Papers by Stefano Urbinati
Monaldi Archives for Chest Disease - Cardiac Series, May 1, 2002
Giornale italiano di cardiologia, 2010
Fino alla fine degli anni ’90 i trial realizzati con le statine prevedevano il loro utilizzo solo... more Fino alla fine degli anni ’90 i trial realizzati con le statine prevedevano il loro utilizzo solo in pazienti con coronaropatia stabile e in questo contesto avevano documentato un beneficio prognostico che compariva tardivamente, in media dopo 1-2 anni. In quegli anni le statine erano usate in meno di un terzo dei pazienti dimessi dalle Cardiologie1 e le motivazioni a supporto dell’uso delle statine dopo un ricovero per sindrome coronarica acuta (SCA) erano da ricercare nel fatto che i pazienti trattati con statine prima della dimissione avevano un’aderenza nel lungo termine con positive ricadute sulla prognosi2. In quegli stessi anni una serie di studi sperimentali ha ipotizzato che le statine potessero agire sulla funzione endoteliale3, sulla prevenzione della trombosi4 e sulla componente infiammatoria5, locale o sistemica, costituendo il razionale per il loro utilizzo anche nelle SCA. Negli anni successivi una serie di studi avrebbe testato questa ipotesi con risultati che hanno ...
![Research paper thumbnail of Position paper ANMCO: Le attività ambulatoriali cardiologiche nella fase di transizione della pandemia COVID-19./ [ANMCO Position paper: Cardiological outpatient activities in the transition phase of the COVID-19 pandemic]](https://attachments.academia-assets.com/91645679/thumbnails/1.jpg)
essenziale per riservare percorsi prioritari di diagnosi e cura ai pazienti che ne hanno esigenza... more essenziale per riservare percorsi prioritari di diagnosi e cura ai pazienti che ne hanno esigenza e per minimizzare i rischi connessi a nuove possibilità di contagio in ambiente ospedaliero. La difficoltà diagnostica precoce dell’infezione da COVID-19, soprattutto nei soggetti asintomatici o con sintomi lievi, impone un’attenta stratificazione del rischio infettivo e un’adeguata sanificazione degli ambienti e degli strumenti diagnostici. I servizi di telemedicina rappresentano una valida risposta all’esigenza di cura e assistenza di pazienti con patologie cardiovascolari, compresi quelli in quarantena o in isolamento fiduciario. Tali prestazioni contribuiscono efficacemente a contrastare la diffusione del virus garantendo al tempo stesso possibilità di terapia e supporto tramite servizi a distanza che risultano essere, pertanto, una risorsa da implementare e favorire in questo stato di necessità4. Il presente documento è rivolto a tutti gli operatori sanitari che lavorano nelle stru...
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo, 2002
European Heart Journal Supplements
Infections by SARS CoV2 - COVID-19 have become in a short time a worldwide health emergency. Due ... more Infections by SARS CoV2 - COVID-19 have become in a short time a worldwide health emergency. Due to cardiovascular implications of COVID-19 and to very frequent previous cardiovascular disorders of COVID-19 patients, it is presently crucial that Cardiologists are fully aware of COVID-19 related epidemiological, pathophysiological and therapeutic problems, in order to manage at best the present emergency by appropriate protocols developed on the basis of the competences acquired and shared on the field. The aim of this document is to propose algorithms for the management of cardiovascular diseases during COVID-19 emergency with the objective of providing patients with optimal care, minimizing contagion risk and appropriately managing personal protective equipment.
![Research paper thumbnail of [Heart-brain interactions]](https://a.academia-assets.com/images/blank-paper.jpg)
Heart-brain interactions are represented by the association of cerebral ischemia with coronary ar... more Heart-brain interactions are represented by the association of cerebral ischemia with coronary artery disease, cardioembolic cerebral ischemia, and cardiovascular complications due to brain damage. As atherosclerosis is a systemic inflammatory disease, in patients with transient ischemic attack, stroke or asymptomatic carotid artery disease, a previous myocardial infarction, angina or an asymptomatic coronary artery disease are often associated and a correlation between the carotid atherosclerosis and coronary artery disease severity has been reported. Furthermore, the long-term prognosis of patients with stroke is strongly affected by coronary events. At the same time, the prevalence of concomitant cerebrovascular disease is common in patients with coronary artery disease. Other cardiovascular diseases, including left atrial and left atrial appendage thrombosis in atrial fibrillation, thrombi in the left ventricle in acute and chronic coronary artery disease and dilated cardiomyopa...
