Fondazione Toscana G. Monasterio

Pisa, Italy

Fondazione Toscana G. Monasterio

Pisa, Italy
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Cantinotti M.,Fondazione Toscana G. Monasterio | Law Y.,University of Washington | Vittorini S.,Fondazione Toscana G. Monasterio | Crocetti M.,Fondazione Toscana G. Monasterio | And 4 more authors.
Heart Failure Reviews | Year: 2014

The aim of this article is to review the diagnostic and prognostic relevance of measurement of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in pediatric patients with heart failure caused by various acquired and congenital heart diseases (CHD). In January 2013, we performed a computerized literature search in the National Library of Medicine (PubMed access to MEDLINE citations; The search strategy included a mix of Medical Subject Headings and free-text terms for the key concepts, starting from BNP assay and ‘NT-proBNP assay’, children, CHD. The search was further refined by adding the keywords neonate/s, newborn/s, heart failure, cardiomyopathy, screening, prognosis, follow-up, and management. BNP values are age and method dependent, even in pediatric populations. Regardless of age, there is great variability in BNP/NT-proBNP values within CHD characterized by different hemodynamic and clinical conditions. There is enough evidence to support the use of BNP/NT-proBNP as an adjunctive marker in the integrated evaluation of patients with congenital and acquired heart disease to help define severity and progression of heart failure as well in the monitoring of response to treatment. BNP/NT-proBNP can also be used for the screening of heart failure and as a prognostic marker in children undergoing cardiac surgery; however, to date, there are studies with heterogeneous patient groups, and diverse outcome measures selected are still few. BNP/NT-proBNP can be used as adjunctive markers in the integrated screening, diagnosis, management, and follow-up of children with heart failure caused by various acquired and congenital heart disease. © 2014, Springer Science+Business Media New York.

Cantinotti M.,Fondazione Toscana G. Monasterio | Scalese M.,CNR Institute of Clinical Physiology | Molinaro S.,CNR Institute of Clinical Physiology | Murzi B.,Fondazione Toscana G. Monasterio | And 2 more authors.
Journal of the American Society of Echocardiography | Year: 2012

An echocardiographic quantitative evaluation of the cardiac and vascular structures is often of critical importance for the diagnosis and management of congenital heart diseases. The authors reviewed the accuracy and limits of published echocardiographic nomograms for cardiac chamber, valve, and main vessel dimensions in children, with special attention to the neonatal age group. A computerized literature search in the National Library of Medicine using the keywords "echocardiographic normal/references values ± children/neonates/newborns" was performed. The research was redefined adding separately the keywords "aortic valve/annulus," "aortic arch," "atrio-ventricular valve/annulus," "left ventricle," "mitral valve/annulus," "pulmonary valve/annulus," "pulmonary artery," and "tricuspid valve/annulus." The analysis highlights the accuracy of the latest studies but also underscores that some limitations remain. In many studies, the number of healthy subjects was limited, with poor differentiation among age subgroups, and neonates were fully investigated in a very limited number of studies; moreover, data for many cardiac structures were not numerous, especially for the aortic arch and pulmonary branches. Finally, several methodologic limitations were encountered, including the lack of standardization, the different types of body size measurements used for normalization, and the various ways to express normalized data. As a result, nomograms were heterogeneous and although for some cardiac structures provided comparable confidence intervals, for others showed widely different values. The lack of solid, standardized nomograms, based on a large set of healthy children, may affect accuracy in estimating the severity of defects, especially in neonates, and possibly introduce bias in the clinical decision-making process. © 2012 by the American Society of Echocardiography.

