Papers by Rita Camporotondo
Giornale italiano di cardiologia, 2020
<jats:p> <jats:bold>Background</jats:bold> : Aim of this study is to assess the... more <jats:p> <jats:bold>Background</jats:bold> : Aim of this study is to assess the circadian variation in the occurrence of Tako-tsubo cardiomyopathy(TTC). </jats:p> <jats:p> <jats:bold>Methods:</jats:bold> We evaluated 78 consecutive pts (76 F, median age 61 yy) with TTC occurring between 2002 and 2008 at the Tako-Tsubo Cardiomyopathy Italian Network (TIN) Centers. All pts fulfilled the following diagnostic criteria for TTC: </jats:p> <jats:p> <jats:list list-type="order"> <jats:list-item> <jats:p>transient akinesia/diskinesia beyond a single major coronary artery vascular distribution;</jats:p> </jats:list-item> <jats:list-item> <jats:p>no angiographic evidence of significant coronary artery disease;</jats:p> </jats:list-item> <jats:list-item> <jats:p>new electrocardiographic changes;</jats:p> </jats:list-item> <jats:list-item> <jats:p>absence of intracranial bleeding, pheochromocitoma, myocarditis or hypertrophic cardiomyopathy.</jats:p> </jats:list-item> </jats:list> </jats:p> <jats:p> The time of symptom onset during day was categorized into four 6-hour intervals (night: 00:00 – 06:00; morning: 06:00 –12:00; afternoon: 12:00 –18:00; evening: 18:00 –24:00) for circadian analysis. Information on timing of the event that allowed categorization in to 1 of the 4 groups was available in 70 of 78 cases (90%). The distribution was tested for uniformity by the χ <jats:sup>2</jats:sup> test goodness of fit. </jats:p> <jats:p> <jats:bold>Results:</jats:bold> A circadian pattern, characterized by a significant peak in the morning (χ <jats:sup>2</jats:sup> =13,38, p=0.004), was found in patents with TTC (figure <jats:xref ref-type="fig" /> ). This pattern persisted even after adjustment according to a worst-case scenario in which untimed cases were arbitrarily assigned equally to each period according to the null amplitude hypothesis. </jats:p> <jats:p> <jats:bold>Conclusions</jats:bold> : Our data indicate a morning prevalence in the onset of TTC similar to other cardiovascular conditions and might be related to the circadian catecholamine activity. </jats:p> <jats:p> <jats:graphic xmlns:xlink="http://www.w3.org/1999/xlink" orientation="portrait" position="anchor" xlink:href="4005F1.jpeg" /> </jats:p>
Clinical Research in Cardiology
Background Pulmonary embolism (PE) has been described in coronavirus disease 2019 (COVID-19) crit... more Background Pulmonary embolism (PE) has been described in coronavirus disease 2019 (COVID-19) critically ill patients, but the evidence from more heterogeneous cohorts is limited. Methods Data were retrospectively obtained from consecutive COVID-19 patients admitted to 13 Cardiology Units in Italy, from March 1st to April 9th, 2020, and followed until in-hospital death, discharge, or April 23rd, 2020. The association of baseline variables with computed tomography-confirmed PE was investigated by Cox hazards regression analysis. The relationship between d-dimer levels and PE incidence was evaluated using restricted cubic splines models. Results The study included 689 patients (67.3 ± 13.2 year-old, 69.4% males), of whom 43.6% were non-invasively ventilated and 15.8% invasively. 52 (7.5%) had PE over 15 (9–24) days of follow-up. Compared with those without PE, these subjects had younger age, higher BMI, less often heart failure and chronic kidney disease, more severe cardio-pulmonary i...
Catheterization and Cardiovascular Interventions
Reliable preprocedural risk scores for the prediction of Contrast‐Induced Acute Kidney Injury (CI... more Reliable preprocedural risk scores for the prediction of Contrast‐Induced Acute Kidney Injury (CI‐AKI) following Percutaneous Coronary Intervention (pPCI) in patients with ST‐elevation myocardial infarction (STEMI) are lacking. Aim of this study was to derive and validate a preprocedural Risk Score in this setting.
