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4. The rough guide to systematic reviews and meta-analyses

Author

Biondi-Zoccai G, Lotrionte M, Giovanni LANDONI, Mg, Modena, Biondi Zoccai, G, Lotrionte, M, Landoni, Giovanni, and Modena, Mg

Subjects
meta-analysis, systematic review, meta-regression, Review-Article
Abstract

The hierarchy of evidence based medicine postulates that systematic reviews of homogenous randomized trials represent one of the uppermost levels of clinical evidence. Indeed, the current overwhelming role of systematic reviews, meta-analyses and meta-regression analyses in evidence based heath care calls for a thorough knowledge of the pros and cons of these study designs, even for the busy clinician. Despite this sore need, few succinct but thorough resources are available to guide users or would-be authors of systematic reviews. This article provides a rough guide to reading and, summarily, designing and conducting systematic reviews and meta-analyses.

Published
2011

5. Comparative effectiveness of novel oral anticoagulants for atrial fibrillation: evidence from pair-wise and warfarin-controlled network meta-analyses

Author

BIONDI ZOCCAI, Giuseppe, Malavasi, V., D'Ascenzo, F., Abbate, A., Agostoni, P., Lotrionte, M., Castagno, D., Van Tassell, B., Casali, E., Marietta, M., Modena, M. G., Ellenbogen, K. A., and Frati, Giacomo

Subjects
meta-analysis, warfarin, systematic review, Apixaban, atrial fibrillation, dabigatran, Meta-analysis, rivaroxaban, Systematic review, Warfarin, apixaban, Research-Article, cardiovascular diseases
Abstract

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

Published
2013

9. Percutaneous coronary intervention with everolimus-eluting stents (Xience V): Systematic review and direct-indirect comparison meta-analyses with paclitaxel-eluting stents (Taxus) and sirolimus-eluting stents (Cypher)

Author

Giuseppe Biondi-Zoccai, Lotrionte, M., Moretti, C., Agostoni, P., Sillano, D., Laudito, A., and Sheiban, I.

Subjects
Paclitaxel, angioplasty, drug-eluting stents, percutaneous coronary, meta-analysis as topic, transluminal, Treatment Outcome, sirolimus, coronary artery disease, Humans, Everolimus, Angioplasty, Balloon, Coronary, Immunosuppressive Agents
Abstract

First-generation drug-eluting stents (DES) have brought major improvements in results of percutaneous coronary intervention (PCI). However, there is currently debate on the safety of these first-generation DES, given the potential for late stent thrombosis, especially after discontinuation of dual antiplatelet therapy. Second-generation DES, such as zotarolimus- (Endeavor) and everolimus-eluting stents (Xience V), have recently become available in the USA and/or Europe. Indeed, the Xience V stent holds the promise of superior anti-restenotic efficacy as well as long-term safety, yet there is uncertainty on its risk-benefit balance. Authors conducted a systematic review of basic science and clinical evidence on the Xience V, by thoroughly searching PubMed and online databases (updated September 2007). They also compared the clinical results of Xience V vs paclitaxel-eluting stents (Taxus) and sirolimus-eluting stents (Cypher) by means of direct and indirect comparison meta-analysis. A total of three clinical studies has been retrieved focusing on Xience V, however both most recent and important trials were still unpublished. The first trial compared Xience V vs bare-metal stents, whereas the other two randomized trials compared Xience V vs Taxus. Direct meta-analysis of Xience V vs Taxus showed that Xience V was significantly superior to Taxus in preventing binary angiographic restenosis and target lesion revascularization (P0.05 for both). Indirect comparison between Xience V and Cypher, exploiting a recent 16-trial large meta-analysis, showed that Xience V was at least as effective as Cypher in preventing target lesion revascularization (P=0.12). Everolimus-eluting stents (Xience V) appear as a major breakthrough in coronary interventions, and superior efficacy has already been demonstrated in comparison to paclitaxel-eluting stents (Taxus). Data available to date also suggest that Xience V is at least as effective as sirolimus-eluting stents (Cypher). Whether long-term results and direct comparison to Cypher will also be favorable remains to be established by future clinical trials.

Published
2008

11. Appraising cardiotoxicity associated with liposomal doxorubicin by means of tissue Doppler echocardiography end-points: rationale and design of the LITE (Liposomal doxorubicin-Investigational chemotherapy-Tissue Doppler imaging Evaluation) randomized pilot study

Author

Lotrionte, M., Palazzoni, G., Natali, R., Comerci, G., Abbate, A., Di Persio, S., and BIONDI ZOCCAI, Giuseppe

Subjects
Antibiotics, Antineoplastic, cardiotoxicity, Breast Neoplasms, Pilot Projects, anthracycline, randomized clinical trial, Echocardiography, Doppler, Doxorubicin, echocardiography, tissue doppler imaging, Liposomes, Humans, Female, Cardiomyopathies
Abstract

Cardiomyopathy following anthracycline chemotherapy may have ominous clinical implications in cancer patients treated with this effective yet potentially toxic therapy. Early detection at subclinical stage is pivotal to minimize the risk of overt cardiotoxicity. Liposomal anthracyclines have the potential for more selective uptake by cancer cells and reduced cardiac toxicity.We designed a single-center randomized clinical trial, the Liposomal doxorubicin-Investigational chemotherapy-Tissue Doppler imaging Evaluation (LITE) pilot study to compare the safety of liposomal doxorubicin vs standard epirubicin in terms of clinical and subclinical cardiotoxicity.Whereas diagnostic and prognostic instruments effective at early recognition of cardiomyopathy are lacking, promising data have been reported for tissue Doppler imaging (TDI) echocardiography. The study will enroll 80 patients with breast cancer and indication to anthracycline chemotherapy, randomizing them in a 1:1 ratio to liposomal doxorubicin or standard epirubicin. The primary end-point will be the comparison of changes from baseline to 12-month follow-up of left ventricular TDI systolic function parameters, and the co-primary end-point will be based instead on changes in TDI diastolic function parameters. Among secondary end-points, we will adjudicate changes in standard 2-dimensional echocardiography parameters, including ejection fraction, peak values of biochemical markers of cardiac damage and heart failure, ie cardiac troponin T and BNP, overall survival, functional class, freedom from cancer recurrence, and adverse effects of chemotherapy.Results of the LITE pilot study should provide important clinical and mechanistic insights on the promising role of liposomal anthracyclines in patients with breast cancer and indication to anthracycline chemotherapy (ClinicalTrials.gov identifier NCT00531973).

Published
2007

12. Assessment of left ventricular systolic dysfunction by tissue Doppler imaging to detect subclinical cardiomyopathy early after anthracycline therapy

Author

Lotrionte, M., Palazzoni, G., Natali, R., Comerci, G., Abbate, A., Loperfido, F., and Giuseppe Biondi-Zoccai

Subjects
Adult, Male, anthracyclines, Time Factors, Systole, echocardiography, toxicity, Breast Neoplasms, Middle Aged, Ventricular Dysfunction, Left, Diastole, Data Interpretation, Statistical, Humans, Female, Cardiomyopathies, Follow-Up Studies
Abstract

Anthracycline (ANT) chemotherapy for breast cancer, while associated with high response rates, is fraught by risks of irreversible cardiotoxicity. Unfortunately means to detect such cardiotoxicity early on and at a sublinical stage are lacking. We evaluated the role of systolic tissue Doppler imaging (TDI) in appraising postchemotherapy left ventricular (LV) remodelling.Patients undergoing ANT-chemotherapy for breast cancer were enrolled, and underwent baseline and6-months echocardiography (standard and TDI). According to the pattern of LV-TDI systolic remodelling from baseline to follow-up, patients were stratified in: group 1 (no LV-TDI worsening), group 2 (minor LV-TDI worsening), and group 3 (major LV-TDI worsening). Fifty-six patients were included (follow-up 9+/-6 months).At baseline, no patient had abnormal LV ejection fraction (LVEF), LV-TDI systolic dysfunction or New York Heart Association (NYHA)1. Follow-up overall analysis showed significant deterioration in LVEF, end-diastolic diameter (EDD) end-systolic diameter (ESD), and TDI-systolic parameters (all P0.05). Specifically, 29 (51.8%) patients showed no adverse LV-TDI systolic remodelling, while 17 (30.4%) were in group 2, and 10 (17.9%) in group 3. All groups shared similar conditions at baseline. Patients with adverse LV-TDI remodelling had significant increases in EDD and ESD, as well as a significantly decreased LVEF (all P0.05). No patient in group 1 had abnormal LVEF at follow-up, while 1 patient in group 2 and 2 patients in group 3 had abnormal LVEF (P0.05).Subclinical systolic dysfunction occurs in almost 50% of patients early after chemotherapy for breast cancer, with a more adverse by LV-TDI remodelling implying a more pronounced deterioration of standard echocardiographic parameters.