Cantinotti M.,Fondazione Toscana G. Monasterio | Lopez L.,Childrens Hospital at Montefiore
Journal of the American Society of Echocardiography | Year: 2013

Interest in diastolic function in children has increased recently. However, the strengths and limitations of published pediatric nomograms for echocardiographic diastolic parameters have not been critically evaluated, especially in the neonatal population. A literature search was performed within the National Library of Medicine using the keywords normal/reference values, power Doppler/tissue Doppler velocities, and children/neonates. The search was further refined by adding the keywords diastolic function, myocardial, mitral/tricuspid inflow, pulmonary vein, and Tei index. Thirty-three published studies evaluating diastolic function in normal children were included in this review. In many studies, sample sizes were limited, particularly in terms of neonates. There was heterogeneity in the methodologies to perform and normalize measurements and to express normalized data (Z scores, percentiles, and mean values). Although most studies adjusted measurements for age, classification by specific age subgroups varied, and few addressed the relationships of measurements to body size and heart rate (especially with higher neonatal heart rates). Although reference values were reproducible in older children, they varied significantly in neonates and infants. Pediatric diastolic nomograms are limited by small sample sizes and inconsistent methodologies for the performance and normalization of measurements, with few data on neonates. Some studies do reveal reproducible patterns in diastolic function in older children. A comprehensive pediatric nomogram of diastolic function involving a large population of normal infants and older children and using standardized methodology is warranted and would have tremendous impact in the care of children with acquired and congenital heart disease. Copyright 2013 by the American Society of Echocardiography.

Del Turco S.,CNR Institute of Neuroscience | Basta G.,CNR Institute of Neuroscience | Lazzerini G.,CNR Institute of Neuroscience | Chancharme L.,Institute Of Recherches Internationales Servier | And 3 more authors.
Vascular Pharmacology | Year: 2014

Background: Thromboxane (TX) A2, prostaglandin endoperoxides and F2-isoprostanes exert their effects through a TX-prostanoid (TP) receptor, also expressed in endothelial cells. We investigated a role of the TP receptor in the endothelial expression of tissue factor (TF), a key trigger to thrombosis. Methods and results: Human umbilical vein endothelial cells (HUVEC) exposed to the TP receptor agonist U46619 featured a concentration-dependent increase in TF surface exposure and procoagulant activity. HUVEC pre-incubation with the TP receptor antagonist S18886, followed by stimulation with either U46619 or tumor necrosis factor-α (TNF-α), attenuated TF surface exposure and activity compared with stimulated control. Aspirin or indomethacin, while inhibiting cyclooxygenase (COX)-1 and -2 activities, did not mimic this effect. Probing of underlying mechanisms by selective pharmacological and gene silencing experiments showed that S18886 reduced U46619- or TNF-α-induced TF expression inhibiting ROS production, NAD(P)H oxidase and PKC activation. In addition, S18886 also inhibited ERK activation in the presence of both U46619 and TNF-α alone, while inhibition of JNK activation only occurred in the presence of U46619. Conclusion: The endothelial TP receptor contributes to TF surface exposure and activity induced not only by known TP receptor agonists, but also by TNF-α. Such findings expand the therapeutic potential of TP receptor inhibition. © 2014 Elsevier Inc.

Sironi A.M.,National Research Council Italy | Petz R.,National Research Council Italy | De Marchi D.,Fondazione Toscana G. Monasterio | Buzzigoli E.,National Research Council Italy | And 5 more authors.
Diabetic Medicine | Year: 2012

Objective Previous studies have highlighted the associations between abdominal, cardiac or total fat accumulation and cardiovascular disease. The aim of this study was to investigate the impact of different ectopic fat depots on measurements of metabolic dysfunction and cardiovascular disease risk. Methods Using magnetic resonance imaging in 113 subjects, we measured abdominal (visceral and subcutaneous) and cardiac (epicardial and extra-pericardial) fat depots and examined their association with overall (BMI) and abdominal obesity (waist circumference), dyslipidaemia (triglycerides, total and HDL cholesterol), glucose tolerance (by an oral glucose tolerance test) and insulin sensitivity, blood pressure and 10-year coronary heart disease risk by Framingham score. Results Fat accumulation was proportional to the degree of obesity, with body fat ranging from 14 to 33kg, visceral fat from 0.8 to 1.8kg and cardiac fat from 134 to 236g. Most cardiac fat (70% on average) was extra-pericardial, with a wide variability for both cardiac depots (epicardial: 172-2008mm 2; extra-pericardial: 100-5056mm 2). Only visceral and extra-pericardial fat, but not epicardial or subcutaneous fat, could discriminate between subjects with three or more factors of the metabolic syndrome or medium-to-high coronary heart disease risk score. Controlling for gender and BMI by multivariable analysis, the best marker of reduced insulin sensitivity was visceral fat (partial r=-0.35); extra-pericardial fat was the closest associate of increased blood pressure (partial r=0.26) and both extra-pericardial and visceral fat clustered with hypertriglyceridaemia (partial r=0.29 and 0.24; both P<0.02). Conclusion Increased epicardial fat per se does not necessarily translate into presence or prediction of disease. In contrast, increased deposition of visceral abdominal and extra-pericardial mediastinal fat are both associated with an enhanced cardiovascular disease risk profile. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