European Heart Journal, Aug 1, 2017
46.4%,mean age 52.2) and 43 asymptomatic patients with normal coronary arteries (male 44.2%, mean... more 46.4%,mean age 52.2) and 43 asymptomatic patients with normal coronary arteries (male 44.2%, mean age 49.6) as the control group. MEE was calculated with a validated formula by using TTE parameters; circumferential end-systolic stress, LVOT ejection time, stroke volume. Results: In patients with CSX, MEE (cal/systole) was significantly higher than the control group (1,19±0,42 cal/sys vs. 0,86±0,17cal/sys, p<0.001). Correlation analysis demonstrated a significant negative relationship between MEE and DTS (β:-0.456, p<0.001). A cutoff value of 0,98 cal/min for MEE has 76,3% sensitivity and 74,6% specificity for prediction of CSX (AUC: 0.816, p<0.001). Conclusion: Our study demonstrated increased MEE in CSX patients. In conjunction with other postulated mechanisms, increased MEE may have a crucial role in CSX pathophysiology. This consideration may provide a different point of view to this entity.
European Heart Journal, Aug 1, 2017
Background: Clinical benefits of ticagrelor in ischemic heart disease have been previously establ... more Background: Clinical benefits of ticagrelor in ischemic heart disease have been previously established in the PLATO trial. In addition to a significant decrease in cardiovascular adverse events, an unexpected decrease in all-cause mortality was also observed. This so-called pleiotropic effect has been attributed to a non-platelet derived improve in endothelial function. Circulating endothelial cells (CECs) can be identified by their morphological properties and the expression of specific cellular markers. The number of CECs has been described as a strong prognosis determinant after acute coronary syndromes (ACS). In the other side, bone marrow-derived circulating progenitor endothelial cells (EPCs) have been related to a better outcome due to their reparative properties. Purpose: To determine differences in endothelial progenitor cells (EPCs) and mature circulating endothelial cells (CECs) between patients treated with ticagrelor or clopidogrel for an acute coronary syndrome. Methods: Prospective, multicentre, randomized study. Patients were considered for inclusion after ACS diagnose whenever they were P2Y12 inhibitors-naïve and no contraindication for antiplatelet or antithrombotic use was present. After inclusion, patients were allocated to ticagrelor or clopidogrel in a 1:1 manner. Blood samples for EPCs and CECs determination were extracted before antiplatelet loading dose and 48h from index pain presentation. Increment from basal levels at 48h is expressed as percentage. A multichannel cytometer was used and simultaneous tracing was performed for CD34, CD133, CD45, CD146, CD31 to allow optimal cell characterization (CD34+, CD133+, CD45-, CD146+ and CD31+ for EPCs and CD34+, CD133-, CD45-, CD146+ and CD31+ for CECs). Results: During the recruitment period, a total of 96 patients fulfilled inclusion criteria. Neither absolute CECs/EPCs absolute count nor increment from basal levels showed differences between groups. Results for EPCs and CECs are summarized in Table 1. Conclusions: Patients treated with ticagrelor during acute coronary syndromes, as compared to clopidogrel, showed similar levels of EPCs and CECs. These data suggest that endothelial protective effect mediated by ticagrelor is not related to bone marrow physiology modulation.
Journal of Cardiovascular Medicine
: The mechanisms underlying the relationships between elevated serum uric acid (SUA) and adverse ... more : The mechanisms underlying the relationships between elevated serum uric acid (SUA) and adverse outcomes in ST-segment elevation myocardial infarction (STEMI) are poorly investigated. Inflammation plays a central role in the pathogenesis of ischemia/ reperfusion damage after primary percutaneous coronary intervention (pPCI). The aim of our study was to explore the relationship between SUA and the inflammatory response in patients with STEMI undergoing pPCI. We included 45 consecutive patients, SUA levels were assessed on admission, high sensitivity C-Reactive Protein (hsCRP) and interleukin (IL) 6 were collected before and 6-12-24-36h after pPCI. Patients with SUA>6.8 mg/dl had higher hs-CRP and IL-6 peak values (respectively, P = 0.004 and P = 0.006). In the overall population, there was a significant linear correlation between SUA levels and Lnhs-CRP and LnIL-6 peak values (respectively, R = 0.366, P = 0.015 and R = 0.484, P = 0.001). The associations were maintained after adjusting for covariates. Our findings put the spotlight on a possible pathophysiological role of SUA in STEMI treated with pPCI and warrant further investigation.
