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1. A matter of sex—persistent predictive value of MECKI score prognostic power in men and women with heart failure and reduced ejection fraction: a multicenter study

Author

Giulia Grilli, Elisabetta Salvioni, Federica Moscucci, Alice Bonomi, Gianfranco Sinagra, Michele Schaeffer, Jeness Campodonico, Massimo Mapelli, Maddalena Rossi, Cosimo Carriere, Michele Emdin, Massimo Piepoli, Stefania Paolillo, Michele Senni, Claudio Passino, Anna Apostolo, Federica Re, Caterina Santolamazza, Damiano Magrì, Carlo M. Lombardi, Ugo Corrà, Rosa Raimondo, Antonio Cittadini, Annamaria Iorio, Andrea Salzano, Rocco Lagioia, Carlo Vignati, Roberto Badagliacca, Andrea Passantino, Pasquale Perrone Filardi, Michele Correale, Enrico Perna, Davide Girola, Marco Metra, Gaia Cattadori, Marco Guazzi, Giuseppe Limongelli, Gianfranco Parati, Fabiana De Martino, Maria Vittoria Matassini, Francesco Bandera, Maurizio Bussotti, Angela Beatrice Scardovi, Susanna Sciomer, Piergiuseppe Agostoni, MECKI Score Research Group, Armando Ferraretti, Cristina Gussago, Domenico Scrutinio, Donatella Bertipaglia, Elisa Battaia, Michele Moretti, Francesca Pietrucci, Geza Halasz, Bruno Capelli, Giovanna Gallo, Emiliano Fiori, Giovanni Marchese, Giuseppe Pacileo, Fabio Valente, Rossella Vastarella, Rita Gravino, Matilda Shkoza, Nikita Baracchini, Teresa Capovilla, Andrea Di Lenarda, Alberto Maria Marra, Roberta D’Assante, Giulia Crisci, Roberto Ricci, Luca Arcari, Sergio Caravita, Elena Viganò, Stefania Farina, Beatrice Pezzuto, Pietro Palermo, Mauro Contini, Paola Gugliandolo, Irene Mattavelli, and Michele Della Rocca

Subjects
heart failure with reduced ejection fraction, prognosis, sex, MECKI score, risk, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundA sex-based evaluation of prognosis in heart failure (HF) is lacking.Methods and resultsWe analyzed the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score registry, which includes HF with reduced ejection fraction (HFrEF) patients. A cross-validation procedure was performed to estimate weights separately for men and women of all MECKI score parameters: left ventricular ejection fraction (LVEF), hemoglobin, kidney function assessed by Modification of Diet in Renal Disease, blood sodium level, ventilation vs. carbon dioxide production slope, and peak oxygen consumption (peakVO2). The primary outcomes were the composite of all-cause mortality, urgent heart transplant, and implant of a left ventricle assist device. The difference in predictive ability between the native and sex recalibrated MECKI (S-MECKI) was calculated using a receiver operating characteristic (ROC) curve at 2 years and a calibration plot. We retrospectively analyzed 7,900 HFrEF patients included in the MECKI score registry (mean age 61 ± 13 years, 6,456 men/1,444 women, mean LVEF 33% ± 10%, mean peakVO2 56.2% ± 17.6% of predicted) with a median follow-up of 4.05 years (range 1.72–7.47). Our results revealed an unadjusted risk of events that was doubled in men compared to women (9.7 vs. 4.1) and a significant difference in weight between the sexes of most of the parameters included in the MECKI score. S-MECKI showed improved risk classification and accuracy (area under the ROC curve: 0.7893 vs. 0.7799, p = 0.02) due to prognostication improvement in the high-risk settings in both sexes (MECKI score >10 in men and >5 in women).ConclusionsS-MECKI, i.e., the recalibrated MECKI according to sex-specific differences, constitutes a further step in the prognostic assessment of patients with severe HFrEF.

Published
2024
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2. Pick Your Threshold

Author

Elisabetta Salvioni, Massimo Mapelli, Alice Bonomi, Damiano Magrì, Massimo Piepoli, Maria Frigerio, Stefania Paolillo, Ugo Corrà, Rosa Raimondo, Rocco Lagioia, Roberto Badagliacca, Pasquale Perrone Filardi, Michele Senni, Michele Correale, Mariantonietta Cicoira, Enrico Perna, Marco Metra, Marco Guazzi, Giuseppe Limongelli, Gianfranco Sinagra, Gianfranco Parati, Gaia Cattadori, Francesco Bandera, Maurizio Bussotti, Federica Re, Carlo Vignati, Carlo Lombardi, Angela B. Scardovi, Susanna Sciomer, Andrea Passantino, Michele Emdin, Claudio Passino, Caterina Santolamazza, Davide Girola, Denise Zaffalon, Fabiana De Martino, Piergiuseppe Agostoni, Stefania Farina, Beatrice Pezzuto, Anna Apostolo, Pietro Palermo, Mauro Contini, Paola Gugliandolo, Irene Mattavelli, Michele Della Rocca, Giovanna Gallo, Federica Moscucci, Anita Iorio, Geza Halasz, Bruno Capelli, Simone Binno, Giuseppe Pacileo, Fabio Valente, Rossella Vastarella, Cosimo Carriere, Marco Masè, Marco Cittar, Andrea Di Lenarda, Sergio Caravita, Elena Viganò, Giovanni Marchese, Roberto Ricci, Luca Arcari, Domenico Scrutinio, Elisa Battaia, Michele Moretti, Maria Vittoria Matassini, Matilda Shkoza, Roland Herberg, Antonio Cittadini, Andrea Salzano, Alberto Marra, Eluisa Lafranca, and Giuseppe Vitale

