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Gallarate, Italy

Migliore F.,University of Padua | Baritussio A.,University of Padua | Stabile G.,Mediterranean Clinic | Reggiani A.,Carlo Poma Hospital | And 10 more authors.
Journal of Cardiovascular Medicine | Year: 2016

Aims: Accurate selection of patients with left bundle branch block (LBBB) may help increasing response to cardiac resynchronization therapy (CRT). There is no agreement on LBBB definition. The aim of the study was to investigate the prevalence of 'true-LBBB' according to Strauss in patients undergoing CRT. Methods and results: The study population included 414 consecutive patients (71.9% men; mean age 69.7 ± 9.6 years), who underwent CRT according to 2010 European Society of Cardiology (ESC) guidelines. Patients were classified into three groups: traditional LBBB according to American Heart Association, LBBB according to Strauss and intraventricular conduction delay (IVCD). Subsequently, they were re-classified into classes of recommendations, according to the current 2013 ESC Guidelines. Traditional LBBB was recorded in 229 patients (55%), an LBBB according to Strauss in 153 (37%) and an IVCD in 32 (8%). Patients with an LBBB according to Strauss showed a significantly more prolonged QRS duration (P < 0.001), greater baseline end-systolic and end-diastolic volumes (P = 0.011 and P = 0.013, respectively) compared with those with IVCD. The prevalence of mid-QRS notching in at least two contiguous leads was 100% in LBBB according to Strauss; 24% in traditional LBBB and 21.9% in IVCD (P < 0.001). At multivariate analysis, PR interval less than 200 ms and QRS of at least 150 ms were independent predictors of mid-QRS notching [odds ratio (OR) 1.78; 95% confidence interval (95% CI) 1.10-2.88; P = 0.02 and OR 2.88; 95% CI 1.80-4.62;P < 0.0001]. Applying stricter criteria for LBBB according to Strauss, a significant reduction in Class I recommendation and an increase in Class II was observed (90.1 vs. 37%; P < 0.0001 and 9.9 vs. 63%; P < 0.0001). Conclusions: Applying stricter criteria, only 37% of patients undergoing CRT showed a true-LBBB according to Strauss. Accurate identification of true-LBBB may have a potential additional value in better selecting patients. © 2016 Italian Federation of Cardiology. All rights reserved. Source

Geraci A.,Santa Maria del Prato Hospital | Zatta D.,Santa Maria del Prato Hospital | Strazzabosco C.,Santa Maria del Prato Hospital | Tomasello G.,University of Palermo | And 4 more authors.
Minerva Ortopedica e Traumatologica | Year: 2012

Aim: Osteoarthritis (OA) is a degeneration of articular cartilage. Four components of the cartilage structure, glucosamine, chondroitin collagen type II and hyaluronic acid are available in a food supplement. It has been claimed that they reduce the pain of OA and help rebuild cartilage in patients with early OA. Methods: A multicentre, randomized, double-blind ascorbic acid controlled study was carried out in patients with osteoarthritis of the knee. The purpose of the study was to evaluate the effectiveness of a food supplement sachet containing glucosamine sulfate (500 mg), chondrotin sulfate (400 mg), hydrolyzed collagen type II and hyaluronic acid mixture (300 mg), L-carnitine fumarate (345 mg). One hundred twenty patients suffering from osteoarthritis of the knee were randomized into 2 groups. Sixty randomized patients in group A received a single sachet daily for 60 days. Sixty randomized patients in group B received a placebo sachet daily containing 1 gram of ascorbic acid. Clinical follow-up was performed at 2, 4, 8, and 12 weeks. The degree of knee pain was assessed using a VAS score. WOMAC score, KOOS scale and Lequesne index were used to assess the knee injury and OA outcome score. Results: The reduction of VAS score from baseline through week 12 was statistically significant only in group A (P<0.05). WOMAC and KOOS scales showed improvement only in Group A for pain at week 4, for stiffness and difficulty in carrying out normal physical activities at week 8. Also the Lequesne index showed an improvement exclusively in group A, after week 4. Conclusion: The results show that the combination of substances contained in the food supplement studied can be considered as a response to pain symptoms in patients with mild to moderate osteoarthritis. Source

Sciahbasi A.,Unita Operativa Complessa di Cardiologia | Rizzello V.,Ospedale San Giovanni | Gonzini L.,Associazione Nazionale Medici Cardiologi Ospedalieri Research Center | Giampaoli S.,Italian Health Institute | And 6 more authors.
European Journal of Preventive Cardiology | Year: 2014

