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Boriani G.,University of Bologna | Gasparini M.,IRCCS Instituto | 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 | Belli R.,Maria Vittoria Hospital | Brucato A.,Papa Giovanni XXIII Hospital | Cemin R.,San Maurizio Regional Hospital | And 11 more authors.
The Lancet | Year: 2014

Background Colchicine is eff ective for the treatment of acute pericarditis and fi rst recurrences. However, conclusive data are lacking for the effi cacy and safety of colchicine for treatment of multiple recurrences of pericarditis. Methods We did this multicentre, double-blind trial at four general hospitals in northern Italy. Adult patients with multiple recurrences of pericarditis (.two) were randomly assigned (1:1) to placebo or colchicine (OE5 mg twice daily for 6 months for patients weighing more than 70 kg or 0E5 mg once daily for patients weighing 70 kg or less) in addition to conventional anti-infl ammatory treatment with aspirin, ibuprofen, or indometacin. Permuted block randomisation (size four) was done with a central computer-based automated sequence. Patients and all investigators were masked to treatment allocation. The primary outcome was recurrent pericarditis in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT00235079. Findings 240 patients were enrolled and 120 were assigned to each group. The proportion of patients who had recurrent pericarditis was 26 (21E6%) of 120 in the colchicine group and 51 (42E5%) of 120 in the placebo group (relative risk 0E49; 95% CI 0E24.0E65; p=0E0009; number needed to treat 5). Adverse eff ects and discontinuation of study drug occurred in much the same proportions in each group. The most common adverse events were gastrointestinal intolerance (nine patients in the colchicine group vs nine in the placebo group) and hepatotoxicity (three vs one). No serious adverse events were reported. Interpretation Colchicine added to conventional anti-infl ammatory treatment signifi cantly reduced the rate of subsequent recurrences of pericarditis in patients with multiple recurrences. Taken together with results from other randomised controlled trials, these fi ndings suggest that colchicine should be probably regarded as a fi rst-line treatment for either acute or recurrent pericarditis in the absence of contraindications or specifi c indications. Funding Azienda Sanitaria 3 of Torino (now ASLTO2). © Chataway et al. Open Access article distributed under the terms of CC BY.


Imazio M.,Maria Vittoria Hospital | Brucato A.,Ospedale Papa Giovanni XXIII | Cemin R.,San Maurizio Regional Hospital | Ferrua S.,Ospedale degli Infermi | And 9 more authors.
New England Journal of Medicine | Year: 2013

BACKGROUND: Colchicine is effective for the treatment of recurrent pericarditis. However, conclusive data are lacking regarding the use of colchicine during a first attack of acute pericarditis and in the prevention of recurrent symptoms. METHODS: In a multicenter, double-blind trial, eligible adults with acute pericarditis were randomly assigned to receive either colchicine (at a dose of 0.5 mg twice daily for 3 months for patients weighing >70 kg or 0.5 mg once daily for patients weighing ≤70 kg) or placebo in addi;tion to conventional antiinflammatory therapy with aspirin or ibuprofen. The primary study outcome was incessant or recurrent pericarditis. RESULTS: A total of 240 patients were enrolled, and 120 were randomly assigned to each of the two study groups. The primary outcome occurred in 20 patients (16.7%) in the colchicine group and 45 patients (37.5%) in the placebo group (relative risk reduction in the colchicine group, 0.56; 95% confidence interval, 0.30 to 0.72; number needed to treat, 4; P<0.001). Colchicine reduced the rate of symptom persistence at 72 hours (19.2% vs. 40.0%, P=0.001), the number of recurrences per patient (0.21 vs. 0.52, P=0.001), and the hospitalization rate (5.0% vs. 14.2%, P=0.02). Colchicine also improved the remission rate at 1 week (85.0% vs. 58.3%, P<0.001). Overall adverse effects and rates of study-drug discontinuation were similar in the two study groups. No serious adverse events were observed. CONCLUSIONS: In patients with acute pericarditis, colchicine, when added to conventional anti-inflammatory therapy, significantly reduced the rate of incessant or recurrent pericarditis. Copyright © 2013 Massachusetts Medical Society.


