rome and Myocardial-Ischemia

e-Health (electronic health) refers to the use of information and communication technologies (ICT) to promote organizational change and facilitate new healthcare skills. In the last few years, several telemedicine services using ICT have been launched and the updating of related regulations has started, also for the increase in demand for services, their complexity and the need to offer adequate care to the patient. In cardiology, the experiences concern mainly patients suffering from heart failure or the carriers of cardiac implantable electronic devices (CIEDs), and few experiences are described in ischemic heart disease. In this article we present the design, the implementation and the results of the telemedicine service at the Cardiology Unit of the G.B. Grassi Hospital in Rome, concerning follow-up televisits for patients with heart failure, ischemic heart disease and for management of treatment plans, telemonitoring and telecontrol of CIEDs carriers and teleconsultation in ischemic heart disease. The considerations of this review, the experiences reported and the speed of digital evolution make the implementation of existing practices and the redesign of new pathways necessary.

Topics: Cardiology; Heart Failure; Hospitals; Humans; Italy; Myocardial Ischemia; Rome; Telemedicine

To prospectively assess the impact of post-procedural side-branch (SB) stenosis on inducible myocardial ischemia in patients with bifurcated lesions undergoing percutaneous interventions.. Provisional-stenting with drug-eluting stents (DES) is the recommended strategy to treat percutaneously bifurcated lesions but is associated to variable degrees of residual SB stenosis. The role of SB residual stenosis on post-procedural myocardial ischemia is uncertain.. Patients with bifurcations treated by DES according to provisional-stenting technique were enrolled in the study if they had no other untreated lesion. Patients were divided into two groups according to post-procedural 3D-quantitative coronary analysis (3DQCA): group OR (optimal result: stenosis < 50% of SB lumen area at 3DQCA) and group SR, suboptimal result: (stenosis ≥ 50% of SB lumen area at 3DQCA). Treadmill exercise stress test (EST) was performed within 1 week from PCI. The primary study endpoint was myocardial ischemia (≥1 mm ST-segment depression at EST).. Sixty patients were enrolled: 49 (81.7%) comprised group OR and 11 (18.3%) group SR. Post-PCI myocardial ischemia at EST was inducible in 17 (34.7%) patients of group OR versus 10 (90.9%) patients of group SR (P = 0.0007). During the follow-up, patients of Group SR (vs. Group OR) had a significantly higher occurrence of inducible myocardial ischemia during late (>8 weeks) stress tests (P < 0.001).. In patients with bifurcated lesions treated by a provisional-stenting technique, residual SB stenosis ≥ 50% at 3DQCA is associated with post-procedural inducible myocardial ischemia at EST.

Topics: Aged; Angioplasty, Balloon, Coronary; Coronary Angiography; Coronary Stenosis; Drug-Eluting Stents; Exercise Test; Female; Humans; Imaging, Three-Dimensional; Logistic Models; Male; Middle Aged; Multivariate Analysis; Myocardial Ischemia; Odds Ratio; Predictive Value of Tests; Prospective Studies; Prosthesis Design; Rome; Severity of Illness Index; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