Frullini A.,Studio Medico Flebologico | Da Pozzo E.,University of Pisa | Felice F.,University of Pisa | Burchielli S.,Fondazione Toscana G. Monasterio | And 2 more authors.
Dermatologic Surgery | Year: 2014

The foam sclerotherapy technique has become one of the most commonly used treatments for superficial venous insufficiency. Despite excellent results, few visual/neurologic disturbances have been recently reported; their pathogenesis is still debated but a correlation with endothelin-1 (ET-1) release from the treated vein has been proposed. OBJECTIVE: The purpose of this work was to evaluate the ET-1 release after sclerotherapy and to investigate the effects of the anti-endothelin drug aminaphtone. METHODS AND MATERIALS: As in vitro sclerotherapy model, an endothelial cell culture, mimicking vascular endothelium, was pretreated with aminaphtone and exposed to detergents. Cell survival and ET-1 release were measured. In in vivo experiments, 45 rats, fed with different aminaphtone-rich diets, were subjected to sclerotherapy, and the systemic ET-1 was measured. RESULTS: Aminaphtone cell exposure caused a statistically significant reduction in ET-1 release, both before and after in vitro sclerotherapy. Rats fed with aminaphtone showed a trend toward reduced mortality and a significant decrease of ET-1 release after sclerotherapy. CONCLUSION: This is the first study in which an anti-endothelin agent was able to cause a significant reduction of ET-1 release during sclerotherapy. Although clinical studies are required, these findings might advocate the use of anti-endothelin agents in prophylaxis of neurologic or visual disturbances after sclerotherapy. © 2014 by the American Society for Dermatologic Surgery, Inc.

Gimelli A.,Fondazione Toscana G. Monasterio | Liga R.,University of Pisa | Pasanisi E.M.,Fondazione Toscana G. Monasterio | Giorgetti A.,Fondazione Toscana G. Monasterio | And 5 more authors.
European Heart Journal Cardiovascular Imaging | Year: 2014

Aims: To evaluate the relationships between measures of left ventricular (LV) filling dynamics at cadmium-zinc-telluride (CZT) imaging and indexes of LV diastolic function at transthoracic echocardiography. Methods and results: Two hundred and forty-seven patients underwent myocardial perfusion imaging at rest and after stress with a low-dose CZT protocol and a baseline transthoracic echocardiography study. All patients were submitted to invasive or computed coronary angiography. The peak filling rate (PFR) and the time to PFR (TPFR) were derived from gated CZT images as measures of LV filling dynamics. LV diastolic function was also evaluated at echocardiography and the presence of significantly increased LV filling pressures determined. Increased LV filling pressures at transthoracic echocardiography were evident in 103 (42%) patients. Interestingly, independently from the presence of coronary artery disease, therewasa strict correlation between the presence and severity of LV diastolic dysfunction at echocardiography and CZT-derived measures of filling dynamics, i.e. PFR (P = 0.001) and TPFR (P = 0.001). At receiving operating characteristic analysis, a composite index of reduced PFR (≤2.11 end-diastolic volumes -1) and increased TPFR (>234 ms) showed a sensitivity of 84% and a specificity of 67% in unmasking the presence of elevated LV filling pressures at echocardiography. Conclusions: CZT-derived measures of LV filling dynamics correlate with echocardiographic parameters of diastolic function and may identify the presence of increased LV filling pressures. © The Author 2014.

