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Dozio E.,University of Milan | Dogliotti G.,University of Milan | Malavazos A.E.,Unita Operativa di Diabetologia e Malattie Metaboliche | Bandera F.,Unita Operativa di Cardiologia | And 13 more authors.
International Journal of Immunopathology and Pharmacology | Year: 2012

Interleukin-18 (IL-18) is a member of the interleukin-1 family of cytokines produced constitutively by different cell types and by adipose tissue. Due to the link between obesity, inflammation and cardiovascular diseases, we aimed to measure IL-18 circulating level in patients undergoing open-heart surgery both for elective coronary artery bypass grafting (CABG) or for valve replacement (VR), and we also evaluated whether epicardial adipose tissue (EAT) depot may be a potential source of IL-18. Circulating IL-18 protein was quantified by enzyme-linked immunosorbent assay. IL-18, IL-18 receptor 1 (IL-18 R1) and IL-18 receptor accessory protein (IL-18-RAP) gene expression in EAT depot were evaluated by one colour microarray platform. EAT thickness was measured by echocardiography. In this study we found that all cardiovascular patients (CABG and VR) have increased circulating IL-18 level compared to healthy control subjects (p < 0.0001), but no statistical significant difference was observed between CABG and VR groups (p = 0.35). A great increase in the gene expression of IL-18 (p < 0.05), IL-18 R1 (p < 0.01) and IL-18 RAP (p < 0.001) was observed in EAT samples obtained from CABG vs VR patients. In conclusion, CABG and VR patients had similar increased level of circulating IL-18 protein, but in EAT depots isolated from CABG gene expression of IL-18, IL-18 R1 and IL-18-RAP resulted higher than in VR patients. Future investigation on local IL-18 protein production, its autocrine-paracrine effect and its correlation with plasmatic IL-18 level could give more information on the relationship between IL-18 and coronary artery disease. Copyright © by BIOLIFE, s.a.s. Source

Milano A.D.,Unita Operativa di Cardiochirurgia | Dodonov M.,Unita Operativa di Cardiochirurgia | Faggian G.,Unita Operativa di Cardiochirurgia | Tomezzoli A.,University of Verona
Cardiology | Year: 2011

Aim: It was the aim of our study to determine whether myocardial fibrosis influences physiologic or non-physiologic left ventricular (LV) hypertrophy in severe aortic stenosis. Methods: Myocardial fibrosis was evaluated using specimens taken from the ventricular septum in 79 patients submitted to aortic valve replacement because of symptomatic aortic stenosis. Patients were considered to have physiologic LV hypertrophy if end-systolic wall stress, evaluated by echocardiography, was <90kdyn/cm 2, while those with end-systolic wall stress >90 kdyn/cm 2 were considered to have non-physiologic hypertrophy. Results: Fibrosis tissue mass index was significantly inversely related with LV fractional shortening and directly related with LV diastolic and systolic diameter and LV mass index (LVMI). Patients with non-physiologic hypertrophy (n = 24) had a higher LVMI due to larger LV diastolic and systolic diameters with thinner wall, resulting in lower relative wall thickness. These patients had a higher fibrosis tissue mass index and impaired LV systolic and diastolic functions, as suggested by lower LV fractional shortening and higher mean wedge pressure. At follow-up of 7.4 ± 2.1 months, the LVMI and New York Heart Association class remained higher in patients with non-physiologic hypertrophy. Conclusions: Our study suggests a different quality of hypertrophies in patients with aortic stenosis, where myocardial fibrosis seems to be the critical abnormality that differentiates adaptive from maladaptive response to increased afterload. © 2011 S. Karger AG, Basel. Source

Contini G.A.,Unita Operativa di Cardiochirurgia | Nicolini F.,Unita Operativa di Cardiochirurgia | Vignali L.,Unita Operativa di Cardiologia | Valgimigli M.,Unita Operativa di Cardiologia Azienda Ospedialiero | And 2 more authors.
International Journal of Cardiology | Year: 2013

