte filters effectively reduced WRF incidence. Not all cardiopulmonary bypass-related anti-inflammatory strategies analyzed reduced renal damage after cardiac operations. In adult patients, probably other factors are predominant on inflammation in determining AKI, and only leukocyte filters were effective. Large multicenter RCTs are needed in order to better evaluate the role of inflammation in AKI development after cardiac operations.
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- 2013
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