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Trento, Italy

Cioffi G.,Villa Bianca Hospital | Tarantini L.,Ospedale Civile S. Martino | Faggiano P.,Spedali Civili
IJC Metabolic and Endocrine | Year: 2014

Hypothesis: Type 2 diabetes mellitus (T2DM) and chronic heart failure (CHF) are associated with renal dysfunction. We tested the hypothesis that the degree of renal dysfunction influences the negative impact on the outcome of T2DM in patients with CHF and reduced left ventricular ejection fraction (LVEF). Methods: From November 1, 2009 to December 31, 2012, the "Trieste Registry of CV Diseases" enrolled 19,589 patients. Those with diagnosis of CHF and reduced LVEF were analyzed. The primary end-point was all-cause mortality. Results: 554 patients were selected (73±10years old, 32% females), 192 had T2DM (35%). During follow-up (23±11months), all-cause death occurred in 57 patients (30%) who had T2DM and in 58 (16%, p<0.001) who had not; T2DM was associated with an increased risk of death (adjusted HR 2.55 [95% CI 1.02-6.36], p=0.04). The prognostic impact of T2DM was lost when patients were selected according to renal function: adjusted HR 1.44 [0.21-9.93], p=0.71, in patients with normal renal function, defined as estimated glomerular filtration rate (eGFR) >60, and adjusted HR 3.37 [0.96-11.80], p=0.08 in patients with renal dysfunction (eGFR<60ml/min*1.73m2). T2DM predicted all-cause mortality only in the subgroup with eGFR between 90 and 30ml/min*1.73m2 (adjusted HR 2.52 [1.01-6.30], p=0.04). Conclusions: In patients with CHF and reduced LVEF the prognostic impact of T2DM depends on the degree of renal dysfunction. Its contribution in all-cause mortality risk prediction is limited to mild-moderate renal dysfunction subgroup, while prognostic power is lost in normal renal function and in severe renal dysfunction patients. © 2014 The Authors. Source

Oliva S.,Cardiology Unit | Cioffi G.,Villa Bianca Hospital | Frattini S.,Spedali Riuniti | Simoncini E.L.,Spedali Riuniti | And 9 more authors.
Oncologist | Year: 2012

Background. Adjuvant trastuzumab therapy improves the outcome of patients with early breast cancer (EBC) and overexpression of human epidermal growth factor receptor 2 (HER2). However, it is potentially cardiotoxic. This study aims to evaluate the relationship between the use of angiotensin-converting enzyme inhibitors/receptor blockers (ACEi/ARBs) and/or β-blockers and development of heart failure (HF) and/or left ventricular dysfunction during 1 year of adjuvant trastuzumab therapy. Methods. A total of 499 women receiving adjuvant trastuzumab therapy for EBC entered in a multicenter registry and were divided into four subgroups according to treatment with ACEi/ARBs and/or β-blockers. Occurrence of HF and decrease of left ventricular ejection fraction (LVEF; minimum 10 percentage points) were recorded. Results. HF occurred in 2% of patients who did not take either ACEi/ARBs or β-blockers, 8% of patients receiving ACEi/ARBs alone, 8% receiving β-blockers alone (p =.03), and 19% receiving both medications (p <.01). The prevalence of patients with LVEF that decreased by at least 10 percentage points was similar in all groups. Combined ACEi/ARBs and β-blocker therapy was independently associated with hypertension and a significant reduction of LVEF from baseline to 3-month evaluation. The use of ACEi/ARBs alone or β-blockers alone was predicted only by hypertension. Combined therapy of ACEi/ARBs plus β-blockers predicted LVEF recovery from the 3-month to 12-month evaluation. Conclusions. In clinical practice, the degree of hypertension and decrease in LVEF during the first 3 months of adjuvant trastuzumab therapy for EBC are associated with the use of ACEi/ARBs and β-blockers. The combined use of these two medications is associated with a recovery of LVEF during months 3-12 of adjuvant trastuzumab therapy. ©AlphaMed Press. Source

Cioffi G.,Villa Bianca Hospital | De Simone G.,University of Naples Federico II | Cramariuc D.,University of Bergen | Mureddu G.F.,Cardiology Unit | Gerdts E.,University of Bergen
Journal of Hypertension | Year: 2012