High on-treatment platelet reactivity (HTPR) is associated with adverse outcomes. We aim to compare the novel thienopyridine prasugrel versus double-dose clopidogrel in patients with HTPR and explore the interaction between CYP2C19 genotype and both drugs.. Consecutive stable patients undergoing percutaneous coronary intervention were screened with the Multiplate Analyzer P2Y12 assay, defining HTPR as area under the curve >450. Those with HTPR were randomized to prasugrel (10 mg/day) or high-dose clopidogrel (150 mg/day) for 2 weeks and then crossed-over to, respectively, clopidogrel and prasugrel, repeating the P2Y12 assay at the end of each cycle. Clinical follow-up (until 3 months) and CYP2C19 genotyping was performed in all patients. The primary end point was platelet reactivity after 14 days of prasugrel versus high-dose clopidogrel. Thirty-two patients were randomized to prasugrel and then high-dose clopidogrel or to high-dose clopidogrel followed by prasugrel. Prasugrel was associated with a significantly lower platelet reactivity than high-dose clopidogrel was (325.8 versus 478.5 area under the curve, P=0.028). No patient treated with prasugrel exhibited HTPR, whereas 9 (28.1%) receiving high-dose clopidogrel still had prevalence of HTPR (P=0.001). Similar findings were obtained changing cutoffs or considering platelet reactivity as a continuous variable. Genotyping showed the same efficacy between high-dose clopidogrel and prasugrel in the 18 (56.3%) CYP2C19*2 noncarriers (HTPR in 12.5% versus 0, P=0.274), whereas it was significantly worse in the 14 (43.7%) carriers (HTPR in 43.7% versus 0, P=0.003).. HTPR is successfully abolished by therapy with prasugrel irrespective of CYP2C19 genotype. Conversely, high-dose clopidogrel can address HTPR only in CYP2C19*2 noncarriers.. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01465828.

Topics: Aged; Area Under Curve; Aryl Hydrocarbon Hydroxylases; Blood Platelets; Chi-Square Distribution; Clopidogrel; Coronary Artery Disease; Cross-Over Studies; Cytochrome P-450 CYP2C19; Drug Substitution; Female; Genotype; Humans; Male; Middle Aged; Myocardial Ischemia; Percutaneous Coronary Intervention; Phenotype; Piperazines; Platelet Aggregation Inhibitors; Platelet Function Tests; Prasugrel Hydrochloride; Prospective Studies; Purinergic P2Y Receptor Antagonists; Receptors, Purinergic P2Y12; Rome; Thiophenes; Ticlopidine; Treatment Outcome

To evaluate whether coronary artery bypass graft (CABG) surgery is equally provided among different socioeconomic status (SES) groups in accordance with need. To estimate the association between SES and mortality occurring 30 days after CABG surgery.. Individual socioeconomic index assigned with respect to the characteristics of the census tract of residence (level I = highest SES; level IV = lowest SES). Comparison of age adjusted hospital admission rates of ischaemic heart disease (IHD) and CABG surgery among four SES groups. Retrospective cohort study of all patients who underwent CABG surgery during 1996-97.. Rome (2 685 890 inhabitants) and the seven cardiac surgery units in the city.. All residents in Rome aged 35 years or more. A cohort of 1875 CABG patients aged 35 years or more.. Age adjusted hospitalisation rates for CABG and IHD and rate of CABG per 100 IHD hospitalisations by SES group, taking level I as the reference group. Odds ratios of 30 day mortality after CABG surgery, adjusted for age, gender, illness severity at admission, and type of hospital where CABG was performed.. People in the lowest SES level experienced an excess in the age adjusted IHD hospitalisation rates compared with the highest SES level (an excess of 57% among men, and of 94% among women), but the rate of CABG per 100 IHD hospitalisations was lower, among men, in the most socially disadvantaged level (8.9 CABG procedures per 100 IHD hospital admissions in level IV versus 14.1 in level I rate ratio= 0.63; 95% CI 0.44, 0.89). The most socially disadvantaged SES group experienced a higher risk of 30 day mortality after CABG surgery (8. 1%) than those in the highest SES group (4.8%); this excess in mortality was confirmed even when initial illness severity was taken into account (odds ratio= 2.89; 95% CI 1.44, 5.80).. The universal coverage of the National Health Service in Italy does not guarantee equitable access to CABG surgery for IHD patients. Factors related to SES are likely to influence poor prognosis after CABG surgery.

