Papers by Antonio de Luna
Solving the gap between HCV detection and treatment in prison. HCV-RNA testing and treatment in a cohort of new arriving convicts in Southern Italy
Reviews on Recent Clinical Trials, 2021
Introduction: HCV infection elimination is set to be carried out by 2030. To achieve this goal, t... more Introduction: HCV infection elimination is set to be carried out by 2030. To achieve this goal, the WHO has set minor achievable short-term “mini-goals.” One of these is the treatment of “difficult to reach and treat populations,” such as prisoners. One of the biggest obstacles to reaching this mini goal is the poor knowledge of the real HCV prevalence in such a population and the barriers to its detection, treatment, and follow-up. Even if HCV testing in Italian prisons is feasible and recommended, it is not always carried out. To worsen the picture, the peculiar status of conviction is correlated with the difficulty in carrying out the antiviral therapy due to challenges in follow-up and the refusals by inmates. Aims: A point-of-care test-and-treat program was set up in a penitentiary in Southern Italy to reduce the number of patients lost-to-follow-up (LTFU) between detection and treatment. A secondary aim was to evaluate the prevalence of HCV-infected patients in a cohort of new...
HCV point‐of‐care screening programme and treatment options for people who use drugs in a metropolitan area of Southern Italy
Liver International, 2019
People who use drugs (PWUD) represent an active reservoir of HCV infection. The prevalence of chr... more People who use drugs (PWUD) represent an active reservoir of HCV infection. The prevalence of chronic HCV infection in PWUD in Italy remains unknown because of the lack of systematic screening. Thanks to direct‐acting antiviral agents (DAAs), hepatitis C can now be cured in most patients. Thus, the next challenge is to provide linkage‐to‐care for these patients.
Antiviral therapy, Jan 11, 2017
Direct Antiviral Agents (DAA) demonstrated high efficacy among HCV-infected patients in registere... more Direct Antiviral Agents (DAA) demonstrated high efficacy among HCV-infected patients in registered trials. Nevertheless, the impact of these therapies on liver stiffness measurement(LSM) and liver functionality in "real-life" is not well-known. Aim of the present study was to evaluate the SVR impact on LSM and clinical parameters of DAA-therapy on a real-life population of HCV patients with F3/F4 fibrosis. 749 HCV genotype 1-4 patients with F3/F4 hepatitis undergoing antiviral therapy, were consecutively enrolled in four centers of Hepatology of Italy. Clinical, biochemical and imaging data were collected at the baseline(T0), at the End of Therapy(EoT) and after 12 weeks(SVR12). Out of 749 patients, 69.7% was F4 and 30.3% was F3. SVR12 was reached in 97,5%. LSM significantly decreased from T0 to EoT(p<0.001) whereas it did not from EoT to SVR12(p:ns). Moreover, in F4 no significant differences were found in Child and MELD between T0, EoT and SVR12(p=ns). At the univaria...
