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Cemin R.,San Maurizio Regional Hospital | Donazzan L.,San Maurizio Regional Hospital | Lippi G.,Clinical Chemistry Laboratory | Clari F.,San Maurizio Regional Hospital | Daves M.,Clinical Biochemical Laboratory
Clinical Chemistry and Laboratory Medicine | Year: 2011

Background: The aim of this study is to analyse the relation between red blood cells, platelets morphology and acute myocardial infarction (AMI), and to assess whether they could supplement the role of traditional cardiac biomarkers in the early identification of patients with AMI. Methods: All consecutive patients admitted to our emergency department between the 1st January and the 31st August 2009 due to chest pain of suspected cardiac origin were included in the study. All the patients underwent physical examination, a 12-lead ECG, blood sampling for determination of cardiac troponin I and a complete blood count. Results: A percentage of 6.7% of the 1971 patients had a confirmed diagnosis of AMI. Mean corpuscular volume (MCV), red blood cells distribution width (RDW) and platelets count (Plt) did not differ between patients with and without AMI. However, the mean platelet volume (MPV) was significantly higher in AMI patients (7.9 vs. 7.7 fL; p=0.0457). After stratification for gender, men with AMI displayed a lower RDW (p=0.0464) and a higher MPV (p=0.0062) as compared with those without AMI. The MCV and Plt were not significantly different. Women with AMI had a higher RDW (p=0.0079) as compared with those without AMI, while the MCV, Plt and MPV were not significantly different. Conclusions: Our study partially confirms previous data on the association between MPV or RDW and AMI. The inclusion of these parameters along with other conventional cardiac biomarkers might be a valuable perspective when evaluating patients with suspected AMI, although gender differences should be taken in account. © 2011 by Walter de Gruyter Berlin Boston.

Imazio M.,Maria Vittoria Hospital | Brucato A.,Ospedali Riuniti | Ferrazzi P.,Cardiac Surgery | Rovere M.E.,Cardiac Surgery | And 14 more authors.
Circulation | Year: 2011

Background-: Inflammation and pericarditis may be contributing factors for postoperative atrial fibrillation (POAF), and both are potentially affected by antiinflammatory drugs and colchicine, which has been shown to be safe and efficacious for the prevention of pericarditis and the postpericardiotomy syndrome (PPS). The aim of the Colchicine for the Prevention of the Post-Pericardiotomy Syndrome (COPPS) POAF substudy was to test the efficacy and safety of colchicine for the prevention of POAF after cardiac surgery. Methods and Results-: The COPPS POAF substudy included 336 patients (mean age, 65.7±12.3 years; 69% male) of the COPPS trial, a multicenter, double-blind, randomized trial. Substudy patients were in sinus rhythm before starting the intervention (placebo/colchicine 1.0 mg twice daily starting on postoperative day 3 followed by a maintenance dose of 0.5 mg twice daily for 1 month in patients ge;70 kg, halved doses for patients <70 kg or intolerant to the highest dose). The substudy primary end point was the incidence of POAF on intervention at 1 month. Despite well-balanced baseline characteristics, patients on colchicine had a reduced incidence of POAF (12.0% versus 22.0%, respectively; P=0.021; relative risk reduction, 45%; number needed to treat, 11) with a shorter in-hospital stay (9.4±3.7 versus 10.3±4.3 days; P=0.040) and rehabilitation stay (12.1±6.1 versus 13.9±6.5 days; P=0.009). Side effects were similar in the study groups. Conclusion-: Colchicine seems safe and efficacious in the reduction of POAF with the potentiality of halving the complication and reducing the hospital stay. Clinical Trial Registration-: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00128427. © 2011 American Heart Association, Inc.

Boriani G.,University of Bologna | Gasparini M.,Istituto | Landolina M.,Fondazione Policlinico S. Matteo | Lunati M.,Niguarda Ca Granda Hospital | And 8 more authors.
European Journal of Heart Failure | Year: 2011