Topics: Adult; Aged; Cohort Studies; Coronary Artery Bypass; Delivery of Health Care; Female; Hospitalization; Humans; Male; Middle Aged; Myocardial Ischemia; Retrospective Studies; Risk Factors; Rome; Social Class; Socioeconomic Factors

Background Myocardial bridging (MB) may represent a cause of myocardial ischemia in patients with non-obstructive coronary artery disease (NOCAD). Herein, we assessed the interplay between MB and coronary vasomotor disorders, also evaluating their prognostic relevance in patients with myocardial infarction and non-obstructive coronary arteries (MINOCA) or stable NOCAD. Methods and Results We prospectively enrolled patients with NOCAD undergoing intracoronary acetylcholine provocative test. The incidence of major adverse cardiac events, defined as the composite of cardiac death, non-fatal myocardial infarction, and rehospitalization for unstable angina, was assessed at follow-up. We also assessed angina status using Seattle Angina Questionnaires summary score. We enrolled 310 patients (mean age, 60.6±11.9; 136 [43.9%] men; 169 [54.5%] stable NOCAD and 141 [45.5%] MINOCA). MB was found in 53 (17.1%) patients. MB and a positive acetylcholine test coexisted more frequently in patients with MINOCA versus stable NOCAD. MB was an independent predictor of positive acetylcholine test and MINOCA. At follow-up (median, 22 months; interquartile range, 13-32), patients with MB had a higher rate of major adverse cardiac events, mainly driven by a higher rate of hospitalization attributable to angina, and a lower Seattle Angina Questionnaires summary score (all

Topics: Acetylcholine; Coronary Angiography; Coronary Artery Disease; Coronary Vasospasm; Coronary Vessels; Diagnosis, Differential; Electrocardiography; Female; Follow-Up Studies; Humans; Incidence; Injections, Intra-Arterial; Male; Middle Aged; Myocardial Bridging; Myocardial Ischemia; Prognosis; Prospective Studies; Risk Factors; Rome; Vasodilation; Vasodilator Agents

Living in areas with higher levels of surrounding greenness and access to urban green areas have been associated with beneficial health outcomes. Some studies suggested a beneficial influence on mortality, but the evidence is still controversial.. We used longitudinal data from a large cohort to estimate associations of two measures of residential greenness exposure with cause-specific mortality and stroke incidence.. We studied a population-based cohort of 1,263,721 residents in Rome aged [Formula: see text], followed from 2001 to 2013. As greenness exposure, we utilized the leaf area index (LAI), which expresses the tree canopy as the leaf area per unit ground surface area, and the normalized difference vegetation index (NDVI) within 300- and [Formula: see text] buffers around home addresses. We estimated the association between the two measures of residential greenness and the outcomes using Cox models, after controlling for relevant individual covariates and contextual characteristics, and explored potential mediation by air pollution [fine particulate matter with aerodynamic diameter [Formula: see text] [Formula: see text] and [Formula: see text]] and road traffic noise.. We observed 198,704 deaths from nonaccidental causes, 81,269 from cardiovascular diseases [CVDs; 29,654 from ischemic heart disease (IHD)], 18,090 from cerebrovascular diseases, and 29,033 incident cases of stroke. Residential greenness, expressed as interquartile range (IQR) increase in LAI within [Formula: see text], was inversely associated with stroke incidence {hazard ratio (HR) 0.977 [95% confidence interval (CI): 0.961, 0.994]} and mortality for nonaccidental [HR 0.988 (95% CI: 0.981, 0.994)], cardiovascular [HR 0.984 (95% CI: 0.974, 0.994)] and cerebrovascular diseases [HR 0.964 (95% CI: 0.943, 0.985)]. Similar results were obtained using NDVI with 300- or [Formula: see text] buffers.. Living in greener areas was associated with better health outcomes in our study, which could be partly due to reduced exposure to environmental hazards. Further research is required to understand the underlying mechanisms. https://doi.org/10.1289/EHP2854.