Objective: In some patients with aortic stenosis left-ventricular hypertrophy exceeds what is needed to sustain the hemodynamic load imposed by the aortic stenosis, a condition named inappropriately high left-ventricular mass (iLVM). Although iLVM is associated with increased mortality after aortic valve replacement, prevalence and covariates of iLVM in asymptomatic aortic stenosis are unknown. Methods: We analyzed baseline data from 1614 patients (67 ± 10 years, 51% hypertensive) recruited in the Simvastatin Ezetimibe in Aortic Stenosis study evaluating placebo-controlled combined simvastatin and ezetimibe treatment in asymptomatic mild-moderate aortic stenosis. iLVM was diagnosed by Doppler echocardiography as LVM greater than 28% of the expected LVM predicted from height, sex and stroke work. Results: iLVM was detected in 268 patients (16.6%), irrespective of concomitant hypertension. Patients with iLVM had higher body weight, LVM and relative wall thickness, higher prevalence of systolic dysfunction (88 vs. 15%) and lower left-ventricular afterload (all P < 0.01) than patients with appropriate LVM in spite of comparable aortic stenosis severity. In multivariate analysis, all these five variables were independently associated with iLVM. The simple coexistence of low stress-corrected midwall shortening and left-ventricular hypertrophy was the best clinical model describing iLVM phenotype (sensitivity 72%, specificity 96%, area under the receiver operating characteristic curve 0.954). Conclusion: iLVM is common in asymptomatic mild-moderate aortic stenosis and unrelated to severity of aortic stenosis or presence of hypertension. iLVM was associated with combined concentric geometry and reduced left-ventricular myocardial contractility, suggesting iLVM in asymptomatic aortic stenosis as a marker of more advanced myocardial disease. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Tarantini L.,S. Martino Hospital | Gori S.,S. M. della Misericordia Hospital | Faggiano P.,Spedali Civili | Pulignano G.,Camillo Hospital | And 6 more authors.
Annals of Oncology | Year: 2012

Background: Adjuvant Trastuzumab with chemotherapy is the gold standard for human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (HER2+ EBC). Older patients have been largely under-represented in clinical trials, and few data on Trastuzumab cardiotoxicity have been reported in this subgroup. Patients and methods: Four hundred and ninety-nine consecutive HER2+ EBC patients were treated with adjuvant trastuzumab and chemotherapy (aTrastC) at 10 Italian institutions. We evaluated disease prevalence and patient characteristics in the patients older than 60 years of age (over-60), prevalence of aTrastC cardiotoxicity and risk factors. Results: There were 160 'over-60' patients (32%), in whom a higher prevalence of hypertension, diabetes, renal dysfunction, dyslipidemia and treatment with ACEi (40 versus 8%) and beta blockers (20 versus 8%) was found than in the younger patients (339 = 68%). Clinical heart failure occurred in 6% of the 'over-60' and in 2% of the younger patients. A reduction in left ventricular ejection fraction of >10 points was detected in 33% of the 'over-60' and in 23% of the younger patients (all P < 0.05). aTrastC was discontinued in 10% of the 'over-60' and in 4% of the younger patients (P = 0.003), restarted in 44% of the 'over-60' and in 58% of the younger women (P = ns). Conclusion: In clinical practice, 32% of HER2+ EBC patients treated with aTrastC are 'over-60'. These patients have an increased cardiovascular risk profile and develop aTrastC cardiotoxicity commonly. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. Source

Cioffi G.,Villa Bianca Hospital | Faggiano P.,Cardiology Unit | Vizzardi E.,University of Brescia | Tarantini L.,Ospedale Civile di Belluno | And 3 more authors.
Heart | Year: 2011

Objectives: In patients with aortic stenosis (AS) left ventricular (LV) myocardial growth may exceed individual needs to compensate LV haemodynamic load leading to inappropriately high LV mass (iLVM), a condition at high risk of adverse cardiovascular events. The prognostic impact of iLVM was determined in 218 patients with asymptomatic severe AS. Methods: iLVM was recognised when the measured LV mass exceeded 10% of the expected value predicted from height, sex and stroke work (prognostic cut-off assessed by a specific ROC analysis). For assessment of outcome, the endpoint was defined as death from all causes, aortic valve replacement or hospital admission for non-fatal myocardial infarction and/or congestive heart failure. Results: At the end of follow-up (22+13 months) complete clinical data were available for 209 participants (mean age 75+11 years). A clinical event occurred in 81 of 121 patients (67%) with iLVM and in 26 of 88 patients (30%) with appropriate LV mass (aLVM) (p<0.001). Event-free survival in patients with aLVM and iLVM was 78% vs 56% at 1-year, 68% vs 29% at 3-year and 56% vs 10% at 5-year follow-up, respectively (all p<0.01). Cox analysis identified iLVM as a strong predictor of adverse outcome (Exp β 3.08; CI 1.65 to 5.73) independent of diabetes, transaortic valve peak gradient and extent of valvular calcification. Among patients with LV hypertrophy, those with iLVM had a risk of adverse events 4.5-fold higher than counterparts with aLVM. Conclusions: iLVM is common in patients with asymptomatic severe AS and is associated with an increased rate of cardiovascular events independent of other prognostic covariates. Source

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