Villa Bianca Hospital

Trento, Italy

Villa Bianca Hospital

Trento, Italy
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Gerdts E.,University of Bergen | Pedersen T.R.,University of Oslo | Cioffi G.,Villa Bianca Hospital | Lonnebakken M.T.,University of Bergen | And 3 more authors.
Circulation: Cardiovascular Imaging | Year: 2015

Background-The prognostic importance of left ventricular (LV) mass in nonsevere asymptomatic aortic stenosis has not been documented in a large prospective study. Methods and Results-Cox regression analysis was used to assess the impact of echocardiographic LV mass on rate of major cardiovascular events in 1656 patients (mean age, 67 years; 39.6% women) with mild-to-moderate asymptomatic aortic stenosis participating in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study. Patients were followed during 4.3 years of randomized treatment with combined simvastatin 40 mg and ezetimibe 10 mg daily or placebo. At baseline, LV mass index was 45.9+14.9 g/m2.7, and peak aortic jet velocity was 3.09+0.54 m/s. During follow-up, 558 major cardiovascular events occurred. In Cox regression analyses, 1 SD (15 g/m2.7) higher baseline LV mass index predicted increases in hazards of 12% for major cardiovascular events, 28% for ischemic cardiovascular events, 34% for cardiovascular mortality, and 23% for combined total mortality and hospitalization for heart failure (all P<0.01), independent of confounders. In time-varying models, taking the progressive increase in LV mass index during follow-up into account, 1 SD higher in-study LV mass index was consistently associated with 13% to 61% higher hazard for cardiovascular events (all P<0.01), independent of age, sex, body mass index, valvuloarterial impedance, LV ejection fraction and concentricity, and the presence of concomitant hypertension. Conclusions-Higher LV mass index is independently associated with increased cardiovascular morbidity and mortality during progression of aortic stenosis. © 2015 American Heart Association, Inc.


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.


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.


Tarantini L.,Ospedale Civile S. Martino | Cioffi G.,Villa Bianca Hospital | Gori S.,Ospedale S.M. della Misericordia | Tuccia F.,Ospedale Civile S. Martino | And 7 more authors.
Journal of Cardiac Failure | Year: 2012

Background: Adjuvant trastuzumab therapy improves survival of human epidermal growth factor receptor 2 (HER2)-positive women with early breast cancer (EBC). A careful monitoring of cardiac function is needed due to potential trastuzumab cardiotoxicity (Tcardiotox). To date, the incidence, timing, and phenotype of patients with Tcardiotox in clinical practice are not well known. Methods and Results: A total of 499 consecutive HER2-positive women (mean age 55 ± 11 years) with EBC treated with trastuzumab between January 2008 and June 2009 at 10 Italian institutions were followed for 1 year. We evaluated incidence, time of occurrence, and clinical features associated with Tcardiotox. Left ventricular ejection fraction (LVEF) was evaluated by echocardiography at baseline and at 3, 6, 9, and 12 months during trastuzumab therapy. Tcardiotox was recognized in 133 patients (27%): 102 (20%) showed asymptomatic reduction in LVEF of >10% but ≤20% (grade 1 Tcardiotox); 15 (3%) had asymptomatic decline of LVEF of >20% or <50% (grade 2); and 16 (3%) had symptomatic heart failure (grade 3). Trastuzumab was discontinued due to cardiotoxicity in 24 patients (5%) and restarted in 13 after LVEF recovery. Forty-one percent of Tcardiotox cases occurred within the first 3 months of follow-up, most prevalently in older patients with higher creatinine levels and in patients pretreated with doxorubicin and radiotherapy. Conclusions: In clinical practice,Tcardiotox is frequent in HER2-positive women with EBC and occurs in the first 3 months of therapy. Cardiac dysfunction is mild and asymptomatic in the majority of patients. The interruption of treatment is a rare event which occurs, however, in a significantly higher percentage than reported in randomized clinical trials. © 2012 Elsevier Inc. All rights reserved.


Faden G.,Cardiology Unit | Faganello G.,Cardiovascular Center | De Feo S.,Pederzolli Hospital | Berlinghieri N.,Cardiology Unit | And 4 more authors.
Diabetes Research and Clinical Practice | Year: 2013