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.


Imazio M.,Maria Vittoria Hospital | Trinchero R.,Maria Vittoria Hospital | Brucato A.,Ospedali Riuniti | Rovere M.E.,Cardiac Surgery | And 13 more authors.
European Heart Journal | Year: 2010

AimsNo drug has been proven efficacious to prevent the post-pericardiotomy syndrome (PPS), but colchicine seems safe and effective for the treatment and prevention of pericarditis. The aim of the COlchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS) trial is to test the efficacy and safety of colchicine for the primary prevention of the PPS.Methods and resultsThe COPPS study is a multicentre, double-blind, randomized trial. On the third post-operative day, 360 patients (mean age 65.7 ± 12.3 years, 66 males), 180 in each treatment arm, were randomized to receive placebo or colchicine (1.0 mg twice daily for the first day followed by a maintenance dose of 0.5 mg twice daily for 1 month in patients ≥70 kg, and halved doses for patients <70 kg or intolerant to the highest dose). The primary efficacy endpoint was the incidence of PPS at 12 months. Secondary endpoint was the combined rate of disease-related hospitalization, cardiac tamponade, constrictive pericarditis, and relapses. Baseline characteristics were well balanced between the study groups. Colchicine significantly reduced the incidence of the PPS at 12 months compared with placebo (respectively, 8.9 vs. 21.1; P = 0.002; number needed to treat = 8). Colchicine also reduced the secondary endpoint (respectively, 0.6 vs. 5.0; P = 0.024). The rate of side effects (mainly related to gastrointestinal intolerance) was similar in the colchicine and placebo groups (respectively, 8.9 vs. 5.0; P = 0.212).ConclusionColchicine is safe and efficacious in the prevention of the PPS and its related complications and may halve the risk of developing the syndrome following cardiac surgery. ClinicalTrials.gov number, NCT00128427. © 2010 The Author.


Sieni E.,Azienda Ospedaliero A Meyer Children Hospital | Cetica V.,Azienda Ospedaliero A Meyer Children Hospital | Piccin A.,San Maurizio Regional Hospital | Gherlinzoni F.,U.L.S.S. | And 7 more authors.
PLoS ONE | Year: 2012

Familial Hemophagocytic lymphohistiocytosis (FHL) is a rare immune deficiency with defective cytotoxic function. The age at onset is usually young and the natural course is rapidly fatal if untreated. A later onset of the disease has been sporadically reported even in adolescents and adults. We report the results of our retrospective data collection of all cases diagnosed with FHL at an age of 18 years or older and enrolled in the Italian Registry of HLH. All cases were diagnosed with FHL based on evidence of genetic defect in one FHL-related gene. A total of 11 patients were diagnosed with FHL. They were 9 males and 2 females, from 10 unrelated families; their age ranged between 18 and 43 years (median, 23 years). Family history was unremarkable in eight families at the time of the diagnosis. Their genetic diagnoses are: FHL2 (n = 6), FHL3 (n = 2), FHL5 (n = 1), XLP1 (n = 2). Clinical, molecular and functional data are described. These data confirm that FHL may present beyond the pediatric age and up to the fifth decade. FHL2 due to perforin defect is the most frequently reported subtype. Adult specialists should consider FHL in the differential diagnosis of patients with cytopenia and liver or central nervous system disorders, especially when a lymphoproliferative disease is suspected but eventually not confirmed. FHL may turn to be fatal within a short time course even in adults. This risk, together with the continuous improvement in the transplant technique, especially in the area of transplant from matched unrelated donor, resulting in reduced treatment related mortality, might suggest a wider use of SCT in this population. Current diagnostic approach allows prompt identification of patients by flow-cytometry screening, then confirmed by the genetic study, and treatment with chemo-immunotherapy followed by stem cell transplantation. © 2012 Sieni et al.


