Mascioli G.,Cliniche Humanitas Gavazzeni |
Curnis A.,Spedali Civili di Brescia |
Landolina M.,IRCSS Fondazione Policlinico San Matteo |
Klersy C.,Biometry and Statistic Service |
And 2 more authors.
Europace | Year: 2011
AimThe number of cardiac implantable electronic devices (CIEDs) is continuously growing and this translates into a high number of in-hospital follow-ups. This workload justifies the increasing popularity of remote monitoring systems for the follow-up of CIEDs. The ATHENS registry was designed to find out what actions are taken during in-hospital follow-up of CIEDs at 10 different centres in Northern Italy. Methods and resultsBetween 1 March 2010 and 30 June 2010, all patients who came to our centres for a follow-up of their CIEDs were enrolled in the registry. We defined as visit with an action (VWA) a follow-up that elicited an action in that patient. The primary endpoint was the prevalence of VWA on the whole population. The secondary endpoints were: prevalence of VWA on the pacemaker (PM) population; prevalence of VWA on the implantable cardioverter defibrillator (ICD) population; prevalence of VWA on the cardiac resynchronization therapy (CRT) population; predictors of VWA in univariate and multivariate analyses. A total of 3362 patients were recruited. The primary endpoint was reached in 762 patients, 22.8 of patients (95 CI 21.424.3). The prevalence of action was highest for CRT (29.8), followed by PM (22.8) and ICD (18.6). In a multivariate model, the prevalence of action was higher for CRT, than for PM and was lowest for ICD and it was higher for unscheduled visits and first visits than for scheduled visits. ConclusionsOur registry demonstrates that 'some actions' are taken during about 20 of scheduled in-hospital follow-up of CIEDs. These data should encourage the use of remote follow-up systems. © 2011 The Author.
Fiorino C.,San Raffaele Scientific Institute |
Rancati T.,Fondazione IRCCS Instituto Nazionale Dei Tumori |
Fellin G.,Ospedale Santa Chiara |
Vavassori V.,Cliniche Humanitas Gavazzeni |
And 8 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012
Purpose: To model late fecal incontinence after high-dose prostate cancer radiotherapy (RT) in patients accrued in the AIROPROS (prostate working group of the Italian Association of Radiation Oncology) 0102 trial using different endpoint definitions. Methods and Materials: The self-reported questionnaires (before RT, 1 month after RT, and every 6 months for ≤3 years after RT) of 586 patients were available. The peak incontinence (P-INC) and two longitudinal definitions (chronic incontinence [C-INC], defined as the persistence of Grade 1 or greater incontinence after any Grade 2-3 event; and mean incontinence score [M-INC], defined as the average score during the 3-year period after RT) were considered. The correlation between the clinical/dosimetric parameters (including rectal dose-volume histograms) and P-INC (Grade 2 or greater), C-INC, and M-INC of ≥1 were investigated using multivariate logistic analyses. Receiver operating characteristic curves and the area under the curve were used to assess the predictive value of the different multivariate models. Results: Of the 586 patients, 36 with a Grade 1 or greater incontinence score before RT were not included in the present analysis. Of the 550 included patients, 197 (35.8%) had at least one control with a Grade 1 or greater incontinence score (M-INC >0). Of these 197 patients, 37 (6.7%), 22 (4.0%), and 17 (3.1%) were scored as having P-INC, M-INC ≥1, and C-INC, respectively. On multivariate analysis, Grade 2 or greater acute incontinence was the only predictor of P-INC (odds ratio [OR], 5.9; p =.0009). Grade 3 acute incontinence was predictive of C-INC (OR, 9.4; p =.02), and percentage of the rectal volume receiving >40 Gy of ≥80% was predictive of a M-INC of ≥1 (OR, 3.8; p =.008) and of C-INC (OR, 3.6; p =.03). Previous bowel disease, previous abdominal/pelvic surgery, and the use of antihypertensive (protective factor) correlated highly with both C-INC and M-INC ≥1. The predictive values of the models for C-INC (area under the curve, 0.83) and M-INC ≥1 (area under the curve, 0.73) were greater than the ones for P-INC (area under the curve, 0.62) and more reliable (p =.0001-.0003 against p =.02). Nomograms for the two longitudinal definitions were derived. Conclusions: The longitudinal definitions of fecal incontinence (C-INC and M-INC ≥1) were helpful in accounting for both the persistence and the severity of the incontinence. A significant fraction of peak events was consequential to acute incontinence, and a longer duration of symptoms mainly depended on the rectal dose bath (percentage of rectal volume receiving >40 Gy), and pretreatment clinical factors. © 2012 Elsevier Inc. All rights reserved.