Subjects
Pulmonary and Respiratory Medicine, Cardiology and Cardiovascular Medicine, Critical Care and Intensive Care Medicine
Published
2022

3. Does moderate hyperkalemia influence survival in HF? Insights from the MECKI score data base

Author

Federica Toto, Elisabetta Salvioni, Damiano Magrì, Susanna Sciomer, Massimo Piepoli, Roberto Badagliacca, Arianna Galotta, Nikita Baracchini, Stefania Paolillo, Ugo Corrà, Rosa Raimondo, Rocco Lagioia, Pasquale Perrone Filardi, Annamaria Iorio, Michele Senni, Michele Correale, Mariantonietta Cicoira, Enrico Perna, Marco Metra, Marco Guazzi, Giuseppe Limongelli, Gianfranco Sinagra, Gianfranco Parati, Gaia Cattadori, Francesco Bandera, Maurizio Bussotti, Massimo Mapelli, Manlio Cipriani, Alice Bonomi, Gonçalo Cunha, Federica Re, Carlo Vignati, Andrea Garascia, Carlo Lombardi, Angela B. Scardovi, Andrea Passantino, Michele Emdin, Claudio Passino, Caterina Santolamazza, Davide Girola, Denise Zaffalon, Dario Vizza, Fabiana De Martino, Piergiuseppe Agostoni, Toto, Federica, Salvioni, Elisabetta, Magrì, Damiano, Sciomer, Susanna, Piepoli, Massimo, Badagliacca, Roberto, Galotta, Arianna, Baracchini, Nikita, Paolillo, Stefania, Corrà, Ugo, Raimondo, Rosa, Lagioia, Rocco, Filardi, Pasquale Perrone, Iorio, Annamaria, Senni, Michele, Correale, Michele, Cicoira, Mariantonietta, Perna, Enrico, Metra, Marco, Guazzi, Marco, Limongelli, Giuseppe, Sinagra, Gianfranco, Parati, Gianfranco, Cattadori, Gaia, Bandera, Francesco, Bussotti, Maurizio, Mapelli, Massimo, Cipriani, Manlio, Bonomi, Alice, Cunha, Gonçalo, Re, Federica, Vignati, Carlo, Garascia, Andrea, Lombardi, Carlo, Scardovi, Angela B, Passantino, Andrea, Emdin, Michele, Passino, Claudio, Santolamazza, Caterina, Girola, Davide, Zaffalon, Denise, Vizza, Dario, De Martino, Fabiana, Agostoni, Piergiuseppe, Toto, F., Salvioni, E., Magri, D., Sciomer, S., Piepoli, M., Badagliacca, R., Galotta, A., Baracchini, N., Paolillo, S., Corra, U., Raimondo, R., Lagioia, R., Filardi, P. P., Iorio, A., Senni, M., Correale, M., Cicoira, M., Perna, E., Metra, M., Guazzi, M., Limongelli, G., Sinagra, G., Parati, G., Cattadori, G., Bandera, F., Bussotti, M., Mapelli, M., Cipriani, M., Bonomi, A., Cunha, G., Re, F., Vignati, C., Garascia, A., Lombardi, C., Scardovi, A. B., Passantino, A., Emdin, M., Passino, C., Santolamazza, C., Girola, D., Zaffalon, D., Vizza, D., De Martino, F., and Agostoni, P.

Subjects
Renin angiotensin aldosterone system inhibitor, Prognosi, Heart failure, Hyperkalemia, Prognosis, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Cardiology and Cardiovascular Medicine
Abstract

Background: The prognostic role of moderate hyperkalemia in reduced ejection fraction (HFrEF) patients is still controversial. Despite this, it affects the use of renin–angiotensin–aldosterone system inhibitors (RAASi) with therapy down-titration or discontinuation. Objectives: Aim of the study was to assess the prognostic impact of moderate hyperkalemia in chronic HFrEF optimally treated patients. Methods and results: We retrospectively analyzed MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes) database, with median follow-up of 4.2 [IQR 1.9–7.5] years. Data on K+ levels were available in 7087 cases. Patients with K+ plasma level ≥ 5.6 mEq/L and < 4 mEq/L were excluded. Remaining patients were categorized into normal >4 and < 5 mEq/L (n = 4826, 68%) and moderately high ≥5.0 and ≤ 5.5 mEq/L (n = 496, 7%) K+. Then patients were matched by propensity score in 484 couplets of patients. MECKI score value was 7% [IQR 3.1–14.1%] and 7.3% [IQR 3.4–15%] (p = 0.678) in patients with normal and moderately high K+ values while cardiovascular mortality events at two years follow-up were 41 (4.2%) and 33 (3.4%) (p = 0.333) in each group respectively. Conclusions: Moderate hyperkalemia does not influence patients' outcome in a large cohort of ambulatory HFrEF patients.