Lippi G.,Academic Hospital of Parma | Lippi G.,San Maurizio Regional Hospital | Lippi G.,General Hospital of Trento | Daves M.,Academic Hospital of Parma | And 5 more authors.
Biochemia Medica | Year: 2014

The use of contrast media such as organic iodine molecules and gadolinium contrast agents is commonplace in diagnostic imaging. Although there is widespread perception that side effects and drug interactions may be the leading problems caused by these compounds, various degrees of interference with some laboratory tests have been clearly demonstrated. Overall, the described interference for iodinate contrast media include inappropriate gel barrier formation in blood tubes, the appearance of abnormal peaks in capillary zone electrophoresis of serum proteins, and a positive bias in assessment of cardiac troponin I with one immunoassay. The interference for gadolinium contrast agents include negative bias in calcium assessment with ortho-cresolphthalein colorimetric assays and occasional positive bias using some Arsenazo reagents, negative bias in measurement of angiotensin converting enzyme (ACE) and zinc (colorimetric assay), as well as positive bias in creatinine (Jaffe reaction), total iron binding capacity (TIBC, ferrozine method), magnesium (calmagite reagent) and selenium (mass spectrometry) measurement. Interference has also been reported in assessment of serum indices, pulse oximetry and methaemoglobin in samples of patients receiving Patent Blue V. Under several circumstances the interference was absent from manufacturer-supplied information and limited to certain type of reagents and/or analytes, so that local verification may be advisable to establish whether or not the test in use may be biased. Since the elimination half-life of these compounds is typically lower than 2 h, blood collection after this period may be a safer alternative in patients who have received contrast media for diagnostic purposes. © by Croatian Society of Medical Biochemistry and Laboratory Medicine.


Cemin R.,San Maurizio Regional Hospital | Donazzan L.,San Maurizio Regional Hospital | Lippi G.,Academic Hospital of Parma | Clari F.,San Maurizio Regional Hospital | Daves M.,San Maurizio Regional Hospital
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.


Daves M.,San Maurizio Regional Hospital | Cemin R.,San Maurizio Regional Hospital | Floreani M.,San Maurizio Regional Hospital | Pusceddu I.,San Maurizio Regional Hospital | And 2 more authors.
Clinical Chemistry and Laboratory Medicine | Year: 2011

Background: Transferrin (Tf) glycoform lacking one or two complete or incomplete glycan chains (i.e., asialo-monosialo- and disialo-Tf) typically appear in blood after chronic alcohol consumption, though recently it was reported that monosialo-Tf is associated with trisialo-Tf but not with alcohol consumption. These glycoforms are collectively known as carbohydrate-deficient transferrin (CDT). Since samples from alcoholic patients are characterized by decreased sialic acid content in serum transferrin, the assessment of CDT is thereby widely used for laboratory evaluation of chronic alcohol abuse. Methods: CDT analysis has been performed in 6011 consecutive subjects undergoing national mandatory testing after the confiscation of driving license for driving under the influence of alcohol. Out of the 6011 specimens, 539 (9%) displayed values exceeding the specific cut-off (>1.3%) on multicapillary electrophoresis (MCE) (Capillarys2 Sebia, France), and were further analyzed with a routine high-pressure liquid chromatography (HPLC) technique. Results: The overall correlation between the methods in the total 539 samples was satisfactory, displaying a correlation coefficient (r) of 0.960. Nevertheless, the correlation was lower in the group with CDT values comprised between 1.3% and 1.9% (group 1; r=0.60) than in those with CDT values >2.0% (group 2; r=0.98). Moreover, the discordance between values exceeding the method-specific threshold in the former group of samples was also remarkably high (62% of samples in group 1 vs. 0.6% in group 2). Finally, a significant difference of CDT values was observed in group 1 (p<0.001), and in group 2 (p<0.0001) by Wilcoxon test. Conclusions: The MCE is characterized by a high throughput and it seems a suitable approach for laboratory monitoring of alcohol abuse when CDT is used as medical parameter in the diagnosis and follow-up of heavy drinking. However, CDT measured by screening techniques must be confirmed by a confirmatory technique, in particular for forensic purpose. © 2011 by Walter de Gruyter Berlin Boston.


Daves M.,San Maurizio Regional Hospital of Bolzano | Pusceddu I.,San Maurizio Regional Hospital of Bolzano | 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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