Papers by Maurizio Zanobetti
Italian heart journal. Supplement: official journal of the Italian Federation of Cardiology
Academic Emergency Medicine
The absence of frequent physiological measurements available in the prehospital setting necessita... more The absence of frequent physiological measurements available in the prehospital setting necessitates providers make rapid decisions about priority of care, treatment, and evacuation based upon isolated physiologic data points. The U.S. Military is seeking other tools that may aid in triage and treatment decisions for combat medics.
Archives of Cardiovascular Imaging, 2015
Italian heart journal. Supplement: official journal of the Italian Federation of Cardiology
Italian heart journal. Supplement: official journal of the Italian Federation of Cardiology
Italian heart journal. Supplement: official journal of the Italian Federation of Cardiology
Italian heart journal. Supplement: official journal of the Italian Federation of Cardiology
European Heart Journal Supplements
European Heart Journal Supplements
European Heart Journal, 2013
Comparison of delayed exercise 99m TC-MIBI SPET versus early rest 99m TC-MIBI SPET in patients with acute chest pain and normal ECG Alberto Conti, Chiara Gallini, Barbara Paladini, Maurizio Zanobetti, Iacopo Olivotto, Stefano Grifoni, Giancarlo Berni, Egidio Costanzo, Paolo Ferri, Maria Matteini,... Left atrial appendage (LAA) is the major site of clot formation in severe mitral stenosis (MS). T... more Left atrial appendage (LAA) is the major site of clot formation in severe mitral stenosis (MS). There are not enough studies properly evaluating LAA function in a large number of patients (pts) with isolated severe MS. The purpose of this study was to analyze the LAA function with LAA clot and spontaneous echo contrast (SEC). Method: LAA function [LAA-ejectlo" fraction (EF), peak filling and emptying velocities and their velocity time integrals (VTls)] was prospectively evaluated I" 200 consecutive pls (mean age 30.2 r 9.4 years, 51.5% females) of severe MS by transesophageal echocardiography (TEE). Pts with more than mild mitral regurgitation, significant aortic valve disease, previous valvulotomy and on anticoagulatlon or antiplatelet therapy were excluded. Twenty normal controls were compared. Result: Fifty five (27.5%) were in atrial fibrillation (AF). LAA clot was present in 25% pts and 56.5% had SEC. On univariate analysis the older age, increased duration of symptoms, AF, SEC, larger LA area, depressed LAA function and type II and III-LAA flow patter" correlated significantly (~~0.05) with LAA clot. LAA-EF was significantly less in pts with clot (21.8 + 12.8% Vs 39.1 t 13.2%, p<O.OOOl) and with SEC (30.3 r 16.2% Vs 40.3 i 11.3%, p<O.OOl). LAA filling (16.0 * 11.7 Vs. 27.6 f 11.8 cm/s, p<O.OOl) and emptying (15.4 ? 7.0 Vs 21.5 + 9.6 cm/s, p<O.OOl) velocities and filling (1.4 t 1 .O Vs 2.5 f 1.4 cm, p<O.OOOl) and emptying (1.5 + 1.2 Vs 2.1 f 1.2 cm, ~~0.05) VTls were also significantly lower in pts with clot. Similarly pts with SEC had significantly lower fliling and emptying velocities and VTls. On multivariate regression analysis, AF and LAA-EF were the only independent predictors of LAA clot formation. Pts with LAA-EF < 25% had 62.5% incidence of clot as compared to 10.4% with LAA-EF >25%. In a subgroup of the pts with sinus rhythm (NSR) the LAA-EF was significantly less in pts with clot (31.2 + 13.2 Vs 41.2 + 11.5% p<O.Ol) and was the only predictor of clot formation. Conclusion: We conclude that in the pts with severe MS, besides AF, a subgroup of pts in NSR with depressed LAA -EF (< 25%) had a higher risk of LAA clot formation and we suggest that these pts should be routinely anticoagulated for prevention of LAA clot. MD
American Journal of Hypertension, 1995
The Qulet-trak (QT) ambulatory blood pressure (BP) recorder (I'yros·Welch·Allyn.Arden,NC) was eva... more The Qulet-trak (QT) ambulatory blood pressure (BP) recorder (I'yros·Welch·Allyn.Arden,NC) was evaluated according to the protocol of theBritish Hypertension Society (BHS). Qulet-trak, a lightweight, automatic, programmable device, uses anauscultatory measuring system.The protocol ofthe British Hypertension Society (BHS) was composed of subsequent phases with QT and two observers laking simultaneous measurements at the same ann.ln a preliminary assessment nointerdevices differences were observed either before orafter a one-month period of usc. Intense clinical use did not reduce the devices perfonnancc. Average differences between QTand observers for systolic and diastolic were O.6t3.6 and -0.4t3.6 mmHg before-use. -O.7±3.3 mmHg and -0.6 ±3.8 mmHg after-use. Atthe main validation procedure, performed in85 subjects, the average difference between QTand observers was 0.3±3.4 and ·O.l±3.5 mmHg for systolic and diastolic. 89% and 99% systolic and 88% and 98% diastolic QTreadings were within 5 and 10mmHg ofobservers determinations (Class A).Accurac)' was confirmed also in special group population. In childhood (n=30) 87% and 90% ofsystolic and diastolic QTreaomgs were within 5 mmHg of observers' (average differences· I.I±3.0 and O.I±3.6 mmHg). In the elderly (n=30) 91 % and 92% of systolic and diastolic QT readings were within 5 mmHg of mercury dctermlnations (average differences ·0.8±3.2 and ·O.2±4.5 mmHg). Inpregnancy (n=30) differences were ·0.3±3.4 and O.l±2.9 mmHg for systolic and diastolic pressure with 93% and 92% of readings within 5 mmHg of mercury column determinations (Class A in all groups). Posture did not affect accuracy. 92% and 89'io ofsystolic and diastolic readings differed less than 5 mmHg from lhc mercury readings in supine position, 89% and 90% in the standing position and 88% and 90% in the silting position. During the treadmill exercise test (Bruce protocol), 71 % and 91 %and 55% and 84% of automatic systolic and diastolic readings, differed less than 5% and 10% from observers (Class Ainall positions). Inconclusion the QT achieved A rating for SBP and A rating for DBP fulfilling the criteria of the BHS Protocol. Thr QT was acceptable to patients because of itssmall size, light weight and noiseless performance.