Published
2023

4. Quantification of entanglement and coherence with purity detection

Author

Ting Zhang, Graeme Smith, John A. Smolin, Lu Liu, Xu-Jie Peng, Qi Zhao, Davide Girolami, Xiongfeng Ma, Xiao Yuan, and He Lu

Subjects
Physics, QC1-999, Electronic computers. Computer science, QA75.5-76.95
Abstract

Abstract Entanglement and coherence are fundamental properties of quantum systems, promising to power near-future quantum technologies, such as quantum computation, quantum communication, and quantum metrology. Yet, their quantification, rather than mere detection, generally requires reconstructing the spectrum of quantum states, i.e., experimentally challenging measurement sets that increase exponentially with the system size. Here, we demonstrate quantitative bounds to operationally useful entanglement and coherence that are universally valid, analytically computable, and experimentally friendly. Specifically, our main theoretical results are lower and upper bounds to the coherent information and the relative entropy of coherence in terms of local and global purities of quantum states. To validate our proposal, we experimentally implement two purity detection methods in an optical system: shadow estimation with random measurements and collective measurements on pairs of state copies. The experiment shows that both the coherent information and the relative entropy of coherence of pure and mixed unknown quantum states can be bounded by purity functions. Our research offers an efficient means of verifying large-scale quantum information processing.

Published
2024
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5. Pick Your Threshold: A Comparison Among Different Methods of Anaerobic Threshold Evaluation in Heart Failure Prognostic Assessment

Author

Elisabetta, Salvioni, Massimo, Mapelli, Alice, Bonomi, Damiano, Magrì, Massimo, Piepoli, Maria, Frigerio, Stefania, Paolillo, Ugo, Corrà, Rosa, Raimondo, Rocco, Lagioia, Roberto, Badagliacca, Pasquale Perrone, Filardi, Michele, Senni, Michele, Correale, Mariantonietta, Cicoira, Enrico, Perna, Marco, Metra, Marco, Guazzi, Giuseppe, Limongelli, Gianfranco, Sinagra, Gianfranco, Parati, Gaia, Cattadori, Francesco, Bandera, Maurizio, Bussotti, Federica, Re, Carlo, Vignati, Carlo, Lombardi, Angela B, Scardovi, Susanna, Sciomer, Andrea, Passantino, Michele, Emdin, Claudio, Passino, Caterina, Santolamazza, Davide, Girola, Denise, Zaffalon, Fabiana, De Martino, Piergiuseppe, Agostoni, Giuseppe, Vitale, Salvioni, Elisabetta, Mapelli, Massimo, Bonomi, Alice, Magrì, Damiano, Piepoli, Massimo, Frigerio, Maria, Paolillo, Stefania, Corrà, Ugo, Raimondo, Rosa, Lagioia, Rocco, Badagliacca, Roberto, Filardi, Pasquale Perrone, Senni, Michele, Correale, Michele, Cicoira, Mariantonietta, Perna, Enrico, Metra, Marco, Guazzi, Marco, Limongelli, Giuseppe, Sinagra, Gianfranco, Parati, Gianfranco, Cattadori, Gaia, Bandera, Francesco, Bussotti, Maurizio, Re, Federica, Vignati, Carlo, Lombardi, Carlo, Scardovi, Angela B, Sciomer, Susanna, Marra, Alberto, Passantino, Andrea, Emdin, Michele, Passino, Claudio, Santolamazza, Caterina, Girola, Davide, Zaffalon, Denise, De Martino, Fabiana, and Agostoni, Piergiuseppe

Subjects
Heart Failure, Oxygen Consumption, Anaerobic Threshold, Anaerobic threshold, cardiopulmonary exercise test, heart failure, prognosis, Exercise Test, Humans, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Prognosis
Abstract

Background: In clinical practice, anaerobic threshold (AT) is used to guide training and rehabilitation programs, to define risk of major thoracic or abdominal surgery, and to assess prognosis in heart failure (HF). AT of oxygen uptake (V.O2; V.O2AT) has been reported as an absolute value (V.O2ATabs), as a percentage of predicted peak V.O2 (V.O2AT%peak_pred), or as a percentage of observed peak V.O2 (V.O2AT%peak_obs). A direct comparison of the prognostic power among these different ways to report AT is missing. Research question: What is the prognostic power of these different ways to report AT? Study design and methods: In this observational cohort study, we screened data of 7,746 patients with HF with a history of reduced ejection fraction (< 40%) recruited between 1998 and 2020 and enrolled in the Metabolic Exercise Combined With Cardiac and Kidney Indexes register. All patients underwent a maximum cardiopulmonary exercise test, executed using a ramp protocol on an electronically braked cycle ergometer. Results: This study considered 6,157 patients with HF with identified AT. Follow-up was median, 4.2 years (25th-75th percentiles, 1.9-5.0 years). Both V.O2ATabs (mean ± SD, 823 ± 305 mL/min) and V.O2AT%peak_pred (mean ± SD, 39.6 ± 13.9%), but not V.O2AT%peak_obs (mean ± SD, 69.2 ± 17.7%), well stratified the population regarding prognosis (composite end point: cardiovascular death, urgent heart transplant, or left ventricular assist device). Comparing area under the receiver operating characteristic curve (AUC) values, V.O2ATabs (0.680) and V.O2AT%peak_pred (0.688) performed similarly, whereas V.O2AT%peak_obs (0.538) was significantly weaker (P < .001). Moreover, the V.O2AT%peak_pred AUC value was the only one performing as well as the AUC based on peak V.O2 (0.710), with an even a higher AUC (0.637 vs 0.618, respectively) in the group with severe HF (peak V.O2 < 12 mL/min/kg). Finally, the combination of V.O2AT%peak_pred with peak V.O2 and V. per CO2 production shows the highest prognostic power. Interpretation: In HF, V.O2AT%peak_pred is the best way to report V.O2 at AT in relationship to prognosis, with a prognostic power comparable to that of peak V.O2 and, remarkably, in patients with severe HF.

