Papers by Domenico Cianflone
European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2009
Arterial vasa vasorum (VV) are known to be involved in the atherosclerotic process. The aim of th... more Arterial vasa vasorum (VV) are known to be involved in the atherosclerotic process. The aim of the present study was to explore whether ultrasound imaging with contrast agent is able to visualize adventitial VV in human carotid atherosclerosis. We studied with standard ultrasound 25 patients with carotid stenosis >50% (ATS group) and 15 patients without carotid artery plaques and an intima-media thickness (IMT) <1.0 mm (CTRL group). All patients underwent contrast ultrasound to evaluate periadventitial VV and B-flow imaging (BFI) modality was used to improve and measure periadventitial flow signal. On contrast-enhanced images, a fast microbubble flow and a homogeneous and linear periadventitial contrast signal using BFI were detectable in the adventitial area in all patients of both groups. Periadventitial signal thickness by BFI was higher in patients with atherosclerosis than in the control group (mean +/- SD: CTRL 0.80+/-0.06 mm; ATS 1.10+/-0.11 mm; P<0.001). Moreover, c...
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2015
Clinical success of atrial fibrillation (AF) ablation depends on persistent block of electrical c... more Clinical success of atrial fibrillation (AF) ablation depends on persistent block of electrical conduction across the ablation lines. The fate of ablations performed with temperature-controlled bipolar radiofrequency (RF) is unknown. The purpose of this study was to validate the electrophysiological (EP) efficacy of these lesions, recording pulmonary vein isolation (PVI) after open chest ablation, in the human being. Ten consecutive mitral patients (mean age: 53 ± 12 years) with concomitant AF were treated with the Cobra Revolution (Estech, San Ramon, CA, USA) bipolar RF device were enrolled for EP assessment. During surgery, pairs of additional temporary wires were positioned on the right PVs (RPV) and on the roof of the left atrium (RLA), before ablation. Pacing thresholds (PTs) were assessed before, after a single encircling ablation and at chest's closure. EP study was repeated before discharge and at 3 weeks. RLA wires served as control. Baseline PTs were 0.83 ± 0.81 mA (ra...
Background—Enhanced coronary vasomotion may contribute to acute coronary occlusion during the acu... more Background—Enhanced coronary vasomotion may contribute to acute coronary occlusion during the acute phase of myocardial infarction (AMI). Japanese have a higher incidence of variant angina than Caucasian patients, but racial differences in vasomotor reactivity early after AMI are controversial. Methods and Results—The same team studied 15 Japanese and 19 Caucasian patients within 14 days of AMI by acetylcholine injection into
Nutrition, Metabolism and Cardiovascular Diseases, 2008
Journal of the American College of Cardiology, 2008
This study was designed to evaluate contrast-enhanced ultrasound imaging of carotid atheroscleros... more This study was designed to evaluate contrast-enhanced ultrasound imaging of carotid atherosclerosis as a clinical tool to study intraplaque neovascularization.
Journal of the American College of Cardiology, 2004
Journal of the American College of Cardiology, 2002
lowed prospectively for cardiovascular events after screening for baseline cardiovascular risks a... more lowed prospectively for cardiovascular events after screening for baseline cardiovascular risks and cTnl. Patients who had suffered any acute coronary event within the preceding 30 days were excluded from the study.
European Journal of Cardio-Thoracic Surgery, 2012
OBJECTIVES: Clinical success of atrial fibrillation (AF) ablation depends on persistent blocking ... more OBJECTIVES: Clinical success of atrial fibrillation (AF) ablation depends on persistent blocking of electrical conduction across the ablation lines. Epicor high-intensity focused ultrasound (HIFU) ablation has been credited with a variable clinical efficacy. The aim of this work is to ascertain the electrophysiological (EP) efficacy of such lesions, by assessing pulmonary vein isolation (PVI) after open chest HIFU ablation, in the clinical setting.