PubMed | Cliniche Humanitas Gavazzeni, Albert Ludwigs University of Freiburg, Cardiovascular Clinic Bad Neustadt, University of Bologna and 8 more.
Type: Journal Article | Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery | Year: 2016
The study was conducted to evaluate, on the basis of a multicentre analysis, current results of elective open aortic arch surgery performed during the last decade.Data of 1232 consecutive patients who underwent aortic arch repair with reimplantation of at least one supra-aortic artery between 2004 and 2013 were collected from 11 European cardiovascular centres, and retrospective statistical examination was performed using uni- and multi-variable analyses to identify predictors for 30-day mortality. Acute aortic dissections and arch surgeries not involving the supra-aortic arteries were not included.Arch repair involving all 3 arch arteries (total), 2 arch arteries (subtotal) or 1 arch artery (partial) was performed in 956 (77.6%), 155 (12.6%) and 121 (9.8%) patients, respectively. The patients characteristics as well as the surgical techniques, including the method of cannulation, perfusion and protection, varied considerably between the clinics participating in the study. The in-hospital and 30-day mortality rates were 11.4 and 8.8% for the entire cohort, respectively, ranging between 1.7 and 19.0% in the surgical centres. Multivariable logistic regression analysis identified surgical centre, patients age, number of previous surgeries with sternotomy and concomitant surgeries as independent risk factors of 30-day mortality. The follow-up of the study group was 96.5% complete with an overall follow-up duration of 3.3 2.9 years, resulting in 4020 patient-years. After hospital discharge, 176 (14.3%) patients died, yielding an overall mortality rate of 25.6%. The actuarial survival after 5 and 8 years was 72.0 1.5% and 64.0 2.0, respectively.The surgical risk in elective aortic arch surgery has remained high during the last decade despite the advance in surgical techniques. However, the patients characteristics, numbers of surgeries, the techniques and the results varied considerably among the centres. The incompleteness of data gathered retrospectively was not effective enough to determine advantages of particular cannulation, perfusion, protection or surgical techniques; and therefore, we strongly recommend further prospective multicentre studies, preferably registries, in which all relevant data have to be clearly defined and collected.
Paoletti Perini A.,University of Florence |
Bartolini S.,University of Florence |
Pieragnoli P.,University of Florence |
Ricciardi G.,University of Florence |
And 9 more authors.
Europace | Year: 2014
AimsCHADS2 and CHA2DS2-VASc scores are pivotal in assessing the risk of stroke in atrial fibrillation patients, and were recently proved to predict hospitalizations and mortality in specific clinical settings. Aim of this study was to evaluate whether these scores could predict clinical outcomes [first hospitalization for heart failure (HF) and a combined event of HF hospitalization and death for any cause] in patients candidates to cardiac resynchronization therapy and implantable defibrillator (CRT-D).Methods and resultsIn a retrospective multicentre Italian study, we enrolled 559 consecutive HF patients candidates to CRT-D, and we grouped them in three pre-specified risk classes: low (CHADS2/CHA2DS 2-VASc 1-2), moderate (CHADS2/CHA2DS 2-VASc 3-4), and high (CHADS2 5-6/CHA2DS 2-VASc 5-8). All patients underwent regular follow-up at implanting centres every 6 months; data collection was extended till the 72th month of follow-up. At a median FU of 30 months, 143 patients (25.4%) were hospitalized for HF and 110 (19.5%) died. Event-free survival analysis showed a significant difference according to baseline CHADS2 and CHA2DS 2-VASc scores (Log-Rank for HF P < 0.001 for CHADS2 and CHA2DS2-VASc; Log-Rank for combined end-point P = 0.001 for CHADS2, P < 0.001 for CHA2DS2-VASc). At multivariate analysis, independent predictors of endpoints were: previous atrial fibrillation (AF) or AF at implant, NYHA class, QRS duration and the CHA 2DS2-VASc score (for HF hospitalization P = 0.013; for the combined event, P = 0.007), while the CHADS2 score was not independently associated with either the end-points.ConclusionIn CRT-D patients, pre-implant CHA2DS2-VASc score is an independent predictor of major clinical events at 30-month follow-up. © 2013 The Author.