European Heart Journal
Conclusion: Percutaneous coronary intervention may shortening the duration of rhythm conversion o... more Conclusion: Percutaneous coronary intervention may shortening the duration of rhythm conversion of patients with STEMI (>12 hours) who were presented with third or second degree type two AV block.
Diabetes Care
OBJECTIVE ST-segment elevation myocardial infarction (STEMI) patients with type 2 diabetes mellit... more OBJECTIVE ST-segment elevation myocardial infarction (STEMI) patients with type 2 diabetes mellitus (DM) have higher in-hospital mortality than those without. Since cardiac and renal functions are the main variables associated with outcome in STEMI, we hypothesized that this prognostic disparity may depend on a higher rate of cardiac and renal dysfunction in DM patients. RESEARCH DESIGN AND METHODS We retrospectively analyzed 5,152 STEMI patients treated with primary angioplasty. Left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR) were evaluated at hospital admission. The primary end point was in-hospital mortality. A composite of in-hospital mortality, cardiogenic shock, and acute kidney injury was the secondary end point. RESULTS There were 879 patients (17%) with DM. The incidence of LVEF ≤40% (30% vs. 22%), eGFR ≤60 mL/min/1.73 m2 (27% vs. 18%), or both (12% vs. 6%) was higher (P < 0.001 for all comparisons) in DM patients. In-hospital mo...
European Heart Journal
Young Investigator Award Session Thrombosis / Sex-related differences in the outcomes of cardiova... more Young Investigator Award Session Thrombosis / Sex-related differences in the outcomes of cardiovascular interventions 433 predictors of major bleeding in normotensive patients only. Haemodynamic instability was associated with 2.07-fold increased risk for major bleeding (1.26-3.38, p=0.004). Predictors of major bleeding Conclusion: In this large pooled European multicentre "real-world" cohort of thrombolysed PE patients, the prevalence of risk factors for major bleeding and their prognostic impact differed in haemodynamic unstable compared to normotensive patients. If considering thrombolysis in normotensive PE patients, the risk of major bleeding related to anaemia, female sex and syncope might deserve more attention.
International Journal of Infectious Diseases
Nutrition, Metabolism and Cardiovascular Diseases
International Journal of Cardiology
EP Europace
Aims To assess the clinical relevance of a history of atrial fibrillation (AF) in hospitalized pa... more Aims To assess the clinical relevance of a history of atrial fibrillation (AF) in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods and results We enrolled 696 consecutive patients (mean age 67.4 ± 13.2 years, 69.7% males) admitted for COVID-19 in 13 Italian cardiology centres between 1 March and 9 April 2020. One hundred and six patients (15%) had a history of AF and the median hospitalization length was 14 days (interquartile range 9–24). Patients with a history of AF were older and with a higher burden of cardiovascular risk factors. Compared to patients without AF, they showed a higher rate of in-hospital death (38.7% vs. 20.8%; P < 0.001). History of AF was associated with an increased risk of death after adjustment for clinical confounders related to COVID-19 severity and cardiovascular comorbidities, including history of heart failure (HF) and increased plasma troponin [adjusted hazard ratio (HR): 1.73; 95% confidence interval (CI) 1.06–2.84; P = 0.02...