Arteriosclerosis, Thrombosis, and Vascular Biology, 2008
The T-cell receptor zeta (TCR)-chain is a master sensor and regulator of lymphocyte responses. Lo... more The T-cell receptor zeta (TCR)-chain is a master sensor and regulator of lymphocyte responses. Loss of TCR-chain expression has been documented during infectious and inflammatory diseases and defines a population of effector T cells (TCR dim T cells) that migrate to inflamed tissues. We assessed the expression and functional correlates of circulating TCR dim T cells in coronary artery disease. Methods and Results-We examined the expression of TCR-chain by flow cytometry in 140 subjects. Increased peripheral blood CD4 ϩ TCR dim T cells were found in patients with acute coronary syndromes (ACS, nϭ66; median 5.3%, interquartile 2.6 to 9.1% of total CD4 ϩ T cells; PϽ0.0001) compared to chronic stable angina (CSA, nϭ32; 1.6%; 1.0 to 4.1%) and controls (nϭ42; 1.5%; 0.5 to 2.9%). Such increase was significantly greater in ACS patients with elevated levels of C-reactive protein, and it persisted after the acute event. Moreover, TCR dim cells were also more represented within CD8 ϩ T cell, NK, and CD4 ϩ CD28 null T cell subsets in ACS compared to CSA and controls. Finally, CD4 ϩ and CD8 ϩ TCR dim T cells isolated from ACS displayed an enhanced transendothelial migratory capacity.
European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2009
Arterial vasa vasorum (VV) are known to be involved in the atherosclerotic process. The aim of th... more Arterial vasa vasorum (VV) are known to be involved in the atherosclerotic process. The aim of the present study was to explore whether ultrasound imaging with contrast agent is able to visualize adventitial VV in human carotid atherosclerosis. We studied with standard ultrasound 25 patients with carotid stenosis >50% (ATS group) and 15 patients without carotid artery plaques and an intima-media thickness (IMT) <1.0 mm (CTRL group). All patients underwent contrast ultrasound to evaluate periadventitial VV and B-flow imaging (BFI) modality was used to improve and measure periadventitial flow signal. On contrast-enhanced images, a fast microbubble flow and a homogeneous and linear periadventitial contrast signal using BFI were detectable in the adventitial area in all patients of both groups. Periadventitial signal thickness by BFI was higher in patients with atherosclerosis than in the control group (mean +/- SD: CTRL 0.80+/-0.06 mm; ATS 1.10+/-0.11 mm; P<0.001). Moreover, c...
Heart, 2003
Objective: To identify in humans the temporal patterns of no reflow and their functional implicat... more Objective: To identify in humans the temporal patterns of no reflow and their functional implications. Methods: 24 patients with first acute myocardial infarction and successful coronary recanalisation by recombinant tissue-type plasminogen activator (n = 15) or primary percutaneous transluminal coronary angioplasty (n = 9) were studied by myocardial contrast echocardiography within 24 hours of recanalisation and at one month's follow up. Myocardial contrast echocardiography was performed by intermittent harmonic power Doppler and intravenous Levovist. The regional contrast score index (CSI) was calculated within dysfunctioning myocardium. Videointensity was measured (dB) within risk and control areas and their ratio was calculated. Results: In 8 patients reflow was observed at 24 hours and persisted at one month. Conversely in 16 patients areas of no reflow were detectable at 24 hours. At one month, no reflow was spontaneously reversible in 9 patients (mean (SD) CSI and videointensity ratio improved from 2.5 (0.5) to 1.4 (0.6) and from 0.6 (0.1) to 0.7 (0.1), respectively; p < 0.05) and was sustained in the remaining 7 patients (CSI and videointensity ratio remained unchanged from 2.6 (0.6) to 2.6 (0.5) and from 0.5 (0.2) to 0.5 (0.2), respectively; NS). Left ventricular function improved significantly in patients with reflow and reversible no reflow. Volumes were enlarged only in patients with sustained no reflow. Conclusions: No reflow detected at 24 hours may be sustained or spontaneously reversible at one month. Such reversibility of the phenomenon is associated with preserved left ventricular volumes and function. Clarification of the mechanisms of delayed reversibility may lead to tailored treatment of no reflow even in the subacute phase of myocardial infarction.