Published
2022

6. Cardiovascular Death Risk in Recovered Mid-Range Ejection Fraction Heart Failure: Insights From Cardiopulmonary Exercise Test

Author

Magri', Damiano, Massimo, Piepol, Ugo, Corrà, Gallo, Giovanna, Maruotti, Antonello, Carlo, Vignati, Elisabetta, Salvioni, Massimo, Mapelli, Stefania, Paolillo, Pasquale Perrone Filardi, Davide, Girola, Metra, Marco, Angela, B Scardovi, Rocco, Lagioia, Giuseppe, Limongelli, Michele, Senni, Domenico, Scrutinio, Michele, Emdin, Claudio, Passino, Carlo, Lombardi, Gaia, Cattadori, Gianfranco, Parati, Mariantonietta, Cicoira, Michele, Correale, Maria, Frigerio, Francesco, Clemenza, Maurizio, Bussotti, Guazzi, Marco, Badagliacca, Roberto, Sciomer, Susanna, Andrea Di Lenarda, Aldo, Maggioni, Gianfranco, Sinagra, Volpe, Massimo, Piergiuseppe, Agostoni, MECKI score Research Group, Magri, D., Piepoli, M., Corra, U. G. O., Gallo, G., Maruotti, A., Vignati, C., Salvioni, E., Mapelli, M., Paolillo, S., PERRONE FILARDI, P., Girola, D., Metra, M., Scardovi, A. B., Lagioia, R., Limongelli, G., Senni, M., Scrutinio, D., Emdin, M., Passino, C., Lombardi, C., Cattadori, G. A. I. A., Parati, G., Cicoira, M., Correale, M., Frigerio, M., Clemenza, F., Bussotti, M., Guazzi, M., Badagliacca, R., Sciomer, S., DI LENARDA, A., Maggioni, A. L. D. O., Sinagra, G., Volpe, M., Agostoni, P., Magrì, D, Piepoli, M, Corrà, U, Gallo, G, Maruotti, A, Vignati, C, Salvioni, E, Mapelli, M, Paolillo, S, Perrone Filardi, P, Girola, D, Metra, M, Scardovi, A, Lagioia, R, Limongelli, G, Senni, M, Scrutinio, D, Emdin, M, Passino, C, Lombardi, C, Cattadori, G, Parati, G, Cicoira, M, Correale, M, Frigerio, M, Clemenza, F, Bussotti, M, Guazzi, M, Badagliacca, R, Sciomer, S, DI Lenarda, A, Maggioni, A, Sinagra, G, Volpe, M, and Agostoni, P

Subjects
medicine.medical_specialty, Multivariate analysis, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Heart failure, 030204 cardiovascular system & hematology, Cardiovascular death, heart failure, mecki score, cardiopulmonary exercise test, prognosis, 03 medical and health sciences, 0302 clinical medicine, MECKI score, Internal medicine, Cardiopulmonary exercise test, Cause of Death, medicine, Humans, 030212 general & internal medicine, Ejection fraction, End point, business.industry, VO2 max, Cardiopulmonary exercise testing, Stroke Volume, medicine.disease, Cardiology, Exercise Test, Cardiology and Cardiovascular Medicine, business, prognosi
Abstract

Background Heart failure with midrange ejection fraction (HFmrEF) represents a heterogeneous category where phenotype, as well as prognostic assessment, remains debated. The present study explores a specific HFmrEF subset, namely those who recovered from a reduced EF (rec-HFmrEF) and, particularly, it focuses on the possible additive prognostic role of cardiopulmonary exercise testing. Methods and Results We analyzed data from 4535 patients with HFrEF and 1176 patients with rec-HFmrEF from the Metabolic Exercise combined with Cardiac and Kidney Indexes database. The end point was cardiovascular death at 5 years. The median follow-up was 1343 days (25th–75th range 627–2403 days). Cardiovascular death occurred in 552 HFrEF and 61 rec-HFmrEF patients. The multivariate analysis confirmed an independent role of the MECKI score's variables in HFrEF (C-index = 0.744) whereas, in the rec-HFmrEF group, only age and peak oxygen uptake (pVO2) remained associated to the end point (C-index = 0.745). A peak oxygen uptake of ≤55% of predicted and a ventilatory efficiency of ≥31 resulted as the most accurate cut-off values in the outcome prediction. Conclusions: Present data support the cardiopulmonary exercise test and, particularly, the peak oxygen uptake, as a useful tool in the rec-HFmrEF prognostic assessment. A peak VO2 of ≤55% predicted and ventilatory efficiency of ≥31 might help to identify a high-risk rec-HFmrEF subgroup.