Background: The study compares five-year clinical outcomes of CABG vs PCI in a real world population of diabetic patients with multivessel coronary disease since it is not clear whether to prefer surgical or percutaneous revascularization. Methods: Between July 2002 and December 2008, 2885 multivessel coronary diabetic patients underwent revascularization (1466 CABG and 1419 PCI) at hospitals in Emilia-Romagna Region, Italy and were followed for 1827±617 days by record linkage of two clinical registries with the regional administrative database of hospital admissions and the mortality registry. Five-year incidences of MACCE (mortality, acute myocardial infarction [AMI], stroke, and repeat revascularization [TVR]) were assessed with Kaplan-Meier estimates, Cox proportional hazards regression and cumulative incidence functions of death and TVR, to evaluate the competing risk of AMI on death and TVR. The same analyses were applied to the propensity score matched subgroup of patients undergoing CABG or PCI with DES and with complete revascularization. Results: PCI had higher mortality for all causes (HR: 1.8, 95% CI 1.4-2.2 p<0.0001), AMI (HR: 3.3, 95% CI 2.4-4.6 p<0.0001) and TVR (HR: 4.5, 95% CI 3.4-6.1 p<0.0001). No significant differences emerged for stroke (HR: 0.8, 95% CI 0.5-1.2 p=0.26). The higher incidence of AMI caused highermortality in PCI group. Results did not change comparing CABG with PCI patients receiving complete revascularization or DES only. Conclusions: Diabetics show a higher incidence of MACCE with PCI than with CABG: thus diabetes and its degree of control should be considered when choosing the type of revascularization. © 2012 Elsevier Ireland Ltd. All rights reserved. Source

Nicolini F.,University of Parma | Agostinelli A.,Unita Operativa di Cardiochirurgia | Vezzani A.,Unita Operativa di Cardiochirurgia | Manca T.,Unita Operativa di Cardiochirurgia | And 3 more authors.
BioMed Research International | Year: 2014

Due to the increase in average life expectancy and the higher incidence of cardiovascular disease with advancing age, more elderly patients present for cardiac surgery nowadays. Advances in pre- and postoperative care have led to the possibility that an increasing number of elderly patients can be operated on safely and with a satisfactory outcome. Currently, coronary artery bypass surgery, aortic and mitral valve surgery, and major surgery of the aorta are performed in elderly patients. The data available show that most cardiac surgical procedures can be performed in elderly patients with a satisfactory outcome. Nevertheless, the risk for these patients is only acceptable in the absence of comorbidities. In particular, renal dysfunction, cerebrovascular disease, and poor clinical state are associated with a worse outcome in elderly patients. Careful patient selection, flawless surgery, meticulous hemostasis, perfect anesthesia, and adequate myocardial protection are basic requirements for the success of cardiac surgery in elderly patients. The care of elderly cardiac surgical patients can be improved only through the strict collaboration of geriatricians, anesthesiologists, cardiologists, and cardiac surgeons, in order to obtain a tailored treatment for each individual patient. © 2014 Francesco Nicolini et al. Source

Galvani G.,Unita Operativa di Cardiochirurgia | Grassetto A.,Unita Operativa di Cardiochirurgia | Sterlicchio S.,Unita Operativa di Cardiochirurgia | Themistoclakis S.,Unita Operativa di Cardiochirurgia | And 3 more authors.
Journal of Atrial Fibrillation | Year: 2015

Background: Dabigatran exilate has emerged as a highly effective tool in treating atrial fibrillation, AF). Its relative convenience in terms of cost and overall utility with respect to other anti-coagulants, however, has not been explored in much detail yet. Methods and Results: We run a Markovian disease simulation model based on a cohort of 1000 randomly generated patients which were sub-grouped by average risk of hemorrhage and average risk of stroke to compare treatments with Aspirin, Warfarin and Dabigatran. Quality-adjusted life-year, QALYs) for the patients were projected over up to 30 years with mortality statistics database and properly adjusted after every 5-year survival from the starting date. If managed within the prescribed range, Warfarin offers the highest outcome in terms of QALYs: 7.93 versus 7.61 for the Aspirin treatment and 7.57 for highest dose treatment with Dabigatran. Dabigatran outperformed the other treatments in patients at high risk of major stroke, provided Warfarin was not managed optimally. The incremental cost-effectiveness ratio for Dabigatran versus sub-optimally managed Warfarin was €7,759.48/QALY meaning that every year in perfect health earned with Dabigatran cost less than €8,000 more than the alternative treatment with Warfarin. Conclusions: The therapy with high-dose Dabigatran proved the most clinically safe solution for patients at high risk of stroke unless Warfarin therapy was excellent. Source

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