Atherosclerosis Supplements, 2011
Patients with systemic lupus erythematosus (SLE) are at higher risk for cardiovascular (CV) event... more Patients with systemic lupus erythematosus (SLE) are at higher risk for cardiovascular (CV) events, mainly due to an increased atherosclerotic burden. Traditional, immunological, disease-and treatment-related factors could explain such difference, but their single contributions on the pathogenesis of atherosclerosis is unclear. Methods: In fifty patients (44±10 years, 86% female) with a median SLE duration of 14 years, and 50 sex-and age-matched controls 56 subsets of circulating CD4 T-cells were investigated by 8/color/polycromatic flow cytometry (CD3/CD4/CD45RO/CD45RA/CCR7/CCR5/CXCR3/HLA-DR) and correlated to lipid, metabolic, inflammatory profile and carotid intima-media thickness (CIMT). Results: Patients with SLE did not differ in terms of CV risk factors and metabolic profile compared to controls, except for a reduction in highdensity lipoprotein levels (p < 0.001). SLE patients presented significant changes concerning the immunological profile (increase in C-reactive protein, lymphopenia and modified levels of circulating HLA-DR+, CCR5+T and effector memory T-cells). Age-adjusted mean CIMT was significantly higher in patients compared to controls (p = 0.03). In univariate analysis correlations were observed between age-adjusted mean CIMT and systolic blood pressure (p = 0.048), LDL cholesterol (trend p = 0.06) and body-mass index (p = 0.01) but not with immunological parameters. Among variables associated to the treatment only antimalarian hydroxycloroquine therapy was associated with lower CIMT. Conclusions: As traditional CV risks factors are significantly associated with accelerated atherosclerosis in SLE patients, management of CV risk factors should be part of the treatment. As the inflammatory status in SLE is not a constant but a waxing and waning pressure, that could explain the lack of correlation between CIMT and immunological features.
Atherosclerosis Supplements, 2011
Under the casein-induced inflamed animal model, IL-6R signaling blockade by tocilizumab resulted ... more Under the casein-induced inflamed animal model, IL-6R signaling blockade by tocilizumab resulted in an enhanced expression of ABCA1, ABCG1 and LXRa in peritoneal macrophages and aortae, while a reduction in aortic root atherosclerotic lesion area. Conclusions: IL-6 decreased ABCA1 and ABCG1 expression and inhibited cholesterol efflux, which was mediated by IL-6-induced JAK/STAT3 signaling pathway and accompanying LXR inhibition.
Atherosclerosis Supplements, 2009
Pharmacological Research, 1998
The growing size of trials on primary and secondary prevention of acute coronary syndromes charac... more The growing size of trials on primary and secondary prevention of acute coronary syndromes characterised by very broad inclusion criteria may seem logical to 'trialists', who reason that the broader the inclusion criteria, the easier it is to recruit large numbers of patients in a short period of time and the more widely applicable are the results of the study. However, large trials with very broad inclusion criteria raise two grounds for concern for physicians. The first is that the broader the inclusion criteria for enrolment in a trial in order to prove a statistically significant benefit, the greater the heterogeneity of the study population which is likely to include both susceptible and non-susceptible patients to the tested treatment. The second is that this method of assessment rapidly increases the number of treatments that produce a statistically-significant improvement in prognosis within the same broad group of patients. On the contrary, the identification of potential responders to a specific treatment can provide a personalised form of medical care suited to the needs of each individual patient with an optimal cost᎐benefit ratio. This approach, however, represents a major challenge as it can only be based on the identification of homogeneous subgroups of patients with common risk factors for the development of acute coronary syndromes or of their recurrence. This challenge can only be overcome by a strong commitment in funding studies on the multiple causes of acute coronary syndromes.
Nutrition, Metabolism and Cardiovascular Diseases, 2008
Nutrition, Metabolism and Cardiovascular Diseases, 2008
Uploads
Papers by Domenico Cianflone