Published
2020

7. Heart failure and anemia: Effects on prognostic variables

Author

Giovanni Marchese, Simone Binno, Fabrizio Oliva, Pantaleo Giannuzzi, Stefania Farina, Alessandro Mezzani, Michele Emdin, Elisa Battaia, Michele Correale, Chiara Minà, Roberto Badagliacca, Claudio Passino, Piergiuseppe Agostoni, Gianfranco Sinagra, Giuseppe Pacileo, Alice Bonomi, Elisabetta Salvioni, Mauro Contini, Marco Metra, Alessandro Ferraironi, Davide Girola, Anna Maria Iorio, Rocco La Gioia, Susanna Sciomer, Mariantonietta Cicoira, Ugo Corrà, Sergio Caravita, Angela Beatrice Scardovi, Domenico Scrutinio, Marco Guazzi, Stefania Paolillo, Maria Frigerio, Damiano Magrì, Pasquale Perrone Filardi, Fabrizio Veglia, Gaia Cattadori, Francesco Clemenza, Rosa Raimondo, Massimo Mapelli, Romualdo Belardinelli, Pietro Palermo, Andrea Di Lenarda, Anna Apostolo, Massimo F Piepoli, Maurizio Bussotti, Giuseppe Limongelli, Federica Re, Gianfranco Parati, Carlo Lombardi, Paola Gargiulo, Cattadori, G, Agostoni, P, Corrà, U, Sinagra, G, Veglia, F, Salvioni, E, Bonomi, A, La Gioia, R, Scardovi, Ab, Ferraironi, A, Emdin, M, Metra, M, Di Lenarda, A, Limongelli, G, Raimondo, R, Re, F, Guazzi, M, Belardinelli, R, Parati, G, Caravita, S, Magrì, D, Lombardi, C, Frigerio, M, Oliva, F, Girola, D, Mezzani, A, Farina, S, Mapelli, M, Scrutinio, D, Pacileo, G, Apostolo, A, Iorio, A, Paolillo, S, Filardi, Pp, Gargiulo, P, Bussotti, M, Marchese, G, Correale, M, Badagliacca, R, Sciomer, S, Palermo, P, Contini, M, Giannuzzi, P, Battaia, E, Cicoira, M, Clemenza, F, Minà, C, Binno, S, Passino, C, Piepoli, M, Cattadori, Gaia, Agostoni, Piergiuseppe, Corrã , Ugo, Sinagra, Gianfranco, Veglia, Fabrizio, Salvioni, Elisabetta, Bonomi, Alice, La Gioia, Rocco, Scardovi, Angela B., Ferraironi, Alessandro, Emdin, Michele, Metra, Marco, Di Lenarda, Andrea, Limongelli, Giuseppe, Raimondo, Rosa, Re, Federica, Guazzi, Marco, Belardinelli, Romualdo, Parati, Gianfranco, Caravita, Sergio, Magrã¬, Damiano, Lombardi, Carlo, Frigerio, Maria, Oliva, Fabrizio, Girola, Davide, Mezzani, Alessandro, Farina, Stefania, Mapelli, Massimo, Scrutinio, Domenico, Pacileo, Giuseppe, Apostolo, Anna, Iorio, Annamaria, Paolillo, Stefania, Filardi, Pasquale Perrone, Gargiulo, Paola, Bussotti, Maurizio, Marchese, Giovanni, Correale, Michele, Badagliacca, Roberto, Sciomer, Susanna, Palermo, Pietro, Contini, Mauro, Giannuzzi, Pantaleo, Battaia, Elisa, Cicoira, Mariantonietta, Clemenza, Francesco, Minã , Chiara, Binno, Simone, Passino, Claudio, Piepoli, Massimo F., Corrà, Ugo, DI LENARDA, Andrea, Magrì, Damiano, Minà, Chiara, Scardovi, A, and Filardi, P

Subjects
Male, Prognostic variable, medicine.medical_specialty, Anemia, Prognosi, Renal function, Heart failure, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Comorbidity, 030204 cardiovascular system & hematology, Cohort Studies, Prognosis, Hemoglobins, 03 medical and health sciences, Oxygen Consumption, 0302 clinical medicine, Internal medicine, medicine, Internal Medicine, Humans, Prospective Studies, 030212 general & internal medicine, Aged, Proportional Hazards Models, Entire population, Ejection fraction, business.industry, Sodium, Hazard ratio, Stroke Volume, Carbon Dioxide, Middle Aged, medicine.disease, Italy, Multivariate Analysis, Exercise Test, Cardiology, Female, Hemoglobin, Pulmonary Ventilation, business
Abstract

Background: Anemia is frequent in heart failure (HF), and it is associated with higher mortality. The predictive power of established HF prognostic parameters in anemic HF patients is unknown. Methods: Clinical, laboratory, echocardiographic and cardiopulmonary-exercise-test (CPET) data were analyzed in 3913 HF patients grouped according to hemoglobin (Hb) values. 248 (6%), 857 (22%), 2160 (55%) and 648 (17%) patients had very low (b11 g/dL), low (11–12 for females, 11–13 for males), normal (12–15 for females, 13–15 for males) and high (N15) Hb, respectively. Results: Median follow-up was 1363 days (606–1883). CPETs were always performed safely. Hb was related to prognosis (Hazard ratio (HR) = 0.864). No prognostic difference was observed between normal and high Hb groups. Peak oxygen consumption (VO2), ventilatory efficiency (VE/VCO2 slope), plasma sodium concentration, ejection fraction (LVEF), kidney function and Hb were independently related to prognosis in the entire popula- tion. Considering Hb groups separately, peakVO2 (very low Hb HR = 0.549, low Hb HR = 0.613, normal Hb HR = 0.618, high Hb HR = 0.542) and LVEF (very low Hb HR = 0.49, low Hb HR = 0.692, normal Hb HR = 0.697, high Hb HR = 0.694) maintained their prognostic roles. High VE/VCO2 slope was associated with poor prognosis only in patients with low and normal Hb. Conclusions: Anemic HF patients have a worse prognosis, but CPET can be safely performed. PeakVO2 and LVEF, but not VE/VCO2 slope, maintain their prognostic power also in HF patients with Hb b 11 g/dL, suggesting CPET use and a multiparametric approach in HF patients with low Hb. However, the prognostic effect of an anemia-oriented follow-up is unknown.