Mascioli G.,Cliniche Humanitas Gavazzeni |
Padeletti L.,University of Florence |
Sassone B.,Ospedale Bentivoglio |
Zecchin M.,Ospedali Riuniti |
And 8 more authors.
PACE - Pacing and Clinical Electrophysiology | Year: 2012
Background: Cardiac resynchronization therapy (CRT) has proved to be very effective in improving morbidity and mortality in patients affected with severe congestive heart failure. Its efficacy has been shown to be greater in patients with left bundle branch block (LBBB). The aim of our study was to verify if newly proposed criteria for true LBBB identify patients with a better clinical and instrumental response to CRT. Methods: Between May 2007 and April 2011, 111 patients with left ventricular ejection fraction (LVEF) ≤ 35% and LBBB morphology received a CRT device and were divided into two groups according to QRS morphology. Group 1 (61 patients) consisted of patients with LBBB morphology; group 2 (50 patients) consisted of patients with LBBB. The primary endpoint was the utility of criteria for true LBBB to predict a composite endpoint of all-cause mortality and hospital admission with heart failure. The secondary endpoint was the utility of the same criteria to predict an absolute increase in LVEF ≥ 10%. Results: LBBB morphology and a dose of bisoprolol <5 mg at last follow-up were the only parameters related to clinical outcome in multivariate analysis (respectively: hazard ratio [HR] 3.98, confidence interval [CI] 95% 1.51-10.48; HR 0.15, CI 95% 0.05-0.43). LBBB morphology was the only variable significantly related to a greater increase in LVEF (HR 4.57, CI 95% 1.36-8.28). Conclusion: True LBBB morphology is related to a higher event-free survival rate in CRT patients and better echocardiographic response. (PACE 2012; 35:927-934) © 2012 Wiley Periodicals, Inc.
PubMed | S Anna And S Sebastiano Hospital, University of Florence, Cliniche Humanitas Gavazzeni and University of Siena
Type: | Journal: International journal of cardiology | Year: 2016
Many trials demonstrated the beneficial effects on hospitalizations and mortality of cardiac resynchronization therapy (CRT). The purpose of this study was to evaluate CRT effects on functional performance and cognition, two determinants of disability, frailty development and survival.All consecutive patients receiving a CRT device were evaluated at baseline and at the 6-month follow-up. Functional profile was assessed with the Short Physical Performance Battery (SPPB), a measure exploring balance, gait, strength and endurance, highly predictive of incident disability and mortality. The Mini-Mental State Examination (MMSE) was used to study the cognitive profile.We enrolled 54 patients; two of them died during the follow-up, two refused to continue the study. Age was 6710years (men: 80%, LVEF: 285%); medical therapy was optimized (ACE-I/ARB: 84%, beta-blockers: 80%). After 6months, CRT was associated with the improvement of LVEF (358 vs. 285%, p<0.001) and NYHA Class (1.80.6 vs. 2.60.5, p<0.001), and with the reduction of left ventricular end-systolic diameter (509 vs. 579mm, p<0.001). SPPB improved in its total score (10.32.0 vs. 9.12.7, p<0.001) and in the scores exploring gait speed and strength and endurance. These changes were associated with a better cognitive profile (MMSE score: 27.03.5 vs. 25.94.8, p=0.009). Advanced age was an independent predictor of improved functional performance and cognition.CRT is associated with higher functional and cognitive profile after only 6months of therapy. These findings let us hypothesize a powerful effect of treatment to slow disability and frailty development in heart failure.
[Nephron sparing surgery in renal cell carcinoma: our experience of a 20-year clinical practice]. [Nephron sparing surgery nei tumori del rene: nostra esperienza relativa a 20 anni di pratica clinica.]