Published
2007

14. Pathophysiologic role of myocardial hypertrophy, microcirculatory dysfunction and cardiomyocyte apoptosis in aortic stenosis

Author

Lotrionte, M., Galiuto, L., BIONDI ZOCCAI, Giuseppe, and Abbate, A.

Subjects
Coronary Circulation, Microcirculation, microcirculatory dysfunction, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Humans, cardiomyocyte apoptosis, aortic stenosis, Apoptosis, Cardiomegaly, Myocytes, Cardiac, Aortic Valve Stenosis
Abstract

The burden of aortic stenosis is increasing steadily and, despite major advances in diagnosis and management, surgical valve replacement is still the only effective treatment. Most recently, experimental studies in animals and clinical studies in humans have shown that myocardial hypertrophy, microcirculatory dysfunction and cardiomyocyte apoptosis are among the central pathophysiologic mechanisms involved in the natural history of aortic stenosis, i.e. the passage from a compensated and hypertrophic heart to a dysfunctional heart prone to ischemia, arrhythmia and pump failure. This updated review emphasizes the promises of these new research avenues as well as their potential therapeutic applications.

Published
2006

24. Compliance with QUOROM and quality of reporting of overlapping meta-analyses on the role of acetylcysteine in the prevention of contrast associated nephropathy: Case study

Author

Biondi-Zoccai, G. G. L., Lotrionte, Marzia, Abbate, Antonio, Testa, L., Remigi, E., Burzotta, Francesco, Valgimigli, M., Romagnoli, Elisa, Crea, Filippo, Agostoni, P., Lotrionte M., Abbate A., Burzotta F. (ORCID:0000-0002-6569-9401), Romagnoli E., Crea F. (ORCID:0000-0001-9404-8846), Biondi-Zoccai, G. G. L., Lotrionte, Marzia, Abbate, Antonio, Testa, L., Remigi, E., Burzotta, Francesco, Valgimigli, M., Romagnoli, Elisa, Crea, Filippo, Agostoni, P., Lotrionte M., Abbate A., Burzotta F. (ORCID:0000-0002-6569-9401), Romagnoli E., and Crea F. (ORCID:0000-0001-9404-8846)

Abstract

Objective: To appraise multiple systematic reviews on the same clinical topic, focusing on predictors and correlates of quality of reporting of meta-analysis (QUOROM) scores. Design: Case study. Setting: Reviews providing at least individual quantitative estimates on role of acetylcysteine in the prevention of contrast associated nephropathy. Data sources: PubMed, the database of abstracts of reviews of effects, and the Cochrane database of systematic reviews (updated March 2005). Main outcome measures: Funding, compliance with the QUOROM checklist, scores on the Oxman and Guyatt quality index, and authors' recommendations. Results: 10 systematic reviews, published August 2003 to March 2005, were included. Nine pooled events despite heterogeneity and five recommended routine use of acetylcysteine, whereas the remaining studies called for further research. Compliance with the 18 items on the QUOROM checklist was relatively high (median 16, range 11 to 17), although shorter manuscripts had significantly lower scores (R = 0.73; P = 0.016). Reviewers who reported previous not for profit funding were more likely to score higher on the Oxman and Guyatt quality index. No association was found between QUOROM and Oxman and Guyatt scores (R = - 0.06; P = 0.86), mainly because of greater emphasis of the Oxman and Guyatt scores on the appraisal of bias in selection and validity assessment (inadequate in five reviews). Conclusions: Multiple systematic reviews on the same clinical topic varied in quality of reporting and recommendations. Longer manuscripts and previous not for profit funding were associated with higher quality.

Published
2006

25. A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease

Author

Biondi-Zoccai, G. G. L., Lotrionte, Marzia, Agostoni, P., Abbate, Antonio, Fusaro, Enrica Maria, Burzotta, Francesco, Testa, L., Sheiban, I., Sangiorgi, G., Lotrionte M., Abbate A., Fusaro M., Burzotta F. (ORCID:0000-0002-6569-9401), Biondi-Zoccai, G. G. L., Lotrionte, Marzia, Agostoni, P., Abbate, Antonio, Fusaro, Enrica Maria, Burzotta, Francesco, Testa, L., Sheiban, I., Sangiorgi, G., Lotrionte M., Abbate A., Fusaro M., and Burzotta F. (ORCID:0000-0002-6569-9401)

Abstract

Aims: The role of aspirin in patients with coronary artery disease (CAD) is well established, yet patients happen to discontinue aspirin according to physician's advice or unsupervised. We thus undertook a systematic review to appraise the hazards inherent to aspirin withdrawal or non-compliance in subjects at risk for or with CAD. Methods and results: Electronic databases were systematically searched (updated January 2006). Study designs, patient characteristics, and outcomes were abstracted. Pooled estimates for odds ratios (OR) were computed according to random-effect methods. From the 612 screened studies, six were selected (50 279 patients). One study (31 750 patients) focused on adherence to aspirin therapy in the secondary prevention of CAD, two studies (2594) on aspirin discontinuation in acute CAD, two studies (13 706) on adherence to aspirin therapy before or shortly after coronary artery bypass grafting, and another (2229) on aspirin discontinuation among patients undergoing drug-eluting stenting. Overall, aspirin non-adherence/withdrawal was associated with three-fold higher risk of major adverse cardiac events (OR=3.14 [1.75-5.61], P=0.0001). This risk was magnified in patients with intracoronary stents, as discontinuation of antiplatelet treatment was associated with an even higher risk of adverse events (OR=89.78 [29.90-269.60]). Conclusion: Non-compliance or withdrawal of aspirin treatment has ominous prognostic implication in subjects with or at moderate-to-high risk for CAD. Aspirin discontinuation in such patients should be advocated only when bleeding risk clearly overwhelms that of atherothrombotic events. © The European Society of Cardiology 2006. All rights reserved.

Published
2006

26. Long-term benefits of an early invasive management in acute coronary syndromes depend on intracoronary stenting and aggressive antiplatelet treatment: A metaregression

Author

Biondi-Zoccai, G. G. L., Abbate, Antonio, Agostoni, P., Testa, L., Burzotta, Francesco, Lotrionte, Marzia, Trani, Carlo, Biasucci, Luigi Marzio, Abbate A., Burzotta F. (ORCID:0000-0002-6569-9401), Lotrionte M., Trani C. (ORCID:0000-0001-9777-013X), Biasucci L. M. (ORCID:0000-0002-6921-6497), Biondi-Zoccai, G. G. L., Abbate, Antonio, Agostoni, P., Testa, L., Burzotta, Francesco, Lotrionte, Marzia, Trani, Carlo, Biasucci, Luigi Marzio, Abbate A., Burzotta F. (ORCID:0000-0002-6569-9401), Lotrionte M., Trani C. (ORCID:0000-0001-9777-013X), and Biasucci L. M. (ORCID:0000-0002-6921-6497)

Abstract

Background: Although recent data support an early invasive management in acute coronary syndromes (ACS), overall evidence appears conflicting. We performed a metaregression to explore the impact of intracoronary stenting and aggressive antiplatelet treatment on the risk/benefit ratio of an early invasive approach. Methods: We searched several databases up to March 2004 for randomized trials comparing an early invasive versus delayed invasive or conservative management in ACS. Random-effects odds ratios were computed for death and/or myocardial infarction at the longest follow-up. Log (odds ratios) were tested for interaction with stenting and aggressive antiplatelet treatment (ie, glycoprotein IIb/IIIa inhibitors or thienopyridines in addition to aspirin). Results: Ten trials (9990 patients, median follow-up 12 months) were pooled. Overall, an early invasive management was associated with significantly reduced rates of death or myocardial infarction (P =. 01). Metaregression analysis showed that the 2 most significant predictors of the benefits of an early invasive strategy in patients with ACS on event-free survival were the use, in subjects managed invasively, of aggressive antiplatelet treatment (P =. 005) and stenting (P =. 011). Moreover, both stenting and aggressive antiplatelet treatment were significantly associated with reduced mortality (respectively, P =. 014 and P =. 009) and correlated to each other (r = 0.76, P =. 010). Conclusions: This study shows that the benefits of an early invasive approach in patients with ACS are significantly associated with concomitant aggressive antiplatelet treatment and stenting. These findings thus suggest the overall superiority of an early invasive approach in ACS, as long as state-of-the-art therapies are implemented. © 2005, Elsevier Inc. All rights reserved.