The complexity of cardiovascular diseases has led to an extensive use of technological instrument... more The complexity of cardiovascular diseases has led to an extensive use of technological instruments and the development of multimodality imaging. This extensive use of different cardiovascular imaging tests in the same patient has increased costs and waiting times.The concept of appropriateness has changed over time. Appropriateness criteria address the need for specific cardiovascular imaging tests in well-defined clinical scenarios, and define the kind of cardiovascular imaging that is appropriated for each clinical scenario in different stages of the disease. The concept of appropriateness criteria has replaced the old idea of appropriate use criteria and reflects the increasing effort of the international Scientific Societies to create and review in a critical way the management of diagnostic tests used by clinicians.The aim of this Italian consensus document is to address the use of multimodality imaging in the diagnosis and management of the major cardiovascular clinical scenar...
European Heart Journal Supplements
Sacubitril/valsartan (S/V) has been shown to reduce the risk of cardiovascular death or heart fai... more Sacubitril/valsartan (S/V) has been shown to reduce the risk of cardiovascular death or heart failure hospitalization and improve symptoms in chronic heart failure with reduced ejection fraction compared with enalapril. After 7 years since the publication of the results of PARADIGM-HF, further insight has been gained with potential new indications. Two prospective randomized multicentre studies (PIONEER-HF and TRANSITION) in patients hospitalized for acute heart failure (AHF) have shown an improved clinical outcome and biomarker profile as compared with enalapril, and good tolerability, safety, and feasibility of initiating in-hospital administration of S/V. Furthermore, some studies have highlighted the favourable effects of S/V in attenuating adverse myocardial remodelling, supporting an early benefit after treatment. Observational data from non-randomized studies in AHF report that in-hospital and pre-discharge prescription of evidence-based drugs associated with better survival ...
European Heart Journal Supplements
The COVID-19 pandemic has become a global health emergency. In Italy, the number of people infect... more The COVID-19 pandemic has become a global health emergency. In Italy, the number of people infected by SARS-COVID-2 is rapidly increasing and what emerges from the current data is that the majority do not present any symptoms or only minor flu-like symptoms. In about 20% of the patients, the disease progresses towards more complex forms (interstitial pneumonia to acute respiratory distress and multiple organ failure) with the need of hospitalization in CICU and advanced ventilator assistance. The transmission of the virus occurs very easily from the symptomatic patient s droplets from coughing and sneezing and from direct contact with persons or surfaces. In a patient presenting with ST elevation (STEMI) myocardial infarction or STEMI-like, if positive to COVID-19, the reperfusion therapeutic strategy depends on the local organization and on the possibility to access without delay a PCI COVID Center, on the basis, obviously, of the risk/benefit assessment of the individual case. How...
Strumenti per la didattica e la ricerca
Il progetto ABC si basa sulla redazione di 130 casi clinici sul tema della dislipidemia nel gener... more Il progetto ABC si basa sulla redazione di 130 casi clinici sul tema della dislipidemia nel genere maschile e in quello femminile, provenienti da Unità Operative di Medicina Interna e/o Diabetologia, sia ospedaliere, sia universitarie, assolutamente rappresentativi della realtà nazionale. La redazione dei casi si articola nella compilazione di campi obbligatori e a testo libero, all’interno di un form prestabilito: ciò ha consentito un’analisi globale dei vari dati aggregati, permettendo di ottenere una vera e propria fotografia delle caratteristiche cliniche, dei fattori di rischio, delle indagini diagnostiche e dell’impostazione terapeutica dei pazienti che abitualmente afferiscono al lipidologo clinico italiano per il problema della ipercolesterolemia e dei valori target da raggiungere sia in prevenzione primaria, nel paziente ad alto rischio, sia in quella secondaria.
European Heart Journal Supplements
To speak of my feelings about my long-time attendance at "our" Congresses is not as simple as it ... more To speak of my feelings about my long-time attendance at "our" Congresses is not as simple as it may seem at first glance, because images and memories fill my mind and having to choose one or another amongst them seems almost disrespectful to who has made and who will continue to make this small and yet important associative history. I will however try and divide my memories into specific and precise timeframes-as you will see I believe that the associative and scientific role covered cannot neglect the way you "live" the Congress. The first years I attended my first ANMCO Congress, which was held at the Fortezza da Basso in Florence, in 1996. I was already working at the Lancisi Hospital in Ancona but as a "youngster" it was somewhat difficult to find a way of attending the more important Congresses. I vividly remember my arrival at the Savoy Hotel and then going immediately to the Fortezza to attend the Scientific Sessions, my enthusiasm as a "beginner" for the few days of full immersion in the culture and world of National Cardiology and the sensation of quiet power and competence that the ANMCO Congress inspired in me. Since then the ANMCO Congress became "The Congress", the one never to miss at National level, making me a regular attendant, while slowly taking on different roles, from learner to Member of the Faculty , in accordance with my professional and associative growth.