Academic Emergency Medicine, 2006
The American Journal of Emergency Medicine, 2013
Purpose: To assess stress-echo (SE) diagnostic performance in patients presenting to the emergenc... more Purpose: To assess stress-echo (SE) diagnostic performance in patients presenting to the emergency department (ED) with spontaneous chest pain, especially in subgroups in which exercise ECG diagnostic performance has been questioned (women, elderly, history of coronary artery disease). Methods: Between June 2008 and May 2011, 474 patients with an episode of spontaneous chest pain, nondiagnostic electrocardiogram and negative cardiac necrosis markers underwent SE. Patients with inducible ischemia (Isch) were asked to undergo coronary angiography. Patients with negative SE were discharged and contacted by telephone at least 6 months after discharge, to ascertain the occurrence of new cardiac events. Main findings: Exercise stress-echo (ESE) was employed in 270 patients and dobutamine (DSE) in 218 (including 14 with inconclusive ESE); a diagnosis of coronary artery disease (CAD) was confirmed or excluded in 434 (92%) patients. SE was negative for Isch in 318 patients (206 ESE and 112 DSE) and positive in 132. During follow-up, patients with negative SE had 4 cardiac events. SE showed: sensitivity 90%, specificity 92%, positive predictive value 78% and negative predictive value 97%. Sensitivity was comparable between patients aged b or ≥ 70 years (84 vs 94%) and between gender (89 vs 96%), but lower in patients with known CAD (88 vs 94%, P b .05); specificity was comparable regardless of age (94 vs 99%) and presence of CAD (97 vs 91%), but was lower among women (87 vs 96%, P b .05). Conclusions: SE had a very good diagnostic performance in ED patients with suspected Isch, both overall and in selected high-risk groups.
Archives of Internal Medicine, 2006
Background: In patients with acute pulmonary embolism, right ventricular dysfunction (RVD) on hos... more Background: In patients with acute pulmonary embolism, right ventricular dysfunction (RVD) on hospital admission is a predictor of adverse short-term clinical outcome. The aim of this study was to evaluate the prognostic value of RVD persistence at hospital discharge with regard to the likelihood of recurrent venous thromboembolism (VTE).
The Journal of Emergency Medicine, 2007
Purpose of study: The symptoms of cardiac and respiratory causes of dyspnea overlap and rapid dif... more Purpose of study: The symptoms of cardiac and respiratory causes of dyspnea overlap and rapid differentiation of causes of dyspnea remains a clinical challenge, especially in prehospital setting. This study was undertaken to determine the role of QC and pro-BNP in the evaluation of respiratory distress (asthma and chronic obstructive pulmonary disease vs pulmonary edema and congestive heart failure) in the field. Method and patients: Data were collected prospectively in CEMM from January 2005 until June 2006. petCO2, proBNP and others variables were obtained prior to medication. We compared two groups of moderate to severe dyspnea (asthma and COPD vs CHF and pulmonary edema). Initial petCO2 was monitored with in line sensor (Lifepak 12 -Medtronic Physiocontrol, Corporate Headquarters, Redmond, USA) and pro-BNP was obtained with Cardiac Reader, Roche Diagnostic, Mannheim, Germany. Patients younger than 18 years of age were excluded. Statistics exact Fisher test and Mann-Whitney test, multivariate logistic regression analysis; pϽ0.05. Results: In univariate analysis we observed significantly difference in values of proBNP and petCO2 between patients with asthma /COPD and patients with CHF/pulmonary edema patients(proBNP 947,2 ϩ/Ϫ140,5 vs.2686,8 ϩ/Ϫ 386,5,pϽ0.01; petCO2-kPa 6,4 ϩ/Ϫ 1,1 vs. 3,8 ϩ/Ϫ1,2, pϽ0.01).In multivariate logistic regression analysis OR for pro-BNP for diagnosis of CHF/edema is 12,1 (95%CI: 6,8 -23,2; pϽ 0.0001) and for petCO2 is 2,8 (95%CI: 1,5 -4,2). Conclusion: The intial value of petCO2 and rapid measurement of proBNP are useful tools in differentiating between cardiac and respiratory causes of acute dyspnea in prehospital setting.
European Journal of Emergency Medicine, 2013
Objectives The aim of this study was to identify a reliable tool for the early prognostic stratif... more Objectives The aim of this study was to identify a reliable tool for the early prognostic stratification of septic patients admitted to the emergency department-high dependency unit (ED-HDU), a clinical setting providing a subintensive level of care; we also estimated the cost saving associated with HDU stay compared with ICU stay.
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Papers by Maurizio Zanobetti