Pace G.,Cliniche Humanitas Gavazzeni
Urologia | Year: 2013
Nephron sparing surgery (NSS) is now considered the standard of care in the treatment of renal cell carcinoma (RCC) in stage T1. We retrospectively evaluated our results related to the use of NSS in over twenty years of clinical practice. We reviewed our database relating to the use of NSS in the last twenty years of clinical practice, from 1988 to July 2012, in 549 patients. The pre- and post-operative parameters recorded are the evaluation of the site and size of the renal lesion obtained from radiological investigations, the need for clamping the renal pedicle, open or laparoscopic surgical approach, blood loss, histology and intra- and postoperative complications. We also evaluated the parameters related to renal function before and after surgery. The mean follow-up was 95 months (7.6 years). The average diameter of the lesion at CT abdomen was 4.8 cm (1-8 cm). The warm ischemia was required in 317 patients, cold in 18 patients, no need for ischemia in 214 patients. The total duration of surgery was 122.56 ± 52.76 min. 15 procedures were performed laparoscopically. Ischemia time: 3'-25'; bleeding: 50-1000 cc. The lesion was benign in 115 of the 549 patients enrolled; it was a RCC in the remaining cases except for three, which were papillary carcinomas. At 5 years, the cancer free survival rate was 97.5%. Our data show that the implementation of NSS offers long-term benefits in terms of functional results and a good cancer control.
Troisi N.,Cliniche Humanitas Gavazzeni |
Esposito G.,Cliniche Humanitas Gavazzeni |
Cefal P.,Cliniche Humanitas Gavazzeni |
Setti M.,Cliniche Humanitas Gavazzeni
Journal of Vascular Surgery | Year: 2011
Inferior mesenteric artery aneurysms are very rare and they are among the rarest of visceral artery aneurysms. Sometimes, the distribution of the blood flow due to chronic atherosclerotic occlusion of some arteries can establish an increased flow into a particular supplying district (high flow state). A high flow state in a stenotic inferior mesenteric artery in compensation for a mesenteric occlusive disease can produce a rare form of aneurysm. We report the case of an atherosclerotic inferior mesenteric aneurysm secondary to high flow state (association with occlusion of the celiac trunk and severe stenosis of the superior mesenteric artery), treated by open surgical approach. © 2011 Society for Vascular Surgery.
Ceresoli G.L.,Cliniche Humanitas Gavazzeni |
Zucali P.A.,Humanitas Cancer Center
Cancer Treatment Reviews | Year: 2015
Therapeutic options for malignant pleural mesothelioma (MPM) are limited. Most patients are treated with chemotherapy during the course of their disease. The combination of pemetrexed with a platinum compound is the standard of care in the first-line setting, while no established treatment exists in the second and beyond-line setting. Vinca alkaloids are chemotherapeutic agents that have demonstrated clinical efficacy both as single agents and in combination in a broad spectrum of cancers, including MPM. Vinorelbine has shown activity in MPM patients as neoadiuvant therapy, first-line treatment, and in the second and third-line setting. Vinflunine is a derivative of vinorelbine that has been studied in MPM as first-line agent. While the role of vinca alkaloids in the first-line treatment of MPM seems marginal, treatment with vinorelbine remains a reasonable option for pemetrexed-pretreated patients in clinical practice, based on an acceptable rate of stable disease, confirmed by several trials. Ongoing studies on predictive biomarkers for vinorelbine will hopefully be able to individualize treatment, increasing response rates and survival outcomes. © 2015 Elsevier Ltd.
PubMed | Cliniche Humanitas Gavazzeni
Type: Journal Article | Journal: Pacing and clinical electrophysiology : PACE | Year: 2016
Patients with atrial fibrillation (AF) have an increased thromboembolic risk that can be estimated with risk scores and sometimes require oral anticoagulation therapy (OAT). Despite correct anticoagulation, some patients still develop left atrial spontaneous echo contrast (SEC) or thrombosis. The value of traditional risk scores (RThe aim of our study was to explore variables linked to severe SEC or atrial thrombosis and evaluate the performance of traditional risk scores in identifying these patients. In order to do this, we retrospectively analyzed 568 patients with nonvalvular nonparoxysmal AF who underwent electrical cardioversion from January 2011 to December 2016 after OAT for a minimum of 4 weeks. A transesophageal echocardiogram was performed in 265 patients for various indications, and 24 exhibited left atrial SEC or thrombosis. Female gender, history of heart failure or left ventricular ejection fraction <40%, and high levels (>1 mg/dL) of C-reactive protein (CRP) were independently associated with left atrial SEC/thrombosis. A score composed by these factors (denominated HIS [Heart Failure, Inflammation, and female Sex]) showed a sensitivity of 79% and a specificity of 60% (area under receiver operating characteristic curve 0.695, P = 0.002) in identifying patients with a positive transesophageal echo; traditional risk scores did not perform as well.In patients with persistent AF and suboptimal anticoagulation, a risk score composed by history of heart failure, high CRP, and female gender identifies patients at high risk of left atrial SEC/thrombosis when its value is >1.