European Journal of Internal Medicine
BMJ Open
ObjectivesTo evaluate the effect of cardiologist care on adherence to evidence-based secondary pr... more ObjectivesTo evaluate the effect of cardiologist care on adherence to evidence-based secondary prevention medications, mortality and readmission within 6 months of discharge in patients with heart failure (HF).DesignRetrospective observational study based on administrative data.SettingLocal Healthcare Authority (LHA) of Bologna, one of the largest LHAs of Italy with ~870 000 inhabitants.ParticipantsAll patients residing in the LHA of Bologna discharged from hospital with a diagnosis of HF between 1 January 2015 and 31 December 2015.Primary and secondary outcome measuresMultivariable regression analysis was used to assess the association of inpatient and outpatient cardiologist care with adherence to evidence-based medications, all-cause mortality and hospital readmission (including emergency room visits) within 6 months of discharge.ResultsThe study population included 2650 patients (mean age 82.3 years). 340 (12.8%) patients were discharged from cardiology wards, while 635 (24.0%) ...
Giornale italiano di cardiologia (2006), 2018
Sacubitril/valsartan, the first-in-class angiotensin receptor neprilysin inhibitor (ARNI), is the... more Sacubitril/valsartan, the first-in-class angiotensin receptor neprilysin inhibitor (ARNI), is the first medication to demonstrate a mortality benefit in patients with chronic heart failure and reduced ejection fraction (HFrEF) since the early 2000s. Sacubitril/valsartan simultaneously suppresses renin-angiotensin-aldosterone system activation through blockade of angiotensin II type 1 receptors and enhances the activity of vasoactive peptides including natriuretic peptides, through inhibition of neprilysin, the enzyme responsible for their degradation. In the landmark PARADIGM-HF trial, patients with HFrEF treated with sacubitril/valsartan had a 20% reduction in the primary composite endpoint of cardiovascular death or heart failure hospitalization, a 20% lower risk of cardiovascular death, a 21% to 20% lower risk of a first heart failure hospitalization, and a 16% to 20% lower risk of death from any cause, compared with subjects allocated to enalapril (all p<0.001).Following the ...
Giornale italiano di cardiologia (2006), 2018
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the cornerstone o... more Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the cornerstone of the pharmacologic management of patients with acute coronary syndrome (ACS) and/or receiving coronary stents. Long-term (>1 year) DAPT may further reduce the risk of stent thrombosis after percutaneous coronary intervention (PCI) and may decrease the occurrence of non-stent-related ischemic events in patients with ACS. Nevertheless, compared with aspirin alone, extended use of aspirin plus a P2Y12 receptor inhibitor may increase the risk of bleeding events that have been strongly linked to adverse outcomes including recurrent ischemia, repeat hospitalization, and death. Over the last years, multiple randomized clinical trials have been published comparing duration of DAPT after PCI and in ACS patients investigating either a shorter or prolonged DAPT regimen.Although current European Society of Cardiology guidelines provide backup to individualize treatment, it seems difficult to ide...
European heart journal supplements : journal of the European Society of Cardiology, 2018
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y receptor inhibitor is the cornerstone of ... more Dual antiplatelet therapy (DAPT) with aspirin and a P2Y receptor inhibitor is the cornerstone of pharmacologic management of patients with acute coronary syndrome (ACS) and/or those receiving coronary stents. Long-term (>1 year) DAPT may further reduce the risk of stent thrombosis after a percutaneous coronary intervention (PCI) and may decrease the occurrence of non-stent-related ischaemic events in patients with ACS. Nevertheless, compared with aspirin alone, extended use of aspirin plus a P2Y receptor inhibitor may increase the risk of bleeding events that have been strongly linked to adverse outcomes including recurrent ischaemia, repeat hospitalisation and death. In the past years, multiple randomised trials have been published comparing the duration of DAPT after PCI and in ACS patients, investigating either a shorter or prolonged DAPT regimen. Although the current European Society of Cardiology guidelines provide a backup to individualised treatment, it appears to be diffi...
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Papers by Stefano Urbinati