Published
2005

27. Poster session V * Saturday 11 December 2010, 08:30-12:30

Author

Pham, Q. H., primary, Von Lueder, T. G., additional, Namtvedt, S. K., additional, Rosjo, H., additional, Omland, T., additional, Steine, K., additional, Timoteo, A. T., additional, Mota Carmo, M., additional, Simoes, M., additional, Branco, L. M., additional, Ferreira, R. C., additional, Kato, R., additional, Ito, J., additional, Tahara, T., additional, Yokoyama, Y., additional, Ashikaga, T., additional, Satoh, Y., additional, Na, J. O., additional, Hong, H. E., additional, Kim, M. N., additional, Shin, S. Y., additional, Choi, C. U., additional, Kim, E. J., additional, Rha, S. W., additional, Park, C. G., additional, Seo, H. S., additional, Oh, D. J., additional, Ticulescu, R., additional, Brigido, S., additional, Vriz, O., additional, Sparacino, L., additional, Popescu, B. A., additional, Ginghina, C., additional, Carerj, S., additional, Nicolosi, G. L., additional, Antonini-Canterin, F., additional, Onaindia Gandarias, J. J., additional, Romero, A., additional, Laraudogoitia, E., additional, Velasco, S., additional, Quintana, O., additional, Cacicedo, A., additional, Rodriguez, I., additional, Alarcon, J. A., additional, Gonzalez, J., additional, Lekuona, I., additional, Subinas, A., additional, Abdula, G., additional, Lund, L. H., additional, Winter, R., additional, Brodin, L., additional, Sahlen, A., additional, Masaki, M., additional, Cha, Y. M., additional, Yuasa, T., additional, Dong, K., additional, Dong, Y. X., additional, Mankad, S. V., additional, Oh, J. K., additional, Vallet, F., additional, Lequeux, B., additional, Diakov, C., additional, Sosner, P., additional, Christiaens, L., additional, Coisne, D., additional, Kihara, C., additional, Murata, K., additional, Wada, Y., additional, Uchida, K., additional, Ueyama, T., additional, Okuda, S., additional, Susa, T., additional, Matsuzaki, M., additional, Cho, E. J., additional, Choi, K. Y., additional, Kwon, B. J., additional, Kim, D. B., additional, Jang, S. W., additional, Cho, J. S., additional, Jung, H. O., additional, Jeon, H. K., additional, Youn, H. J., additional, Kim, J. H., additional, Cikes, M., additional, Bijnens, B., additional, Velagic, V., additional, Kopjar, T., additional, Milicic, D., additional, Biocina, B., additional, Gasparovic, H., additional, Almuntaser, I., additional, Brown, A., additional, Foley, B., additional, Mulvihill, N., additional, Crean, P., additional, King, G., additional, Murphy, R., additional, Takata, Y., additional, Taniguchi, M., additional, Nobusada, S., additional, Sugawara, M., additional, Toh, N., additional, Kusano, K., additional, Itoh, H., additional, Wellnhofer, E., additional, Kriatselis, C., additional, Nedios, S., additional, Gerds-Li, J. H., additional, Fleck, E., additional, Poulsen, M. K., additional, Henriksen, J. E., additional, Dahl, J., additional, Johansen, A., additional, Haghfelt, T., additional, Hoilund-Carlsen, P. F., additional, Beck-Nielsen, H., additional, Moller, J. E., additional, Dankowski, R., additional, Wierzchowiecki, M., additional, Michalski, M., additional, Nowicka, A., additional, Szymanowska, K., additional, Pajak, A., additional, Poprawski, K., additional, Szyszka, A., additional, Kasner, M., additional, Westermann, D., additional, Schultheiss, H. P., additional, Tschoepe, C., additional, Watanabe, T., additional, Iwai-Takano, M., additional, Kobayashi, A., additional, Machii, H., additional, Takeishi, Y., additional, Paelinck, B. P., additional, Van Herck, P. L., additional, Bosmans, J. M., additional, Vrints, C. J., additional, Lamb, H. J., additional, Doltra, A., additional, Vidal, B., additional, Silva, E., additional, Poyatos, S., additional, Mont, L., additional, Berruezo, A., additional, Castel, A., additional, Tolosana, J. M., additional, Brugada, J., additional, Sitges, M., additional, Dencker, M., additional, Bjorgell, O., additional, Hlebowicz, J., additional, Szelenyi, Z. S., additional, Szenasi, G., additional, Kiss, M., additional, Prohaszka, Z., additional, Patocs, A., additional, Karadi, I., additional, Vereckei, A., additional, Saha, S. K., additional, Anderson, P. L., additional, Govind, S., additional, Govindan, M., additional, Moggridge, J. C., additional, Kiotsekoglou, A., additional, Gopal, A. S., additional, Loegstrup, B. B., additional, Christophersen, T. B., additional, Hoefsten, D. E., additional, Moeller, J. E., additional, Boetker, H. E., additional, Egstrup, K., additional, Graefe, M., additional, Huang, F. Q., additional, Zhang, R. S., additional, Le, T. T., additional, Tan, R. S., additional, Sattarzadeh Badkoubeh, R., additional, Tavoosi, A., additional, Elahian, A. R., additional, Drapkina, O., additional, Ivashkin, V. I., additional, Fazakas, A., additional, Pepo, L., additional, Janosi, O., additional, Kopitovic, I., additional, Goncalves, A., additional, Marcos-Alberca, P., additional, Almeria, C., additional, Feltes, G., additional, Rodriguez, E., additional, Garcia, E., additional, Hernandez-Antolin, R., additional, Macaya, C., additional, Silva Cardoso, J., additional, Zamorano, J. L., additional, Navarro, M. S., additional, Valentin, M., additional, Banes, C. M., additional, Rigo, F., additional, Grolla, E., additional, Tona, F., additional, Cuaia, V., additional, Moreo, A., additional, Badano, L., additional, Raviele, A., additional, Iliceto, S., additional, Tarzia, P., additional, Sestito, A., additional, Nerla, R., additional, Di Monaco, A., additional, Infusino, F., additional, Matera, D., additional, Greco, F., additional, Tacchino, R. M., additional, Lanza, G. A., additional, Crea, F., additional, Nemes, A., additional, Balazs, E., additional, Pinter, K. S., additional, Egyed, A., additional, Csanady, M., additional, Forster, T., additional, Holte, E., additional, Vegsundvag, J., additional, Hole, T., additional, Hegbom, K., additional, Wiseth, R., additional, Sharif, D., additional, Sharif-Rasslan, A., additional, Shahla, C., additional, Khalil, A., additional, Rosenschein, U., additional, Zagatina, A., additional, Zhuravskaya, N., additional, Tyurina, T. V., additional, Tagliamonte, E., additional, Cirillo, T., additional, Coppola, A., additional, Marinelli, U., additional, Romano, C., additional, Riccio, G., additional, Citro, R., additional, Astarita, C., additional, Capuano, N., additional, Quaranta, G., additional, Desiderio, A., additional, Frattini, S., additional, Faggiano, P., additional, Zilioli, V., additional, Locantore, E., additional, Longhi, S., additional, Bellandi, F., additional, Faden, G., additional, Triggiani, M., additional, Dei Cas, L., additional, Dalsgaard, M., additional, Kjaergaard, J., additional, Iversen, K., additional, Hassager, C., additional, Dinh, W., additional, Nickl, W. N., additional, Smettan, J. S., additional, Koehler, T. K., additional, Scheffold, T. D., additional, Coll Barroso, M. C. B., additional, Guelker, J. G., additional, Fueth, R. F., additional, Kamperidis, V., additional, Hadjimiltiades, S., additional, Sianos, G., additional, Efthimiadis, G., additional, Karvounis, H., additional, Parcharidis, G., additional, Styliadis, I. H., additional, Velasco Del Castillo, M. S., additional, Onaindia, J. J., additional, Telleria, M., additional, Carstensen, H. G., additional, Nordenberg, C., additional, Sogaard, P., additional, Fritz-Hansen, T., additional, Bech, J., additional, Galatius, S., additional, Jensen, J. S., additional, Mogelvang, R., additional, Bartko, P. E., additional, Graf, S., additional, Rosenhek, R., additional, Burwash, I. G., additional, Bergler-Klein, J., additional, Clavel, M.-A., additional, Baumgartner, H., additional, Pibarot, P., additional, Mundigler, G., additional, Kirilmaz, B., additional, Eser, I., additional, Tuzun, N., additional, Komur, B., additional, Dogan, H., additional, Taskiran Comez, A., additional, Ercan, E., additional, Cusma-Piccione, M., additional, Zito, C., additional, Oreto, G., additional, Piluso, S., additional, Tripepi, S., additional, Oreto, L., additional, Longordo, C., additional, Ciraci, L., additional, Di Bella, G., additional, Piatkowski, R., additional, Kochanowski, J., additional, Scislo, P., additional, Grabowski, M., additional, Marchel, M., additional, Roik, M., additional, Kosior, D., additional, Opolski, G., additional, Sknouril, L., additional, Dorda, M., additional, Holek, B., additional, Gajdusek, L., additional, Chovancik, J., additional, Branny, M., additional, Fiala, M., additional, Szymanski, P., additional, Lipczynska, M., additional, Klisiewicz, A., additional, Hoffman, P., additional, Jander, N., additional, Minners, J., additional, Martin, G., additional, Zeh, W., additional, Allgeier, M., additional, Gohlke-Baewolf, C., additional, Gohlke, H., additional, Nistri, S., additional, Porciani, M. C., additional, Attanasio, M., additional, Abbate, R., additional, Gensini, G. F., additional, Pepe, G., additional, Duncan, R. F., additional, Piantadosi, C., additional, Nelson, A. J., additional, Wittert, G., additional, Dundon, B., additional, Worthley, M. I., additional, Worthley, S. G., additional, Jung, P., additional, Berlinger, K., additional, Rieber, J., additional, Sohn, H. Z., additional, Schneider, P., additional, Leibig, M., additional, Koenig, A., additional, Klauss, V., additional, Tomkiewicz-Pajak, L., additional, Kolcz, J., additional, Olszowska, M., additional, Pieculewicz, M., additional, Podolec, P., additional, Przewlocki, T., additional, Suchon, E., additional, Sobien, B., additional, Wilkolek, P., additional, Ziembicka, A., additional, Hlawaty, M., additional, Van De Bruaene, A., additional, Hermans, H., additional, Buys, R., additional, Vanhees, L., additional, Delcroix, M., additional, Voigt, J.-U., additional, Budts, W., additional, De Cillis, E., additional, Acquaviva, T., additional, Basile, D., additional, Bortone, A. 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Published
2010
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34. The rough guide to systematic reviews and meta-analyses.