Topics: Adult; Aged; Aged, 80 and over; Air Pollution; Cardiovascular Diseases; Cerebrovascular Disorders; Female; Humans; Incidence; Italy; Longitudinal Studies; Male; Middle Aged; Motor Vehicles; Myocardial Ischemia; Noise; Particulate Matter; Prospective Studies; Rome; Stroke

Gut microbiota is emerging as a novel risk factor for atherothrombosis, but the predictive role of gut-derived lipopolysaccharide (LPS) is unknown. We analyzed (1) the association between LPS and major adverse cardiovascular events (MACE) in atrial fibrillation (AF) and (2) its relationship with adherence to a Mediterranean diet (Med-diet).. This was a prospective single-center study including 912 AF patients treated with vitamin K antagonists (3716 patient-years). The primary end point was a composite of MACE. Baseline serum LPS, adherence to Med-diet (n=704), and urinary excretion of 11-dehydro-thromboxane B. In this cohort of AF patients, LPS levels were predictive of MACE and negatively affected by high adherence to Med-diet. LPS may contribute to MACE incidence in AF by increasing platelet activation.

Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Bacteria; Biomarkers; Cerebrovascular Disorders; Diet, Mediterranean; Female; Gastrointestinal Microbiome; Humans; Intestines; Kaplan-Meier Estimate; Lipopolysaccharides; Male; Myocardial Ischemia; Patient Compliance; Platelet Activation; Prospective Studies; Protective Factors; Risk Factors; Rome; Time Factors; Treatment Outcome; Vitamin K

Out-of-hospital coronary heart disease death is a major public health problem, but the association with air pollution is not well understood.. We evaluated the association between daily ambient air pollution levels (particle number concentration [PNC]--a proxy for ultrafine particles [diameter < 0.1 microm], mass of particles with diameter less than 10 microm [PM10]; CO, NO2, and O3) and the occurrence of fatal, nonhospitalized coronary events.. Subjects were 5,144 out-of-hospital fatalities (410-414, International Classification of Diseases-9; 1998-2000) who had been residents of Rome. Hospitalizations during the 3 yr before death were considered to identify comorbidities (e.g., diabetes, hypertension, heart failure, dysrhythmia, chronic obstructive pulmonary disease). Statistical analyses were performed using a case-crossover design.. The association with out-of-hospital coronary deaths was statistically significant for PNC, PM10, and CO. Air pollution on the day of death had the strongest effect (e.g., 7.6% increase [95% confidence interval, 2.0-13.6%]) for an interquartile range of PNC, 27,790 particles/cm3. The 65-74- and 75+-yr age groups were at higher risk than the 35-64-yr age group, and there was a suggestion of effect modification for people with hypertension and chronic obstructive pulmonary disease.. Air pollutants originating from combustion processes, including ultrafine particles, are related to fatal, nonhospitalized coronary events. The effect is stronger among people over 65 years of age, but is not limited to a group with a specific comorbidity.

Topics: Aged; Air Pollutants; Air Pollution; Carbon Monoxide; Case-Control Studies; Cross-Over Studies; Female; Humans; Male; Middle Aged; Myocardial Ischemia; Nitrogen Dioxide; Ozone; Particle Size; Rome; Sulfur Dioxide

The study examined a group of 150 patients with acute myocardial infarction aged under 60 years old. The subjects examined were divided into smokers and non-smokers; smokers were further subdivided into three groups: those smoking less than 20, between 20 and 40 and more than 40 cigarettes a day. Furthermore, they were divided into two groups aged under or over 40. The following parameters were evaluated and compared: the method of onset of acute myocardial infarction, the site of infarction, the presence or absence of the Q wave on the ECG, the presence of angina before and after acute myocardial infarction, arrhythmia during the acute phase and during hospitalisation, mortality during the first 10 days of hospitalisation. The results showed that cigarette smoking is a major risk factor able to influence the age of onset of acute myocardial infarction, especially if over 20 cigarettes a day, whereas it has no influence on clinical history and early death.

Topics: Adult; Chi-Square Distribution; Electrocardiography; Humans; Middle Aged; Myocardial Infarction; Myocardial Ischemia; Risk Factors; Rome; Smoking; Urban Population