S2072 Interferon-Related Autoimmune Thyroid Disease in 3414 Naïve Patients with Chronic Hepatitis C
Gastroenterology, 2009
Gastroenterology, Volume 136, Issue 5, Pages A-324, May 2009, Authors:Filomena Morisco; Daniela C... more Gastroenterology, Volume 136, Issue 5, Pages A-324, May 2009, Authors:Filomena Morisco; Daniela C. Amoruso; Mariateresa Tartaglione; Antonio D. Luna; Pietro Andreone; Carmine Coppola; Nicola Passariello; Carlo Carella; Alessandra Scuteri; Claudio Iannacone; Nicola
Cardiovascular Engineering and Technology, Oct 26, 2010
The American Journal of Cardiology, Dec 1, 2006
The aim of this study was to evaluate the association between heart rate turbulence (HRT) paramet... more The aim of this study was to evaluate the association between heart rate turbulence (HRT) parameters and clinical, biochemical, echocardiographic, and electrocardiographic measures of heart failure (HF) in a large, prospectively enrolled population of patients with HF to determine whether HRT could be considered a marker of HF advancement and progression, giving insight into hemodynamic changes as well as changes of the autonomic nervous system. In 487 patients with HF (mean age 63 years), the following tests were performed: 12-lead surface electrocardiography, echocardiography, chest x-rays, N-terminal-pro-brain natriuretic peptide levels, and 24-hour Holter monitoring for HRT and heart rate variability analyses. Most patients were in New York Heart Association class II (82%) and had a mean left ventricular (LV) ejection fraction of 37 ؎ 14%. Both HRT parameters, but especially turbulence slope, were significantly correlated with clinical indexes of HF (the third heart sound, peripheral edemas, jugular distension, and pulmonary congestion). Patients in New York Heart Association class III had significantly lower turbulence slopes and greater turbulence onset values than those in class II. Significant correlations were found between HRT parameters and the LV ejection fraction as well as with LV diameters. HRT parameters were significantly correlated with N-terminal-pro-brain natriuretic peptide levels (r ؍ ؊0.47, p <0.001 for turbulence slope). Multivariate analyses showed that abnormal HRT parameters were independent predictors of HF severity measured by New York Heart Association class III and a LV ejection fraction <40%. In conclusion, the findings indicate that in patients with HF, HRT reflects well the severity of HF and associated LV dysfunction, which were verified in this study by a series of established clinical, echocardiographic, and biochemical parameters.
J Amer Coll Cardiol, 2010
RITA (Randomized Intervention Trial of Unstable Angina) 3 trial had a wide separation in the freq... more RITA (Randomized Intervention Trial of Unstable Angina) 3 trial had a wide separation in the frequency of revascularization rates between the 2 arms of the respective trials compared with a modest difference in the ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes) trial.
There are fibers in the left ventricle (LV) (LV middle network) that in around one third of cases... more There are fibers in the left ventricle (LV) (LV middle network) that in around one third of cases may be considered a true septal fascicle that arises from the common left bundle. Its presence and the evidence that there are 3 points of activation onset in the LV favor the quadrifascicular theory of the intraventricular activation of both ventricles. Since the 70s, different authors have suggested that the block of the left middle fibers (MS)/left septal fascicle may explain different electrocardiographic (ECG) patterns. The 2 hypothetically based criteria that are in some sense contradictory include: a) the lack of septal "q" wave due to first left and later posteriorly shifting of the horizontal plane loop and b) the presence of RS in lead V 2 (V 1 -V 2 ) due to some anterior shifting of the horizontal plane vectorcardiogram loop. However, there are many evidence that the lack of septal q waves can be also explained by predivisional first-degree left bundle-branch block and that the RS pattern in the right precordial leads may be also explained by first-degree right bundle-branch block. The transient nature of these patterns favor the concept that some type of intraventricular conduction disturbance exists but a doubt remains about its location. Furthermore, the RS pattern could be explained by many different normal variants. To improve our understanding whether these patterns are due to MF/left septal fascicle block or other ventricular conduction disturbances (or both), it would be advisable: 1) To perform more histologic studies (heart transplant and necropsy) of the ventricular conduction system; 2) To repeat prior experimental studies using new methodology/technology to isolate the MF; and 3) To change the paradigm: do not try to demonstrate if the block of the fibers produces an ECG change but to study with new electroanatomical imaging techniques, if these ECG criteria previously described correlate or not with a delay of activation in the zone of the LV that receives the activation through these fibers or in other zones.