Author

Biondi-Zoccai, G., Lotrionte, M., Landoni, G., and Modena, M. G.

Subjects
SYSTEMATIC reviews, META-analysis, REGRESSION analysis, CLINICAL trials
Abstract

The hierarchy of evidence based medicine postulates that systematic reviews of homogenous randomized trials represent one of the uppermost levels of clinical evidence. Indeed, the current overwhelming role of systematic reviews, meta-analyses and meta-regression analyses in evidence based heath care calls for a thorough knowledge of the pros and cons of these study designs, even for the busy clinician. Despite this sore need, few succinct but thorough resources are available to guide users or would-be authors of systematic reviews. This article provides a rough guide to reading and, summarily, designing and conducting systematic reviews and meta-analyses. [ABSTRACT FROM AUTHOR]

Published
2011

39. Poster session Thursday 12 December - AM: 12/12/2013, 08:30-12:30 * Location: Poster area

Author

Abdovic, E, Abdovic, S, Hristova, K, Hristova, K, Katova, TZ, Katova, TZ, Gocheva, N, Gocheva, N, Pavlova, M, Pavlova, M, Gurzun, M M, Ionescu, A, Canpolat, U, Yorgun, H, Sunman, H, Sahiner, L, Kaya, EB, Ozer, N, Tokgozoglu, L, Kabakci, G, Aytemir, K, Oto, A, Gonella, A, Dascenzo, F, Casasso, F, Conte, E, Margaria, F, Grosso Marra, W, Frea, S, Morello, M, Bobbio, M, Gaita, F, Seo, HY, Lee, SP, Lee, JM, Yoon, YE, Park, E, Kim, HK, Park, SJ, Lee, H, Kim, YJ, Sohn, DW, Nemes, A, Domsik, P, Kalapos, A, Orosz, A, Lengyel, C, Forster, T, Enache, R, Muraru, D, Popescu, BA, Calin, A, Nastase, O, Botezatu, D, Purcarea, F, Rosca, M, Beladan, CC, Ginghina, C, Canpolat, U, Aytemir, K, Ozer, N, Yorgun, H, Sahiner, L, Kaya, EB, Oto, A, Trial, Turkish Atrial Fibrosis, Muraru, D, Piasentini, E, Mihaila, S, Padayattil Jose, S, Peluso, D, Ucci, L, Naso, P, Puma, L, Iliceto, S, Badano, LP, Cikes, M, Jakus, N, Sutherland, GR, Haemers, P, Dhooge, J, Claus, P, Yurdakul, S, Oner, FATMA, Direskeneli, HANER, Sahin, TAYLAN, Cengiz, BETUL, Ercan, G, Bozkurt, AYSEN, Aytekin, SAIDE, Osa Saez, A M, Rodriguez-Serrano, M, Lopez-Vilella, R, Buendia-Fuentes, F, Domingo-Valero, D, Quesada-Carmona, A, Miro-Palau, VE, Arnau-Vives, MA, Palencia-Perez, M, Rueda-Soriano, J, Lipczynska, M, Piotr Szymanski, PS, Anna Klisiewicz, AK, Lukasz Mazurkiewicz, LM, Piotr Hoffman, PH, Kim, KH, Cho, SK, Ahn, Y, Jeong, MH, Cho, JG, Park, JC, Chinali, M, Franceschini, A, Matteucci, MC, Doyon, A, Esposito, C, Del Pasqua, A, Rinelli, G, Schaefer, F, group, the 4C study, Kowalik, E, Klisiewicz, A, Rybicka, J, Szymanski, P, Biernacka, EK, Hoffman, P, Lee, S, Kim, W, Yun, H, Jung, L, Kim, E, Ko, J, Ruddox, V, Norum, IB, Edvardsen, T, Baekkevar, M, Otterstad, JE, Erdei, T, Edwards, J, Braim, D, Yousef, Z, Fraser, AG, Cardiff, Investigators, MEDIA, Melcher, A, Reiner, B, Hansen, A, Strandberg, LE, Caidahl, K, Wellnhofer, E, Kriatselis, C, Gerd-Li, H, Furundzija, V, Thnabalasingam, U, Fleck, E, Graefe, M, Park, YJ, Moon, JG, Ahn, TH, Baydar, O, Kadriye Kilickesmez, KK, Ugur Coskun, UC, Polat Canbolat, PC, Veysel Oktay, VO, Umit Yasar Sinan, US, Okay Abaci, OA, Cuneyt Kocas, CK, Sinan Uner, SU, Serdar Kucukoglu, SK, Ferferieva, V, Claus, P, Rademakers, F, Dhooge, J, Le, T T, Wong, P, Tee, N, Huang, F, Tan, RS, Altman, M, Logeart, D, Bergerot, C, Gellen, B, Pare, C, Gerard, S, Sirol, M, Vicaut, E, Mercadier, JJ, Derumeaux, G A, investigators, PREGICA, Park, T-H, Park, J-I, Shin, S-W, Yun, S-H, Lee, J-E, Makavos, G, Kouris, N, Keramida, K, Dagre, A, Ntarladimas, I, Kostopoulos, V, Damaskos, D, Olympios, CD, Leong, DP, Piers, SRD, Hoogslag, GE, Hoke, U, Thijssen, J, Ajmone Marsan, N, Schalij, MJ, Bax, JJ, Zeppenfeld, K, Delgado, V, Rio, P, Branco, L, Galrinho, A, Cacela, D, Abreu, J, Timoteo, A, Teixeira, P, Pereira-Da-Silva, T, Selas, M, Cruz Ferreira, R, Popa, B A, Zamfir, L, Novelli, E, Lanzillo, G, Karazanishvili, L, Musica, G, Stelian, E, Benea, D, Diena, M, Cerin, G, Fusini, L, Mirea, O, Tamborini, G, Muratori, M, Gripari, P, Ghulam Ali, S, Cefalu, C, Maffessanti, F, Andreini, D, Pepi, M, Mamdoo, F, Goncalves, A, Peters, F, Matioda, H, Govender, S, Dos Santos, C, Essop, MR, Kuznetsov, V A, Yaroslavskaya, E I, Pushkarev, G S, Krinochkin, D V, Kolunin, G V, Bennadji, A, Hascoet, S, Dulac, Y, Hadeed, K, Peyre, M, Ricco, L, Clement, L, Acar, P, Ding, WH, Zhao, Y, Lindqvist, P, Nilson, J, Winter, R, Holmgren, A, Ruck, A, Henein, MY, Illatopa, V, Cordova, F, Espinoza, D, Ortega, J, Cavalcante, JL, Patel, MT, Katz, W, Schindler, J, Crock, F, Khanna, MK, Khandhar, S, Tsuruta, H, Kohsaka, S, Murata, M, Yasuda, R, Tokuda, H, Kawamura, A, Maekawa, Y, Hayashida, K, Fukuda, K, Le Tourneau, T, Kyndt, F, Lecointe, S, Duval, D, Rimbert, A, Merot, J, Trochu, JN, Probst, V, Le Marec, H, Schott, JJ, Veronesi, F, Addetia, K, Corsi, C, Lamberti, C, Lang, RM, Mor-Avi, V, Gjerdalen, G