European Journal of Heart Failure
JAMA Cardiology
IMPORTANCE Myocardial injury, detected by elevated plasma troponin levels, has been associated wi... more IMPORTANCE Myocardial injury, detected by elevated plasma troponin levels, has been associated with mortality in patients hospitalized with coronavirus disease 2019 (COVID-19). However, the initial data were reported from single-center or 2-center studies in Chinese populations. Compared with these patients, European and US patients are older, with more comorbidities and higher mortality rates. OBJECTIVE To evaluate the prevalence and prognostic value of myocardial injury, detected by elevated plasma troponin levels, in a large population of White Italian patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS This is a multicenter, cross-sectional study enrolling consecutive patients with laboratory-confirmed COVID-19 who were hospitalized in 13 Italian cardiology units from March 1 to April 9, 2020. Patients admitted for acute coronary syndrome were excluded. Elevated troponin levels were defined as values greater than the 99th percentile of normal values. MAIN OUTCOMES AND MEASURES Clinical characteristics and outcomes stratified as elevated or normal cardiac troponin levels at admission, defined as troponin T or troponin I at a level greater than the 99th percentile of normal values. RESULTS A total of 614 patients with COVID-19 were included in this study (mean age [SD], 67 [13] years; 70.8% male), of whom 148 patients (24.1%) died during the hospitalization. Elevated troponin levels were found in 278 patients (45.3%). These patients were older (mean [SD] age, 64.0 [13.6] years vs 71.3 [12.0] years; P < .001) and had higher prevalence of hypertension (168 patients [50.5%] vs 182 patients [65.9%]; P < .001), heart failure (24 [7.2%]; 63 [22.8%]; P < .001), coronary artery disease (50 [15.0%] vs 87 [31.5%]; P < .001), and atrial fibrillation (33 [9.9%] vs 67 [24.3%]; P < .001). Elevated troponin levels were associated with an increased in-hospital mortality (37% vs 13%; HR, 1.71 [95% CI, 1.13-2.59]; P = .01 via multivariable Cox regression analysis), and this was independent from concomitant cardiac disease. Elevated troponin levels were also associated with a higher risk of in-hospital complications: heart failure (44 patients [19.2%] vs 7 patients [2.9%]; P < .001), sepsis (31 [11.7%] vs 21 [6.4%]; P = .03), acute kidney failure (41 [20.8%] vs 13 [6.2%]; P < .001), multiorgan failure (21 [10.9%] vs 6 [2.9%]; P = .003), pulmonary embolism (27 [9.9%] vs 17 [5.2%]; P = .04), delirium (13 [6.8%] vs 3 [1.5%]; P = .02), and major bleeding (16 [7.0%] vs 4 [1.6%]; P = .008). CONCLUSIONS AND RELEVANCE In this multicenter, cross-sectional study of Italian patients with COVID-19, elevated troponin was an independent variable associated with in-hospital mortality and a greater risk of cardiovascular and noncardiovascular complications during a hospitalization for COVID-19.
EP Europace
Aims The adoption of percutaneous stellate ganglion blockade for the treatment of drug-refractory... more Aims The adoption of percutaneous stellate ganglion blockade for the treatment of drug-refractory electrical storm (ES) has been increasingly reported; however, the time of onset of the anti-arrhythmic effects, the safety of a purely anatomical approach in conscious patients and the additional benefit of repeated procedures remain unclear. Methods and results This study included consecutive patients undergoing percutaneous left stellate ganglion blockade (PLSGB) in our centre for drug-refractory ES. Lidocaine, bupivacaine, or a combination of both were injected in the vicinity of the left stellate ganglion. Overall, 18 PLSGBs were performed in 11 patients (age 69 ± 13 years; 63.6% men, left ventricular ejection fraction 31.6 ± 16%). Seven patients received only one PLSGB; three underwent two procedures and one required three PLSGB and two continuous infusions to control ventricular arrhythmias (VAs). All PLSGBs were performed with an anatomical approach; lidocaine, alone, or in comb...
European Journal of Heart Failure
We describe the first case of acute cardiac injury directly linked to myocardial localization of ... more We describe the first case of acute cardiac injury directly linked to myocardial localization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a 69-year-old patient with flu-like symptoms rapidly degenerating into respiratory distress, hypotension, and cardiogenic shock. The patient was successfully treated with venous-arterial extracorporeal membrane oxygenation (ECMO) and mechanical ventilation. Cardiac function fully recovered in 5 days and ECMO was removed. Endomyocardial biopsy demonstrated low-grade myocardial inflammation and viral particles in the myocardium suggesting either a viraemic phase or, alternatively, infected macrophage migration from the lung.
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Papers by Rita Camporotondo