The American Journal of Emergency Medicine, Jan 11, 2003
Spontaneous coronary artery dissection is an unusual cause of acute coronary syndrome. We describ... more Spontaneous coronary artery dissection is an unusual cause of acute coronary syndrome. We describe a series of cases that with an early diagnosis and aggressive treatment, which includes percutaneous angioplasty with stent implantation and cardiac surgery, had a good outcome. The objective was to study the demographic characteristics, clinical settings, treatments, and inhospital course of patients with spontaneous coronary artery dissection. We studied a retrospective case series in 3 coronary care units in third-level university hospitals. The spontaneous coronary artery dissection diagnosis was made by coronary angiography. Seven cases of spontaneous coronary artery dissections were recorded. They were 5 women and 2 men. The age range was 28 to 64 years. Two of them took oral contraceptives and one case occurred in the postpartum period. An acute anterior wall myocardial infarction was the most frequent clinical presentation, occurring in 4 of the 7 cases. In fact, the left anterior descending artery was involved in 6 cases. An urgent coronary angiogram was performed in all cases. Definitive treatment included percutaneous angioplasty and stent implantation in 3 cases, coronary artery bypass surgery in 2 case, and cardiac transplantation in another case. One patient was treated medically. None of the patients died in the hospital. Spontaneous coronary artery dissection remains an unusual cause of acute coronary syndrome. It should be included in the differential diagnosis of acute myocardial infarction, especially when it affects young, healthy females. An early clinical suspicion and diagnosis with urgent coronary angiography and aggressive treatment that includes percutaneous angioplasty with stent implantation and cardiac surgery could improve the prognosis of these patients. (Am J Emerg Med 2003;21:549-551.
Impact of telaprevir in HCV patients with cirrhosis and RVR: real-life data from Boceprevir or Telaprevir based "triple therapy" experience in southern Italy
Reviews on recent clinical trials, Jan 17, 2015
Background and rationale of study The real-life data of triple therapy-based treatment in patient... more Background and rationale of study The real-life data of triple therapy-based treatment in patients with chronic hepatitis C were investigated in this survey of 12 clinical centers of southern Italy. This retrospective study analyzed data from 176 consecutive patients. Methods 125(70%) patients were treated with telaprevir, and 51(30%) with boceprevir. There were no differences in demographic characteristics between the groups. The degree of liver fibrosis(LF) was evaluated according to liver biopsy(LB) and/or transient elastography(TE). 53/176 patients (30%) had liver cirrhosis. Sixteen patients(9%) were treatment naïve, and the remaining were not: 92 were non-responders(52,84%), 63 relapsed(35,79%), and 5 discontinued treatment (2,8%). Results Overall, the rapid virological response(RVR) rate was 67.6%. Of the 103 patients who had follow-up for at least 12 weeks after the end of treatment, 61 (59,2%) achieved a sustained virological response(SVR). According to multivariate analysis...
[Electrophysiologic characteristics of the transplanted heart]
Archivos del Instituto de Cardiología de México
The electrophysiologic characteristics of the denervated human heart were assessed in 20 cardiac ... more The electrophysiologic characteristics of the denervated human heart were assessed in 20 cardiac transplants recipient from the Cardiology Department, at the Hospital of San Pablo, Barcelona, Spain. We studied the donor and the recipient sinus node function at rest and exercise test. Holter recording of 24 hours was performed in a few cases. At rest, in 14 patients the intrinsic heart rate of the donor atrium was slower when we used the technique of José. When we analyzed all the results we did not find statistical differences in the heart rate of either: the donor or the recipient atria (r = 0.58, p less than 0.01). However we observed a marked increase in heart rate of the donor with exercise test and normal activity (Holter), probably reflecting an increase in circulating catecholamines (exercise test: base-line 116 +/- 16 vs maximum exercise 140 +/- 10, p less than 0.001; Holter: minimal rate 64 +/- 9.66 vs maximal rate 112 +/- 23, p less than 0.001). We also describe the cardiac arrhythmias including two sudden deaths associated with ventricular tachyarrhythmias and in five patients sinus node disfunction in relation with episodes of acute rejection. We concluded that is important to perform a standard 12 lead electrocardiogram, exercise testing, Holter recording and electrophysiologic study as part of the ongoing routine evaluation of surviving cardiac transplant patients.