Miceli A.,Fondazione Toscana G. Monasterio | Miceli A.,Bristol Heart Institute | Santarpino G.,University of Bristol | Pfeiffer S.,University of Bristol | And 7 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2014

Objective The aim of our study was to evaluate the early outcomes and 1-year survival of patients undergoing minimally invasive aortic valve replacement with the Perceval S sutureless valve for severe aortic stenosis.© 2014 The American Association for Thoracic Surgery Methods From March 2010 to March 2013, 281 high-risk patients underwent minimally invasive aortic valve replacement with the Perceval S sutureless valve through either right anterior minithoracotomy (n = 164) or upper ministernotomy (n = 117) at 2 cardiac centers.Results The overall in-hospital mortality was 0.7% (2 patients). The overall median cardiopulmonary bypass and crossclamp time was 81 minutes (interquartile range, 68-98) and 48 minutes (interquartile range, 37-60), respectively. Postoperative stroke occurred in 5 patients (1.8%). The incidence of paravalvular leak greater than 1 of 4 and atrioventricular block requiring pacemaker implantation was 1.8% (5 patients) and 4.2% (12 patients), respectively. No migration occurred, and the mean postoperative gradient was 13 ± 4 mm Hg. At a median follow-up of 8 months (interquartile range, 4-14), the overall survival was 90%.Conclusions Minimally invasive aortic valve replacement with the Perceval S sutureless valve in high-risk patients is a safe and reproducible procedure associated with excellent hemodynamic results, postoperative outcomes, and 1-year survival.

Miceli A.,Fondazione Toscana G. Monasterio | Murzi M.,Fondazione Toscana G. Monasterio | Gilmanov D.,Fondazione Toscana G. Monasterio | Fuga R.,Fondazione Toscana G. Monasterio | And 3 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2014

Objective To compare the outcomes of right minithoracotomy (RT) versus ministernotomy (MS) in patients undergoing minimally invasive aortic valve replacement (AVR). Methods From January 2005 to December 2011, 406 patients underwent minimally invasive AVR, of whom 251 patients were in the RT group and 155 were in the MS group. Results The overall in-hospital mortality was 1.2% with no difference between the 2 groups (1.2% in RT vs 1.3% in MS). Patients undergoing minimally invasive AVR using RT had a lower incidence of postoperative atrial fibrillation (19.5% vs 34.2%, P =.01), shorter ventilation time (median, 7 vs 8 hours; interquartile range, 5-9 vs 6-12 hours, P =.003), intensive care unit stay (median 1 vs 1 day; interquartile range, 1-1 vs 1-2 days; P =.001), and hospital stay (median, 5 vs 6 days; interquartile range, 5-6 vs 5-8 days; P =.0001). No difference was found in terms of cardiopulmonary time, crossclamping time, postoperative stroke, re-exploration for bleeding, or blood transfusion. Conclusions Minimally invasive AVR using RT was associated with lower postoperative morbidities and a shorter hospital stay than MS. © 2014 by The American Association for Thoracic Surgery.

The thyroid and the cardiovascular system are closely related, both in physiological and pathological conditions. The adverse consequences on the heart of overt thyroid disease are well-known and even subclinical forms of both hyperthyroidism and hypothyroidism are associated with increased cardiovascular mortality. In recent years, attention has shifted towards milder forms of thyroid disease, such as the so-called "low T3 syndrome", which is characterized by an isolated reduction in circulating levels of the biologically active form of thyroid hormone, triiodothyronine (T3). Furthermore, variations of T3 within the physiological range have been linked to coronary artery disease, one of the leading causes of morbidity and mortality worldwide. The present manuscript provides an overview of thyroid physiology and pathophysiology, with a particular focus on cardiovascular disease in patients with milder forms of thyroid dysfunction. © 2013 by AVES Yayi{dotless}nc i{dotless}li{dotless}k Ltd.

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