F, Hisdal, J, Solberg, EE, Andersen, TE, Radunovic, Z, Steine, K, Maffessanti, F, Gripari, P, Tamborini, G, Muratori, M, Fusini, L, Ferrari, C, Caiani, EG, Alamanni, F, Bartorelli, AL, Pepi, M, Dascenzi, F, Cameli, M, Iadanza, A, Lisi, M, Reccia, R, Curci, V, Sinicropi, G, Henein, M, Pierli, C, Mondillo, S, Rekhraj, S, Hoole, SP, Mcnab, DC, Densem, CG, Boyd, J, Parker, K, Shapiro, LM, Rana, BS, Kotrc, M, Vandendriessche, T, Bartunek, J, Claeys, MJ, Vanderheyden, M, Paelinck, B, De Bock, D, De Maeyer, C, Vrints, C, Penicka, M, Silveira, C, Albuquerque, ESA, Lamprea, DL, Larangeiras, VL, Moreira, CRPM, Victor Filho, MVF, Alencar, BMA, Silveira, AQMS, Castillo, JMDC, Zambon, E, Iorio, A, Carriere, C, Pantano, A, Barbati, G, Bobbo, M, Abate, E, Pinamonti, B, Di Lenarda, A, Sinagra, G, Salemi, V M C, Tavares, L, Ferreira Filho, JCA, Oliveira, AM, Pessoa, FG, Ramires, F, Fernandes, F, Mady, C, Cavarretta, E, Lotrionte, M, Abbate, A, Mezzaroma, E, De Marco, E, Peruzzi, M, Loperfido, F, Biondi-Zoccai, G, Frati, G, Palazzoni, G, Park, T-H, Lee, J-E, Lee, D-H, Park, J-S, Park, K, Kim, M-H, Kim, Y-D, Van T Sant, J, Gathier, WA, Leenders, GE, Meine, M, Doevendans, PA, Cramer, MJ, Poyhonen, P, Kivisto, S, Holmstrom, M, Hanninen, H, Schnell, F, Betancur, J, Daudin, M, Simon, A, Carre, F, Tavard, F, Hernandez, A, Garreau, M, Donal, E, Calore, C, Muraru, D, Badano, LP, Melacini, P, Mihaila, S, Denas, G, Naso, P, Casablanca, S, Santi, F, Iliceto, S, Aggeli, C, Venieri, E, Felekos, I, Anastasakis, A, Ritsatos, K, Kakiouzi, V, Kastellanos, S, Cutajar, I, Stefanadis, C, Palecek, T, Honzikova, J, Poupetova, H, Vlaskova, H, Kuchynka, P, Linhart, A, Elmasry, O, Mohamed, MH, Elguindy, WM, Bishara, PNI, Garcia-Gonzalez, P, Cozar-Santiago, P, Bochard-Villanueva, B, Fabregat-Andres, O, Cubillos-Arango, A, Valle-Munoz, A, Ferrer-Rebolleda, J, Paya-Serrano, R, Estornell-Erill, J, Ridocci-Soriano, F, Jensen, M, Havndrup, O, Christiansen, M, Andersen, PS, Axelsson, A, Kober, L, Bundgaard, H, Karapinar, H, Kaya, A, Uysal, EB, Guven, AS, Kucukdurmaz, Z, Oflaz, MB, Deveci, K, Sancakdar, E, Gul, I, Yilmaz, A, Tigen, M K, Karaahmet, T, Dundar, C, Yalcinsoy, M, Tasar, O, Bulut, M, Takir, M, Akkaya, E, Jedrzejewska, I, Braksator, W, Krol, W, Swiatowiec, A, Dluzniewski, M, Lipari, P, Bonapace, S, Zenari, L, Valbusa, F, Rossi, A, Lanzoni, L, Molon, G, Canali, G, Campopiano, E, Barbieri, E, Rueda Calle, E, Alfaro Rubio, F, Gomez Gonzalez, J, Gonzalez Santos, P, Cameli, M, Lisi, M, Focardi, M, Dascenzi, F, Solari, M, Galderisi, M, Mondillo, S, Pratali, L, Bruno, R M, Corciu, AI, Comassi, M, Passera, M, Gastaldelli, A, Mrakic-Sposta, S, Vezzoli, A, Picano, E, Perry, R, Penhall, A, De Pasquale, C, Selvanayagam, J, Joseph, M, Simova, I I, Katova, T M, Kostova, V, Hristova, K, Lalov, I, Dascenzi, F, Pelliccia, A, Natali, BM, Cameli, M, Alvino, F, Zorzi, A, Corrado, D, Bonifazi, M, Mondillo, S, Rees, E, Rakebrandt, F, Rees, DA, Halcox, JP, Fraser, AG, Odriscoll, J, Lau, N, Perez-Lopez, M, Sharma, R, Lichodziejewska, B, Goliszek, S, Kurnicka, K, Kostrubiec, M, Dzikowska Diduch, O, Krupa, M, Grudzka, K, Ciurzynski, M, Palczewski, P, Pruszczyk, P, Gheorghe, LL, Castillo Ortiz, J, Del Pozo Contreras, R, Calle Perez, G, Sancho Jaldon, M, Cabeza Lainez, P, Vazquez Garcia, R, Fernandez Garcia, P, Chueca Gonzalez, E, Arana Granados, R, Zhao, XX, Xu, XD, Bai, Y, Qin, YW, Leren, IS, Hasselberg, NE, Saberniak, J, Leren, TP, Edvardsen, T, Haugaa, KH, Daraban, A M, Sutherland, GR, Claus, P, Werner, B, Gewillig, M, Voigt, JU, Santoro, A, Ierano, P, De Stefano, F, Esposito, R, De Palma, D, Ippolito, R, Tufano, A, Galderisi, M, Costa, R, Fischer, C, Rodrigues, A, Monaco, C, Lira Filho, E, Vieira, M, Cordovil, A, Oliveira, E, Mohry, S, Gaudron, P, Niemann, M, Herrmann, S, Strotmann, J, Beer, M, Hu, K, Bijnens, B, Ertl, G, Weidemann, F, Baktir, AO, Sarli, B, Cicek, M, Karakas, MS, Saglam, H, Arinc, H, Akil, MA, Kaya, H, Ertas, F, Bilik, MZ, Yildiz, A, Oylumlu, M, Acet, H, Aydin, M, Yuksel, M, Alan, S, Odriscoll, J, Gravina, A, Di Fino, S, Thompson, M, Karthigelasingham, A, Ray, K, Sharma, R, De 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Munoz, DA, Moya Mur, JL, Becker Filho, D, Gonzalez, A, Casas Rojo, E, Garcia Martin, A, Recio Vazquez, M, Rincon, LM, Fernandez Golfin, C, Zamorano Gomez, JL, Ledakowicz-Polak, A, Polak, L, Zielinska, M, Kamiyama, T, Nakade, T, Nakamura, Y, Ando, T, Kirimura, M, Inoue, Y, Sasaki, O, Nishioka, T, Farouk, H, Sakr, B, Elchilali, K, Said, K, Sorour, K, Salah, H, Mahmoud, G, Casanova Rodriguez, C, Cano Carrizal, R, Iglesias Del Valle, D, Martin Penato Molina, A, Garcia Garcia, A, Prieto Moriche, E, Alvarez Rubio, J, De Juan Bagua, J, Tejero Romero, C, Plaza Perez, I, Korlou, P, Stefanidis, A, Mpikakis, N, Ikonomidis, I, Anastasiadis, S, Komninos, K, Nikoloudi, P, Margos, P, and Pentzeridis, P