Aims: Type 2 diabetes mellitus (DM) is associated with higher risk of heart failure. Over the last three decades several studies demonstrated the presence of asymptomatic systolic and/or diastolic left ventricular (LV) dysfunction (asymLVD) in patients with normal LV ejection fraction (LVEF). Purpose of our study was to assess the prevalence and factors associated with asymLVD in DM patients by echocardiographic indexes more sensitive than LVEF and transmitral flow detected by pulsed Doppler. Methods: 386 DM patients without overt cardiac disease were enrolled from January to October 2011. Stress-corrected midwall shortening (sc-MS) and mitral annular peak systolic velocity (S') were considered as indexes of systolic function of circumferential and longitudinal myocardial fibers, respectively. Early diastolic velocity of transmitral flow was divided by early diastolic Tissue Doppler velocity of mitral annulus for identifying diastolic LVD. Results: asymLVD was detected in 262 patients (68%). 106 (27%) had isolated systolic asymLVD, 61 (16%) isolated diastolic asymLVD; in 95 (25%) systolic and diastolic asymLVD coexisted. Patients with asymLVD were older, had lower glomerular filtration rate, higher levels of glycated hemoglobin, C reactive protein, LV mass, relative wall thickness and prevalence of valve calcifications. Older age (HR 1.1 [1.02-1.18], p= 0.01), aortic valve calcifications (HR 6.3 [1.31-30.31], p= 0.02), LV concentric geometry defined as relative wall thickness ≥0.43 (HR 15.44 [2.96-80.44], p= 0.001) were independent predictors of asymLVD at multivariate analysis. Conclusions: Using suitable echocardiographic indexes, asymLVD is detectable in two/third of DM patients without overt cardiac disease and is predicted by older age, cardiac valve calcifications and LV concentric remodeling. © 2013 Elsevier Ireland Ltd.


Cioffi G.,Villa Bianca Hospital | De Simone G.,University of Naples Federico II | Cramariuc D.,University of Bergen | Mureddu G.F.,San Giovanni Addolorata Hospital | 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.


Cioffi G.,Villa Bianca Hospital | Russo T.E.,Villa Bianca Hospital | Stefenelli C.,Villa Bianca Hospital | Selmi A.,Villa Bianca Hospital | And 4 more authors.
Journal of Hypertension | Year: 2010

Background: Obstructive sleep apnea (OSA) has several negative effects on the heart including increase in myocardial end-systolic stress, venous return and sympathetic activity, all potential stimuli of left ventricular (LV) hypertrophy. The impact of the severity of OSA on LV geometry is unknown. We hypothesized that OSA is related to concentric LV geometry. Methods: One hundred and fifty-seven patients with suspected OSA underwent echocardiography, ambulatory 24-h blood pressure and ECG monitoring. On the basis of the severity of OSA, patients were divided into controls, mild OSA and moderate/severe OSA (apnea-hypopnea index <5, 5-15 and >15/h, respectively). Patients with LV hypertrophy were defined as LV mass at least 49.2 g/m2.7 for men and at least 46.7 for women. Relative wall thickness of at least 0.43 identified patients with concentric LV geometry. Results: Patients with moderate/severe OSA (n = 86) had a higher body mass index and a higher prevalence of paroxysmal atrial fibrillation than those (n = 51) with mild OSA and controls (n = 20). Prevalence of hypertension, diabetes, obesity, LV mass and blood pressure did not differ between the groups. Relative wall thickness was positively related to apnea-hypopnea index (r = 0.30; P = 0.003) and the prevalence of concentric LV geometry was 20% in controls, 12% in mild OSA and 58% in moderate/severe OSA (P < 0.001). In logistic regression analysis concentric LV geometry was associated with moderate/severe OSA [odds ratio (OR) 7.6, P < 0.001], low stress-corrected midwall shortening (OR 3.38, P = 0.004), and higher body mass index (OR 1.09, P = 0.03). Conclusions: Moderate/severe OSA is associated with high prevalence of concentric LV geometry. This increased prevalence may in part explain the increased rate of cardiovascular events in these patients. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Cioffi G.,Villa Bianca Hospital | Tarantini L.,Ospedale S. Martino | Frizzi R.,Villa Bianca Hospital | Stefenelli C.,Villa Bianca Hospital | And 5 more authors.
Journal of Hypertension | Year: 2011

Background: The hemodynamic alterations induced by the impairment of renal function explain only in part the development of left ventricular hypertrophy in patients with chronic kidney disease (CKD), who are theoretically exposed to an inappropriate high growth of left ventricular mass (iLVM) due to the activation of neuro-hormonal stressors. Few data are available on the relations between iLVM and renal function. Study Design and Measurements: Three hundred and forty individuals at increased risk for cardiovascular events underwent assessment of renal function by the estimation of glomerular filtration rate (eGFR) and echocardiography: 227 patients had stages 1-2 CKD (eGFR 60 ml/min per 1.73 m), and 113 stages 3-5 (eGFR <60 ml/min per 1.73 m). LVM was predicted in each patient from height, sex and stroke work using a validated equation. iLVM was defined as LVM more than 28% of the predicted value. Sixty-eight healthy individuals served as controls. Results: iLVM was detected in seven controls (10%) and in 146 study patients (43%). There was an inverse relation between observed/predicted LVM ratio and eGFR (r 0.54, P < 0.001). In linear regression analysis, iLVM was related to eGFR (β 0.40), relative wall thickness (β 0.29), diabetes (β 0.14), and maximal left atrial volume (β 0.25) (all P < 0.001). Prevalence of iLVM was 10% in patients in stage-1 CKD, 31% in stage 2, 67% in stage 3, and 100% in stages 4 and 5. Conclusion: In patients at increased risk for cardiovascular events, iLVM is strongly related to the presence and magnitude of CKD. Further longitudinal studies are needed to evaluate the prognostic value of the coexistence of iLVM and CKD. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Paparella D.,University of Bari | Guida P.,Puglia Health Regional Agency | Di Eusanio G.,Citta Of Lecce Hospital | Caparrotti S.,Villa Bianca Hospital | And 8 more authors.
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery | Year: 2014