[Transposition of .he great vessels. (Programmed instruction)]
Revista Espa de Cardiologia
American heart journal
Emergent reperfusion strategies are integral to providing optimal patient outcomes in the setting... more Emergent reperfusion strategies are integral to providing optimal patient outcomes in the setting of acute coronary artery occlusion. ST-segment elevation on the surface 12-lead electrocardiogram, although specific as a surrogate marker, is insensitive to acute posterior circulation coronary artery occlusion. Studies of non-ST-segment elevation acute coronary syndrome consistently identify patients who have epicardial vessel occlusion at the time of initial angiography, which is usually delayed for hours or days after the initial presentation. In addition, studies of ST-segment elevation myocardial infarction often divulge a disparity in identification of the infarct-related artery, with an underrepresentation of the left circumflex artery. Taken together, it is likely that many patients with left circumflex artery occlusion are "missed" during the early phases of myocardial infarction due to the electrocardiographically silent nature of the posterior territory, resulting in delayed myocardial salvage and worse cardiovascular outcomes. In this review, we report on the magnitude of missed left circumflex infarction and the consequences of this delay in diagnosis. We review the electrocardiographic findings of left circumflex occlusion and discuss strategies to enhance early identification. Heightened awareness of this clinical scenario and the available methods to avoid missing this elusive diagnosis are imperative in our quest to further improve the outcomes of patients with acute myocardial infarction. (Am Heart J 2009;158:706-12.)
Impaired interatrial conduction or interatrial block is well documented but is not described as a... more Impaired interatrial conduction or interatrial block is well documented but is not described as an individual electrocardiographic (ECG) pattern in most of ECG books, although the term atrial abnormalities to encompass both concepts, left atrial enlargement (LAE) and interatrial block, has been coined. In fact, LAE and interatrial block are often associated, similarly to what happens with ventricular enlargement and ventricular block. The interatrial blocks, that is, the presence of delay of conduction between the right and left atria, are the most frequent atrial blocks. These may be of first degree (P-wave duration N120 milliseconds), third degree (longer P wave with biphasic [±] morphology in inferior leads), and second degree when these patterns appear transiently in the same ECG recording (atrial aberrancy). There are evidences that these electrocardiographic P-wave patterns are due to a block because they may (a) appear transiently, (b) be without associated atrial enlargement, and (c) may be reproduced experimentally. The presence of interatrial blocks may be seen in the absence of atrial enlargement but often are present in case of LAE. The most important clinical implications of interatrial block are the following: (a) the first degree interatrial blocks are very common, and their relation with atrial fibrillation and an increased risk for global and cardiovascular mortality has been demonstrated; (b) the third degree interatrial blocks are less frequent but are strong markers of LAE and paroxysmal supraventricular tachyarrhythmias. Their presence has been considered a true arrhythmological syndrome.
Recently, a new complexity measure, multiscale entropy (MSE), has been developed based on the qua... more Recently, a new complexity measure, multiscale entropy (MSE), has been developed based on the quantification of heart rate fluctuations over a range of time scales. Here, we use the MSE algorithm to analyze the cardiac interbeat interval time series from patients with congestive heart failure (CHF) enrolled in the MUSIC study. Our hypothesis is that the heart rate time series from the patients who survived have more dynamical complexity that those from patients who did not survive. MUSIC (Muerte Subita en Insufficiencia Cardiaca) is a prospective multicenter longitudinal study designed to assess risk predictors of death inpatients with heart failure. The MSE algorithm was used to quantify the degree of complexity of the interbeat interval time series derived from 24-hour Hotter recordings. The analysis was performed up to scale 20 that corresponds to approximately 20 seconds. For all measured time scales, the mean MSE values were significantly (p < 0.01) higher for the entire RR ...