Published
2017

8. Prognostic role of atrial fibrillation in patients affected by chronic heart failure. Data from the MECKI score research group

Author

Marco Metra, Angela Beatrice Scardovi, Francesco Clemenza, Marco Guazzi, Giuseppe Limongelli, Federica Re, Claudio Passino, Piergiuseppe Agostoni, Rosa Raimondo, Massimo F Piepoli, Maria Frigerio, Romualdo Belardinelli, Domenico Scrutinio, Stefania Paolillo, Andrea Di Lenarda, Daniele Masarone, Rocco La Gioia, Davide Girola, Marta Giovannardi, Gianfranco Parati, Gaia Cattadori, Michele Correale, Pasquale Perrone-Filardi, Giuseppe Pacileo, Michele Emdin, Mariantonietta Cicoira, Gianfranco Sinagra, Paola Gargiulo, Carlo Lombardi, Annamaria Iorio, Elisabetta Salvioni, Ugo Corrà, Paolillo, S, Agostoni, P, Masarone, D, Corrà, U, Passino, C, Scrutinio, D, Correale, M, Cattadori, G, Metra, M, Girola, D, Piepoli, M, Salvioni, E, Giovannardi, M, Iorio, A, Emdin, M, Raimondo, R, Re, F, Cicoira, M, Belardinelli, R, Guazzi, M, Clemenza, F, Parati, G, Scardovi, A, Di Lenarda, A, La Gioia, R, Frigerio, M, Lombardi, C, Gargiulo, P, Sinagra, G, Pacileo, G, Perrone Filardi, P, Limongelli, G, Piepoli, Mf, Iorio, Annamaria, Scardovi, Ab, DI LENARDA, Andrea, Sinagra, Gianfranco, Limongelli, G., Paolillo, Stefania, Agostoni, Piergiuseppe, Masarone, Daniele, Corrà, Ugo, Passino, Claudio, Scrutinio, Domenico, Correale, Michele, Cattadori, Gaia, Metra, Marco, Girola, Davide, Piepoli, Massimo F, Salvioni, Elisabetta, Giovannardi, Marta, Emdin, Michele, Raimondo, Rosa, Re, Federica, Cicoira, Mariantonietta, Belardinelli, Romualdo, Guazzi, Marco, Clemenza, Francesco, Parati, Gianfranco, Scardovi, Angela B, Di Lenarda, Andrea, La Gioia, Rocco, Frigerio, Maria, Lombardi, Carlo, Gargiulo, Paola, Pacileo, Giuseppe, PERRONE FILARDI, Pasquale, Limongelli, Giuseppe, Piepoli, Massimo F., Scardovi, Angela B., and Perrone Filardi, Pasquale

Subjects
Male, medicine.medical_specialty, Digoxin, Prognosi, Left, Renal function, Heart failure, Matching analysi, Kaplan-Meier Estimate, Severity of Illness Index, Regression Analysi, Ventricular Function, Left, Atrial fibrillation, MECKI score, Matching analysis, Prognosis, Aged, Atrial Fibrillation, Biomarkers, Chronic Disease, Female, Heart Failure, Hospitalization, Humans, Middle Aged, Multivariate Analysis, Regression Analysis, Internal medicine, medicine, Clinical endpoint, Internal Medicine, Ventricular Function, Sinus rhythm, Multivariate Analysi, Ejection fraction, business.industry, Biomarker, medicine.disease, medicine.anatomical_structure, Ventricle, Cardiology, business, medicine.drug, Human
Abstract

Background Atrial fibrillation (AF) is common in heart failure (HF). It is unclear whether AF has an independent prognostic role in HF. The aim of the present study was to assess the prognostic role of AF in HF patients with reduced ejection fraction (EF). Methods HF patients were followed in 17 centers for 3.15 years (1.51–5.24). Study endpoints were the composite of cardiovascular (CV) death and heart transplant (HTX) and all-cause death. Data analysis was performed considering the entire population and a 1 to 1 match between sinus rhythm (SR) and AF patients. Match process was done for age ± 5, gender, left ventricle EF ± 5, peakVO 2 ± 3 (ml/min/kg) and recruiting center. Results A total of 3447 patients (SR = 2882, AF = 565) were included in the study. Considering the entire population, CV death and HTX occurred in 114 (20%) AF vs. 471 (16%) SR (p = 0.026) and all-cause death in 130 (23%) AF vs. 554 (19.2%) SR patients (p = 0.039). At univariable Cox analysis, AF was significantly related to prognosis. Applying a multivariable model based on all variables significant at univariable analysis (EF, peakVO 2 , ventilation/carbon dioxide relationship slope, sodium, kidney function, hemoglobin, beta-blockers and digoxin) AF was no longer associated with adverse outcomes. Matching procedure resulted in 338 couples. CV death and HTX occurred in 63 (18.6%) AF vs. 74 (21.9%) SR (p = 0.293) and all-cause death in 71 (21%) AF vs. 80 (23.6%) SR (p = 0.406), with no survival differences between groups. Conclusion In systolic HF AF is a marker of disease severity but not an independent prognostic indicator.