Abstract

Purpose: Atrial fibrillation (AF) is the most prevalent sustained arrhythmia. It is a disease of the elderly and it is common in patients (pts) with structural heart disease. Hypertension (HA), hypertensive heart disease (HHD), diabetes mellitus (DM), coronary artery disease (CAD), heart failure (HF), and valvular heart disease (VHD) are recognized predisposing factors to AF. Objectives: To echocardiographicly disclose the most common predisposing morbidities to AF in our population sample. Methods: From June 2000 to February 2013, 3755 consecutive pts with AF were studied during echocardiographic check-up. According to transthoracic echo, pts were divided in groups based on dominative underlying heart diseases. Electrocardiographically documented AF was subdivided in two groups: transitory and chronic. Transitory AF fulfilled criteria for paroxysmal or persistent AF. Chronic AF were cases of long-standing persistent or permanent AF. Results: The median age was 72 years, age range between 16 and 96 years. There were 51.4% of females. Chronic AF was observed in 68.3% pts. Distribution of underlying heart diseases is shown in figure. Lone AF was diagnosed in only 25 pts, mostly in younger males (median age 48 years, range 29–59, men 80%). Chronic AF was predominant in groups with advanced cardiac remodeling such as dilatative cardiomyopaty (DCM) and VHD, mostly in elderly. HA and DM were found in 75.4% and 18.8%, respectively. Almost 1/2 of pts with AF had HF and 59.2% had diastolic HF. Conclusion: Up to now, echocardiographic categorization of the predisposing factors to AF was not reported. Echocardiographic evaluation of patients with AF could facilitate in identification and well-timed treatment of predisposing comorbidites. Figure Etiological distribution of AF

Published
2013
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40. Clinical activity and cardiac tolerability of non-pegylated liposomal doxorubicin in breast cancer: a synthetic review

Author

Mario Airoldi, Dino Amadori, Sandro Barni, Saverio Cinieri, Sabino De Placido, Angelo Di Leo, Alessandra Gennari, Stefano Iacobelli, Maria Teresa Ionta, Vito Lorusso, Marzia Lotrionte, Paolo Marchetti, Rodolfo Mattioli, Giorgio Minotti, Paolo Pronzato, Giovanni Rosti, Carlo Alberto Tondini, Andrea Veronesi, Airoldi, M., Amadori, D., Barni, S., Cinieri, S., DE PLACIDO, Sabino, Di Leo, A., Gennari, A., Iacobelli, S., Ionta, M. T., Lorusso, V., Lotrionte, M., Marchetti, P., Mattioli, R., Minotti, G., Pronzato, P., Rosti, G., Tondini, C. A., and Veronesi, A.

Subjects
Cancer Research, Antibiotics, Antineoplastic, Heart Diseases, Breast Neoplasms, Heart, General Medicine, breast cancer, non-pegylated liposomal doxorubicin, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Treatment Outcome, 0302 clinical medicine, Oncology, Doxorubicin, Predictive Value of Tests, Risk Factors, 030220 oncology & carcinogenesis, Liposomes, Humans, Female
Abstract

Anthracycline-containing regimens have demonstrated significant disease-free and overall survival benefits in the adjuvant setting and also provide palliative benefit in metastatic disease. . Over the past two decades, an increasing proportion of patients have been exposed to adjuvant anthracyclines with concomitant reduction in their use for palliation, as a result of concerns regarding efficacy and cumulative anthracycline-associated cardiotoxicity, as well as the availability of other systemic chemotherapeutic options. This report reflects the consensus view of a meeting of oncologists, pharmacologists and cardiologists held in Florence, Italy, on April 30, 2010. The objectives of the meeting were to review the role and limits of conventional anthracyclines in the treatment of breast cancer, to provide recommendations for the use of novel anthracycline formulations, such as non-pegylated liposomal doxorubicin (NPLD), and to identify potential future indications for NPLD that warrant further research.

Published
2011

41. Impaired coronary and myocardial flow in severe aortic stenosis is associated with invreased apoptosis: a transthoracic Doppler and myocardial contrast echocardiography study

Author

Giuseppe Biondi-Zoccai, Gianfederico Possati, F. Crea, Antonio Abbate, F De Giorgio, Mario Gaudino, George W. Vetrovec, Alfonso Baldi, Marzia Lotrionte, Leonarda Galiuto, Feliciano Baldi, Amedeo Anselmi, Galiuto, L, Lotrionte, M, Crea, F, Anselmi, A, BIONDI ZOCCAI, Gg, DE GIORGIO, F, Baldi, Alfonso, Baldi, F, Possati, G, Gaudino, M, Vetrovec, Gw, and Abbate, A.

Subjects
Male, medicine.medical_specialty, myocardial flow, Diastole, apoptosis, aortic stenosis, Cardiovascular Medicine, Doppler echocardiography, Coronary circulation, Coronary Circulation, Internal medicine, medicine, Humans, Myocytes, Cardiac, Aged, Pressure overload, medicine.diagnostic_test, business.industry, Microcirculation, Aortic Valve Stenosis, medicine.disease, Echocardiography, Doppler, Stenosis, medicine.anatomical_structure, Echocardiography, Aortic valve stenosis, Heart failure, Circulatory system, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Blood Flow Velocity
Abstract

Objective: To test the hypothesis that impaired coronary and myocardial blood flow are linked with increased myocyte apoptosis, thus establishing a link between pressure overload and left ventricular (LV) remodelling. Methods and results: Peak diastolic coronary blood flow velocity (CBFV) was evaluated at transthoracic Doppler echocardiography, and signal intensity (SI) and the rate of SI rise (β) were measured at myocardial contrast echocardiography in 11 patients with severe aortic stenosis and LV hypertrophy. In the same patients, biopsies were obtained from the anterolateral LV free wall during surgery and analysed for cardiomyocyte apoptosis. LV mass corrected CBFV (CBFVI) was significantly lower in patients than in controls (median 0.100 cm·g/s (interquartile range 0.07–0.115) v 0.130 cm·g/s (0.130–0.160), p = 0.002). Similarly, SI*β was significantly lower in patients than in controls (11 1/s (8–66) v 83 1/s (73–95), p = 0.001). Apoptotic rate was increased in aortic stenosis more than 100-fold versus controls (1.2% (0.8–1.4) v 0.01% (0.01–0.01), p r = −0.77, p = 0.001 for both). Conclusions: Patients with severe aortic stenosis and LV hypertrophy have impaired myocardial perfusion, which is associated with enhanced cardiomyocyte apoptosis. Impaired myocardial perfusion and the ensuing oxygen demand–supply imbalance may, at least partially, be responsible for increased apoptosis and possible transition to heart failure, thus establishing a link between pressure overload, LV remodelling, and heart failure.