Background: The cardioprotective role that statin and aspirin has appears to be reduced in patients with chronic kidney disease (CKD). This analysis aims to evaluate the impact of statin and aspirin on the outcome of patients with CKD and acute coronary syndrome (ACS). Methods: All patients who were enrolled in the IN-ACS Outcome registry, diagnosed with CKD, were included in our analysis. We divided patients into four groups, according to previous chronic therapy: neither aspirin nor statin therapy (Group 1), aspirin only therapy (Group 2), statin only therapy (Group 3) and aspirin plus statin therapy (Group 4). Results: Of the 5483 patients enrolled that had data on glomerular filtration rate available, 1484 had CKD: These segregated into 589 patients in Group 1, 477 in Group 2, 89 in Group 3 and 329 in Group 4. Despite having a higher baseline risk profile, groups 3 and 4, as compared to the other two groups, exhibited a significantly lower in-hospital mortality (1% in Group 3, 2% in Group 4; but 8% in Group 1 and 7% in Group 2, p0.0007); while at 30 days it remained so, as it was 1% in Group 3, 4% in Group 4 (and 10% in Group 1 and 10% in Group 2 p0.0002); and at 1 year it was 11% in Group 3 and 13% in Group 4 (compared to 20% in Group 1 and 23% in Group 2, p0.0012). Conclusions: In a large cohort of patients with CKD and ACS, chronic treatment with statin or the combination of aspirin and statin is associated with short-term and long-term better outcomes for in-hospital mortality, as compared to those receiving no therapy or aspirin therapy alone. © The European Society of Cardiology 2012. Source

Vidale S.,SantAnna Hospital | Arnaboldi M.,SantAnna Hospital | Bezzi G.,Sondrio Hospital | Bono G.,Circolo Hospital | And 7 more authors.
International Journal of Cardiology | Year: 2016

Background and purpose Thrombolysis represents the best therapy for ischemic stroke but the main limitation of its administration is time. The avoidable delay is a concept reflecting the effectiveness of management pathway. For this reason, we projected a study concerning the detection of main delays with following introduction of corrective factors. In this paper we describe the results after these corrections. Materials and methods Consecutive patients admitted for ischemic stroke during a 3-months period to 35 hospitals of a macro-area of Northern Italy were enrolled. Each time of management was registered, identifying three main intervals: pre-hospital, in-hospital and total times. Previous corrective interventions were: 1.increasing of population awareness to use the Emergency Medical Service (EMS); 2.pre-notification of Emergency Department; 3.use of high urgency codes; 4.use of standardised operational algorithm. Statistical analysis was conducted using time-to-event analysis and Cox proportional hazard regression. Results 1084 patients were enrolled. EMS was alerted for 56.3% of subjects, mainly in females and severe strokes (p < 0.001). Thrombolytic treatment was performed in 4.7% of patients. Median pre-hospital and in-hospital times were 113 and 105 min, while total time was 240. High urgency codes at transport contributed to reduce pre-hospital and in-hospital time (p < 0.05). EMS use and high urgency codes promoted thrombolysis. Treatment within 4.5 hours from symptom onset was performed in 14% of patients more than the first phase of study. Conclusions The implementation of an organizational system based on EMS and concomitant high urgency codes use was effective to reduce avoidable delay and to increase thrombolysis. © 2016 Elsevier Ireland Ltd. All rights reserved. Source

Polizzi G.,Centro Studi CUS Palermo | Giaccone M.,Centro Studi CUS Palermo | Gervasi M.,Urbino University | D'Amato A.,SantAntonio Abate Hospital | And 5 more authors.
Medicina dello Sport | Year: 2014

Aim. Moderate-altitude (2000 m) training can increase endurance performance at sea level; it improves physiological parameters, including maximum oxygen uptake, muscle oxygen extraction, red blood cell volume, plasma hemoglobin mass and concentration, and maximal cardiac output and systolic stroke volume; and it can also reduce resting and submaximal exercise intensity heart rate. To date, no studies have investigated the effects of moderate-altitude training on resting cardiac output and systolic blood pressure, and on the metabolic thresholds commonly used in evaluating endurance athletes. The aim of this study was to evaluate blood, cardiac, and metabolic parameters following training and sojourn at moderate altitude (2000 m above sea level). Methods. In this pilot study, 10 middle-distance runners sojourned and trained at moderate altitude for 1 month. Hemoglobin concentration, red blood cell count, mean corpuscular volume, hematocrit, systolic stroke volume, heart rate, and anaerobic threshold were measured before the start of training and at 2 weeks after return to sea level. Results. Comparison of pre- and post-training values showed a significant reduction in resting heart rate and a significant increase in hemoglobin concentration, resting systolic stroke volume, resting cardiac output, running speed at individual lactate threshold and at the blood lactate concentration of 4 mmol/L. Conclusion. Physiological response to moderate-altitude training can predict improvements in sea-level performance. The data from this pilot study will provide the basis for a larger-scale study that will include a control group and additional physiological parameters. Source

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