Published
2015

9. Deceptive meaning of oxygen uptake measured at the anaerobic threshold in patients with systolic heart failure and atrial fibrillation

Author

Damiano, Magrì, Piergiuseppe, Agostoni, Ugo, Corrà, Claudio, Passino, Domenico, Scrutinio, Pasquale, Perrone-Filardi, Michele, Correale, Gaia, Cattadori, Marco, Metra, Davide, Girola, Massimo F, Piepoli, AnnaMaria, Iorio, Michele, Emdin, Rosa, Raimondo, Federica, Re, Mariantonietta, Cicoira, Romualdo, Belardinelli, Marco, Guazzi, Giuseppe, Limongelli, Francesco, Clemenza, Gianfranco, Parati, Maria, Frigerio, Matteo, Casenghi, Angela B, Scardovi, Alessandro, Ferraironi, Andrea, Di Lenarda, Maurizio, Bussotti, Anna, Apostolo, Stefania, Paolillo, Rocco, La Gioia, Paola, Gargiulo, Pietro, Palermo, Chiara, Minà, Stefania, Farina, Elisa, Battaia, Antonello, Maruotti, Giuseppe, Pacileo, Mauro, Contini, Fabrizio, Oliva, Roberto, Ricci, Gianfranco, Sinagra, Corrado, Vassanelli, Magrì, D, Agostoni, P, Corrà, U, Passino, C, Scrutinio, D, Perrone Filardi, P, Correale, M, Cattadori, G, Metra, M, Girola, D, Piepoli, M, Iorio, A, Emdin, M, Raimondo, R, Re, F, Cicoira, M, Belardinelli, R, Guazzi, M, Limongelli, G, Clemenza, F, Parati, G, Frigerio, M, Casenghi, M, Scardovi, A, Ferraironi, A, Di Lenarda, A, Bussotti, M, Apostolo, A, Paolillo, S, La Gioia, R, Gargiulo, P, Palermo, P, Minà, C, Farina, S, Battaia, E, Maruotti, A, Pacileo, G, Contini, M, Oliva, F, Ricci, R, Sinagra, G, Magrì, Damiano, Agostoni, Piergiuseppe, Corrà, Ugo, Passino, Claudio, Scrutinio, Domenico, Perrone Filardi, Pasquale, Correale, Michele, Cattadori, Gaia, Metra, Marco, Girola, Davide, Piepoli, Massimo F., Iorio, Annamaria, Emdin, Michele, Raimondo, Rosa, Re, Federica, Cicoira, Mariantonietta, Belardinelli, Romualdo, Guazzi, Marco, Limongelli, Giuseppe, Clemenza, Francesco, Parati, Gianfranco, Frigerio, Maria, Casenghi, Matteo, Scardovi, Angela B., Ferraironi, Alessandro, DI LENARDA, Andrea, Bussotti, Maurizio, Apostolo, Anna, Paolillo, Stefania, La Gioia, Rocco, Gargiulo, Paola, Palermo, Pietro, Minà, Chiara, Farina, Stefania, Battaia, Elisa, Maruotti, Antonello, Pacileo, Giuseppe, Contini, Mauro, Oliva, Fabrizio, Ricci, Roberto, Sinagra, Gianfranco, PERRONE FILARDI, Pasquale, Piepoli, Massimo F, Scardovi, Angela B, Di Lenarda, Andrea, Magri', D, Corra', U, PERRONE FILARDI, P, Correal, M, Piepoli, Mf, Iorio, Am, Raimonod, R, Cicoria, M, Scardovi, Ab, DI LENARDA, A, LA GIOIA, R, Mina', C, and Sinagra, G.

Subjects
Male, Time Factors, Digoxin, Anaerobic Threshold, Epidemiology, medicine.medical_treatment, Heart failure, anaerobic threshold, atrial fibrillation, exercise, prognosis, Predictive Value of Test, Kaplan-Meier Estimate, Risk Factors, Atrial Fibrillation, Sinus rhythm, Prospective Studies, Multivariate Analysi, Heart transplantation, Ejection fraction, Cardiology and Cardiovascular Medicine, Atrial fibrillation, Middle Aged, Prognosis, Italy, Area Under Curve, Cardiology, Female, Anaerobic exercise, prognosi, medicine.drug, Human, medicine.medical_specialty, Time Factor, Prognosi, Reproducibility of Result, Oxygen Consumption, Predictive Value of Tests, Internal medicine, Aged, Heart Failure, Systolic, Heart Transplantation, Humans, Multivariate Analysis, Proportional Hazards Models, ROC Curve, Reproducibility of Results, Exercise Test, medicine, business.industry, Risk Factor, medicine.disease, Transplantation, Prospective Studie, Proportional Hazards Model, business, Systolic
Abstract