The Value of Electrocardiographic Abnormalities in the Prognosis of Pulmonary Embolism: A Consensus Paper
Annals of Noninvasive Electrocardiology, 2015
Electrocardiographic (ECG) abnormalities in the setting of acute pulmonary embolism (PE) are bein... more Electrocardiographic (ECG) abnormalities in the setting of acute pulmonary embolism (PE) are being increasingly characterized and mounting evidence suggests that ECG plays a valuable role in prognostication for PE. We review the historical 21-point ECG prognostic score for the severity of PE and examine the updated evidence surrounding the utility of ECG abnormalities in prognostication for severity of acute PE. We performed a literature search of MEDLINE, EMBASE, and PubMed up to February 2015. Article titles and abstracts were screened, and articles were included if they were observational studies that used a surface 12-lead ECG as the instrument for measurement, a diagnosis of PE was confirmed by imaging, arteriography or autopsy, and analysis of prognostic outcomes was performed. Thirty-six articles met our inclusion criteria. We review the prognostic value of ECG abnormalities included in the 21-point ECG score, including new evidence that has arisen since the time of its publication. We also discuss the potential prognostic value of several ECG abnormalities with newly identified prognostic value in the setting of acute PE.
Annals of hepatology
Background and rationale of the study. Hepatitis C infection is very common among injection drug ... more Background and rationale of the study. Hepatitis C infection is very common among injection drug users(IDUs). In clinical practice there is reluctance to treat IDUs, because considered difficult-to-treat. Aim of this study was to evaluate the response to antiviral treatment in IDUs compared to non-IDUs. In this observational retrospective study, 204 non cirrhotic patients(112 IDUs, 92 non-IDUs) with chronic hepatitis C, treated with PEG-IFN and ribavirin in a tertiary centre for IDUs of Southern Italy from 2008 to 2011 were analyzed. Age, sex, genotype, steatosis, response to previous therapy, rapid(RVR), early(EVR), end-of-treatment(ETR), sustained(SVR) virological response were evaluated. IDUs were mainly young and males, with prevalence of genotype 3. A higher SVR rate in IDUs group compared to non-IDUs only in PerProtocol(PP) analysis (90% vs. 78,9% ;p = 0.04). On the contrary, in IntentionToTreat(ITT) analysis, no significant difference was relieved. A higher SVR rate at ITT an...
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2007
Subjects with ischemic dilated cardiomiopathy tend to suffer episodes of sudden cardiac death, th... more Subjects with ischemic dilated cardiomiopathy tend to suffer episodes of sudden cardiac death, thus risk stratification is essential to establish an adequate therapy for the patients. In this work, a new methodology was proposed for the study of the heart rate variability by using a multiscale analysis based on the concept of entropy rates, for improving risk prediction in cardiac patients. Symbolic dynamics were applied to RR time series and sets of words in several scales were constructed. The multiscale regularity analysis was proposed by comparing the entropies, calculated using Shannon and Renyi definitions, of the series of words in different scales. The study considered the selection of the best parameters for the length of the words (l) and the order of the entropies (q). Statistical analysis with repeated measures and discriminant analysis revealed statistically significant differences (p-value<0.05) and a high percentage of well classified subjects in their different ri...
Electrocardiographic findings in patients with cryptogenic ischemic stroke and patent foramen ovale
Journal of electrocardiology, 2007
A characteristic electrocardiogram (ECG) pattern called crochetage has been described in patients... more A characteristic electrocardiogram (ECG) pattern called crochetage has been described in patients with atrial septal defects. Nevertheless, there are discrepancies regarding its frequency in patients with patent foramen ovale (PFO). We analyzed the ECGs of patients who had cryptogenic stroke to study crochetage and other possible patterns in relation to PFO. We prospectively included consecutive patients who have had a cryptogenic stroke and are undergoing a right-to-left shunt (RLS) study with transesophageal echocardiography and simultaneous transcranial Doppler. Two blinded and independent cardiologists analyzed the ECGs for crochetage, defined as a notch near the apex of the R wave in inferior limb leads, P wave abnormalities, and right bundle branch block (RBBB). We studied 104 patients whose mean age was 55.1 +/- 12.7 years; 60.6% were men. PFO was detected in 40.4% of patients. Cardiologists recorded crochetage in 26.2% of patients with PFO and 14.5% of patients without PFO (...
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Papers by Antonio de Luna