OBJECTIVES: To evaluate performance of the European System for Cardiac Operation Risk Evaluation (EuroSCORE II), to assess the influence of model updating and to derive a hierarchical tree for modelling the relationship between EuroSCORE II risk factors and hospital mortality after cardiac surgery in a large prospective contemporary cohort of consecutive adult patients.METHODS: Data on consecutive patients, who underwent on-pump cardiac surgery or off-pump coronary artery bypass graft intervention, were retrieved from Puglia Adult Cardiac Surgery Registry. Discrimination, calibration, re-estimation of EuroSCORE II coefficients and hierarchical tree analysis of risk factors were assessed.RESULTS: Out 6293 procedures, 6191 (98.4%) had complete data for EuroSCORE II assessment with a hospital mortality rate of 4.85% and EuroSCORE II of 4.40 ± 7.04%. The area under the receiver operator characteristic curve (0.830) showed good discriminative ability of EuroSCORE II in distinguishing patients who died and those who survived. Calibration of EuroSCORE II was preserved with lower predicted than observed risk in the highest EuroSCORE II deciles. At logistic regression analysis, the complete revision of the model had most of re-estimated regression coefficients not statistically different from those in the original EuroSCORE II model. When missing values were replaced with the mean EuroSCORE II value according to urgency and weight of intervention, the risk score confirmed discrimination and calibration obtained over the entire sample. A recursive tree-building algorithm of EuroSCORE II variables identified three large groups (55.1, 17.1 and 18.1% of procedures) with low-to-moderate risk (observed mortality of 1.5, 3.2 and 6.4%) and two groups (3.8 and 5.9% of procedures) at high risk (mortality of 14.6 and 32.2%). Patients with low-to-moderate risk had good agreement between observed events and predicted frequencies by EuroSCORE II, whereas those at greater risk showed an underestimation of expected mortality.CONCLUSIONS: This study demonstrates that EuroSCORE II is a good predictor of hospital mortality after cardiac surgery in an external validation cohort of contemporary patients from a multicentre prospective regional registry. The EuroSCORE II predicts hospital mortality with a slight underestimation in high-risk patients that should be further and better evaluated. The EuroSCORE II variables as a risk tree provides clinicians and surgeons a practical bedside tool for mortality risk stratification of patients at low, intermediate and high risk for hospital mortality after cardiac surgery. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.


Cioffi G.,Villa Bianca Hospital | Russo T.E.,Villa Bianca Hospital | Selmi A.,Villa Bianca Hospital | Stefenelli C.,Villa Bianca Hospital | Furlanello F.,Villa Bianca Hospital
European Journal of Echocardiography | Year: 2011

Aims: Midwall mechanics reveal systolic dysfunction in obese and hypertensive patients with concentric left ventricular (LV) geometry, which is frequently detected in subjects with obstructive sleep apnoea (OSA). Midwall mechanics have never been studied in these patients, who frequently experience heart failure (HF).Methods and resultsWe analysed midwall stress-shortening relations by echocardiography in 150 controls and 200 patients with OSA (age 62 ± 13 years) without known cardiac disease. On the basis of the severity of OSA, patients were divided into mild OSA (n 63), moderate OSA (n 70), and severe OSA (n 67). LV stress-corrected midwall shortening (scMS) was considered low if <87 in men and <90 in women. scMS was similar in controls and mild OSA (90 ± 13 and 91 ± 18, respectively) and significantly lower in moderate and severe OSA (83 ± 14 and 83 ± 15; all P < 0.001 vs. controls and mild OSA). Prevalence of low scMS was 40 and 39 in controls and mild OSA (PNS), 62 in moderate and 61 in severe OSA (both P < 0.001 vs. controls and mild OSA). In logistic regression analysis, low scMS was associated with moderatesevere OSA (OR 3.82, P < 0.001) independent of significant associations with diabetes (OR 5.06, P < 0.01), LV hypertrophy (OR 1.89, P 0.01), and LV concentric geometry (OR 2.79, P < 0.001). Conclusion Midwall mechanics are impaired in more than half of middle-aged patients with OSA without known cardiac disease. Moderatesevere OSA predicts LV systolic dysfunction independent of diabetes, LV hypertrophy, and concentric geometry. These relations may in part explain the increased rate of HF and cardiovascular events in these patients. © The Author 2010.

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