Published
2005

42. Acetylsalicylic acid challenge or desensitization in sensitive patients with cardiovascular disease.

Author

Cortellini G, Raiteri A, Galli M, Lotrionte M, Piscaglia F, and Romano A

Subjects
Humans, Aspirin adverse effects, Platelet Aggregation Inhibitors adverse effects, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Cardiovascular Diseases drug therapy, Acute Coronary Syndrome drug therapy, Anaphylaxis chemically induced, Percutaneous Coronary Intervention, Drug Hypersensitivity therapy, Drug Hypersensitivity drug therapy, Angioedema chemically induced, Angioedema drug therapy, Atherosclerosis drug therapy
Abstract

The use of acetylsalicylic acid (ASA) is problematic in subjects with histories of hypersensitivity reactions (HRs) to it or with cross-reactive types of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity. We sought to evaluate the efficacy of low-dose ASA challenge (LDAC) and desensitization to allow ASA therapy at an antiplatelet dose in patients with atherosclerotic cardiovascular disease (ASCVD) or multiple related risk factors and histories of HRs to ASA or ≥ 2 chemically unrelated NSAIDs. We studied prospectively all patients with such histories and ≥ 3 risk factors for ASCVD (group I), chronic coronary syndrome (CCS, group II), and acute coronary syndrome (ACS) with indication for ASA desensitization (group III). Patients from groups I and II underwent LDACs (cumulative dose of 110 mg), while those from group III were desensitized (cumulative dose of 100.1 mg). We evaluated 103 patients: 62 from group I, 24 from group II, and 17 from group III. Eighty-two of the 86 patients from the first two groups underwent LDACs and 2 reacted. Subsequently, 22 (27.5%) of the 80 patients with negative LDACs were administered dual antiplatelet therapy with ASA after successful percutaneous coronary interventions, thus sparing desensitizations. The remaining 4 patients with CCS and all 17 patients from group III were successfully desensitized. In this pragmatic study, LDAC proved to be a safe and reliable diagnostic tool for identifying patients with histories of HRs to ASA or ≥ 2 different NSAIDs who can tolerate ASA at antiplatelet doses. Routine LDAC is advisable in all patients at high risk for ASCVD or with CCS who report HRs to ASA or ≥ 2 NSAIDs. ASA desensitization remains a safe and effective option in patients with ACS. Study flow-chart. ASCVD atherosclerotic cardiovascular disease; CCS chronic coronary syndrome; ACS acute coronary syndrome; ASA acetylsalicylic acid; DAPT dual antiplatelet therapy; PCI percutaneous coronary intervention; NSAIDs nonsteroidal anti-inflammatory drugs; NERD NSAID-exacerbated respiratory disease; NECD NSAID-exacerbated cutaneous disease; NIUAA NSAID-induced urticaria-angioedema or anaphylaxis; SNIUAA single NSAID-induced urticaria-angioedema or anaphylaxis; SNIDHR single NSAID-induced delayed hypersensitivity reaction., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Published
2023
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43. Comparative safety and effectiveness of coronary computed tomography: Systematic review and meta-analysis including 11 randomized controlled trials and 19,957 patients.

Author

Nudi F, Lotrionte M, Biasucci LM, Peruzzi M, Marullo AGM, Frati G, Valenti V, Giordano A, and Biondi-Zoccai G

Subjects
Coronary Angiography adverse effects, Coronary Artery Disease mortality, Humans, Mortality trends, Randomized Controlled Trials as Topic methods, Tomography, X-Ray Computed adverse effects, Treatment Outcome, Coronary Angiography standards, Coronary Artery Disease diagnostic imaging, Randomized Controlled Trials as Topic standards, Tomography, X-Ray Computed standards
Abstract

Background/objectives: The clinical approach to suspected or established coronary artery disease (CAD) has been revolutionized in the last few decades by coronary computed tomography (coroCT). Yet, uncertainty persists on its comparative diagnostic and clinical effectiveness. We conducted a systematic review on randomized controlled trials (RCTs) of coroCT., Methods: We searched RCTs in PubMed and The Cochrane Library, extracting as outcomes of interest long-term rates of death, myocardial infarction, revascularization, and invasive coronary angiography. Effects were estimated with risk ratios (RR) and 95% confidence intervals., Results: A total of 11 trials were included, with 19,957 patients followed for a median of 6months. One trial focused on screening, 3 on stable CAD, and 7 on acute CAD. Meta-analysis showed that coroCT was associated with a trend toward fewer deaths or myocardial infarctions (RR=0.84 [0.70-1.01]) whereas no significant difference was found for the risk of death (RR=0.91 [0.71-1.18]). Conversely, the risk of myocardial infarction tended to be lower with coroCT at the overall analysis (RR=0.77 [0.59-1.02]), and this effect reached statistical significance in studies focusing on subjects with stable CAD (RR=0.69 [0.49-0.99]). These potential benefits were offset (or mediated) by a significant albeit modest increase in the need for invasive angiography (RR=1.36 [1.08-1.72]), and ensuing coronary revascularization (RR=1.76 [1.29-2.40])., Conclusions: According to the current evidence base, coroCT is associated with an increased usage of invasive angiography and coronary revascularization when compared to standard of care, with possible benefits on nonfatal myocardial infarction, but without significant benefits on death or the composite of death or myocardial infarction., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Published
2016
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44. Which Aspirin Dose and Preparation Is Best for the Long-Term Prevention of Cardiovascular Disease and Cancer? Evidence From a Systematic Review and Network Meta-Analysis.

Author

Lotrionte M, Biasucci LM, Peruzzi M, Frati G, Giordano A, and Biondi-Zoccai G

Subjects
Anticarcinogenic Agents adverse effects, Aspirin adverse effects, Cardiovascular Agents adverse effects, Cardiovascular Diseases mortality, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Compounding, Evidence-Based Medicine, Gastrointestinal Hemorrhage chemically induced, Humans, Intracranial Hemorrhages chemically induced, Neoplasms mortality, Network Meta-Analysis, Odds Ratio, Risk Assessment, Risk Factors, Treatment Outcome, Anticarcinogenic Agents administration & dosage, Aspirin administration & dosage, Cardiovascular Agents administration & dosage, Cardiovascular Diseases prevention & control, Neoplasms prevention & control, Primary Prevention methods
Abstract

The evidence base on aspirin in primary prevention suggests that it can reduce significantly the risk of cardiovascular disease (CVD) events and cancer, especially colorectal, albeit increasing bleeding. There is, however, uncertainty on the optimal aspirin dose and preparation for primary prevention. We thus aimed to review main sources of evidence informing on daily dosage and preparation of aspirin for primary prevention of CVD and cancer. We collected and elaborated aspirin effectiveness and safety data from U.S. Preventive Services Task Force reports on aspirin in primary prevention, distinguishing average daily dose in <100mg, 100mg, and >100mg. The following preparations were also systematically compared: enteric coated, controlled release, non-coated, or otherwise unspecified. Fixed-effect pairwise and network meta-analytic models were run in a frequentist framework. Eleven randomized trials were shortlisted, enrolling 104,101 subjects, followed for a median of 60months. At pairwise analysis, aspirin was associated with significant reductions in death and CVD events, non-significant reductions in cancer death or incidence, and significant increases in the risk of intracranial and gastrointestinal (GI) bleeding. An average daily dose of 100mg had the highest probability of reducing death, cancer death, and cancer incidence, whereas higher doses seemed superior for reducing CVD events, and 100mg or less daily proved better tolerated. Coated preparations appeared more beneficial for death, cancer death, cancer incidence, and GI bleeding, whereas controlled release preparations appeared better for CVD events and non-coated ones for intracranial bleeding. In conclusion, an average daily dose of 100mg of coated aspirin seems more likely to confer favorable preventive effects on death and cancer, with higher doses more appealing for CVD prevention and lower doses better tolerated., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Published
2016
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46. State of the Art on the Evidence Base in Cardiac Regenerative Therapy: Overview of 41 Systematic Reviews.