Aims Uncontrolled ventricular rate (VR) during atrial fibrillation (AF) may cause clinical deterioration in heart failure (HF) patients who need continuous biventricular pacing to achieve cardiac resynchronization therapy (CRT). We aimed at evaluating the association between AF, uncontrolled VR, and sub-optimal CRT, defined as low biventricular pacing percentage (BIVP). Methods and results All 1404 patients had HF, New York Heart Association (NYHA) ≥II, left ventricular ejection fraction (LVEF) ≤35, and QRS ≥120 ms, and received an implantable CRT defibrillator (CRT-D). Occurrence of AF, VR during AF and lifetime BIVP were estimated from device data. Ventricular rate during AF was defined as uncontrolled in patients with mean VR>80 bpm and maximum VR>110 bpm. Over a median follow-up of 18 months, AF was detected in 443 of 1404 patients (32). In this sub-group of AF patients, VR during AF was uncontrolled in 150 of 443 patients (34). Multivariate Cox regression analysis showed that age [hazard ratio (HR) 1.03, 95 confidence interval (CI) 1.001.06, P 0.028], and uncontrolled VR [HR 1.69 (CI 1.012.83), P 0.046] were the only independent predictors of clinical outcome, assessed by HF hospitalizations and death. The median lifetime BIVP was 95 (2575 percentile range 9199). Biventricular pacing percentage was significantly and inversely correlated to VR, decreasing by 7 for each 10 bpm increase in VR. Sub-optimal CRT, defined as BIVP <95, was predicted by the occurrence of persistent or permanent AF [odds ratio (OR) 3.77, CI 2.445.82, P< 0.001], and uncontrolled VR [OR 2.25, CI 1.353.73, P 0.002]. Conclusion Uncontrolled VR occurs in one-third of CRT-D patients, who experience AF, and is associated with HF hospitalizations and death and with sub-optimal CRT (lifetime BIVP<95). © 2011 The Author.

Imazio M.,Maria Vittoria Hospital | Brucato A.,Ospedali Riuniti | Markel G.,Cardiac Rehabilitation Institute | Cemin R.,San Maurizio Regional Hospital | And 3 more authors.
American Journal of Cardiology | Year: 2011

The natural history of postpericardiotomy syndrome (PPS), a relatively common complication of cardiac surgery, varies from mild self-limited episodes to cases with protracted courses, recurrences, and readmissions. Preventive strategies may be valuable to decrease morbidity and management costs. We thus aimed to conduct a comprehensive systematic review on available data for pharmacologic primary prevention of PPS. Controlled clinical studies were searched in several databases and were included provided they focused on pharmacologic primary prevention of PPS. Random-effect odds ratios (ORs) were computed for occurrence of PPS. From the initial sample of 343 citations, 4 controlled clinical trials for primary prevention of PPS were finally included (894 patients); 3 studies were double-blind randomized controlled trials (RCTs). Treatment comparisons were colchicine versus placebo (2 RCTs enrolling 471 patients), methylprednisolone versus placebo (1 RCT on 246 pediatric patients), and aspirin versus historical controls (1 nonrandomized study on 177 pediatric patients). Meta-analytic pooling showed that colchicine was associated with decreased risk of PPS (OR 0.38, 0.22 to 0.65). Data on methylprednisolone (OR 1.13, 0.57 to 2.25) or aspirin (OR 1.00, 0.16 to 6.11) were negative but inconclusive because these were based on 1 study and/or a nonrandomized design. In conclusion, clinical evidence for primary prevention of PPS is still limited to few studies of variable quality. Nevertheless, available data suggest a beneficial profile for colchicine and open a new therapeutic strategy for prevention of PPS. © 2011 Elsevier Inc.

Daves M.,Clinical Biochemical Laboratory | Pusceddu I.,Clinical Biochemical Laboratory | Cemin R.,San Maurizio Regional Hospital
Clinical Biochemistry | Year: 2010

Background: Ethylene diamine tetraacetic acid (EDTA) plasma is the only suitable specimen recommended by the manufacturers to be used in the determination of BNP. It appears crucial to evaluate if more conventional heparin plasma samples could be reliably used for BNP determination. Aim of this study was to evaluate the use of heparin plasma sample for BNP determination. Methods: Venous blood from 42 consecutive patients admitted at the division of cardiology was collected in two test tubes, with K2-EDTA (Group 1) and lithium heparin with gel separator (Group 2) and analysed within 20 min of blood collection. Results: Statistical analysis showed a significant difference between Group 1 and Group 2 (p < 0.0001). Sample collected in K2-EDTA showed a significant underestimation when compared to lithium-heparin. Conclusions: Our data showed that BNP could not be dosed on different collection tubes without altering the results. In our experimental conditions, interestingly we found that BNP levels are significantly lower if measured in EDTA plasma. © 2009 The Canadian Society of Clinical Chemists.

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