Background: Oxygen uptake at the anaerobic threshold (VO 2 AT), a submaximal exercise-derived variable, independent of patients' motivation, is a marker of outcome in heart failure (HF). However, previous evidence of VO 2 AT values paradoxically higher in HF patients with permanent atrial fibrillation (AF) than in those with sinus rhythm (SR) raised uncertainties. Design: We tested the prognostic role of VO 2 AT in a large cohort of systolic HF patients, focusing on possible differences between SR and AF. Methods: Altogether 2976 HF patients (2578 with SR and 398 with AF) were prospectively followed. Besides a clinical examination, each patient underwent a maximal cardiopulmonary exercise test (CPET). Results: The follow-up was analysed for up to 1500 days. Cardiovascular death or urgent cardiac transplantation occurred in 303 patients (250 (9.6%) patients with SR and 53 (13.3%) patients with AF, p=0.023). In the entire population, multivariate analysis including peak oxygen uptake (VO 2 ) showed a prognostic capacity (C-index) similar to that obtained including VO 2 AT (0.76 vs 0.72). Also, left ventricular ejection fraction, ventilation vs carbon dioxide production slope, β-blocker and digoxin therapy proved to be significant prognostic indexes. The receiver-operating characteristic (ROC) curves analysis showed that the best predictive VO 2 AT cut-off for the SR group was 11.7 ml/kg/min, while it was 12.8 ml/kg/min for the AF group. Conclusions: VO 2 AT, a submaximal CPET-derived parameter, is reliable for long-term cardiovascular mortality prognostication in stable systolic HF. However, different VO 2 AT cut-off values between SR and AF HF patients should be adopted.

Published
2015

10. Classical theta constants vs. lattice theta series,and super string partition functions

Author

Sergio L. Cacciatori, Francesco Dalla Piazza, and Davide Girola

Subjects
Physics, High Energy Physics - Theory, Nuclear and High Energy Physics, Pure mathematics, Amplitude, High Energy Physics - Theory (hep-th), Modulo, Lattice (order), FOS: Physical sciences, Superstring theory, Cosmological constant, Fourier series
Abstract

Recently, various possible expressions for the vacuum-to-vacuum superstring amplitudes has been proposed at genus $g=3,4,5$. To compare the different proposals, here we will present a careful analysis of the comparison between the two main technical tools adopted to realize the proposals: the classical theta constants and the lattice theta series. We compute the relevant Fourier coefficients in order to relate the two spaces. We will prove the equivalence up to genus 4. In genus five we will show that the solutions are equivalent modulo the Schottky form and coincide if we impose the vanishing of the cosmological constant., 21 pages

Published
2010

11. A Unified Approach to Local Quantum Uncertainty and Interferometric Power by Metric Adjusted Skew Information

Author

Paolo Gibilisco, Davide Girolami, and Frank Hansen

Subjects
fisher information, operator monotone functions, matrix means, quantum Fisher information, metric adjusted skew information, local quantum uncertainty, Science, Astrophysics, QB460-466, Physics, QC1-999
Abstract

Local quantum uncertainty and interferometric power were introduced by Girolami et al. as geometric quantifiers of quantum correlations. The aim of the present paper is to discuss their properties in a unified manner by means of the metric adjusted skew information defined by Hansen.

Published
2021
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12. Witnessing Multipartite Entanglement by Detecting Asymmetry

Author

Davide Girolami and Benjamin Yadin

Subjects
quantum information, quantum coherence, entanglement, quantum metrology, Science, Astrophysics, QB460-466, Physics, QC1-999
Abstract

The characterization of quantum coherence in the context of quantum information theory and its interplay with quantum correlations is currently subject of intense study. Coherence in a Hamiltonian eigenbasis yields asymmetry, the ability of a quantum system to break a dynamical symmetry generated by the Hamiltonian. We here propose an experimental strategy to witness multipartite entanglement in many-body systems by evaluating the asymmetry with respect to an additive Hamiltonian. We test our scheme by simulating asymmetry and entanglement detection in a three-qubit Greenberger–Horne–Zeilinger (GHZ) diagonal state.

Published
2017
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13. Quantum Processes Which Do Not Use Coherence

Author

Benjamin Yadin, Jiajun Ma, Davide Girolami, Mile Gu, and Vlatko Vedral

Subjects
Physics, QC1-999
Abstract

A major signature of quantum mechanics beyond classical physics is coherence, the existence of superposition states. The recently developed resource theory of quantum coherence allows the formalization of incoherent operations—those operations which cannot create coherence. We identify the set of operations which additionally do not use coherence. These are such that coherence cannot be exploited by a classical observer, who measures incoherent properties of the system, to go beyond classical dynamics. We give a physical interpretation in terms of interferometry and prove a dilation theorem, showing how these operations can always be constructed by the system interacting, in an incoherent way, with an ancilla. Such a physical justification is not known for the incoherent operations; thus, our results lead to a physically well-motivated resource theory of coherence. Next, we investigate the implications for coherence in multipartite systems. We show that quantum correlations can be defined naturally with respect to a fixed basis, providing a link between coherence and quantum discord. We demonstrate the interplay between these two quantities in the operations that we study and suggest implications for the theory of quantum discord by relating these operations to those which cannot create discord.

Published
2016
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