Author

Peruzzi M, De Falco E, Abbate A, Biondi-Zoccai G, Chimenti I, Lotrionte M, Benedetto U, Delewi R, Marullo AG, and Frati G

Subjects
Humans, Cardiovascular Diseases therapy, Cell- and Tissue-Based Therapy, Regenerative Medicine
Abstract

Objectives: To provide a comprehensive appraisal of the evidence from secondary research on cardiac regenerative therapy., Study Design and Setting: Overview of systematic reviews of controlled clinical trials concerning stem cell administration or mobilization in patients with cardiovascular disease., Results: After a systematic database search, we short-listed 41 reviews (660 patients). Twenty-two (54%) reviews focused on acute myocardial infarction (AMI), 19 (46%) on chronic ischemic heart disease (IHD) or heart failure (HF), 29 (71%) on bone marrow-derived stem-cells (BMSC), and 36 (88%) to randomized trials only. Substantial variability among reviews was found for validity (AMSTAR score: median 9 [minimum 3]; 1st quartile 9; 3rd quartile 10; maximum 11), effect estimates (change in ejection fraction from baseline to follow-up: 3.47% [0.02%; 2.90%; 4.22%; 6.11%]), and citations (Web of Science yearly citations: 4.1 [0; 2.2; 6.5; 68.9]). No significant association was found between these three features. However, reviews focusing on BMSC therapy had higher validity scores (P = 0.008) and showed more pronounced effect estimates (P = 0.002). Higher citations were associated with journal impact factor (P = 0.007), corresponding author from North America/Europe (P = 0.022), and inclusion of nonrandomized trials (P = 0.046)., Conclusions: Substantial heterogeneity is apparent among these reviews in terms of quality and effect estimates.

Published
2015
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47. Nephropathy after administration of iso-osmolar and low-osmolar contrast media: evidence from a network meta-analysis.

Author

Biondi-Zoccai G, Lotrionte M, Thomsen HS, Romagnoli E, D'Ascenzo F, Giordano A, and Frati G

Subjects
Bayes Theorem, Contrast Media chemistry, Humans, Osmolar Concentration, Randomized Controlled Trials as Topic, Contrast Media adverse effects, Kidney Diseases chemically induced, Triiodobenzoic Acids adverse effects
Abstract

Background/objectives: Contrast-induced nephropathy (CIN) may be a severe complication to the administration of iodine-based contrast media for diagnostic or interventional procedure using radiation exposure. Whether there is a difference in nephrotoxic potential between the various agents is uncertain. We aimed to perform a systematic review and network meta-analysis of randomized trials on iodine-based contrast agents., Methods: Randomized trials of low-osmolar or iso-osmolar contrast media were searched in CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus. Risk of CIN was appraised within a hierarchical Bayesian model computing absolute rates (AR) and odds ratios (OR) with 95% credibility intervals, and probability of being best (Pbest) for each agent., Results: A total of 42 trials (10048 patients) were included focusing on 7 different iodine-based contrast media. Risk of CIN was similarly low with iodixanol (AR=5.7% [2.2%-13.9%], Pbest=18.8%), iomeprol (AR=6.0% [2.2%-15.4%], Pbest=24.8%), iopamidol (AR=6.1% [2.2%-15.5%], Pbest=21.5%), and ioversol (AR=6.0% [2.1%-16.4%], Pbest=31.3%). Conversely, CIN was twice as common with iohexol (AR=11.2% [4.1%-29.5%], Pbest=0.1%) and ioxaglate (AR=11.0% [4.0%-26.9%], Pbest<0.1%), with both proving less safe than iodixanol (respectively OR=2.18 [1.22-3.92] and 2.05 [1.26-3.29]), iomeprol (OR=2.08 [1.04-4.17] and 1.96 [1.06-3.48]) and iopamidol (OR=2.04 [1.15-3.85] and 1.92 [1.06-3.45]). Data on iopromide were less conclusive (AR=6.9% [2.6%-17.1%], Pbest=3.6%)., Conclusions: Iodixanol, iomeprol, iopamidol and ioversol are iodine-based contrast media with a similar renal safety profile. Iohexol and ioxaglate have a poorer renal safety profile, whereas further data may be required on iopromide., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Published
2014
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48. Review and meta-analysis of incidence and clinical predictors of anthracycline cardiotoxicity.

Author

Lotrionte M, Biondi-Zoccai G, Abbate A, Lanzetta G, D'Ascenzo F, Malavasi V, Peruzzi M, Frati G, and Palazzoni G

Subjects
Comorbidity, Doxorubicin adverse effects, Humans, Incidence, Neoplasms epidemiology, Risk Factors, Anthracyclines adverse effects, Antibiotics, Antineoplastic adverse effects, Heart drug effects, Neoplasms drug therapy
Abstract

The management of individual patients requiring anthracyclines remains challenging because uncertainty persists on predictors of cardiotoxicity. We aimed to perform a systematic review and meta-analysis on incidence and predictors of anthracycline chemotherapy in patients with cancer. Databases were searched for pertinent studies. Meta-analytic pooling with random-effects methods was performed for incidence estimates, while relying on descriptive statistics for prevalence and strength of association of predictors. From 16,054 retrieved citations, 18 studies reporting on 49,017 patients with cancer were included, with 22,815 treated with anthracyclines. After a median follow-up of 9 years, clinically overt cardiotoxicity occurred in 6% (95% confidence interval 3% to 9%), whereas subclinical cardiotoxicity developed in 18% (95% confidence interval 12% to 24%). Appraisal of independent risk factors of cardiotoxicity showed that cumulative anthracycline dose was most consistently reported as an accurate and robust predictor of cardiotoxicity, with an acceptable prognostic role also for chest radiotherapy, African-American ethnicity, very young or very old age, diabetes, hypertension, very high or very low body weight, or severe co-morbidities. In conclusion, despite ongoing refinements in chemotherapy regimens, anthracyclines still pose a significant risk of cardiotoxicity, especially in those requiring a high cumulative dose or chest radiotherapy., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Published
2013
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49. Temporal changes in standard and tissue Doppler imaging echocardiographic parameters after anthracycline chemotherapy in women with breast cancer.

Author

Lotrionte M, Cavarretta E, Abbate A, Mezzaroma E, De Marco E, Di Persio S, Loperfido F, Biondi-Zoccai G, Frati G, and Palazzoni G

Subjects
Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Cyclophosphamide administration & dosage, Docetaxel, Doxorubicin administration & dosage, Female, Fluorouracil administration & dosage, Heart Diseases chemically induced, Heart Diseases diagnostic imaging, Humans, Middle Aged, Prospective Studies, Stroke Volume, Taxoids administration & dosage, Time Factors, Ventricular Dysfunction, Left diagnostic imaging, Breast Neoplasms drug therapy, Doxorubicin adverse effects, Echocardiography, Doppler, Ventricular Dysfunction, Left chemically induced
Abstract

Anthracyclines are established cardiotoxic agents; however, the exact extent and time course of such cardiotoxicity has not been appraised in detail. We aimed to exploit serial measurements of standard and tissue Doppler imaging (TDI) echocardiographic parameters collected in a prospective clinical trial to clarify the outlook of cardiac function during and long after anthracycline chemotherapy. Women enrolled in a randomized trial focusing on liposomal doxorubicin-based chemotherapy for breast cancer and providing ≥4 separate echocardiographic assessments were included. Repeat-measure nonparametric analyses were used to appraise changes over time in the standard and tissue Doppler imaging echocardiographic parameters. A total of 39 patients with serial imaging evaluations were enrolled. Significant temporal changes were found for the left ventricular ejection fraction and diastolic parameters, despite different temporal trends. Specifically, the left ventricular ejection fraction exhibited a V-shaped trend, decreasing initially from 63% to 61% but then recovering to 64% (p <0.001), with a similar trend in the TDI E/Em ratio (p = 0.011). In contrast, persistent impairments typical of an L-shaped trend were found for the E wave (p = 0.006), TDI lateral Em wave (p = 0.001), and TDI septal Em wave (p = 0.001). In conclusion, subclinical temporal changes in the standard and TDI echocardiographic parameters after anthracycline chemotherapy showed a distinctive pattern of transient impairment followed by full recovery of the left ventricular ejection fraction versus a persistent impairment of the diastolic parameters, which must be taken into account in the everyday treatment of such patients., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Published
2013
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